Worms are parasites, which live in human intestines for food and survival. They consume nutrients meant for the human body and cause blood loss, poor nutrition, and stunted growth.
Symptoms in an infected population are related to the magnitude of worms – the greater the number of worms, the greater will be the symptoms. These symptoms can range from abdominal pain, diarrhea, nausea, vomiting, gas/bloating, fatigue, unexplained weight loss and dysentery.
Most common intestinal worms are roundworm, whipworm, and hookworm.
Intestinal worm infections result from poor sanitation and hygiene conditions, and are transmitted from contact with infected soil.
Yes, there are several ways to prevent the spread of intestinal worm infections:
• By improving hygiene, including washing vegetables, fruits and salads in safe and clean water
• Washing hands, particularly before eating and after using toilets, using latrines
• Wearing shoes
• Drinking clean water
• Eating properly cooked food
Intestinal worm infections interfere with the health, nutrition and ultimately education of children. Worms can cause anemia and malnourishment, which has negative effects on mental and physical development.
Children with worm infections are often too sick or too tired to concentrate in class.
A dewormed child grows healthier, is more resistant to other infections, learns better, is active in school and attends school regularly.
Independent rigorous research, including by Nobel Laureate Michael Kremer, shows that deworming leads to significant improvements in nutrition, cognition, school participation, and future earnings. Specifically:
• A meta-analysis found that deworming programs lead to an average weight gain of 0.3kg in children, equivalent to moving a three-year-old from the 25th to the 50th percentile of WHO child growth standards.
• Children who were less than one year old when their siblings received deworming treatment show significant cognitive gains comparable to between 0.5 and 0.8 years of schooling.
• A randomized controlled trial in Western Kenya found that children who received deworming had a 25% reduction in school absenteeism when compared to those who did not.
• Following those same children in Kenya, researchers found that receiving two to three additional years of deworming increased their income by 13% and consumption by 14% two decades after treatment.
More details on this study can be found in this blog.
Schools provide an existing infrastructure that can be easily leveraged to reach a large number of children with treatment at one place.
Children are comfortable with their teachers, and parents have a lot of confidence in them. Teachers can also be trained easily for administering deworming tablets to children in schools.
Out of school children can also be mobilized to come to schools to receive treatment. In certain cases, additional delivery platforms like community health workers are also leveraged to access children that are harder to reach.
School-aged children harbor the highest burden of worm infections -they are generally in a setting of exposure to contaminated soil and water, making them a vulnerable population to intestinal worm infections.
Currently, Pakistan Deworming Initiative (PDI) is treating all school-aged children (5-14 years) living in at-risk districts across public, private and religious schools as well as those that are out of school.
Overtime, PDI will expand its focus to treat other vulnerable population groups, including preschool aged children and women of reproductive age.
The effects of intestinal worms might not be seen immediately. Children can carry worms for a long time and not know they are sick; you will only see that they are doing poorly in school and not growing well. Since Mebendazole is safe, therefore, it is better to treat every child.
What if only half of the children are administered deworming medicine with the other half left untreated?
If only half the children are dewormed, the positive impact of deworming will only be seen in the children that are treated. However, the remaining half of the children will still suffer from worm infections and the associated consequences.
In cases where the environment is shared between the treated and untreated children, there is risk of contamination in the environment by untreated children, and ultimately, the treated children may get re-infected.
Vermox (Mebendazole 500 mg) tablet is a very safe medicine and procured by the Ministry of Health, Government of Pakistan through the World Health Organization’s Drug Donation Program and tested by Drug Regulatory Authority of Pakistan for safe utilization in school-based deworming in Pakistan.
Drug Regulatory Authority of Pakistan (DRAP) has tested and certified Vermox (Mebendazole 500 mg) in mass drug administration in Pakistan.
As per the recommendation of the World Health Organization (WHO) the dose of 500 mg (1 tablet) is a very safe dosage for school-aged children of 5 to 14 years.
Yes, as per the guidelines of the World Health Organization (WHO) for mass drug administration, the dose of 500 mg is a very safe medicine for children over 1 years old.
There may be some mild side effects like dizziness, nausea, headache, and vomiting, all likely due to the worms being passed through the child’s body.
However, these side effects disappear within 2 hours. Side effects are usually experienced by children with high infections and are generally related to the degeneration of worms that have been killed (meaning that the medicine is indeed working)
In more than 90% percent of cases, side effects subside within 2 hours, however, if a child suffers from side effects for more than 2 hours, then the child needs to be transferred to the nearest health facility for management.
Mebendazole is a tablet that can be easily swallowed by a 5 year old or older child with water, or chewed and then taken with water. It has been safely administered across the world for school-aged children.
The PDI is not treating children without testing or evidence. The Ministry of National Health Services, Regulations and Coordination (M/o NHSR&C) conducted a nationwide soil transmitted helminths (STH) prevalence survey in 2016 in which school-aged children were screened for STH infection.
Based on the findings of that study, approximately 17 million school-aged children across 45 districts in Pakistan are at risk of intestinal worm infections and warrant annual treatment (mainly two types of worms named roundworms and whipworms).
A control room is established centrally by the District Health Office (DHO) and Education Department to handle potential adverse events. Health facilities, hospitals and ambulance services are kept on standby throughout the duration of the campaign. Teachers are provided proper training to handle adverse events if such events arise and contact information of the medical officers / health facilities is provided during the training sessions.
The teacher puts the pill inside the bottle cap, and asks the child to pick it up.
The child picks up the pill from the bottle cap and eats it. Teacher confirms that the child has eaten the pill, and calls the next child forward.
No student is forced to take the medicine. The medicine is only administered if the teacher sees the student fit at the time of medicine administration.
Parent refusals can be tackled by calling parent-teacher meetings where the teacher briefs the parents about the program and how it will benefit their child. Different media campaigns (TVCs, Radio, Social Media, PSM) are also used to spread awareness ahead of the campaign so that parents build an acceptability towards the program.
Due to COVID-19, the campaign is spread over a span of 1 week due to alternate days of attendance being observed in schools.
Children in unregistered schools can be treated in registered schools conducting deworming and the parents will be informed via community mobilization where school banners will depict the deworming week going on.
In general, for a school with an enrolment of 250 children, 1 teacher will be trained. For school enrolments exceeding 250 children in a school, 2 teachers will be trained. The trained school teachers will further train their colleagues in school before MDA so that other teachers can also provide support as needed.
The training venues will be located in the smallest administrative unit (union council). Mostly public or private schools are selected as training venues due to their larger capacity.
- Free treatment for children aged 5-14 years, resulting in improved health, education, and nutrition outcomes for children in the schools that participate in the program
- Association with a government-led health initiative promoting health and better educational outcomes for students.
- Embellished standing in the community owing to focus on students’ health. This will gain increased importance as we enter a post-pandemic world
- Compensation for teachers’ time spent in deworming related activities.
Representatives from private associations can be part of governance structures at the provincial and district levels. Private associations can also help in raising awareness about the deworming program