Deworming in children

World Health Organization 64% of the Indian population less than 14 years are at risk of Soil-Transmitted Helminths (STH) infections.

STH transmission

• There are three main types of STH that infect people: roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale).
• Adult worms live in human intestines for food and survival where they produce thousands of eggs each day.
• Infected people who defecate outdoors spread worm eggs in their feces.
• Subsequently, the eggs contaminate the soil which can spread infection in several ways:
• Attached to vegetables that are ingested when the vegetables are not carefully cooked, washed or peeled;
• Ingested from contaminated water sources;
• Ingested by children who play in soil and then put their hands in their mouths without washing them.

Symptoms of infection

• Regular treatment of at-risk populations will reduce the intensity of infection and protect infected individuals from morbidity.
• The greater the amount of worms in an individual (intensity), the more symptoms the infected individual will have.
• People with light infections usually have no symptoms.
• Heavier infections can cause a range of symptoms including diarrhea, abdominal pain, and weakness.
• Loss of appetite.

Harms associated with having worms

Effect of STH on the nutritional status of children

Worms impair the nutritional status of people they infect in multiple ways:

• Worms feed on host tissues, including blood, which leads to a loss of iron and protein and often contributes to anaemia.
• Worms can increase the malabsorption of nutrients; roundworm may compete for Vitamin A in the intestine.
• Some worms can cause a loss of appetite, reducing nutritional intake and physical fitness.
• Some worms can cause diarrhea and dysentery.

Development and educational consequences of worms in children

Worms have negative effects on the mental and physical development of children. Children with worms are often underweight and have stunted growth. Heavy infections often make children too sick or too tired to concentrate at or even attend school. Long term, children not treated for worms are shown to earn less as adults.

Effect of worms on child mortality

Intestinal worm infections affect child morbidity, not mortality. There is not rigorous evidence that suggests that worms affect child mortality but there is ample evidence that worms fundamentally affect the quality of children’s lives and negatively impact their access to health, education and livelihoods.

Prevention of infection

Infections can be prevented by taking precautions, including:

• Using sanitary toilets, not defecating outside.
• Keep the surroundings clean
• Hand-washing, particularly before eating and after using toilets.
• Wearing slippers and shoes.
• Washing fruits and vegetables in safe and clean water.
• Properly cooking food; Keeping cooked food covered
• Always drink clean water

Deworming treatment given to children

Albendazole and Mebendazole are the names of the deworming drugs used by the Government of India and is a safe treatment for intestinal worms. The recommended dosage is as follows

• For children of 2 years and upwards - : 1 tablet Albendazole (400 mg) or 1 tablet Mebendazole (500 mg)
• For children of age 1 – 2 years - ½ tablet of Albendazole (400 mg) or 1 tablet of Mebendazole (500 mg)

Appropriate administration of tablets to children between the ages of 1 and 3 years is important. The tablet should be broken and crushed between 2 spoons, then safe water added to help administer the drug. The older children should chew the tablet and if required should consume some water.

Side effects of deworming treatment

The deworming treatment has very few side effects. There may be some mild side effects like dizziness, nausea, headache, and vomiting, all likely due to the worms being passed through the child’s body. These side effects disappear after some time. Side effects are usually experienced by children with high infections. If symptoms do not go away within 24 hours, or if they are very severe, the child is probably experiencing something unrelated to the treatment and should be taken to the nearest health facility.

Benefits of treatment

Rigorous studies have shown that deworming has a significant impact on the health, education and livelihoods of treated children. Outcomes of deworming can include:

• Decreases anaemia and improves nutrition
• Increases growth and weight gain
• Improves cognition and mental and physical development
• Increases resistance to other infections
• Supports more frequent school attendance
• Improves children’s ability to learn better and be more active in school
• Increase hours worked and wages earned in the long-run in adulthood

Deworming also has important spillover effects, meaning that other members of the community who do not receive treatment benefit, as there are fewer worms in the environment. This is especially important for children who are too young to be treated but for whom worms can greatly impair cognitive development.

National Deworming Day 2021

With an aim to intensify efforts towards STH control among children in India, the Ministry of Health & Family Welfare, Government of India (GoI) observes the National Deworming Day (NDD) bi-annually on 10th February and 10th August in all states and UTs followed by mop-up activities. The NDD is being conducted on 8th February and mop up day on the 14th February. The biennial round (recommended in selected states based on worm prevalence data) is being conducted on August 8 followed by a mop-up activities on August 16. The Mop-Up Day (MUD) on 14th February and August 16th isnbeing organised with the intent of deworming children who missed the dose on February 10th and August 8th respectively. All Government and Government aided schools and anganwadi centers will be the sites for implementation of National Deworming Day across the country.

Currently largest single day public health program in the world, the National Deworming Day this year is set to reach 32.81 crore children and adolescents in 30 states/UTs, in the age group of 1-19 years.

Target audience - All children (both boys and girls) in the age group of 1-19 years.

The NDD is being implemented through the combined efforts of Department of School Education and Literacy under Ministry of Education, Ministry of Women and Child Development and Ministry of Jal Shakti.

Source : National Deworming Day - Training toolkit