The Problem: Parasitic Worms​

MORE THAN 868 MILLION CHILDREN ARE AT RISK OF PARASITIC WORM INFECTIONS WORLDWIDE.

While virtually nonexistent and unheard of in developed countries today, parasitic worm infections are endemic in many of the poorest countries in the world.

These infections, known as soil-transmitted helminths (STH) and schistosomiasis, interfere with nutrient uptake and can lead to anemia, malnourishment, and impaired mental and physical development. They pose a serious threat to children’s long-term health, education, and productivity. Infected children are often too sick or tired to concentrate at school, or to attend at all.

Worm infections disproportionately affect the poor. They are easily transmitted in areas with poor sanitation and open defecation. Children are particularly susceptible to infection and experience the greatest morbidity.

Parasitic worms exact an enormous toll on human capital, slowing economic development in parts of the world that can least afford it.

“A significant body of evidence shows that deworming works to improve children’s health, well-being, education, and long-term economic future.”

— World Health Organization (2016). WHO PCT Databank: Soil-transmitted Helminth Infections.

The Solution:
A Simple Treatment

To combat worm infection, regular treatment with a simple pill is universally recognized as a safe and effective solution. The Deworm the World Initiative supports school-based deworming: treatment delivered through existing education infrastructure, administered by teachers with support from the health system. This approach is highly cost-effective, well accepted by communities, and efficiently targets the population group at greatest risk for infection: children.

Rigorous evidence shows that school-based deworming can improve children’s health, education, and long-term productivity at an average cost of less than $0.50 per child per year.

 


 

THE ABDUL LATIF JAMEEL POVERTY ACTION LAB AT MIT LISTS MASS SCHOOL-BASED DEWORMING AS A “BEST BUY” IN BOTH EDUCATION AND HEALTH.

SIMILARLY, THE COPENHAGEN CONSENSUS NOTES THAT “IN COUNTRIES WHERE MANY PEOPLE ARE INFECTED, THE BENEFITS OF DEWORMING CAN BE UP TO 60 TIMES HIGHER THAN THE COSTS.”


 

Mass treatment of all children in at-risk areas avoids the need to screen individuals for infection, leading to dramatic cost savings, and drugs are safe even for uninfected children. The school-based approach builds upon the documented importance of convenience in preventative healthcare, by bringing treatment to where children already are.

The Deworm the World
Initiative

The Deworm the World Initiative envisions a world where all at-risk children have improved health, increased access to education, and better livelihoods potential as a result of being free of intestinal worms. We work in close partnership with governments to enable elimination of intestinal worms as a public health problem.

  • We advocate for school-based deworming to policymakers, gaining and maintaining critical support amongst stakeholders responsible for children’s health and education.
  • We provide technical assistance to governments to launch, strengthen, and sustain high quality school-based deworming programs that leverage existing education and health infrastructure.
  • We employ an evidence-based approach to rigorously evaluate and learn from programs we support, iterating on program design alongside governments to maximize reach in a cost-effective manner.

VIEW OUR RECENT RESULTS HERE

Deworm the World Initiative: Partnership Model

1.POLICY AND ADVOCACY

We advocate with governments to launch deworming programs, and work collaboratively with ministries of health and education to establish effective policies and governance structures. We support alignment of school-based deworming with other health and education priorities to enable long-term political and resource commitments, and share global best practices to improve cost-effectiveness and results.

2.PREVALENCE SURVEYING AND MAPPING

Guided by World Health Organization protocols, we work with epidemiologists and local partners to assess worm prevalence and intensity through field surveys. We use the survey results to support the development and implementation of appropriate treatment strategies. Once deworming programs are in place, we support governments to assess the impact of sustained mass treatment on worm infection.

3.PROGRAM PLANNING AND MANAGEMENT

We work closely with government partners to design their deworming program, develop operational plans and budgets, coordinate logistics, and provide on-the-ground support to ensure a high quality outcome.

4.PUBLIC AWARENESS AND MOBILIZATION

We work with governments to develop locally appropriate campaigns that educate children and communities about the negative effects of worms, the importance of being dewormed, and behaviors to prevent infection. These campaigns increase acceptance and participation in deworming.

5.TRAINING AND DISTRIBUTION CASCADE

We support governments to design and coordinate an efficient multi-tier training and distribution cascade that is tailored to the local context, ensuring that knowledge and program materials are relayed from the national or state level all the way to the teachers responsible for administering deworming drugs.

6.DRUG MANAGEMENT AND COORDINATION

We help governments evaluate appropriate treatment strategies, support drug procurement including through global pharmaceutical donation programs, and facilitate the development of robust protocols for tracking drug inventories and responding to adverse events.

7.MONITORING AND EVALUATION

We work with governments to develop locally appropriate campaigns that educate children and communities about the negative effects of worms, the importance of being dewormed, and behaviors to prevent infection. These campaigns increase acceptance and participation in deworming.


 

Watch the video below to learn more about our work:

Our Impact

Our results at a glance 

  • In 2017, the Deworm the World Initiative supported governments to treat more than 280 million children in India, Kenya, Ethiopia, Vietnam, and Nigeria.

  • We support India’s National Deworming Day, which targets all children ages 1-19 at schools and preschools; in 2017 the program treated more than 260 million children.

  • With our technical assistance, Kenya’s National School-Based Deworming Program has consistently treated over 6 million children per year since 2012, dramatically reducing STH and schistosomiasis infection.

  • Since 2014, GiveWell has named the Deworm the World Initiative one of its top-rated charities.

 

 

IN NOVEMBER 2018, GIVEWELL NAMED THE DEWORM THE WORLD INITIATIVE AT EVIDENCE ACTION ONE OF ITS TOP-RATED CHARITIES FOR THE FIFTH YEAR IN A ROW, RECOMMENDING US FOR ITS “EXCELLENT COST-EFFECTIVENESS” AND STATING THAT “OF THE DEWORMING CHARITIES WE HAVE EVALUATED, [DEWORM THE WORLD] HAS THE STRONGEST TRACK RECORD OF DEMONSTRATING THAT ITS PROGRAMS ARE EFFECTIVE.”r

What’s next

The Deworm the World Initiative has ambitious plans to help eliminate the public health problem of parasitic worms in the coming years. Alongside evolving our technical assistance to existing government partners to meet their needs, we are leveraging opportunities to accelerate treatment coverage for at-risk children, with a focus on high-need countries like Pakistan and Nigeria.

 We will:

  • Decrease the worm burden by expanding high-quality school-based deworming into new geographies

  • Build sustained government capacity to operate consistent, cost-effective, and high-quality school-based deworming programs

  • With partners, drive further progress towards achievement of the WHO target of STH treatment for 75% of at-risk children by 2020n

The Evidence for Deworming

The evidence for mass school-based deworming

Parasitic worms are debilitating, widespread, and under-treated. School-based deworming is safe, cost-effective and scaleable. There is a robust evidence base for the work the Deworm the World Initiative undertakes.

Deworming has important impacts on school participation, cognition and nutrition, and future earnings. Multiple rigorous studies have shown strong evidence of the effects of deworming, providing confidence in the benefits of treatment. We summarize the evidence base for mass school-based deworming in this post.

School Participation

Parasitic worms limit educational outcomes for children. Not only are infected children less likely to be enrolled in school, but they are also less likely to attend school and more likely to perform lower on testing.

  • A long-term follow-up study linking aggregate infection data with individual socioeconomic data from the southern US in the 1910s found that a non-infected child was 20 percentage points more likely to be enrolled in school than an infected child, and was also 13 percentage points more likely to be literate.

  • Miguel and Kremer’s experimental evaluation in Western Kenya found that deworming treatment resulted in a 25% decrease in absenteeism at treatment schools.

  • In a long-term follow-up study in Kenya, evidence shows that among females, deworming increased the rate of passing the national primary school exit exam by 9.5 percentage points on a base of 41%.

Nutrition and Cognition

Children with parasitic worms suffer from nutritional impairment, impacting their growth and physical development. Deworming treatment leads to significant weight gains and allows more energy to be focused on growth and development.

  • A meta-analysis authored by Croke et al. (2016) finds a substantial and highly robust positive effect on child weight resulting from deworming. The effects are particularly large in areas with at least 20% prevalence; this is the same threshold at which the WHO currently recommends mass treatment.
  • A randomized controlled trial in Uganda finds that the provision of periodic anthelmintic treatment as a part of child health services resulted in an increase in weight gain of about 10% above expected weight gain when treatments were given twice a year, and an increase of 5% when the treatment was given annually.
  • Deworming has positive externalities even for children who are not directly treated. Owen Ozier’s 2016 study finds that younger siblings of children who were treated show cognitive gains comparable to between 0.5 and 0.8 years of schooling ten years later.

Why Mass Treatment

  • Is mass treatment justified? On cost-effectiveness grounds we believe that it clearly is, as the cost of screening is four to ten times that of the treatment itself. Everyone agrees that children infected with worms should be treated. Because the drugs are very effective in treating worms, and are safe even for the uninfected, the WHO recommends mass drug administration as the clinical standard of care in areas where more than 20% of children are infected.
  • Deworming through schools, and preschools in some areas, provides the greatest opportunity to reach a high proportion of the at-risk population while minimizing costs through the use of existing infrastructure.

Where We Work

Where we work

INDIA

  • India is the country with the highest number of worm infections globally; 220 million children at risk for STH infections.

  • We provide technical assistance to the Ministry of Health and Family Welfare along with customized assistance to eleven states: Bihar, Chattisgarh, Haryana, Jharkhand, Madhya Pradesh, Rajasthan, Telangana, Tripura, Uttarakhand, Uttar Pradesh, and Karnataka.

  • In February 2015, we helped the national government initiate National Deworming Day (NDD). The program reach extends to preschools, government schools, private schools, and out-of-school children, targeting all children aged 1-19. As of February 2018, NDD scaled up to 34 states and union territories, with the government reporting treatment of over 266 million children.

KENYA

  • In Kenya, more than 5 million school-age children are at risk of intestinal parasitic worms, including STH and schistosomes.

  • We have supported the Government of Kenya’s school-based deworming at national scale since 2012, annually treating children at risk for STH and schistosomiasis through a collaboration between the Ministry of Education and Ministry of Health. In 2017, the program treated 5.9 million children (including 519,232 for schistosomiasis) across 27 counties. The program reached 80% of at-risk children, exceeding the WHO’s 75% coverage target.

  • Across the 27 counties, STH infections have steadily reduced, from baseline infection of 33.4% to 15.9% after three years of treatment (including a 19% reduction in moderate-to-heavy intensity infections); schistosomiasis infection reductions have also been achieved.

ETHIOPIA

  • Ethiopia is the fifth most burdened country globally by childhood worm infection; 18.4 million school-age children and 6.6 million preschool-age children are at risk for STH infection. Approximately, 14.6 million school-age children are at risk of schistosomiasis.

  • The national deworming program is led by the Federal Ministry of Health, and implemented in partnership with the Ministry of Education and the Ethiopian Public Health Institute. We partner with the Schistosomiasis Control Initiative (SCI) to provide technical assistance to national and sub-national government ministries.

  • As of 2017, the Government of Ethiopia has treated roughly 15 million school-age children children for STH and 4.6 million for schistosomiasis. The program intends to distribute over 100 million deworming treatments to school-age children by 2019.

NIGERIA

  • Nigeria is the third most burdened country in terms of its number of children at risk for worm infections. Approximately 28.6 million school-age children are at risk for STH infection; 23.8 school-age children are at risk of schistosomiasis.

  • We partner with Cross River state and RTI International to provide technical assistance to the State Ministries of Health and Education; our support for school-based treatment complements community-based treatment of other neglected tropical diseases. In its first year of operation, the program treated over 492,179 school-age children for STH and schistosomiasis.

  • We are engaging with the Federal Ministry of Health to support development of a national-level deworming strategy and collaborating on further expansion of school-based deworming in Nigeria. In 2017, our state level support expanded to three additional partner states – Rivers, Oyo, and Ogun – and treated 3.5 million children.

VIETNAM

  • In Vietnam, we partner with Thrive Networks to provide technical assistance to the Government of Vietnam’s deworming program in four provinces.

  • In November 2017 the program treated over 740,000 children, achieving over 90% coverage.

  • Exciting research opportunities exist as part of this program. We are conducting a randomized controlled trial (RCT) to understand whether a school-based hygiene education package is successful and cost-effective at reducing reinfection among school-age children when combined with school-based deworming.

PAKISTAN

  • In 2016 we worked with our partner, Interactive Research & Development (IRD), in coordination with provincial governments in Pakistan, to carry out the country’s first national-level STH survey to map worm prevalence and intensity.

  • Data collected from the survey revealed an estimated 17 million school-age children require annual treatment for STH.

  • We plan to work with health and education stakeholders at the national and provincial level to support the initiation of a school-based deworming program in late 2018 in areas recommended for mass treatment, continuing our partnership with IRD.

Learn More

Learn more about the Deworm the World Initiative in the blog posts below.

Leveraging our existing government partnership in India to tackle anemia

For several years, we’ve partnered with the Government of India to deliver mass school-based deworming as part of our Deworm the World Initiative. The ongoing success of this partnership has allowed us to explore opportunities to extend our impact in India. Ultimately, we settled on one promising area for further exploration through our Beta incubator: India’s national Weekly Iron and Folic Acid Supplementation (WIFS) program, which is designed to address the pressing challenge of anemia among school-age children.

Read More →

School-based Deworming: A Low-Cost Intervention Achieving High-Impact Benefits

There is a difference between a low-cost program and a cost-effective program. Implementing a low-cost program is not sufficient – we want to ensure that the impacts of the program are measurable and that the benefits outweigh the costs – this is what makes a program truly cost-effective. Putting these two parts of the equation – costs and benefits – together, we can estimate the value for money of our program.  

Read More →

Expanding Deworming to Migrant Populations in India under National Deworming Day

India’s National Deworming Day (NDD), initiated in 2015, is the world’s largest single-day public health intervention, providing children between the ages of 1-19 with free deworming tablets. As part of Evidence Action’s technical assistance to the Government of India and select state governments for the August NDD treatment round, we are collaborating on several tailored strategies to target hard-to-reach children, including migrant workers in the north-eastern state of Tripura.

Read More →

Reflecting on 5 Years of Deworming in Kenya for Saumu, Valentiyne, and 6 million of their peers

At Evidence Action, we determine impact based on data, and in partnership with governments, we reached over 280 million children in 2017 alone through our Deworm the World Initiative. Our focus on scale means we rarely have the opportunity to zoom in on an individual’s experience. So in February, we jumped at the chance to visit these two girls, who we first met on a deworming day in Kenya back in 2013.

Read More →

Extending Deworming to the Margins in Kenya

Parasitic worm infections disproportionately affect people living in poverty, especially those who are difficult to reach with mass drug administration. Evidence Action is committed to supporting innovations that enable treatment for all children at risk of worm infections regardless of their circumstances.Here’s a look at some targeted strategies implemented in Kenya to improve coverage of hard-to-reach children over the past year.

Read More →

LATEST NEWS

Digitizing data collection for India’s National Deworming Day

We’ve supported India’s National Deworming Day for the last ~4 years, but monitoring a program of such magnitude isn’t easy. Our data collection has had to evolve with scale in order to continually support cost-effectiveness and maximize efficiency.

Leveraging our existing government partnership in India to tackle anemia

For several years, we’ve partnered with the Government of India to deliver mass school-based deworming as part of our Deworm the World Initiative. The ongoing success of this partnership has allowed us to explore opportunities to extend our impact in India. Ultimately, we settled on one promising area for further exploration through our Beta incubator: India’s national Weekly Iron and Folic Acid Supplementation (WIFS) program, which is designed to address the pressing challenge of anemia among school-age children.

Press Release: Government of Pakistan Launches Deworm Islamabad Initiative

The Government of Pakistan has initiated the “Deworm Islamabad Initiative,” targeting 570,000 children aged 5-15 in Islamabad who are at risk of infection with intestinal worms. Trained school teachers administered free-of-cost deworming medicine (mebendazole), which is universally recognized as a safe and cost-effective treatment.

Evolution of Dispensers: A Case Study of Rigor and Iteration

Our Dispensers for Safe Water program operates at scale across Kenya, Uganda, and Malawi, providing safe water access to 4 million people today. In this post, we share a video highlighting how we’ve continued to iterate and adapt our dispensers to better meet user needs and maintain the low cost-per-person that makes this program a recognized standout in cost-effectiveness.

Living in the service of promise: Reflections from Winning Start volunteers

Winning Start, an education program in our Beta incubator, is designed to improve child literacy and numeracy by using youth volunteers to deliver the rigorously tested and proven “teaching at the right level” (TaRL) pedagogy. As the world celebrates International Volunteer Day, we celebrate Winning Start volunteers – who spend up to a year working to unlock the promise of an upcoming generation. We interviewed five youth who successfully completed the Government of Kenya’s G-United program to learn more about their experiences and motivations.

School-based Deworming: A Low-Cost Intervention Achieving High-Impact Benefits

There is a difference between a low-cost program and a cost-effective program. Implementing a low-cost program is not sufficient – we want to ensure that the impacts of the program are measurable and that the benefits outweigh the costs – this is what makes a program truly cost-effective. Putting these two parts of the equation – costs and benefits – together, we can estimate the value for money of our program.  

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