In times of fiscal restraints in developed countries and private donor fatigue to contribute for massive Public Health initiatives in the developing world, many programs have come under intense scientific and political scrutiny. Mass deworming of people infected with soil-transmitted helminthiasis and schistosomiasis—affecting almost one billion people worldwide—has been implemented with drugs given to school-age children in national campaigns.

Mass deworming per se cannot eliminate helminthiasis if it is not coupled with complementary long-term strategies to improve people’s access to clean water, sanitation facilities, proper housing and labour opportunities. This holistic approach has been pushed by the “Global Health diplomacy.” Several national governments, private donors, aid agencies and big pharma companies signed the “London declaration” to commit to a sustained control and eradication of soil-transmitted helminthiasis in developing countries.

Vivian A. Welch et al. searched 11 databases up to January 2016, websites, trial registers and contacted experts to review reference lists together. They studied the results of massive deworming that involved more than one million children and follow-up of 160,000 children after those campaigns.

Mass deworming with albendazole twice per year compared to controls did not show any improvement in weight or height over a 12 months-period. There was little to no difference in weight-for-height, proportion stunted, performance on short-attention tasks, school attendance and mortality. Mass deworming for schistosomiasis improved children’s weight but not height.

Subgroup and sensitivity analyses are based on aggregate level data, which might conceal the differences in results at the individual level or interaction with other sociological factors like poor sanitation, housing and transport. Treating infected and non-infected children will dilute the resulting data.  Even though studies that used proper screening and targeted treatment for helminthiasis showed benefits in the meta-analyses of results, the massive campaigns are more inexpensive and easier to logistically deploy worldwide. Is economics enough of a reason to treat both the infected and non-infected?

What do you think? Please tell us.

Don’t leave me alone.

2 thoughts on “Mass deworming in developing countries

  1. Dear Mario,
    You have discussed a critical issue in developing countries often ignored by the most of the funding agencies which are focused only to the emerging life style diseases and certain infectious diseases like TB, HIV/AIDS. The issue of malnutrition is very common as one in every four children are malnourished in developing nations. The mass deworming strategy with single dose Albendazole was found be effective in patients for Ascariasis, hookworm and Trichuris clinically but as you mentioned, they are not the mainstay in the long run as you need the other essentials like safe drinking water, proper sanitation, healthy nutrition etc. In many developing countries especially in the open defecation and lack of proper toilet facilities make this worm infestation endemic and unrecognized until the patient experiences the complications. I would like to highlight a case from India where the government has taken the initiative (in October 2014) to ensure proper sanitation throughout the country. You can visit the site for more details. It is basically a movement initiated by every responsible citizen to clean and improve the sanitation. I feel the state and non-state actors need to engage the civil society and community in addressing these broader issues through global health diplomacy and not just by having rounds of mass treatment with Albendazole or any new arrivals as such.

    1. Good morning Vijay and thanks for the excellent commentary of yours. The importance of the provision of proper sanitation facilities and clean water to the population cannot be emphasized strong enough; we must demand the political institutions and the foreign donors to have a more engaged commitment to raise the living standards of the most vulnerable communities in the developing world. I will certainly read that article about the initiative in India. Please keep reading our blog and adding your wisdom at the end of it. Arrivederci.

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