Deworm to not lose gains made on child health and nutrition

National Deworming Day is on 10th February 2015
Government of India is observing National Deworming Day on 10th February to control infections in children caused by Soil-Transmitted Helminths (STH) or intestinal worms, which are among the most common infections worldwide. The World Health Organization (WHO) estimates that 241 million children between the ages of 1 and 14 are at risk of STH infection in India. These worms live in human intestines and consume nutrients meant for the human body. They are transmitted by eggs present in human feces, which contaminate soil in areas where sanitation is poor. STH infections can lead to anemia, malnutrition, impaired mental and physical development, and reduced school participation. Safe, inexpensive and effective medicines are available to control infection.

Regular treatment is a cost-effective method of controlling the public health threat of worms in the absence of improved sanitation.

Jagat Prakash Nadda, Union Minister of Health and Family Welfare, Government of India, wrote to state health ministers that: "[STH] infection of heavy intensity impairs physical growth, cognitive development and is a cause of micronutrient deficiencies like anaemia leading to poor school performance and absenteeism in children. Periodic deworming of children together with improvement of water and sanitation and health education can reduce the transmission of STH infestation. Thus, considering the state's preparedness and with an aim to intensify efforts towards STH control, it has been decided to conduct National Deworming Day, on 10th February 2015 followed by mop-up round on 13th February 2015 in 12 states of India, namely: Assam, Bihar, Chhattisgarh, Delhi, Dadar and Nagar Haveli, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Rajasthan, Tamil Nadu and Tripura. On the national deworming day, children in the age group 1-19 years will be provided Albendazole through the platform of schools and anganwadi centres, except in identified lymphatic filariasis endemic districts."

The WHO recommends school-based deworming as a safe and cost-effective intervention that achieves high coverage of at-risk children.

Priya Jha who leads Evidence Action's Deworming The World initiative in India, had said to Citizen News Service (CNS) last year that side-effects associated with deworming are rare, minor and transitory, for example, feeling nauseated. However, if children have extremely high worm loads, the first round of treatment can cause abdominal pain and gastrointestinal distress. If an area is known to be severely affected, the potential for side-effects should be explained to teachers and families so that they clearly understand that the pain is not the result of the drugs, but due to the dying worms being expelled. The teacher should ask the child to lie down in the shade until they feel better, and if possible, to give clean water to the child to drink. The recommended doses of albendazole have been given to hundreds of millions of children in different countries worldwide with very few adverse reactions reported.
 Nutritional and health consequences of infection: Controlling STH infection is important lest we lose on the gains made in advancing child's health and nutrition. According to the factsheet of Ministry of Health and Family Welfare, Government of India STH impair the nutritional status of the people they infect in multiple ways: worms feed on host tissues, including blood, which leads to anemia; worms increase malabsorption of nutrients. In addition, roundworm may compete for vitamin A in the intestine; and the nutritional impairment caused by STH is recognized to have a significant impact on growth and physical development.

Preventing STH infection
STH infection can be prevented by taking precautions, such as: using sanitary toilets (not defecating outside), hand-washing (particularly before eating and after using toilets), wearing slippers and shoes, washing fruits and vegetables with safe and clean water, eating properly cooking food, and keeping nails clean and short.

Benefits of deworming
According to the factsheet of Ministry of Health and Family Welfare, Government of India: Rigorous studies have shown that deworming has a significant impact on the health, education and livelihood of treated children. Outcomes of deworming include decreased anemia and improved nutrition; increased growth and weight gain; improved cognition and mental and physical development; increased resistance to other infections; improved school attendance; improved children’s ability to learn better and be more active in school; and increased hours worked and wages earned in the long-run in adulthood. Deworming also has important spillover effects, as other members of the community who do not receive treatment also benefit as there are fewer worms in the environment.

Globally, more than 1.5 billion people or 24% of the world's population are infected with STH. Infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China and East Asia. Over 600 million school-age children and 270 million preschool-age children are in need of regular treatment and preventative interventions.

The WHO global target is to eliminate morbidity due to STH in children by 2020. This goal will be achieved by regularly treating at least 75% of the children in endemic areas (an estimated 873 million).

(About the author: Dr Raghav Gattani, MBBS, Junior Consultant at Avadh Hospital and Heart Center is also the honorary Medical Correspondent for CNS - Citizen News Service)
9 February 2015

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