National Deworming Day 2020

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TOPIC: General Studies 2

• Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
• Issues relating to development and management of Social Sector/Services relating to Health

According to the World Health Organisation, about 241 million children in India in the ages of 1-14 years are at a risk of parasitic intestinal worms or STH. This means, India accounts for approximately 28 per cent of the total number of children globally estimated to be at-risk of STH infections.

National Deworming Day

The objective of the National Deworming Day is at eradicating intestinal worms also known as Soil-Transmitted Helminths (STH), among preschool and school-age children (enrolled and non-enrolled) between the ages of 1-19 years through the platform of schools and anganwadi centers in order to improve their overall health, nutritional status, access to education and quality of life, reads the operational guidelines issued for NDD by the Ministry of Health and Family Welfare.

• The deworming activity is carried out in all government and government aided schools and anganwadi centers. 
• On this day, Albendazole tablet (deworming drug) is administered to children. The day is followed by a Mop-Up Day (MUD) with the intent of deworming children who missed the dose on the NDD.
• According to the government data, in the first round of deworming, 8.9 crore children (1-19 years) were covered. With each round, the coverage of NDD has increased and in February 2019, the programme reached out to 22.12 crore children.

The Ministry of Health & Family Welfare, Government of India is the nodal agency for providing all States/UTs with guidelines related to National Deworming Day (NDD) implementation at all levels. The programme is being implemented through the combined efforts of Department of School Education and Literacy under Ministry of Human Resource and Development, Ministry of Women and Child Development and Ministry of Drinking Water and Sanitation. Ministry of Panchayati Raj, Ministry of Tribal Affairs, Ministry of Rural Development, Ministry of Urban Development, and Urban Local Bodies (ULBs) also provide support to deworming program.

What Are Intestinal Worms?

Intestinal worms are parasites that live in the human intestines and consume nutrients and vitamins that a child consumes. There are three main types of STH that infect people

1. Roundworm (Ascaris lumbricoides)
2. Whipworm (Trichuris trichiura)
3. Hookworms (Necator americanus and Ancylostoma duodenale)

These worms depend on the human body for their food and survival and while being there, they lay thousands of eggs each day.

STH transmission:

Soil-transmitted helminths are transmitted by 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. This can happen in several ways:

• Eggs that are attached to vegetables are ingested when the vegetables are not carefully cooked, washed or peeled;
• Eggs are ingested from contaminated water sources;
• Eggs are ingested by children who play in the contaminated soil and then put their hands in their mouths without washing them.

In addition, hookworm eggs hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin. People become infected with hookworm primarily by walking barefoot on the contaminated soil.

There is no direct person-to-person transmission, or infection from fresh faeces, because eggs passed in faeces need about 3 weeks to mature in the soil before they become infective. Since these worms do not multiply in the human host, re-infection occurs only as a result of contact with infective stages in the environment.

The Symptoms

Some of the common and visible signs of intestinal worm infection include unexplained weight loss, fatigue, abdominal pain, diarrhoea, and dysentery. Also, heavy infections often make children too sick or too tired to concentrate at or even attend school. If untreated or undiagnosed, worms can have a long term effect on a child’s health and development.

What is the impact?

Often children consume enough calories but they still suffer from undernutrition largely because their diets are deficient in the essential vitamins and minerals necessary for proper physical and mental development.  In addition to this, suffering from intestinal worms’ infection aggravate and intensify the loss of nutrients, especially vitamin A and Iron. This co-existence of micronutrient deficiencies and worm infestation result in impaired growth and development of our young ones.

Soil-transmitted helminths impair the nutritional status of the people they infect in multiple ways.

• The worms feed on host tissues, including blood, which leads to a loss of iron and protein.
• Hookworms in addition cause chronic intestinal blood loss that can result in anaemia.
• The worms increase malabsorption of nutrients. In addition, roundworm may possibly compete for vitamin A in the intestine.
• Some soil-transmitted helminths also cause loss of appetite and, therefore, a reduction of nutritional intake and physical fitness. In particular, T. trichiura can cause diarrhoea and dysentery.

Morbidity is related to the number of worms harboured. People with infections of light intensity (few worms) usually do not suffer from the infection. Heavier infections can cause a range of symptoms including intestinal manifestations (diarrhoea and abdominal pain), malnutrition, general malaise and weakness, and impaired growth and physical development. Infections of very high intensity can cause intestinal obstruction that should be treated surgically.

The Treatment

Albendazole tablet is the suggested deworming drug and its dosage depends on how young a child is. According to experts, Albendazole is an effective drug and doesn’t have any significant adverse effects.

Prevention is better than Cure

Two main areas for prevention of worm infestation include 

• Ensuring improved access to clean water, sanitation, and hygiene and overall clean surroundings to children so that chances of any infection are minimised
• Improving the quality of food consumed (by optimal processing and cooking techniques like washing raw fruits and vegetables with clean water)

To not let the worms breathe 

• Promote the integration of deworming activities within existing public health programs and inter-sectoral platforms in order to optimise coverage
• Plan optimal delivery strategies for deworming activities that are responsive to local conditions

Connecting the dots:

1. The state must improve sanitation services in the schools to reduce the prevalence of the communicable diseases. Discuss.