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The Basics of Deworming

By: Lourdes Nena A. Cabison-Carlos, MDThe Basics of Deworming

Edible, adj.: Good to eat, and wholesome to digest, as a worm to a toad, a toad to a snake, a snake to a pig, a pig to a man, and a man to a worm. – Ambrose Bierce

We have all heard about deworming: our doctors, veterinarians and now, teachers, are advocating deworming. What is it and more importantly, do we need it? Let’s try to get the basics out and learn more about deworming.

What are worms?

We generally call any wriggly tube as “worms”. Scientifically, there are a number of those tube-like invertebrates scattered in different phyla across the Animal Kingdom, but not all of them are harmful (for instance, the earthworm). Worms are called “parasitic” when they live on and derive nourishment from a human being or animal (called a host). Soil transmitted worms (or helminths) involve different species of parasites. The common culprits are the roundworms (Ascaris sp), hookworms (Ancyclostoma spp and Necator americanus), whipworms (Trichuris sp), tapeworms (Taenia spp), and pinworms (Enterobius).

It is estimated that parasitic worms infect about 1.5 billion people worldwide, and most of them reside in sub-Saharan Africa, Americas, China, and East Asia. The burden of infection is great, as the most intense infections are usually found in the poorest regions and in young children. The Philippines has a relatively high prevalence of soil transmitted parasites. Approximately, 80 provinces in our country are affected, in both urban and rural areas.

How do we get infected?

We can get worms in various ways, but the majority of infections involves lack of access to clean water, sanitation and hygiene (WaSH). The most common site of infestation is in the intestine, although some of these parasites can live on any part of the body such as the heart, lungs, eyes, or the brain.

The adult worm that lives inside the intestine can produce thousands of eggs per day. These eggs are then excreted in the feces. In areas that do not have access to proper waste disposal, or in times of calamities such as flood, the eggs may contaminate the soil. Now, a parasitic egg that stays on the soil cannot do you any harm unless:

  • The eggs attach to vegetables or other food sources and are then eaten without proper washing or cooking
  • The eggs contaminate water sources
  • Children who play in contaminated soil and put their hands in their mouth without washing, thereby ingesting the egg
  • Sometimes, some eggs (hookworms) can hatch in the soil and the resulting larvae can penetrate the skin when you walk barefoot on infected soil. Other modes of infection include eating undercooked infected meat, auto-infection (infecting yourself again by scratching your bottom and putting your fingers in the mouth) and transmission thru fomites such as infected clothing and bed sheets (these can harbor viable eggs for up to 20 days!).

What are the effects of infection?

There are many effects; some of them might even go unnoticed. An infected individual can complain of a number of symptoms including malaise and weakness, abdominal pain and diarrhea, itchiness in the perianal area, and even allergy from chemicals released by the parasites. Some may also have anemia due to chronic blood loss, particularly from hookworm infection.  Nutritionally, aside from iron loss, there can also be malabsortion of nutrients, vitamin deficiency, and loss of appetite.

In children, a parasitic infection can affect development and health, nutrition, cognition, ability to learn and educate. Aside from children, women of child-bearing age (including pregnant and breastfeeding women), and adults involved in occupations such as mining and farming, and those who work in the agricultural industry are at high risk for infection.

Why do we de-worm at school?

The World Health Organization (WHO) advocates the implementation of periodic school-based deworming because studies have shown that worm infection can affect school performance. It can lead to absenteeism, poor test scores, and developmental delay for up to six months when compared to peers of the same age. Scientists have also found that school-age kids have the highest intensity of infection. In fact, in the Philippines, the majority of infections come from the 5-19 years old age group.

Moreover, giving the medicine in school is cost-effective. Schools have a well-defined structure with skilled workforce (mainly, teachers). It is accessible and extends to various areas, even to places not usually reached by healthcare personnel. Teachers can also keep track of the medicine distribution and record any outcome because they see the students five times a week. By de-worming, the WHO aims to increase school enrollment and attendance, thereby leading to an increase in educational attainment.

What is the National School-Based Deworming Day?       

It is a joint program between the Department of Health (DOH) and the Department of Education (DepEd). This program advocates and implements the deworming on children enrolled in public elementary schools. Deworming activities are usually done in July and January. Children are given a single dose of anti-helminthic medicine even without a diagnosis. Commonly used drugs are Albendazole 400mg and Mebendazole 500mg (single dose, regardless of body weight). The treatment is generally safe, even if it is given to uninfected kids.

What can we do as members of the community?

The most important key to prevention is good personal hygiene. Children should be taught proper hand washing and cleanliness at a young age. We also have to teach and remind them to use slippers or shoes when walking and playing outdoors. It is also prudent to advise children to stay away from areas where pets and other animals defecate.

We also have to be careful of what we eat and serve our family: fresh fruits and vegetables should be washed and/or cooked thoroughly, and always buy meat from trusted dealers. In addition, we have to keep our surroundings clean.

The role of the local government in educating and mobilizing the community, and providing proper waste disposal facilities cannot be over-emphasized. Response to calamities, whether private or government-sponsored, should be prompt and appropriate to avoid health problems. Hopefully, with all of us pitching help, we can lessen the burden of parasitic infections and eradicate worms in our children’s tummies. So, remember to keep clean and wash your hands!

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