Win the war on worms

Last year, the World Health Organization declared that around 1.5 billion people worldwide were at risk of getting infections from helicopters (STH) transmitted from the soil – or nematodes. That is, 270 million preschool children and 600 million school-age children live in areas where these parasites are transmitted intensively. India represents a quarter of the children with STH in the world; 64% of them are under the age of 14.

Because of the pronounced impact on the child's growth and development, the 54th World Health Assembly, in 2011, undertook to reduce the prevalence and intensity of helminth infections transmitted from the soil in all countries 50%.

Recognizing this challenge, in 2015 the Ministry of Health and Welfare of the India Family launched the National Program on Health Reduction, one of the largest public health programs for mass administration in the world , to reach over 230 million children by 2020. Mainly a school initiative based on Anganwadi, this involves teachers and health care workers on the front lines who administer worms (Albendazole). This initiative has garnered many awards globally, in particular by public health advocates of neglected tropical diseases.

Open defecation, contaminated soil and water, uncooked food and non-compliance with basic hygiene are the main reasons for transmission (maggots and eggs). If not diagnosed, the worms persist in the body and lay thousands of eggs every day. Worms cause a decline in iron, protein and vitamin A levels, leading to anemia, low appetite, malnutrition and diarrhea.

Although there have been impressive gains with regard to the national worming program, there are some ways in which it can be improved. Firstly, teachers and front-line workers are overworked and have little incentive to participate in the program. Therefore, it is necessary to plan the commitment of community volunteers, young people and health and sanitation committees in the villages. Secondly, it is necessary to focus particularly on out-of-school children and adolescents through intensified intensification and the use of networks of peer groups and youth groups to administer the drug. Thirdly, private schools must raise awareness among parents and increase participation. Finally, state departments (health, women, child development and education) need to better coordinate and improve drug delivery and timely delivery of drugs. The scale of mass drug delivery is commendable, but what India needs to do on a war footing is to focus on preventive chemotherapy, improve sanitation, allow access to water. clean / safe drinking and allow awareness of hygiene. Since the eradication of STH infections is difficult, given its faeco-oral transmission patterns and penetration through the skin, the chances of re-infection are very high in the population living in endemic areas. This is particularly worrying in regions with tropical climate with high humidity and warm temperatures such as Tamil Nadu, Andhra Pradesh, Bihar, Assam and West Bengal and in cities that have seen an unplanned urbanization.

In February 2018, India reached over 266 million children through the national Deworming Day program. State governments are also taking advantage of this program to address health challenges such as anemia and malnutrition by integrating it with other health programs. , for example the Vitamin A of the Government of India and the iron and folic acid program. The Swachh Bharat Mission has largely addressed the issue of open defecation in many states, but we must ensure that this rigor is maintained. It is necessary to prioritize drinking water problems, the safe management of faeces and the safe disposal and recycling of waste. Alternatively, the STH infection problem should also be considered part of the urban planning and urban planning mandates of India.

Dr. Ashutosh Mishra is with RTI International, India

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