Deworming efforts in Bangladesh are about to receive a significant boost as the country reshapes its national soil-transmitted helminthiasis (STH) control program with support from the Children Without Worms program (CWW) at The Task Force for Global Health.
Deputy Program Manager for lymphatic filariasis and STH in Bangladesh, Jahirul Karim, MBBS, says that until recently, his country was focused on controlling intestinal worm infections. “Now, our STH control program has become an STH elimination program, which is a monumental shift for us,” he says.
The new strategy will be implemented based on a work plan that CWW helped Bangladesh develop. The goal of the new plan – expected to be formally adopted in the coming months – is to eliminate illness from intestinal worm infections among school-age children by 2022. The plan’s implementation will be guided by a comprehensive monitoring and evaluation framework that CWW has developed for STH programs, and can be adapted to different countries.
Until recently, the foundation of the national STH campaign rested on deworming campaigns within elementary schools which meant only children between five and 11 years of age who were in school were getting treated. The program has since expanded coverage to cover all children under 16.
Apart from expanding the target population, an important component of Bangladesh’s new multi-year strategy is to tailor interventions based on intensity of the infection (evidenced through the volume of worms in an infected person’s feces). “By controlling intensity of infection, we can lower transmission rates,” says CWW Director Rubina Imtiaz, MD.
The revised strategy also highlights the need for parasitological monitoring. “We can understand program impact best when we measure the burden of disease in people who have participated in mass drug administrations (MDA). For that, we need community-level parasitological data,” says Imtiaz.
Karim says that the community-based surveys that CWW helped develop have been a game changer for STH elimination efforts in Bangladesh. “This allows our program to go beyond program implementation and start thinking about where to modify the frequency of MDAs according to the level of impact (such as reducing frequency of treatments in communities with low-prevalence).”
CWW hopes to use Bangladesh as a prototype for replication in other countries. Imtiaz says the idea is to create STH programs that are models of excellence using World Health Organization guidelines and the latest monitoring & evaluation approaches.
Bangladesh’s campaign to control and eliminate STH began in 2008, and was carried out primarily through mass drug treatments in schools; over the last decade, more than 300 million doses of deworming medicine have been provided to elementary-age school children.
While a single pill can effectively expel the worms, infections recur unless sanitation and hygiene improve. This is one reason why Bangladesh plans to explicitly integrate, for the first time, the delivery and monitoring of health education efforts into the larger STH control program.
The new framework also envisages greater integration with other government departments to improve access to safe water and sanitation, especially in areas where mass treatments are held regularly.
One in five people – mostly children – globally suffer from intestinal worm infections. The disease can leave children physically stunted, impede cognitive development, and cause severe iron deficiency, leading to increased morbidity in pregnant women, infants, and children.
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