Heleminth infections, or the infections caused by roundworms, hookworms, and whipworms (Disease Control Priorities Project, 2008) affect 30% of primary school-aged children worldwide (Planting Peace, 2005). These infections are contracted when children come into contact with the larvae of heleminth parasites, which generally reside in fecal matter. The parasites then enter the intestines, grow into adults, and reside in the intestines, depositing their eggs in the host’s feces, which then continue the cycle (Hotez, 2005). Because the worms feed by inducing intestinal hemorrhage and consuming their host’s blood, they cause anemia and undernourishment, consuming “up to 20 % of a child’s nutritional intake every day” (Planting Peace, 2005). This produces disability, pain, stunting, iron deficiencies, and even, in the most severe cases, death, in the host (Disease Control Priorities Project, 2008). Not only do heleminth infections directly increase levels of undernourishment, but they also impair infected individual’s ability to work, attend school, and generally contribute to their societies in a productive manner.
Deworming primary school-aged children is a very low cost solution to this problem which improves health and school attendance not only in areas where the treatment is provided, but also in neighboring areas, since worms are transmitted from person to person.
Deworming directly addresses undernourishment by allowing children to utilize all of the calories that they take in. In one study of deworming programs, children who were treated exhibited a similar height gain but a 35 % greater weight gain, or an extra 1 kg over 2 years, over a control group (Awasthi).
Deworming incidentally addresses the problem of low school attendance by providing an additional incentive for children to attend school and decreasing sick days among schoolchildren. Absenteeism in treatment schools has been shown to be 25% lower compared to that in control schools, meaning that deworming increases schooling by .15 years for every person treated. In fact, deworming has been shown to be the cheapest way proven to increase school attendance, costing only $3.50 to increase school participation by one child for an entire year (Kremer). Increased school attendance indirectly benefits food security by raising incomes and leading to a more educated population, as described in the primary education solution.
As part of the overall solution to hunger, deworming programs will be implemented in all primary schools in areas where the worm infection rate is greater than 50 percent, as recommended by the WHO (Hall). To do this, we will begin by implementing the program in areas where the worm infection rate is already known to be high, expanding the program as we test schoolchildren in other areas. Each school on the program will be tested every two years to see whether it should remain on the program or whether infection rates have been sufficiently reduced to remove it from the program. Treatment will be phased out by area as worms are eradicated and sanitation becomes less of an issue due to development and education. A general idea of the current problem areas is illustrated by the map below.
(Source: Hotez, Bethony, Bottazzi, Brooker & Buss, 2005)
Beginning immediately, deworming medication will be distributed twice yearly to all existing primary schools in areas which meet the above criteria. This program will also be implemented in any primary schools that arise through our programs in areas where the infection rates meet these criteria. Deworming is a simple procedure which can be done through the ingestion of a single tablet, and hence can be administered easily by schoolteachers or other administrators (Disease Control Priorities Project, 2008). One caveat is that, since concerns have been raised about deworming drugs causing birth defects, girls over 13 years of age will not be treated according to standard practice (Miguel). We will follow the guidelines outlined by the World Health Organization with regards to “Action Against Worms,” a detailed plan of which may be found at http://www.who.int/wormcontrol/newsletter/en/PPC4_eng.pdf.
Given the known effects of this program, its costs are incredibly low.In fact, sixty seven children can be dewormed on only $1 (Planting Peace). Given that children will be dewormed twice yearly for each of the four years that they are in primary school, and that an estimated 320 million school-age children are infected with roundworm, 233 million with whipworm, and 239 million with hookworm (Miller del Rosso), treating half of these cases would cost roughly 14 million dollars per year.
Some NGOs already working on similar plans include Planting Peace, whose Stomp the Worm Project works in Haiti, Sudan, Dominican Republic, and North Korea, and who claims to have reached 7.9 million children (Planting Peace), and Deworm the World, who claims to have dewormed 20 million children in 26 countries in 2009 (Deworm the World). The World Health Organization also promotes deworming programs. All of these efforts should be expanded upon and supported.
Awasthi, S., Peto, R., Pande, V. K., Fletcher, R. H., Read, S., & Bundy, D. A. P. (2008). Effects of Deworming on Malnourished Preschool Children in India: An Open-Labelled, Cluster-Randomized Trial. Public Library of Science.
Deworm the World - Young Global Leaders Making a Difference. Retrieved November 13, 2010, from http://www.dewormtheworld.org/
Disease Control Priorities Project. (2008). Deworming Children Brings Huge Health and Development Gains in Low Income Countries. Retrieved November 29, 2010, from http://www.dcp2.org/file/162/dcpp-helminths-web.pdf
Planting Peace. (2005). Stomp the Worm Project. Retrieved Nov 11, 2010, from http://www.plantingpeace.org/deworm.php
Glewwe, P. & Kremer, M. (2005). Schools, Teachers, and Education Outcomes in Developing Countries. Retrieved November 10, 2010, from http://www.givewell.org/files/DWDA%202009/Interventions/EconEducationHandbook.pdf
Hall, A., Horton, S. & De Silva, N. (n.d.) The costs and cost-effectiveness of mass treatment for intestinal nematode worm infections using different treatment thresholds. Retrieved November 17, 2010, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657832/
Kremer, M. (2003). Randomized evaluations of educational programs in developing countries: Some lessons. American Economic Review, 93(2). 102-06. Retrieved November 10, 2010, from http://www.jstor.org/stable/3132208?seq=1
Latham, M. C. (2007). Global action against worm infections, measles, and malaria. Ithaca: Cornell University.
Miguel, E. & Kremer, M. (January 2004). Worms: Identifying impacts on education and health in the presence of treatment externalities.Econometrica, 72(1), 159-217. Retrieved November 29, 2010, from http://dss.ucsd.edu/~dlake/courses/PS204A/documents/MiguelandKremer.pdf
Hotez, P. J., Bethony, J., Bottazzi, M. E., Brooker, S., & Buss, P. (March 2005). Hookworm: The great infection of mankind. 2(3 e67). 0187-0191. Retrieved November 29, 2010, from http://www.biomedsearch.com/attachments/00/15/78/32/15783256/pmed.0020067.pdf