For almost two decades, children have been the focus of the World Health Organization’s (WHO) global strategy to control morbidity due to infection with soil-transmitted helminths1 (or intestinal worms).
Strong country support and increased availability of donated medicines have substantially improved the treatment of preschool and school-age children.
In 2016, for example, over 530 million children representing 63% of the world’s total were treated. With more improvement expected in 2018, the focus is now shifting on girls and women of reproductive age.
“Soil-transmitted helminth infections impact the health of hundreds of millions of girls and women of reproductive age daily. Global efforts are needed to reduce morbidity associated with these infections,” said Dr Theresa Gyorkos, Professor of Epidemiology at McGill University in Montreal, Canada.
Parasitologists and experts in nutrition and maternal health as well as representatives from endemic countries met at the Rockefeller Foundation Bellagio Center in Italy in June last year and adopted the Bellagio Declaration, which upholds that “every girl and every woman of reproductive age who is infected with soil-transmitted helminths has the right to be treated.”
The meeting was organized by WHO and the WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control at McGill University.
“Intestinal worms depend on their host and they compete for nutrients,” said Dr Virak Khieu, Manager of National Helminth Control Programme of the National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Cambodia. “There is compelling evidence linking worm infections of moderate to heavy intensity with exacerbating anaemia.”
Soil-transmitted helminths are transmitted by microscopic 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.
“Approximately 688 million girls and adult women live in areas in more than 100 countries which are endemic for intestinal worms. The greatest number is found in sub-Saharan Africa, the Americas and Asia,” said Dr Antonio Montresor of WHO’s Department of Control of Neglected Tropical Diseases. “WHO recommends deworming women of reproductive age with single-dose albendazole or mebendazole after their first trimester of pregnancy and where the prevalence of worm infections is 20% or higher.”
Periodical treatment reduces and maintains the low intensity of infection but, in the longer term, provision of adequate sanitation is important. Health and hygiene education can also help in reducing transmission and reinfection .
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1 Soil-transmitted helminthiases are caused by infection with the nematodes: Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm) and Ancylostoma duodenale or Necator americanus (hookworms), the most common parasite infections in humans.