National Deworming Day 2021

What is the need?

According to WHO, 241 million children between the ages of 1 and 14 years are at risk of parasitic intestinal worms in India, known as Soil-Transmitted Helminths (STH). 

• They represent approx. 68% of children in this age-group and 28% of the number of children estimated to be at-risk of STH infections globally. 
• Worms can cause anemia and under-nutrition, thereby impairing mental and physical development. 
• Almost 7 in 10 children in the 6-59 months age-group are anemic, with even higher rates in rural areas. 
• Nearly half of children under-five in India are stunted, and approx. 43% are underweight. 
• The prevalence of anemia in girls and boys of the age group 15-19 years is 56% and 30% respectively. 
• Children with the highest intensity of STH infestation are often too sick or too tired to concentrate at school or attend school at all. 

When is it celebrated?

The National Deworming Day is an initiative of the MoHFW, GoI to make every child in the country worm-free. This is one of the largest public health programs reaching a large number of children during a short period.  

• In 2015 the GOI, launched the fixed-day Anganwadi and school-based National Deworming Day to deworm all children aged 1-19 years. 
• It is conducted in all states/UTs on February 10 every year, with a mop-up day on February 15.  
• Some states/UTs also conduct a bi-annual round on 10 August, depending on worm prevalence in their state/UT.

Objectives of National Deworming Day: 

To deworm all preschool and school-age children (enrolled and non-enrolled) between the ages of 1-19 years through the platform of schools and Anganwadi Centers in order to improve their overall health, nutritional status, access to education and quality of life. 

Target Beneficiaries: 

• All children (both boys and girls) in the age group of 1-19 years. 
• States already conducting biannual deworming linked with Vitamin A Prophylaxis program for children, under-five shall continue to administer deworming drug along with Vitamin-A.
• States currently not having bundling of these two interventions are encouraged to use the platform of National Deworming Day for deworming under-five age group children. 
• women of childbearing age (including pregnant women in the second and third trimesters and breastfeeding women). 

Soil-Transmitted Helminths (STH): 

• It is a sub-group within the group of helminth infections which are transmitted through soil contaminated with fecal matter and are therefore called soil-transmitted helminths. 
• The main species that infect people are the roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and the hookworms (Necator americanus and Ancylostoma duodenale). 

Transmission: 

STH are transmitted by eggs that are passed in the feces of infected people. 

Adult worms live in the intestine where they produce thousands of eggs each day. 

In areas that lack adequate sanitation, these eggs contaminate the soil. This can happen in several ways:

• Eggs that are attached to vegetables are ingested when the vegetables are not carefully cooked, washed, or peeled; 
• Eggs are ingested from contaminated water sources;
• Eggs are ingested by children who play in soil and then put their hands in their mouths without washing them. 
• In addition, hookworm eggs hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin.
• People become infected with hookworm primarily by walking barefoot on the contaminated soil. 
• There is no direct person-to-person transmission, or infection from fresh feces, because eggs passed in feces need about 3 weeks to mature in the soil before they become infective. 
• Since these worms do not multiply in the human host, reinfection occurs only as a result of contact with infective stages in the environment.

Symptoms of infection:

The greater the number of worms in an individual (intensity), the more symptoms the infected an 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

Nutritional and health consequences of infection: 

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

• Worms feed on host tissues, including blood, which leads to anaemia. 
• Worms increase malabsorption of nutrients. In addition, roundworm may compete for vitamin A in the intestine. 
• The nutritional impairment caused by STH is recognized to have a significant impact on growth and physical development

Prevention of infection:

Infections can be prevented by taking precautions, including: 

• Using sanitary toilets, not defecating outside. 
• 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. 

Treatment:

Regular treatment of at-risk populations will reduce the intensity of infection and protect infected individuals from morbidity. 

The WHO recommends deworming treatment without previous individual diagnosis to all at-risk people living in endemic areas. 

Treatment should be given once a year when the STH prevalence in the community is over 20% and twice a year when the STH prevalence exceeds 50%.

Side effects:

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. 
• However, 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 immediately.

Benefits of treatment: 

Deworming has a significant impact on the health, education and livelihoods of treated children. Outcomes of deworming can include: 

• Decreased anemia and improved nutrition
• Increased growth and weight gain 
• Improved cognition and mental and physical development 
• Increased resistance to other infections 
• Increased school attendance 
• Improvement in children’s ability to learn better and be more active in school 
• Increase in no. of hours worked and wages earned in the long-run in adulthood 
• Spillover effects: 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.

References:

1. http://nhm.gov.in/images/pdf/NDD/Guidelines/NDD_Operational_Guidelines.pdf
2. https://www.nhp.gov.in/national-deworming-day-2020_pg
3. https://www.nhp.gov.in/National-Deworming-Day_pg
4. https://health.tripura.gov.in/?q=de-worming-day#:~:text=To%20combat%20this%20issue%2C%20in,up%20day%20on%20February%2015.
5. https://twitter.com/pib_india/status/1226873361290031104 photo credit