Project title: “Worm Free Pakistan”
By Dr M Khurram Rashid
Helminths are parasitic worms. They are the most common infectious agents of humans in developing countries and produce a global burden of disease that exceeds better-known conditions, including malaria and tuberculosis (Bethoney, 2008). More than a third of the world’s population is infected with worms (Helminths). There are many different types, but the most common are soil-transmitted Helminths (roundworm, whipworm and hookworm) and schistosomiasis which can negatively affect children’s health, nutrition and education (Global Atlas of Helminth Infections).
In 2001, World Health Assembly urged all Member States endemic for soil-transmittthiasis (STH) to attain “a minimum target of regular administration of chemotherapy to at least 75% and up to 100% of all school-age children at risk of morbidity by 2010” (WHO, 2008).
Pakistan has been declared one of the endemic countries. According to WHO estimates in 2010, of a total of 10,648,681 preschool-aged children and 23,735,460 school-aged children, only 92,720 have been treated using Albendazole/Mebendazole, amounting to a total of 0.39% of the total children at risk (WHO, 2012).
The benefits of school-based deworming are immediate and enduring. It has been proven to reduce school absenteeism by 25%, and also leads to higher income and literacy as these children grow to adults. Children regularly dewormed are shown to earn over 20% more and work 12% more hours as adults, while those who remain persistently infected are 13% less likely to be literate (The Evidence For School-Based Deworming).
Goal of the project:
The overall goal of the project is to improve the quality of life of the Pakistani citizens. Although various approaches are possible, this project aims at the most cost effective and practical approach to bring about alleviation in the miseries of the poor people in Pakistan.
The objective of the project is to deworm the maximum possible population in the country- one district at a time. This will be done through mass administration of chemotherapy recommended for the treatment and prevention of Helminths.
Helminths affect the areas already downtrodden and with poor sanitation conditions. The targeted population, therefore, are the people of the poor rural and underdeveloped areas of Pakistan. This includes the children, men and women.
“Worm Free Pakistan” intends to intervene at school level through mass drug administration. The drugs used will be Albendazole/Mebendazole, as a single dose. Addressing the problem with a holistic approach, we believe that treating school attending kids alone will not solve the problem. The Helminths will stay in the surroundings and will most likely be able to infiltrate again owing to infected siblings and family members: the programme therefore, intends to treat all the family members of the school going children.
The population of the target area will be tested through faecal tests for Helminths in order to obtain an estimate of the prevalence of Helminths in the area. The tests will be repeated on a random sample of treated individuals after the execution of the project has been completed. A decline in the number of helminth infections and the extent of decline will reveal the effectiveness of the project.
The project will be multi phased:
- Estimates: initial tests will be conducted on a very brief sample of school going children to assess the gravity of the problem and thereby helping in choosing areas on the basis of need of intervention.
- Awareness and consent: this phase involves interactions with the school administrations and mass awareness campaigns through media and pamphlets about the problem and how are we going to address the issue. This will create a general acceptability of the idea amongst the masses and will also ensure their adherence to the drug regime. Consent of the parents of the school children will be taken before the project is actually executed
- Mass drug administration: Schools will be provided packs with single dosage deworming tablets for students and their families. A leaflet with the information will be included.
- Assessment: one month post administration of chemotherapy, random testing will be conducted to assess the efficacy of the project.
- Follow up: the same cycle will be repeated almost one year after the initial dosage to ensure the sustenance of results achieved and to help parents take responsibility for future repetition of the preventive chemotherapy.
The project will initially be run in one district Sargodha as a pilot project. The drug administration will take place exactly one month after the launch of the project, once the estimation and awareness phase have been completed. The drug administration phase will take one month. One month later, the results will be assessed. The first administration can therefore be completed in 3 months. The follow up treatment will be a quick one month project exactly one year after the completion of the initial administration.
The project will utilize the existing infrastructure of school staff with the consent of the education department. The project will take technical inputs from a public health expert. Separate teams will be allocated areas and their respective schools. Other than the top managers, the project will benefit from the services of the locals in order to enhance acceptability of the project and also to avoid expenses on boarding and lodging.
Chemotherapy used, Albendazole/Mebendazole will be the major financial commitment for the project. Printing of information leaflets for distribution through schools will also require funds.
The project, without being too expensive, will be a resourceful effort, making the best of the available resources and some aid.
Bethoney, J. M. (2008). Helminth Infection: The great neglected tropical diseases. Journal f Clinical Investigation, 1311.
GLOBAL ATLAS OF HELMINTH INFECTIONS. (n.d.). Retrieved February 22, 2012, from http://www.thiswormyworld.org/: http://www.thiswormyworld.org/
The Evidence For School-Based Deworming. (n.d.). Retrieved February 21, 2012, from http://www.dewormtheworld.org/?q=node/105: http://www.dewormtheworld.org
WHO. (2008). Soil-transmitted helminthiasis. Geneva: World Health Organization.