Over the past 50 years, the challenge of schistosomiasis control has persisted as a complex dilemma for health policymakers–there has even been a debate about whether schistosomiasis has any “significance” to public health and whether it has priority for control [1]. The major schistosome parasites of humans, Schistosoma haematobium, S. mansoni, and S. japonicum, are prevalent in many parts of Africa, the Middle East, South America, China, Southeast Asia, and the Philippines, and there are 1200 million people who are infected worldwide [2]. The article by Koukounari et al.[3] in this issue of the Journal is part of a modern, multigroup research effort that aims to better define the impact of schistosomiasis on children’s health and to refine the understanding of the specific benefits of mass treatment in schistosomiasis-endemic settings. One of the particular strengths of the study is its large size and the broad distribution of its study subjects across the country of Burkina Faso. The study children were treated there as part of the ongoing Schistosomiasis Control Initiative (SCI). The SCI, which has now been implemented in 7 countries in sub-Saharan Africa, is a collaborative program focused on schistosomiasis morbidity control that is supported by national health and education ministries and the Bill and Melinda Gates Foundation through the Imperial College London. In the article, Koukounari et al. report on the impact of the first year of praziquantel therapy on anemia and nutritional health outcomes among Burkinabé school-aged children (6–14 years old) who were tested at 16 sentinel schools. The study subjects were sampled from among the 13 million children from S. haematobium–endemic areas who were treated during the first year of therapy in the country. The pretreatment results show that, even after adjustment for age, sex, nutritional status, and environmental factors, there is a significant association between heavy S. haematobium infection and individual risk of heavy hematuria. Of interest, then, is that in examining the subjects’ adjusted risk for anemia in this pretreatment setting, independent effects were apparent for high-intensity infection and for hematuria in reducing hemoglobin levels. These findings mirror those of recent studies of S. japonicum, which suggested that both anemia of chronic inflammation and chronic iron loss contribute separately to the causation of anemia in schistosomiasis japonica [4]. Fortunately, with treatment, infection intensity and hematuria scores were markedly improved throughout the study population, and hemoglobin levels were significantly increased among those who had been the most anemic at the start as well as among those who had had the highest level of pretreatment hematuria. Why is there continuing controversy about the disease burden of schistosomiasis and the benefits of its populationbased chemotherapy? The answer derives from our lingering uncertainty about the true disability caused by Schistosoma infection [5]. In areas of endemicity, chronic schistosomiasis represents a significant but poorly gauged cause of disease. Schistosomiasis is a complex, chronic condition that persists for decades, and the experience of infection is strongly embedded in the pattern of rural poverty. Because it is transmitted only by select species of intermediate host snails, the distribution of schistosomiasis can be patchy, but it is always strongly tied to poor sanitation and the local environment [6]. Although many studies have attempted to measure different “objective”