SEATTLE — Two parasitic diseases, schistosomiasis and soil-transmitted helminthiasis (STH), are particularly prevalent in tropical developing countries with subpar water supply and sanitation systems. Two programs aiming to increase deworming in developing countries are Evidence Action’s Deworm the World Initiative and the Schistosomiasis Control Initiative.

Children are a high-risk group for contracting a parasitic illness. The World Health Organization estimates that 873 million children live in regions with a high prevalence of parasitic worms. WHO recommends treatment of 75 percent of children in these areas to control the spread of disease.

A parasitic infection causes severe health problems in children, including anemia, stunted growth, internal bleeding and possible death. Infected children are less likely to attend school and more likely to be low performers.

Mass deworming programs usually distribute drugs to all children in a geographic area, even uninfected children. Distributing deworming drugs to an entire at-risk population is a relatively cheap way to limit the spread of the parasites. The Deworm the World Initiative and the Schistosomiasis Control Initiative promote deworming in developing countries by implementing mass drug administrations to school-aged children through collaborations with local government.

Deworm the World Initiative

Evidence Action is an organization that aims to scale up cost-efficient programs with proven results. The Deworm the World Initiative specifically combats STH in developing countries, though the program does disseminate medication to fight schistosomiasis as needed. The initiative helps governments increase the scale of existing deworming programs and introduces new programs in countries without national deworming projects. Evidence Action offers technical assistance to government deworming initiatives and funds some aspects of the programs.

In addition to technical and financial assistance, the Deworm the World Initiative meets with government officials to advocate for mass distribution of deworming drugs through schools. Administrators teach government officials how to file requests for deworming drugs with WHO. The initiative also spreads information on the importance of participating in deworming days to local communities.

In 2016, Deworm the World helped treat over 196 million children in Kenya, India, Ethiopia, Vietnam and Nigeria, with some preliminary support introduced in Pakistan. Deworm the World’s two biggest programs are in Kenya and India.

In Kenya, the Deworm the World Initiative has helped implement the government of Kenya’s national deworming program in schools since 2012. The collaborative project treated 6.41 million children in 16,708 schools in 2016. The program served 83 percent of children in at-risk areas. Deworm the World’s average cost of treating a child in Kenya is $0.71.

India is the country with the most worm infections; 220 million children are at-risk for infection by STH. In India, the Deworm the World Initiative supported the government with the development and launch of National Deworming Day. National Deworming Day targets all children between one and 19 years old and is implemented in schools. In 2017, the government of India treated over 260 million children. Deworm the World’s average cost of treating a child in India is $0.34.

Schistosomiasis Control Initiative

The Schistosomiasis Control Initiative (SCI) is a partnership project created by the Bill & Melinda Gates Foundation, the World Health Organization and the Harvard School of Public Health. The initiative currently targets schistosomiasis in 15 countries in sub-Saharan Africa with the potential to expand into four additional countries – Chad, Eritrea, Gabon and Swaziland.

Schistosomiasis impacts over 200 million people living in tropical developing countries, but over 600 million people are at risk of coming into contact with the parasite.

SCI collaborates with governments to improve the quality of existing deworming programs or to introduce new programs. The initiative offers technical and financial assistance by helping with budgets, developing program outlines and connecting governments with financial and drug donations. SCI advocates for the introduction of mass drug administrations to government officials in countries without government-run deworming programs.

The program’s average cost of treating a child is $1.13. Excluding the cost of drugs, which are often donated, and in-kind government contributions, the program’s average cost of treating a child is $0.44. In the majority of regions covered by SCI, over 75 percent of children were treated with deworming drugs, exceeding the benchmark developed by WHO.

Recent Progress

Mass drug administrations for deworming in developing countries has increased in recent years. In 2016, 69 percent of at-risk children were treated for STH, a 6 percent increase from 2015. Coverage in African countries was 65 percent in 2016.

Coverage of at-risk children for schistosomiasis was 52 percent in 2016, a 10 percent increase from 2015. Coverage in African countries was 58 percent in 2016.

Programs like the Deworm the World Initiative and the Schistosomiasis Control Initiative have certainly contributed to the increased treatment rate of school-aged children for deworming in developing countries.

– Katherine Parks

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