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Reinfection with worms, and a gradual increase of the worm population in the intestines, may beginn shortly after the pill has killed the intestinal worm population if no change in the hygiene situation of the child is made (e.g. a continuation of [[open defecation]] instead of [[toilet]] use).
Reinfection with worms, and a gradual increase of the worm population in the intestines, may beginn shortly after the pill has killed the intestinal worm population if no change in the hygiene situation of the child is made (e.g. a continuation of [[open defecation]] instead of [[toilet]] use).


Resistance of worms to anthelmintic drugs over time is a possibility.<ref>{{cite journal|last1=Levecke|first1=Bruno|last2=Montresor|first2=Antonio|last3=Albonico|first3=Marco|last4=Ame|first4=Shaali M.|last5=Behnke|first5=Jerzy M.|last6=Bethony|first6=Jeffrey M.|last7=Noumedem|first7=Calvine D.|last8=Engels|first8=Dirk|last9=Guillard|first9=Bertrand|last10=Kotze|first10=Andrew C.|last11=Krolewiecki|first11=Alejandro J.|last12=McCarthy|first12=James S.|last13=Mekonnen|first13=Zeleke|last14=Periago|first14=Maria V.|last15=Sopheak|first15=Hem|last16=Tchuem-Tchuenté|first16=Louis-Albert|last17=Duong|first17=Tran Thanh|last18=Huong|first18=Nguyen Thu|last19=Zeynudin|first19=Ahmed|last20=Vercruysse|first20=Jozef|last21=Olliaro|first21=Piero L.|title=Assessment of Anthelmintic Efficacy of Mebendazole in School Children in Six Countries Where Soil-Transmitted Helminths Are Endemic|journal=PLoS Neglected Tropical Diseases|date=9 October 2014|volume=8|issue=10|pages=e3204|doi=10.1371/journal.pntd.0003204}}</ref> Research is underway for a vaccine against helminths, such as a [[hookworm vaccine]].
Resistance of worms to anthelmintic drugs over time is a possibility.{{citation needed}} Research is underway for a vaccine against helminths, such as a [[hookworm vaccine]].


===National Deworming Programmes===
===National Deworming Programmes===

Revision as of 22:16, 29 July 2015

Mass deworming is the process of treating large numbers of people for helminthiasis (for example soil-transmitted helminths or STH) and schistosomiasis infections in areas with high degree of worm infection in the general population, particularly for children. [1] It involves treating everyone - often all children who attend schools - rather than testing first and then only treating selectively. This is based on the fact that there are no known side effects to being treated when not infected, and testing for the infection is many times more expensive than treating it. So for the same amount of money, mass deworming can treat many more people than selective deworming. Mass deworming is one example of mass drug administration.[1]

Mass deworming of children can be carried out by administering for example mebendazole and albendazole which are two types of anthelmintic drug.[citation needed] The cost of providing one tablet every six months per child (typical dose) is relatively low.[citation needed]

In 2001, the World Health Assembly set a target for the World Health Organization (WHO) to treat 75% of school-aged children by 2010.[2] In 2009, an estimated 200 million children were treated.[2] By 2015, national deworming programs had been started in a number of countries, including in India that aims to target 240 million children at risk for parasitic worms.[3] According to the World Health Organization (WHO), over 870 million children are at risk of parasitic worm infection.[4]. Worm infections interfere with nutrient uptake; can lead to anemia, malnourishment and impaired mental and physical development; and pose a serious threat to children’s health, education, and productivity. Infected children are often too sick or tired to concentrate at school, or to attend at all.[5]

Some non-governmental organizations specifically support mass deworming. The Deworm the World Initiative, a project of the NGO Evidence Action, is one of the highest-rated charities by the evaluator Givewell because of the low cost of deworming children, large-scale implementation, and wider benefits to society.[6]

Nomenclature

National deworming programmes target children of school age, which the WHO defines as being between 5 and 14.[2]

Background

Main articles: Helminthiasis and Schistosomiasis

Intestinal parasites (collectively called soil-transmitted helminths) affect more than 1.4 billion people, according to WHO estimates in 2015,[7] with 249 million being infected with Schistosoma-type worms.[8]

Overview

Medical aspects

Deworming of a child can be carried out by swallowing a pill of an of anthelmintic drug, for example mebendazole and albendazole.[citation needed] In mass deworming programs, each child - whether infected or not - swallows a pill every six months per child.[citation needed] The reason for treating all children is because the diagnostic tests for each individual child would be too expensive.

Reinfection with worms, and a gradual increase of the worm population in the intestines, may beginn shortly after the pill has killed the intestinal worm population if no change in the hygiene situation of the child is made (e.g. a continuation of open defecation instead of toilet use).

Resistance of worms to anthelmintic drugs over time is a possibility.[9] Research is underway for a vaccine against helminths, such as a hookworm vaccine.

National Deworming Programmes

  • India: announced a deworming programme in 2015 which aimed to treat 240 million children.[3]
  • Kenya: began a deworming programme in 2009 of all children in 45 districts of high density STH infections.[10] By 2014, the programme had expanded to target 5 million children.[11]
  • Ethiopia: announced it would begin a national deworming programme in 2015.[12]
  • Cameroon: began a deworming programme in 2006, it expanded to target 4 million children.[13]
  • Central African Republic: began a deworming programme in 2015 aiming to target 250,000 children.[14]
  • Democratic Republic of Congo: began a deworming campaign in 2009 aiming to target 12.5 million children.[15]
  • Gambia: began a deworming programme in 2010, by 2013 it was targetting 1.6 million children.[16]
  • Madagasar: began a deworming programme in 2012 aiming to target all of the children in the country, more than 5 million in total.[17]
  • Malawi: around 3 million children targeted in a deworming programme in 2011.[18]
  • Mozambique: began a deworming programme in 2007 when nearly 500,000 children were treated, by 2014 around 5 million were targeted.[19]
  • Sierra Leone: 1.1 million school children received two doses of medication in 2011[20]

UN Agencies and NGOs involved in deworming programmes

The UN is involved in mass deworming programmes via the World Food Programme[21], UNICEF[10] and World Health Organisation.[10]

NGOs involved in deworming advocacy or delivery include: the Deworm the World Initiative from Evidence Action, Goods For Good, Save the Children, Counterpart International, Helen Keller International, the Carter Center, Inmed Parnerships for Children, Operation Blessing International, and Children Without Worms.[21]

Criticisms

Societal impacts and the 2015 controversy

Many claims have been made about the educational, health and economic effects of deworming programmes including in a World Bank Economic Review paper.[22] The Cochrane Collaboration review on deworming has for many years been critical, as below:

  • A 2007 Cochrane analysis found no significant improvements in physical growth and cognitive performance among routinely dewormed children.[23]
  • A 2012 Cochrane review found no benefit on weight, blood improvement (haemoglobin content), cognition and school performance.[24]
  • An updated 2015 Cochrane review added further doubt about the effects on school attendance due to the reanalysis of the data from a major trial in Kenya which showed it to be subject to bias.[1]

In July 2015, after the publication of the re-analysis of the data in a 2004 deworming trial from Kenya was published, a controversy emerged regarding the robustness of the evidence.[25] As a result of the perceived quality of the Kenyan data, the Cochrane review downgraded their assessment of the likelihood of a link between deworming programmes and educational outcomes.[1]

Organisations running large-scale deworming programmes and other public health experts responded to the re-analysis and the 2015 Cochrane review in several statements in July 2015:

  • Evidence Action called the reanalysis flawed and said that the authors had "done their darndest to generate controversy."[26]
  • Berk Ozler at the World Bank criticised the methods used in the reanalysis studies and concluded "if anything, I find the findings of the original study more robust than I did before" and that a "number of unconventional ways of handling the data and conducting the analysis are jointly required to obtain results that are qualitatively different than the original study."[27]
  • The aid agency Giving What We Can said in a statement that they would consider the changes, but criticised the choice of papers considered in the Cochrane review, particularly the omission of one important study which did not meet the criteria for inclusion in the review.[28]
  • Academic and commentator Chris Blattman stated that "both sides exaggerate, but the errors and issues with the replication seem so great that it looks to me more like attention-seeking than dispassionate science."[29]

Examples

Fit for School Program in the Philippines

Successful deworming and positive health outcomes were also achieved by the Essential Health Care Program implemented by the Philippine Department of Education in the Philippines. UNICEF has noted it as an "outstanding example of at scale action to promote children’s health and education".[30] Deworming twice a year, supplemented with washing hands daily with soap, brushing teeth daily with fluoride, is at the core of this national program. It has also been successfully implemented in Indonesia.[31]

History

United States

Public health campaigns to reduce helminth infections in the US may be traced as far back as 1910, when the Rockefeller Foundation began the fight against hookworm – the so-called “germ of laziness” – in the American South.[32] This campaign was enthusiastically received by educators throughout the region; as one Virginian school observed: “children who were listless and dull are now active and alert; children who could not study a year ago are not only studying now, but are finding joy in learning...for the first time in their lives their cheeks show the glow of health.”[33] From Louisiana, a grateful school board added: "As a result of your treatment...their lessons are not so hard for them, they pay better attention in class and they have more energy...In short, we have here in our school-rooms today about 120 bright, rosy-faced children, whereas had you not been sent here to treat them we would have had that many pale-faced, stupid children."[33]

Deworming in the U.S. in the early 1900’s led to increased school enrollment and attendance for children, and improved literacy and income for adults who were treated as children[34].

Developing countries

Similar (albeit somewhat more imperialist) reports emerged from various other regions of the developing world at the time; for example, two scholars in Puerto Rico found that: "Over all the varied symptoms with which the unfortunate jibaro [peasant], infected by uncinaria [hookworm], is plagued, hangs the pall of a drowsy intellect, of a mind that has received a stunning blow...There is a hypochondriacal, melancholy, hopeless expression, which in severe cases deepens to apparent dense stupidity, with indifference to surroundings and lack of all ambition.’[32]

See also

References

  1. ^ a b c d Taylor-Robinson, David C; Maayan, Nicola; Soares-Weiser, Karla; Donegan, Sarah; Garner, Paul; Taylor-Robinson, David C (2015). "Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance". doi:10.1002/14651858.CD000371.pub6. {{cite journal}}: Cite journal requires |journal= (help)
  2. ^ a b c "Helminth control in school-age children" (PDF). World Health Organisation. 2011. Retrieved 28 July 2015.
  3. ^ a b "World's Largest Deworming Program in India To Start". Evidence Action. 2015. Retrieved 28 July 2015.
  4. ^ "Soil Transmitted Helminths". WHO. Retrieved 28 July 2015.
  5. ^ Miguel, Edward; et al. (May 2015). "Worms at work: Long-run impacts of a child health investment" (PDF). Working Paper. Retrieved 28 July 2015. {{cite journal}}: Explicit use of et al. in: |last1= (help)
  6. ^ "Deworm the World Initiative (DtWI), led by Evidence Action". Givewell. 2014. Retrieved 28 July 2015.
  7. ^ "Soil-transmitted helminth infections". WHO. 2015. Retrieved 29 July 2015.
  8. ^ "WHO". Schistosomiasis fact sheet. 2015. Retrieved 29 July 2015.
  9. ^ Levecke, Bruno; Montresor, Antonio; Albonico, Marco; Ame, Shaali M.; Behnke, Jerzy M.; Bethony, Jeffrey M.; Noumedem, Calvine D.; Engels, Dirk; Guillard, Bertrand; Kotze, Andrew C.; Krolewiecki, Alejandro J.; McCarthy, James S.; Mekonnen, Zeleke; Periago, Maria V.; Sopheak, Hem; Tchuem-Tchuenté, Louis-Albert; Duong, Tran Thanh; Huong, Nguyen Thu; Zeynudin, Ahmed; Vercruysse, Jozef; Olliaro, Piero L. (9 October 2014). "Assessment of Anthelmintic Efficacy of Mebendazole in School Children in Six Countries Where Soil-Transmitted Helminths Are Endemic". PLoS Neglected Tropical Diseases. 8 (10): e3204. doi:10.1371/journal.pntd.0003204.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  10. ^ a b c Kabaka, S; Kisia, CW (2011). "National deworming program rogram rogram rogram - Kenya's experience" (PDF). World Conference on the Social Determinants of Health.
  11. ^ "Kenya National Deworming Programme". Children's Investment Fund Foundation. Retrieved 29 July 2015.
  12. ^ "Ethiopia launches school program to treat parasitic worms". Reuters. Retrieved 29 July 2015.
  13. ^ "Scaling Cameroon's Deworming Program to the National Level". Children Without Worms. 2012. Retrieved 29 July 2015.
  14. ^ "The Central African Republic: Going Beyond Providing Food As Part Of Our School Meal Programme". World Food Programme. 2015. Retrieved 29 July 2015.
  15. ^ "DRC: National deworming campaign under way". IRIN. 2009. Retrieved 29 July 2015.
  16. ^ "Gambia SHN Success Story". Schools and Health. Retrieved 29 July 2015.
  17. ^ "Deworming in Madagascar: The Power of Partnerships". Children Without Worms. 2012. Retrieved 29 July 2015.
  18. ^ "Child Health Week reaches more than two million children in Malawi". UNICEF Malawi. 2011. Retrieved 29 July 2015.
  19. ^ "Schistosomasis Control Initiative - Mozambique". Imperial College. Retrieved 29 July 2015.
  20. ^ "Sierra Leone". Helen Keller International. Retrieved 29 July 2015.
  21. ^ a b Global NGO Deworming Inventory 2010 (2011). "2010 Global NGO Deworming Inventory Summary Report: Deworming Programs by Country" (PDF). http://www.deworminginventory.org. {{cite web}}: External link in |website= (help)CS1 maint: numeric names: authors list (link)
  22. ^ Amrita, Ajuha (June 3, 2015). "When Should Governments Subsidize Health?" (PDF). The World Bank Economic Review Advance Access. Retrieved 28 July 2015.
  23. ^ Dickson, R; Awasthi, S; Demellweek, C; Williamson, P (2007). "WITHDRAWN: Anthelmintic drugs for treating worms in children: effects on growth and cognitive performance". The Cochrane Database of Systematic Reviews (2): CD000371. doi:10.1002/14651858.CD000371.pub2. PMID 17636634.
  24. ^ Taylor-Robinson, DC; Maayan, N; Soares-Weiser, K; Donegan, S; Garner, P (2012). "Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance". The Cochrane Database of Systematic Reviews. 11: CD000371. doi:10.1002/14651858.CD000371.pub5. PMID 23152203.
  25. ^ Belluz, Julia (27 July 2015). "Worm wars: The fight tearing apart the global health community, explained". Vox media. Retrieved 28 July 2015.
  26. ^ "Worms Win, Kids Lose? Our Statement". Evidence Action. Retrieved 24 July 2015.
  27. ^ "Worm Wars: A Review of the Reanalysis of Miguel and Kremer's Deworming Study". World Bank blog. Retrieved 24 July 2015.
  28. ^ "Is deworming really effective? A response to recent deworming studies". Giving What We Can. Retrieved 24 July 2015.
  29. ^ "Dear journalists and policymakers: What you need to know about the Worm Wars". Chris Blattman. Retrieved 24 July 2015.
  30. ^ UNICEF (2012) Raising Even More Clean Hands: Advancing Health, Learning and Equity through WASH in Schools, Joint Call to Action
  31. ^ School Community Manual - Indonesia (formerly Manual for teachers), Fit for School. GIZ Fit for School, Philippines. 2014. ISBN 978-3-95645-250-5.
  32. ^ a b Watkins WE & Pollitt E (1997). "'Stupidity or Worms': Do Intestinal Worms Impair Mental Performance?" (PDF). Psychological Bulletin. 121 (2): 171–91. doi:10.1037/0033-2909.121.2.171. PMID 9100486.
  33. ^ a b Bleakley, Hoyt (2007). "Disease and Development: Evidence From Hookworm Eradication in the American South". The Quarterly Journal of Economics. 122: 73–117. doi:10.1162/qjec.121.1.73. PMC 3800113. PMID 24146438.
  34. ^ Hoyt, Bleakley (2007). "Disease and Development: Evidence from Hookworm Eradication in the American South*". The Quarterly Journal of Economics. 122 (1). Retrieved 28 July 2015.
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