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Why medicines alone won’t prevent the spreading of parasitic worms in Africa

Deworming has turned into a common practise throughout the world. It has proved really successful minimizing the burden of parasitic worms among children by more than 50%.

The success of the last 17 years has been driven by deworming efforts where school-going youngsters get deworming tablets once to twice a year– and could have been greater if there was a vaccine.

But parasitic worms– found mainly in tropical and subtropical places primarily in sub-Saharan Africa, the Americas, China and East Asia– continue to be a challenge. The World Health Organisation’s latest numbers show that around the world, there are close to 1.5 billion individuals– about one fifth of the world’s population– infected with parasitic worms.

The persistence of parasitic worms shows that deworming is not enough to interrupt the worms’ transmission. One part of the problem is that they live in the soil and water where they can constantly reinfect people even after they have been treated. Another part of the worm problem is that diagnoses are poorly efficient, anti-worm drugs are limited and tightly overlapping geographics and ecologics render co-infections with other diseases such as HIV, malaria or tuberculosis frequent.

But most importantly, communities are not informed about the risks. This means that even when they are treated they continue activities that result in them being reinfected.

The WHO has set a goal to eliminate the burden of parasitic worms in children by 2020. To accomplish this, it’s advocating mass deworming campaigns. But the only way to achieve the 2020 goal is to integrate deworming with other tools such as education campaigns.

We learnt some refreshing lessons in rural Cameroon on how this should be carried out. Our research study looked at a campaign against schistosomiasis– more frequently known as snail fever. Part of the project involved educating children, teachers and legal guardians in rural Cameroon about the dangers.

The information we collected showed that mass drug administration alone had a questionable efficiency in stopping schistosomiasis transmission. But that coupling mass drug administration of praziquantel to children with information about risk factors of infection could produce better results. In fact, another recent study in Côte d’Ivoire unequivocally found that repeatedly informing communities how parasitic worms are transmitted and giving them a set of safe practices significantly helped to prevent reinfection.

This underscores the importance of including– among other complementary measures– extensive population awareness campaigns in the deworming techniques to reduce the burden of these diseases. Such health education ventures that are low-cost clearly constitute a necessary tool for creating the enabling environment for mass drug administration campaigns to flourish.

The challenges

There are four main challenges when it comes to handling parasitic worms. All are particularly visible in tropical and sub-tropical countries where sanitatory conditions are inadequate and people’s lifestyles undermine attempts to interrupt the transmission of parasitic worms.

The first challenge is diagnosis. The diseases caused by parasitic worms are usually asymptomatic. This means that the early signs of infection are usually missed. In cases where individuals develop severe disease, they usually have symptoms like diarrhoea, abdominal pain, blood loss that can result in anaemia, cognitive deficit and tissue destruction. On rare occasions, these diseases can result in death.

But because people don’t show symptoms, most do not know that they have the worms in their system until the parasites proliferate.

The second problem is reinfection. Even after populations receive treatment, they can still be reinfected.

The third challenge is that there is a limited repertoire of anthelminthic drug therapies. These have been repeatedly administered for decades raising concerns about drug resistance in areas targeted for frequent campaigns.

And the fourth is the issue of co-infections with major communicable diseases such as HIV, malaria or tuberculosis. In numerous instances the parasitic infections speed up the course of these diseases and intensify their burden.

Dealing with the problem

Creating awareness in communities is crucial and probably the most cost-effective tool in an anti-worm strategy.

It is essential to inform and involve infected individuals in mass deworming campaigns. There are some examples of success. Kenya, for example, has managed to eliminate Guinea worm disease as a result of deworming campaigns being complemented by health education. Guinea worm disease is caused by Dracunculus medinensis– a long, thread-like worm.

Educational campaigns should include three vital messages. The first must explain how parasitic worms are dispersed, the second must explain the importance of sanitation in preventing transmission and the third should stress the limitations of mass drug treatments.

These campaigns should include messages on how to safeguard water resources and sanitation and hygiene practices.

Unless these health awareness campaigns are integrated into strategies that target parasitic worms, there will never be much improvement in attempting to sustainably reduce the burden of parasitic worms and achieve the elimination rather than the management of these kinds of diseases.

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