Deworming campaign improves child health, school attendance in Rwanda

July 2015

A teacher distributing preventive medicine to children in Rwanda during the deworming campaign.
WHO/D. Mupfasoni

Christophe Harerimana, a school teacher for more than 20 years in Rwanda, became worried in recent years. Many of his students were coming to class ill and were having trouble concentrating.

“The children were having abdominal pain, diarrhoea and nausea. This made it difficult for them to follow the lessons,” says Harerimana, who teaches science and Kinyarwanda, the local language of his village, in the Musanze District.

Harerimana later discovered that many of the children had soil-transmitted helminth infections, which impair long-term physical and cognitive development. In 2007, nearly 95% of school-aged children in the Musanze district were infected—one of the highest rates in the country.

How the infection spreads

Soil-transmitted helminth is one of the most common infections worldwide, with roughly 2 billion people affected in the poorest and most deprived communities. Caused by different species of parasitic worms, the infection is transmitted by eggs present in human faeces, which in turn contaminate soil in areas where sanitation is poor. The infection can be caught easily by walking barefoot on the contaminated soil or eating contaminated food.

“In our community the disease is mainly contracted by families who fetch water from Lake Ruhondo and those who use the stagnant water from the former banks of the Mukungwa River. People are drinking contaminated water and using it to wash their hands, dishes and fruits. There are some people who still defecate in the bush instead of using pit latrines.”

Entire families were contracting the disease and had to spend their limited resources on medicine.

“Parents cannot work for the family income, because they take care of their sick children and the children cannot raise chickens and rabbits or grow vegetables to generate a small income,” explains Harerimana.

"Our deworming campaign reached more than 395 million children in 2014, making it one of the largest global public health interventions."

Antonio Montresor, WHO

Controlling the disease

In collaboration with Ministries of Health, WHO is working to control soil-transmitted helminth infections worldwide by implementing a programme that enables wider access to preventive medicine such as albendazole and mebendazole.

A regularly scheduled treatment of the preventive medicine can reduce the worm burden in the children. The programme started more than a decade ago, but has ramped-up globally since 2012.

“Our deworming campaign reached more than 395 million children in 2014, making it one of the largest global public health interventions,” says Dr Antonio Montresor, Medical Officer for WHO in the Department of Control of Neglected Tropical Diseases.

The preventive medicine is donated to Ministries of Health through WHO and disseminated by schools. Harerimana learned about the programme from his local health facility, RWAZA Health Centre. The Ministry of Health provides educational material on infection prevention and control and trains laboratory technicians, nurses and community health workers at RWAZA.

Deworming campaigns in schools

During the deworming campaigns, organized every 6 months by the Ministry of Health, children aged 5 to 15 years are given a single dose of chewable albendazole, by trained teachers. Pre-school- children, aged 1 to 4 years, receive a dose of mebendazole by trained community health workers, under the supervision of nurses. Since the programme started the rate of children with intestinal worms has reduced by nearly 20%, and more work is being done to increase the frequency of treatment rounds.

Harerimana says he notices a difference. “We no longer spend so much time to accompany our children to the health centre and they follow the lectures better too.”

Since the training, Christophe and other teachers have started health promotion clubs at their school called “Protect our Health”, which is helping students make hygiene a priority.

The programme has dramatically improved the health and nutrition status of the children in Harerimana’s class, along with school attendance and performance.

“With the commitment of affected countries, the support of partners and an increased availability of donated medicines, WHO expects to further accelerate coverage during the course of this year,” says Dr Montresor.