Soil Transmitted Helminthiases

Soil Transmitted Helminthiases (STH) afflicts Filipinos living in the endemic areas.  It is the third most prevalent infection worldwide, second only to the diarrheal diseases and tuberculosis. The prevalence of STH among the two to five years old is lesser but they suffer the greatest impact of the disease when they get infected.


Many programs on the deworming of children have recently been established to effectively and efficiently control the STH and mass deworming, considered by the World Bank as the number one cost effective priority intervention among the five to fourteen year group.

The three major causes of intestinal parasitic infections in the Philippines are Ascaris lumbricoides, Trichuris trichiura, and Hookworm (Ancylostoma duodenale and Necator americanus). They are classified as soil transmitted helminths (STH) because their major development takes place in the soil. 

Intestinal parasites live as long as 5 years, passing out as much as 240,000 eggs per worm per day. With unsanitary disposal of human stools, the eggs develop in the soil and can mechanically infect humans when fingers, food or water are contaminated with parasite eggs from the soil or when the infective larva of hookworms in the soil penetrate skin of barefooted individuals. As much as one ton of STH eggs per day is passed out in the soil worldwide.

Signs and Symptoms

• Anemia
• Malnutrition
• Stunted growth in height and body size
• Decreased physical activity
• Impaired mentak development and school performance

Children belonging to 2 to 5 years old are easily infected and they should be given treatment. The 6 to 14 years old harbor the greatest local of infection and are significant source of transmission (reservoir). The treatment should aim to reduce the source of infection. The frequency of treatment is 2x a year for 3 years.

Prevention and Control

Health Education

• Good personal hygiene - thorough washing of hands before eating and after using the toilet
• Keeping fingernails clean and short
• Use of footwear (slippers, shoes, etc.)
• Washing fruits and vegetables very well
• Advocate use of sanitary toilets
• Sanitary disposal of refuse and garbage
• In areas where water is not safe for drinking, teach families how to boil properly (at least 2-3 minutes from boiling point) or chlorinate (seek guidance of Rural Sanitary Inspector)
• Once signs and symptoms appear, consult RHU staff or your doctor

Book source: PUBLIC HEALTH NURSING in the Philippines

WHO: Soil-transmitted helminth infections

Fact sheet
Updated September 2017

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Key facts

• Soil-transmitted helminth infections are caused by different species of parasitic worms.
• They are transmitted by eggs present in human faeces, which contaminate the soil in areas where sanitation is poor.
• Approximately 1.5 billion people are infected with soil-transmitted helminths worldwide.
• Infected children are nutritionally and physically impaired.
• Control is based on:
• periodical deworming to eliminate infecting worms
• health education to prevent re-infection
• improved sanitation to reduce soil contamination with infective eggs.
• Safe and effective medicines are available to control infection.

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Soil-transmitted helminth infections are among the most common infections worldwide and affect the poorest and most deprived communities. They are transmitted by eggs present in human faeces which in turn contaminate soil in areas where sanitation is poor. The main species that infect people are the roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale).

Global distribution and prevalence

More than 1.5 billion people, or 24% of the world’s population, are infected with soil-transmitted helminth infections worldwide. Infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China and East Asia.

Over 267 million preschool-age children and over 568 million school-age children live in areas where these parasites are intensively transmitted, and are in need of treatment and preventive interventions.

Transmission

Soil-transmitted helminths are transmitted by eggs that are passed in the faeces of infected people. Adult worms live in the intestine where they produce thousands of eggs each day. In areas that lack adequate sanitation, these eggs contaminate the soil. This can happen in several ways:

• eggs that are attached to vegetables are ingested when the vegetables are not carefully cooked, washed or peeled;
• eggs are ingested from contaminated water sources;
• eggs are ingested by children who play in the contaminated soil and then put their hands in their mouths without washing them.

In addition, hookworm eggs hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin. People become infected with hookworm primarily by walking barefoot on the contaminated soil.

There is no direct person-to-person transmission, or infection from fresh faeces, because eggs passed in faeces need about 3 weeks to mature in the soil before they become infective. Since these worms do not multiply in the human host, re-infection occurs only as a result of contact with infective stages in the environment.

Nutritional effects

Soil-transmitted helminths impair the nutritional status of the people they infect in multiple ways.

• The worms feed on host tissues, including blood, which leads to a loss of iron and protein.
• Hookworms in addition cause chronic intestinal blood loss that can result in anaemia.
• The worms increase malabsorption of nutrients. In addition, roundworm may possibly compete for vitamin A in the intestine.
• Some soil-transmitted helminths also cause loss of appetite and, therefore, a reduction of nutritional intake and physical fitness. In particular, T. trichiura can cause diarrhoea and dysentery.

Morbidity and symptoms

Morbidity is related to the number of worms harboured. People with infections of light intensity (few worms) usually do not suffer from the infection. Heavier infections can cause a range of symptoms including intestinal manifestations (diarrhoea and abdominal pain), malnutrition, general malaise and weakness, and impaired growth and physical development.

Infections of very high intensity can cause intestinal obstruction that should be treated surgically.

WHO strategy for control

In 2001, delegates at the World Health Assembly unanimously endorsed a resolution (WHA54.19) urging endemic countries to start seriously tackling worms, specifically schistosomiasis and soil-transmitted helminths.

The strategy for control of soil-transmitted helminth infections is to control morbidity through the periodic treatment of at-risk people living in endemic areas. People at risk are:

• preschool children
• school-age children
• women of childbearing age (including pregnant women in the second and third trimesters and breastfeeding women)
• adults in certain high-risk occupations such as tea-pickers or miners.

WHO recommends periodic medicinal treatment (deworming) without previous individual diagnosis to all at-risk people living in endemic areas. Treatment should be given once a year when the baseline prevalence of soil-transmitted helminth infections in the community is over 20%, and twice a year when the prevalence of soil-transmitted helminth infections in the community is over 50%. This intervention reduces morbidity by reducing the worm burden. In addition:

• health and hygiene education reduces transmission and reinfection by encouraging healthy behaviours; and
• provision of adequate sanitation is also important but not always possible in resource-poor settings.

Periodical treatment aims to reduce and maintain the intensity of infection, and to protect infected at-risk populations from morbidity.

Deworming can be easily integrated with child health days or supplementation programmes for preschool children, or integrated with school health programmes. In 2016, over 385 million school-aged children were treated with anthelminthic medicines in endemic countries, corresponding to 68% of all children at risk.

Schools provide a particularly good entry point for deworming activities, as they allow the easy provision of the health and hygiene education component, such as promotion of handwashing and improved sanitation.

In 2017 WHO published an updated, evidence-informed guideline on the regular large-scale treatment of people against intestinal worms (soil-transmitted helminths). The guideline endorses the current practice in areas endemic for the three main worm species that cause the disease.

WHO recommended medicines

The WHO recommended medicines – albendazole (400 mg) and mebendazole (500 mg) – are effective, inexpensive and easy to administer by non-medical personnel (e.g. teachers). They have been through extensive safety testing and have been used in millions of people with few and minor side-effects.

Both albendazole and mebendazole are donated to national ministries of health through WHO in all endemic countries for the treatment of all children of school age.

Global target

The global target is to eliminate morbidity due to soil-transmitted helminthiases in children by 2020. This will be obtained by regularly treating at least 75% of the children in endemic areas (an estimated 836 million in 2016).

Article source: http://www.who.int/mediacentre/factsheets/fs366/en/

DepEd, DOH join efforts to eliminate intestinal parasitism

The Department of Education (DepEd) continues its drive to eliminate intestinal parasitism among the public elementary school learners nationwide through its mass deworming program or the Integrated Helminth Control Program, in cooperation with the Department of Health (DOH).

This mass deworming program aims to reduce the prevalence of soil-transmitted helminthiasis (STH) among school-aged children. If not treated, STH may lead to malnutrition, anemia, growth retardation, impaired cognitive functions and other health problems.

For the School Year 2015-2016, DepEd had given deworming medicines to 11.8 million school-aged children on the first round of the deworming activity, representing 80.56% of the target number of learners to be given with deworming medicines.

In the second round, the program served 10.6 million school-aged children, or 73.3% of the total number of target learners.

Under this effort, the DOH provides the medicines to be administered as a single dose once every six months to ensure the elimination of all types of worms. The medicine is given to school-aged children by DepEd health personnel, with help from other health personnel from the Local Government Units (LGUs).

For each school year, the first round of the deworming program is conducted in the whole month of July, while the second round is in January.

Medicines to be given are Albendazole 400mg or Mebendazole 500mg, both of which are recommended by the World Health Organization (WHO) and DOH.

Since the program launch in 2006, the United Nations Children’s Emergency Fund (UNICEF) and WHO have reported that learners who had undergone the deworming treatment demonstrated significant improvements in language and memory development, and had better iron and vitamin A absorption. 

School-aged children who are not enrolled and those who are enrolled in private schools are also encouraged to participate in this activity. Private schools may coordinate with their DepEd Regional Office for the allotment of deworming medicines.

The Guidelines on the Implementation of the National School Deworming Day is enclosed in the DepEd Memorandum No. 80, s. 2015 which is available online at https://www.deped.gov.ph/memos/dm-80-s-2015.

Article source: http://www.deped.gov.ph/press-releases/deped-doh-join-efforts-eliminate-intestinal-parasitism

All about deworming for kids and adults

Here's why you should undergo deworming once every 6 months.

A few weeks after 18-year-old Rohan joined the college hostel, he started experiencing severe stomach pain. At first he ignored the pain, but when he began vomiting off and on, and found himself losing more than 15 kilos over the next few months, he decided to consult a doctor. The doctor prescribed deworming pills. Soon after, he excreted a long tapeworm. However, by then his intestines were severely damaged! Worms in the body block our digestive track, rob us of nutrients and stop the digestive system from functioning. Tapeworm is not the only worm that affects our digestive system, there are several types of worms that can cause problems, including whip worms, thread worms, hook worms and round-worms.

Here’s how you can get infected

• Walking barefoot in the garden, playground or any infected soil; for example, hookworm larvae burrow through the skin of bare feet.
• Ingesting worm eggs through eating fruits, vegetables, grains, fish and meat contaminated with roundworm or whip worm.
• Washing fruits and vegetables with contaminated water.
• Transfer of the parasitic worms from pets to owner.
• Coming in contact with the soil that has been contaminated with human faeces from an infected person.
• Not washing hands with soap and water after defecating. Open air defecation also increases the risk of worm infestation.

Signs and symptoms of worm infestation

Signs and symptoms are more or less same for children and adults, except that children are more likely to develop abdominal symptoms, as they have smaller intestines so the risk of blockage is higher. Your doctor will prescribe deworming pills when you or your child have the symptoms such as –

• Worms in stool
• Abdominal pain
• Loss of appetite
• Fever
• Wheezing or cough
• Itchy bottom
• Disturbed sleep
• Irritability and general weakness

More severe infestations can cause –

• Abdominal distention (swelling)
• Severe abdominal pain
• Diarrhoea
• Shortness of breath
• Weight loss (in cases of tapeworm infestation)
• Anaemia (in cases of hookworm infestation)
• Fatigue

Deworming for infants and children ‘A worm infestation can cause stomach pain and vomiting. It affects normal growth and can cause malnutrition in children. That is the reason doctors recommend deworming your baby every six months after he turns one’, says Dr Saroja Balan, a senior consultant neonatologist at the Indraprastha Apollo Hospital, New Delhi. ‘Deworming medication kills adult worms but not the eggs. So repeating the dose every six months is vital,’ she continues. Doctors generally prescribe a single dose of albendazole 400mg tablet once every six months for children. It works for most parasitic worms in the gut except for tapeworm. Researchers at King George Medical University, Lucknow, India, conducted a clinical trial and found that albendazole remains almost wholly inside the intestine, and the tablet does not have any significant adverse effects. [1] (Read: 4 natural remedies for intestinal worms)

Heavy worm infection can constrain physical development. Although earlier studies suggested that in areas where worm infection is common, periodic deworming of school-age children can improve weight gain. The researchers at Lucknow did not find any improvement in height and haemoglobin level with albendazole treatment. [1] Severe worm infestation may cause death in malnourished children due to diarrhoea and other complications. So, in addition to albendazole treatment, doctors may also prescribe vitamin A (retinol) capsule of 200 000 IU retinyl acetate in oil every 6 months, especially in malnourished children under 5 years and more than 6 months of age. [2]

Vitamin A is important for the regeneration of the lining of the stomach and intestine, and also helps in regulating immune function. Vitamin A supplementation has a preventive effect on all-cause and disease-specific mortality of diarrhea, measles, pneumonia, meningitis and sepsis. An added benefit of deworming is that routine administration of deworming drugs marginally improves haemoglobin concentration thereby reducing anaemia. [3] (Read: 7 signs that your child has worms)

Pyrantel pamoate is another drug that your child may be prescribed for worms such as pinworm and roundworm. Dosage is as per the weight of the child, viz. 10mg per kilo of the child’s weight. It is usually prescribed as a single dose. Side effects may include vomiting, dizziness or headache. The drug does not work for tapeworm. [4]

Praziquantel and niclosamide are the two drugs that are prescribed for tapeworm infestation. It is again a one-time dosage that is calculated as per the weight of the child, or age of the child. For example, a one-time dose of niclosamide 500mg is given to children under 2 years of age, 1000mg for children aged 2 to 6 years, and 2000mg for children above 6 years of age.  [4] (Read: Intestinal worms — know the symptoms)

The World Health Organization recommends periodic deworming of all children living in endemic areas once a year when the prevalence of soil-transmitted parasitic worms in the community is over 20 percent, and twice a year when it is over 50 percent. [5] They also suggest health and hygiene education in schools to reduce transmission and reinfection by encouraging healthy behaviours, and also to ensure adequate sanitation.

Deworming in adults Deworming drugs for adults are the same as those for children. It’s just the dosage that is different. For example, the most common drug your doctor will give you is albendazole 400mg tablet. The treatment course is two tablets altogether over a period of two weeks, that is, one tablet once a week. Consult your doctor before using deworming drugs [6] if you –

• Have liver problems
• Are pregnant or nursing your baby
• Are taking other prescription or non-prescription medicines, including supplements

Alternative remedies for worm infestation Homeopathy: Examples of homeopathy remedies are given below. [7]

1. Teucrium: Remedy for pinworm and roundworm, and to treat an itchy bottom.
2. Ignatia: It is prescribed when the child has a tickly sensation near the anus.
3. Sabadilla: Is prescribed to people with symptoms of vomiting, nausea, and colic.
4. Indigo: Is prescribed for treating threadworm and roundworm. Symptoms include intense pain around the navel area and convulsions.
5. Cuprum oxydatum nigrum: It treats all kinds of worms, including tapeworm.

Ayurveda: The following herbs are useful as deworming agents. [8]

1. Ajwain (carom seeds): Ajwain seeds taken with jaggery dissolved in cold water early in the morning expels worms during defaecation.
2. Bael (Bengal quince, wood apple): The fruit kills the worm within the body which is then expelled with stools.
3. Palasha (flame of the forest): Effective in treating roundworms. Take the seeds with buttermilk twice daily.
4. Tulsi (sweet basil): Seeds of tulsi in water or even chewing the leaves on an empty stomach is an effective remedy for all parasitic worms, including tapeworm.

Disclaimer: TheHealthSite.com does not guarantee any specific results as a result of the procedures mentioned here and the results may vary from person to person. The topics in these pages including text, graphics, videos and other material contained on this website are for informational purposes only and not to be substituted for professional medical advice.

Article source: http://www.thehealthsite.com/diseases-conditions/deworming-for-kids-and-adults-f1115/

WHO: Deworming in Children

Deworming in children

Soil-transmitted helminth infections are among the most common infections in humans, caused by a group of parasites commonly referred to as worms, including roundworms, whipworms and hookworms. Those living in poverty are most vulnerable to infection which can impair nutritional status by causing:

• internal bleeding which can lead to loss of iron and anaemia;
• intestinal inflammation and obstruction;
• diarrhoea; and
• impairment of nutrient intake, digestion and absorption.

Evidence shows that preventive chemotherapy, or the periodic large-scale administration of anthelminthic medicines to populations at risk, can dramatically reduce the burden of worms caused by soil-transmitted helminth infections.

Preventive chemotherapy is an important part of a comprehensive package to eliminate morbidity due to soil-transmitted helminths in at-risk populations. However, long-term solutions to soil-transmitted helminth infections will need to address many factors, including improvements in water, sanitation and hygiene.

Article Source: http://www.who.int/elena/titles/deworming/en/

DOH CONDUCTS NATIONAL DEWORMING MONTH TO REINFORCE PREVENTION AND CONTROL OF SOIL-TRANSMITTED HELMINTHS

The Department of Health (DOH) continues its nationwide drive to eliminate intestinal parasitism in children. The Department in partnership with schools and local government units (LGUs) are distributing anti-helminthic drugs during the National Deworming Month (NDM), a twice a year campaign held during the months of January and July. The NDM is done by synchronizing the schedules of Mass Drug Administration for Soil Transmitted Helminths (STH) in the schools and the community.

NDM is being done because STH is a public health problem that has detrimental impact on children’s growth and development. STH can cause anemia, malnutrition, weakness, impaired physical and cognitive development resulting to poor growth and school performance in children.

The two components of NDM are National School-Deworming Month (NSDM) and Community Based Deworming Month (CBDM). The NSDM is a massive and simultaneous school-based effort to deworm 17,813,379 school-aged children ages 5-18 y/o enrolled in public schools this July 2017, while the CBDM is deworming of 10,572,404 pre-school children ages 1-4 y/o and 15,471,889 school-aged children not enrolled in public schools in various health centers and rural health units under the Local Government all over the country.

The magnitude of the problem of STH showed that 6 out of 10 pre-school children ages 1-5 years old (baseline prevalence of 66%) (2004, DOH-UP-UNICEF) and 5 out of 10 children (54%) aged 6-14 years old (2003, UP-CPH) were affected with STH. Recent data also showed that the overall prevalence of STH among school-age children is 28.4% with 13 Regions still having prevalence of more than 20% (DOH-RITM National Parasite Survey, 2013-2015).

The World Health Organization (WHO) set the target that at least 75% deworming coverage should be attained but the Department of Health has a higher target which is 85%.

The accomplishment of deworming campaign last year has been tremendous and remarkable. In July 2016, out of 19,250,273 enrolled public school-age children (5-18 y/o), 15,853,687 or 82.4 % have been dewormed. And out of the 10,599,699 pre-school age children (1-4 y/o), a total of 7,875,599 or 74.3% have been dewormed.

January of this year, the deworming coverage among enrolled public school-age children was 84.5% (out of 20,194,252 children, 17,060,163 have been dewormed, while among pre-school age children, the deworming coverage was 74.6% (out of 10,612,738 there were 7,919,273 children were given deworming drugs).

“The DOH together with its partners continues the initiative of conducting the National Deworming Month to achieve our goal in reducing the prevalence of Soil Transmitted Helminths in the country to less than 20% by 2022 to prevent its detrimental impact on children’s health and education if not properly addressed or treated.” Health Secretary Paulyn Jean Rosell-Ubial stated.


Johnson & Johnson (Philippines), Inc., through the WHO, has donated 46,000,000 tablets of Mebendazole which will be used to deworm all five (5) to fourteen (14) year old school-aged children under the National Deworming program of the DOH.

“It is our commitment to foster a healthy community that will address public health challenges like the soil transmitted helminthiasis, with a goal to improve health and nutrition of school-aged children in the country,” said Mr. Jeffrey Go, Managing Director, J&J Philippines.

Activities during the NDM are awareness and advocacy building on deworming and training of regional and provincial healthcare workers. The training included the management  and reporting of adverse events and  the  strengthening of  DOH advocacies to promote  Water, Sanitation, Hygiene  (WASH) and Nutrition strategies to complement the deworming campaign.

Due to the the increase in the age group of children to be dewormed (from 1-12 y/o to 1-18 y/o), the DOH have also increased its budget in support of the Soil Transmitted Helminth Control Program. As compared to 2016, there was an increase in budget by 47 % this 2017 (from 2016 budget of P59, 816,320 to 2017 budget of P106, 350,350) with 82 million pesos allotted for procurement of deworming drugs. Furthermore, the WHO is providing additional 42 million tablets of deworming drugs to be used by the Philippines for this annual campaign.

”We ask for the support of the parents and guardians to support this great endeavor. The success of this DOH campaign relies profoundly with the support and actions of the attached government agencies, non-government organizations, developmental partners and the local government units. With this unified effort, health for all will be achieved” Secretary Ubial concluded.




Article Source: http://www.doh.gov.ph/node/10545