De-worm the children, De-worm the nation (By Adebayo Oladejo)

pharmacy

According to the World Health Organisation, nearly 2 billion people worldwide are infected with soil-transmitted helminthes (intestinal worms) or water-borne trematode worms called schistosomes. Many of those affected by worms live in low-income countries and do not have access to clean water and functional sanitation systems. Worm infections, while not immediately life-threatening, can have a significant negative impact on a child’s cognitive ability and general health. For example, children who have worms are more likely to become seriously ill and less likely to attend school on a regular basis. Worms also present a barrier to increased economic development since children who have worms are less likely to be productive, as adults.

A number of prominent health organisations and experts have promoted the deworming of children in the developing world as a potentially effective public health and development strategy. Because of the relatively low cost of intervention, deworming has attracted the attention of public health officials, development experts, and others concerned with global health, with early studies suggesting positive effects.

Helminths or worm infestations refer to worms that live as parasites in the human body and are fundamental cause of disease associated with health and nutrition problems beyond gastrointestinal tract disturbances. Globally, over 3.5 billion people are infected with intestinal worms, of which 1.47billion are with roundworm, 1.3 billion people with hookworm and 1.05 billion with whipworm. School children aged 5 – 15 years suffer the highest infection rate and worm burden that attributes to poor sanitation and hygiene.

According to Pharm. Adeshina Bashir, head, sales and marketing, Shalina Healthcare, worms are very dangerous for children because its manifestation and symptoms often takes time before it become evident. Bashir further advised that every child must be dewormed at least once in every six months as worms consume nutrients from children they infect, thus retarding their physical development.

“Worm affects children basically the normal way they live their lives. Children, especially those from poor background likes playing on the ground, eating without washing and eating of uncooked food and these are the avenue through which they get infected by worms. Meanwhile, worm infection is totally different from other diseases like malaria and others because it is basically asymptomatic.”

Bashir however advised that, people should not only look at de–worming exercise from the aspect of de-worming once in six months alone, but rather find ways to prevent it as well. “To do these, parents should always ensure that their children eat well cooked food, they don’t walk about bare footed and they wash their hands whenever they want to eat.

Also speaking in the same vein, Pharm.PemiOladipupo, the Association of Community Pharmacists of Nigeria (ACPN), Lagos State chapter’s coordinator for Ketu/Ojota/Ogudu/Magodo zone disclosed that one of the advantages of school based de worming exercise for primary school children is to enable those who do not have access to good health care and proper sanitation to benefit from what the children of the rich are enjoying.

According to him, it has been discovered that majority of children who attend public schools and few private schools do not have access to proper healthcare. “In accordance with UNICEF and WHO standard, children and even adults should be de-wormed once in every six months, but due to poverty and other limitations, you would discover that majority of those children may not be de-wormed even once in three years.”

“De-worming is very important, especially at the early years of pupils. If there is worm in their system, it can lead to their immune system being reduced, infection can also come in, such a pupil would also experience malnutrition, it destroy tissues and organs, causeabdominal pain, diarrhoea, intestinal obstruction, anaemia, ulcers and other health problems. All ofthese consequences of infection can slow cognitive development and thus impair learning.

He also added that de-wormingschool children by anthelmintic drug treatment is a curative approach for expelling the heavy wormload. However, drug therapy alone is only a short-term measure of reducing worm infection and reinfectionis frequent. Control measures through improved sanitation, hygiene and de-worming areneeded to prevent infection and re-infection.

Speaking further on the dangers inherent in not de-worming children, he disclosed that there are a number of measures being taken to prevent infections caused due to the human parasites viz., hookworm, pinworm, roundworm, tapeworm and whipworm. He added that worm infestations often cause serious health problems and impact a child's ability to attend and perform well in school.

Meanwhile, according to UNICEF report, researches have shown that regular de-worming can substantially increase school attendance and significantly improve a child's ability to learn in school. Eventually the growth rate and weight gain of children who are regularly de-wormed is higher than those who aren't. Hence regular de-worming is the best solution for many of the childhood illnesses.

The report further revealed that in most cases, de-worming once every six months is sufficient for children and adult. But, if one suspect that a child is getting worms more frequently, de-worming such a child or the whole family more frequently as deemed appropriate by one physician may be necessary. Except tapeworms (as in the case of pinworm or whipworm infection), a second dose may be necessary after two weeks or 73-75 days after the first dose to break the life cycle/to kill the migrating larval forms of these parasites. In any case, de-worming the whole family twice a year is important.

However in Nigeria, 45 percents of school-age children, totalling nearly 12 million, are estimated to be infected with parasitic worms. Nigeria has an integrated Neglected Tropical Disease (NTD) control policy and plan, a school health policy and school feeding guidelines that all include school-based deworming, and within these frameworks, the federal ministries of health and education have all agreed to work in collaboration specifically on school-based deworming.

In respect to this, in 2011, Ogun State was identified by the Federal Ministries as an area of very high prevalence where pills were available and the State Government would benefit from a comprehensive technical assistance package to enable them to act on the federal policies related to school-based deworming. In response, a group called Deworm the World (DTW) assisted with high level advocacy within the State, which led to the convening of a school-based deworming working group. This group, in close partnership with DTW developed a program plan, targeting strategy and budget.

The State Government was then able to leverage funding for a pilot program that reached three Local Government Areas, trained over 500 teachers, community workers and health workers, and targeted over 100,000 children for treatment for STH and schistosomiasis. The pilot was carried out with financial support from UNICEF and was collaboration between State and Federal Ministries of Education, State and Federal Ministries of Health, the State Universal Basic Education Board, and the Rural Water and Sanitation Agency. While, DtW provided technical assistance and catalytic funding throughout, helping to lead the master training and supporting key components of the training and pill distribution cascade.

Also in November last year, over 23,025 million tablets of Praziquantel were donated through World Health Organization (WHO) by Merck to support the scale-up of treatment of Schistosomiasis, a widespread Neglected Tropical Diseases (NTD). This was acknowledged at a ceremony in Abuja on 8th, November 2012 to highlight the collaborative efforts of Merck, the government of Nigeria and the WHO in the control of schistosomiasis in Nigeria. Schistosomiasis is a worm-like disease stunts growth and cognitive development that causes anaemia, and in pregnant women, and can lead to an increased risk of delivering underweight babies. In Nigeria, more than 30 million people, mainly children, were said to be at risk of schistosomiasis.

Speaking at the event, the Officer in Charge of the WHO Country Office in Nigeria, Dr Alex Gasasira said, the life-saving drugs will be used to treat school-aged children and adults who are most at risk, such as those in endemic areas, and with occupations involving contact with infested water – such as fishermen, farmers, irrigation workers – and women whose domestic tasks bring them into contact with infested water. He added that the treatment will also be complemented with health education. According to WHO, the therapy is considered the most effective intervention in the fight against the parasitic worm disease.

The Commissioner of Health in Ogun State, Dr.Olaokun Soyinka, last year at a deworming exercise programme in the state noted that the most disadvantaged children, such as girls and the poor, often suffer most from ill health and malnutrition, and gain the most benefit from deworming. “Regular desparasitation (deworming) will help children avoid the worst effects of infection, especially where there is no improvement in sanitation; with the overall effects on physical growth, cognitive performance, and improved school attendance,” Soyinka said in a statement signed by the Information Officer in the State Ministry of Health, Miss SeunOyelade.

It is therefore suffice to say that the benefits of deworming the children are immediate and enduring. It has been proven to reduce school absenteeism by 25 per cent, and with the low cost of treatment, regular deworming of children can also prevent the parents from spending unnecessarily on the health and wellbeing of their children.

Also, regular deworming of children can also leads to higher income and literacy as these children grow to adults. Children regularly dewormed are shown to earn over 20 per cents more and work 12 per cent more hours as adults, while those who remain persistently infected are 13 per cent less likely to be literate.

The effects of deworming the children are not limited to just those children who receive treatment. It also positively impacts their siblings and other children who live nearby. Children who were less than one year old at the time of being dewormed in their communities are shown to have large cognitive improvements equivalent to half a year of schooling.

Regular deworming also contributes to good health and nutrition for school-age children, which in turn leads to increased enrolment and attendance, reduced class repetition, and increased educational attainment. It also leads to greater earnings and workforce participation when these children grow to be adults. The most disadvantaged children often suffer most from poor health and malnutrition, and gain the most benefit from deworming.