For nearly one billion children around the world, deworming medication can make the difference between having a healthy future or facing a lifetime of challenges. In countries like Bangladesh and Malawi, innovative approaches are drastically shrinking the prevalence of debilitating parasitic infections, which affect nearly a quarter of the world’s population.
Soil-transmitted helminth (STH) infections are common and may even occur in developed countries. They can cause anemia, malnutrition, and may stunt physical and cognitive growth in children.
The World Health Organization (WHO) has set a goal to reduce suffering from STH and other neglected tropical diseases by 90% in the next five years, which would substantially reduce illness, disability and mortality associated with these diseases. The Task Force’s Children Without Worms (CWW) program is contributing to this effort by supporting five national programs, including those in Bangladesh and Malawi, that have adopted innovative strategies to significantly lower infection prevalence and move towards a more sustainable future.
Bangladesh’s targeted treatment approach
In 2011, surveys showed that nearly 80% of Bangladeshi children had STH infections. Today, that number is just 8%. This means that children in certain areas of Bangladesh no longer need to receive deworming medicine twice a year. This milestone is a result of the Ministry of Health and Family Welfare’s (MOHFW) innovative approach, supported by CWW, and made possible using donated deworming medicines contributed by Johnson & Johnson and GSK.
“For almost a decade, we’ve partnered with Bangladesh’s Ministry of Health and Family Welfare to support its school-based deworming program,” said Aliyah Romero, CWW’s Senior Program Associate.
Along with the distribution of deworming medicines, unique community engagement programs like the Little Doctors program have been pivotal in reaching this goal, where students, or “Little Doctors,” are trained to teach their classmates about good health habits and help distribute the medicines.
“The Little Doctor program is an essential tool for the smooth execution of the deworming activities and enhancing health literacy,” said Dr. Zobayer Ibne Zaid, Program Manager for Filariasis Elimination, STH Control, and the Little Doctor Program.
More than 90% of government-run primary and secondary schools have adopted the Little Doctors program, with the goal of reaching 95% by 2030.
Beyond the classroom, technological approaches in Bangladesh are reshaping the fight against STH infections. With CWW technical support, the MOHFW adopted a geostatistical approach in 2022 to track their progress. This approach combines infection data with population and geographical information to reveal which areas have the highest rates of infections. The Bangladesh hospital systems also conduct surveys every two years to track infections and stop a potential resurgence before it happens.
“The deworming approach in Bangladesh is significant because it represents a shift from a one-size-fits-all strategy in STH control to a more data-driven method of delivering interventions,” said CWW’s Senior Public Health Advisor, Dr. Kristin Sullivan.
Half of Malawi eliminates the need for school-based treatment
In Malawi, entire communities are now free from needing regular STH treatments. Along with Bangladesh, it is one of the first countries in the world to shift away from school-based treatment distributions in affected communities and adopt an as-needed approach for treatments.
“Malawi has made great progress in controlling STH infections,” said Dr. Sullivan. “Per WHO guidelines, the country has stopped distributing deworming medicines through its school-based delivery program in 14 of its 29 districts due to a very low prevalence of infection.”
Because Malawi is among the first to see this type of progress, they are also leading the way in learning how to maintain the gains that have been made, which includes developing a better tracking system.
“The Ministry of Health in Malawi follows the World Health Organization’s established prevalence thresholds to make decisions regarding treatment plans,” said Dr. Michael Luhanga, Senior Disease Control Officer and Program Manager for STH and SCH at the Malawi Ministry of Health. “New survey data is fed into ESPEN, an online portal, to be aligned with treatment protocol, hence guiding Malawi to continue, discontinue, or resume mass drug administrations as needed.”
CWW is supporting the Ministry of Health in its effort to build a more resilient health system that can track and respond to infection trends. To do this, they are looking at which data, indicators, and approaches could be used to identify when infections may be on the rise, and when additional interventions may be needed.
Reshaping communities through sustainable practices
Malawi and Bangladesh are proving that innovation and outreach can have wide-reaching benefits. They are among the first countries to reach these milestones and can help other countries adopt their strategies and pave the way for a more sustainable and healthier future.
“Controlling STH is crucial for the nearly one billion children at risk of infections worldwide,” said Dr. Sullivan. “Ministry of Health commitments to their program through national funding, community involvement, and data-driven programming help make them effective, model programs.”
The shift from school-based preventive chemotherapy distributions to targeted interventions demonstrates how advanced tracking and surveys can improve knowledge about infections, which reduces unnecessary drug distribution. These models, combined with community-based efforts like the Little Doctors program, have the potential to be adopted by other countries around the world to combat infectious diseases, address nutritional deficiencies, and strengthen overall health outcomes.
“It has been absolutely rewarding to be in a role that allows me to support countries as they work to improve the well-being of their communities,” said Aliyah Romero.
Dr. Sullivan finds this work rewarding because it gives children the opportunity that everyone deserves: to live a healthy life free from suffering.
“It’s a true privilege and an honor to support ministries of health worldwide in their efforts to control STH. Personally, I want all children to have the same opportunities as my own, to be healthy, well-educated, and reach their full potential.”
