The Task Force for Global Health is assisting Bangladesh in reshaping its soil-transmitted helminthiasis (STH) program so that the country can eliminate intestinal worm infections among school age children by 2022.
Children Without Worms (CWW), a program of The Task Force and a long-time partner in Bangladesh’s STH control efforts, is working closely with the country’s ministry of health to put together a broad-based plan of action that lays out new interventions and program monitoring strategies to ensure that these infections no longer threaten public health.
CWW director Rubina Imtiaz, MD, said the comprehensive initiative focuses on a broader spectrum of school-age children – from pre-school to secondary school age.
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. “To meet national elimination goals by 2022, it was important to broaden the platform because a lot of children who suffer from intestinal worm infections are of school age, but not in school,” said Imtiaz.
One in five people – mostly children – globally suffer from intestinal worms. The disease can leave children physically stunted, impede cognitive development, and cause severe iron deficiency, leading to increased mortality in pregnant women, infants, and children.
Apart from expanding the target population to cover all children under 16, 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,” said Imtiaz.
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 effective expel the worms, infections recur unless sanitation improves, a reason why CWW is refining communication materials and tactics to educate people about how small changes in hygiene habits can have a big impact on their health and productivity.
The plan also envisages greater integration with other government departments to improve access to safe water and sanitary latrines, especially in areas where mass treatments are held regularly.
A significant component of the revised strategy is a more robust tool to evaluate program interventions that includes parasitological monitoring. “We can understand program impact best when we measure the burden of disease in people who have participated in MDA, and for that we need large-scale parasitological data,” said Imtiaz. “Given the number of deworming campaigns over the years, we must know how things are progressing. Knowing helps us course-correct and also shift resources to areas and age groups with the highest need.”
CWW hopes to use Bangladesh as a prototype for replication in other countries. “The idea is to create STH programs that are models of excellence using World Health Organization guidelines,” said Imtiaz.