WORM WAR
Alarmed by a study showing that seven out of 10 school kids have intestinal worms, the UP-NIH cites the need for a national intestinal-helminth-control program
Since it troubles as many as seven out of every 10 Filipino kids, it is a war worth waging. Said Dr. Jaime Galvez Tan, executive director of the University of the Philippines-National Institutes of Health (UP-NIH): "This is a good war, and it is our patriotic duty."
Intestinal worms, although few realize their impact on public health, are a big barrier not only to many health-promotion efforts, but also to economic development. The World Health Organization, in fact, says that it should be a priority for nations to be able to fight poverty. But there, exactly, lies the challenge--few realize the significance of soil-transmitted helminthiasis (STH). Many Filipinos harbor various misconceptions on the causes and effects of worm infections; there is also now some evidence that doctors may not always know what to do when faced with someone with STH.
On October 7, the UP-NIH, in cooperation with Janssen Pharmaceutica, organized the first national conference on intestinal-helminth control. Dubbed the "War on Worms," the event gathered experts in worm control from here and abroad to highlight the results of new studies as well as unveil strategies that aim to address the problem. Held at the Asian Institute of Msanagement in Makati City, the "war" also enlisted the support of Senator Pia Cayetano, who said: "With these kinds of problems, we see solutions…. The solutions are very simple, and all it requires is the enthusiasm of people."
Kids and adults, and what doctors think
The notion that only kids and the very poor are vulnerable to STH has proved to be inaccurate. Dr. Vicente Belizario Jr., NIH deputy director and professor at the UP College of Public Health, dispelled many wrong beliefs about worm infections by showing the results of several scientific studies.
It is true that kids constitute the bulk of worm-infection patients, but it is untrue that only public-school kids have this problem. In a 2005 survey of private schools in Quezon City and Taguig, about one out of every seven kids was shown to harbor worms, mostly Ascaris and Trichuris. One school even showed a one-in-three prevalence.
Various studies of specific groups have shown that indeed, worm infestation does not stop in childhood. Hookworm, Ascaris, and Trichuris were seen in overseas Filipino workers. In fact, said Belizario, intestinal helminthiasis has been a cause of repatriation for OFWs in Taiwan. Twenty percent of food handlers working in school canteens in Manila's so-called "University Belt" were shown in a 2002 study to harbor intestinal worms. Even soldiers were affected by this problem--nearly three-fourths of soldiers stationed in Gamu, Isabela, were shown in a 2005 study to have worms, primarily hookworms.
Meanwhile, doctors may need additional information on how to go about dealing with worm problems. Dr. Lulu Bravo, chief of infectious and tropical diseases at the UP-Philippine General Hospital Department of Pediatrics, said that continuing the education of doctors on intestinal parasites--a "need for consensus building," she said--would yield significant results, since at least 10 percent of Filipinos choose to consult doctors for their deworming concerns. But in the absence of clinical practice guidelines on intestinal parasites, some misconceptions prevail. In a survey she conducted with Dr. Eva Cutiongco-dela Paz, it was shown that not too many doctors are willing to deworm one-year-old kids, as recommended by the WHO. About 75 percent of those surveyed would only start deworming kids if they are two years old. In addition, only 35 percent would choose to give an antihelminthic to the entire family if a child is infected.
A search for solutions
"Deworming is an essential intervention for child-survival strategies," said Bravo. Worm infection encourages and intensifies malnutrition. Iron-deficiency anemia and weight problems can also be strongly linked to worm infections. And, said Belizario, poor school performance can be connected to the presence of worm infection and malnutrition.
This is why there is a need to initiate and sustain intervention efforts. Health education and improvements in practices involving sanitation should be done. Regular deworming (every six months) should also be observed for high-risk individuals, particularly children.
Belizario and colleagues from the NIH, in cooperation with the Department of Education-Biñan, Laguna, the Biñan local government, and Janssen Pharmaceutica conducted a school-based, district-wide deworming project of public-elementary-school students. They saw that at least seven out of every 10 students were infected; this, Belizario said, "is not acceptable." They then started giving mebendazole, a broad-spectrum antihelminthic, to the students, and monitored their condition between January 2002 and January 2005. After five rounds of treatment, the prevalence of Trichuris went down by 34 percent; mean egg counts also decreased by 88 percent. With Ascaris, which is generally easier to treat than Trichuris, the prevalence dropped by 67 percent; mean egg counts plummeted by 97 percent. In addition, the cumulative STH infection in one school in the district was reduced by 60 percent from July 1999 to January 2005.
Belizario concluded his talk by making an "urgent call to action"--"The time to act in terms of defining policy, providing resources, and implementing local, if not a national intestinal-helminth-control program is now."
J. P. de Guzman
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