ACTION AGAINST EDUCATION is fittingallthetrainers,districtofficialsandsuppliesinto thevehicleatsametime! waslongoverdue.Generally,Uganda, thissimpletypeofhealthintervention theworstproblemexperienced campaignhasalwaysmadesuchprogrammesespeciallypopularwithcommunities–and,for deworming So far, theresponsefromcommunitieshasbeendramatic.Thefeelingofwell-beingthatrapidlyfollowsa another 1millionindividuals,andre-treatmentofthe800000treatedin2003. the sub-countiesofsame18districts.Thethirdphase,scheduledfor2004,willinvolvetreatment The secondphaseisscheduledforlate2003whenanother500000individualswillbetreatedinall the drugs.Thisphasebeganon10April2003andcoveredmorethan300000adultschildren. each ofthe18districts,trainingallschoolandcommunitydrugadministrators,thendistributing first, orpilot,phasehasbeencompleted;itinvolvedselectingoneoftheworst-affectedsub-countiesin W IMPLEMENTATION: SCALINGUPBYDISTRICT witchcraft” and“traditionalmedicinecancurebilharzia”. about schistosomiasis,suchas“thediseaseiscausedby Uganda, thatcounterssomeofthecommonmisconceptions special “Question&Answer”booklet,speciallydesignedfor how toavoidhelminthinfectionareavailable,aswella postersandpamphletson teachers explainallaboutworms, oftheactualtreatmentday.now astandardpart To helpthe healtheducationsessionis officers. Intheschools,aformal nurses, districthealthstaffandcommunitydevelopment communities byschoolteachers,communityhealthworkers, Health educationwascarriedoutintheschoolsand COMMUNITY SENSITIZATION HEALTH EDUCATION AND Hoima District teamdescendingtothe shorelineofLakeAlbert, The survey ith baselinedatacollectioncomplete,implementationbegins!Aphasedapproachisbeingused.The

WORMS 5 A member of the survey teamtalking withschoolchildren A memberofthesurvey T raining atHoima ACTION AGAINST support. support. ordonorcouldhopeto thatanygovernment interventions oneofthemostoverdueand beneficial health to “kick-start” As inUganda,anextrainjectionoffundswouldsurely help Niger, Nigeria,UnitedRepublicofTanzania andZambia. Burkina Faso,Cameroon,Ghana,Kenya,Malawi,Mali, are can“piggy-back”.Thecountriesconcerned deworming the essentialinfrastructureisalreadyinplaceonwhich of thesecountries.Thisisamajoradvantageandmeansthat see www.who.int/wormcontrol) arealreadyworkinginmost forParasiteControl(PPC; fromthePartners several partners national planandappliedtoSCIforfunding.Whatismore, hasprepareda development. Alreadyeachgovernment control.Thisisanextremelyexciting commitment toworm their closely watchingitsroll-out,havenowconfirmed 10 morecountriesinsub-SaharanAfrica,whichhavebeen The Ugandanprogrammeisprovingsosuccessfulthat SPIN-OFFS FROMTHEUGANDAEXPERIENCE see www.freshschools.org/). component (accordingtotheFRESHframework; for schoolhealthprojectsthatincludeadeworming likely tobeamajorcontributor, providing support new diagnostictechniques.EventuallytheWorld Bankis Union, andtheUniversityofBangor, Wales, isworkingon outamorbiditystudyfunded bytheEuropean carrying helped toimprovelaboratories.CambridgeUniversityis System(GIS)mapping. DFIDhas Geographical Information of HygieneandTropical Medicineisinvolvedwith provides fundsforadditionalresearch.TheLondonSchool provides extensivetrainingatalllevels.TheWellcome Trust DevelopmentAgency) DANIDA (DanishInternational inNakasongolaDistrict. TheDBL,fundedby delivery of itsschoolfeedingactivities.SCFisassistingwithdrug tabletsaspart givingoutdeworming has started DevelopmentAgency),WFP CIDA (CanadianInternational controlinUgandaisgrowing.Withworm assistancefrom T WORKING TOGETHER Photo credits:thewriters the SchistosomiasisControlInitiative (SCI). Fenwick, RussellStothard,Howard Thompson,andNarcisKabatereineof This issueof © WORLDHEALTH ORGANIZATION 2003 oday, thenumberofdonorsandagencies workingin at least15millionpeopleoverthenext4years. The targetagreedwiththeBill&MelindaGates with commercial purposes. ©World HealthOrganization2003. orinwhole, butnotforsaleoruse This newslettermay befreelyreviewed,abstracted, reproducedandtranslated,inpart Action AgainstWorms Foundation bySCIistotreatregularly

WORMS was writtenbyCaraKamenka,Alan 6 WHERE WEAREGOING and itiswithinourpowertocontrolentirely. examined withultrasound.Thistypeofsufferingisunacceptable, WHERE WEARE Foundation fortheirgenerousfinancialassistancewhich THE BILL&MELINDAGATES FOUNDATION We

would liketothanktheBill&MelindaGates ... Achildwithsevereschistosomiasisbeing has madethispublicationpossible ... Healthyworm-freechildren.

in conjunction . ACTION AGAINST and thosewhocannotavoidcontactwithwater, suchaswomenduringdomesticworkandfishermen. The prevalenceandintensityof www.who.int/wormcontrol ineast-centralAfrica.Lyinglocked country eastoftheGreatRiftValley, part itforms Uganda, describedbyWinston Churchillas“trulythepearlofAfrica”,isaland- WELCOME TOUGANDA! SEPTEMBER 2003ISSUE3 the intermediate snailhostof the intermediate Vi Edward,GeorgeandKyoga–twomajorriversthe Albert, of thecentralAfricanplateau.Thecountry’s fivemajorlakes–Victoria, tions with soil-transmitted helminths (STH), particularly hookworm. hookworm. tions withsoil-transmittedhelminths(STH),particularly with schistosomiasis,madeworseinmanycasesbyconcurrentinfec- had changed:thelatestdataindicatethat4millionpeopleareinfected years peoplehavesuffereditsdamagingeffects.Untilrecently, nothing harzia). SchistosomiasisisnonewcomertoUganda–forthepast50 responsible fortheAfricanintestinaltypeofschistosomiasis(orbil- prehensive worm control activities. prehensive worm toembark oncom- vinced thegovernment (see bined withthenewandsimplified strategy threat topeople’s health.Thisfact,com- that schistosomiasisalonewas thebiggest from isolatedfishingcommunities showed attention? Theanswerissimple.Evidence tuberculosis, arecommandingsomuch weight” diseases,HIV/AIDS,malaria, trol –butwhy, whenthethree“heavy- Now, con- Ugandahaswokenuptoworm IN 5YEARS UP ANDRUNNING CONTROL PROGRAMME A NATIONAL WORM ctoria and Albert and the White Nile – provide the perfect habitatfor andtheWhite Nile–providetheperfect ctoria andAlbert Action Against Worms, S. mansoni infection areparticularlyhighamongthosewholiveclosetothelakesandrivers NTI ISSUE THIS IN Issue 1),con- Schistosoma mansoni

: not hesitateto contact usbye-mailat: be coveredin thefuture,pleasedo gestions forareasyouwould liketo comments onexistingissues orsug- Ifyouhaveany and informative. Against Worms We WORMS [email protected] H GNASTORY UGANDA THE

very muchhopethat very •A •W •T •T • •W in 5years momentum Spin offs of theprogramme he snowballof he nutsandbolts elcome toUganda! orking together national programme . Thisorganismis is bothenjoyable Action PPC NEWSLETTER ACTION AGAINST WORMS 2 ACTION AGAINST WORMS 3 ACTION AGAINST WORMS 4

THE “SNOWBALL” OF MOMENTUM The launch ceremony was attended by the Ministers of THE “NUTS AND BOLTS” Health and Education, officials from central government Districts selected for baseline data collection and IN WORM CONTROL and endemic districts, and overseas guests from SCI, OF THE PROGRAMME implementation by the Uganda National Bilharzia and Intestinal Worm Control Programme. WHO, DBL, the UK Department for International Following the commitment by the Government of Uganda to Uganda’s worm control programme has three Development (DFID), and Save the Children Fund (SCF). The # tackle the problem of worm infections, WHO and the Danish primary objectives, which support the global targets # # Kitgum entire day was marked by a carnival atmosphere, the local 2 oyo M Bilharziasis Laboratory (DBL) stepped in to assess the nature set by WHO: to ensure that deworming drugs are # ## community having turned out in force to watch their children Arua of an appropriate strategy. As a part of their work, they pro- regularly and efficiently supplied to the districts; to # Adjumani Pader perform dances, songs, and poems and to support their MP, Gulu vided training to district health teams in integrating deworm- regularly treat at least 75% of school-age children in # ## the charismatic Fred Omach. Nebbi Lira ing activities into their regular work. And this is exactly what endemic areas; and provide mass treatment to the # # the new strategy is all about – delivering deworming treat- entire community in areas where more than 50% of # Apac Lake Albert ## Masindi # # # ment through existing infrastructures rather than setting up the people are infected. # # N # # ak as Lake Kyoga Hon Minister Jim Muhwezi Hoima on costly new programmes. go la Kayunga Jinja “Bilharzia is very close to malaria and HIV/AIDS in the threat of yo To achieve these objectives and evaluate the ug Kibale ib After the training, a “snowball” effect became apparent, with d Bugiri un public health. But it is never given the prominence it deserves partly B intervention, four main activities are planned: # health personnel from some of the high-burden areas motivating Wakiso Mukono # Busia # # because the infected people do not know about it. In addition many baseline data collection, health education and ## local aid agencies and NGOs to also invest in worm control. For # community sensitization, regular treatment starting Mayuge example, the Italian Ministry of Foreign Affairs came on board in of them are in rural areas, and it affects the poorest of the poor. The people who are poor are likely to be unhealthy, and the people who in 18 selected high-burden districts, and monitoring Nebbi District, the Italian NGO Collegio Universitario Aspiranti Fred Omach, Lake Victoria are unhealthy will definitely be poor, and poorer. So we need really to by re-examination of the baseline cohort. Medici Missionari in Arua District, and the Victory Outreach MP for Jonam fight the disease in order to break this vicious trap”. Church (United Kingdom) and New Covenant Church (Uganda) County in Apac, Kotido, and Lira. At the same time, the World Food BASELINE DATA COLLECTION: Implementation Programme (WFP) was instrumental in shaping the programme, Children are often infected at a very early age and DEWORMING DRUGS AND BUNS sharing its infrastructure, staff, and resources. However, the great- develop chronic disease, with severe complications Implementation and baseline data collection Dr Alan Fenwick, Director of SCI, described his est boost to the programme came in June 2002, when the as adults. In 8 of the 18 districts selected, baseline data # Sentinel schools Schistosomiasis Control Initiative1 (SCI; see www.schisto.org) personal pleasure in being able to support Uganda’s collection has already been completed (see map chose Uganda to be the first recipient of a grant from the Bill and National Worm Control Programme. “By creating a above). The process was as follows: five schools Melinda Gates Foundation award for worm control in Africa. successful prevention and treatment programme that with a total of 120 children per school in aged cohorts were identified. In addition at least one can be replicated in countries around the world, we Uganda’s programme was officially named the National community in each district was chosen, and 120 members of that community were selected. Each Bilharzia and Intestinal Worm Control Programme. It was for- have the opportunity to make a major impact in the person was then examined, given a treatment card and a single dose of praziquantel and either mally launched on 4 March 2003 by the Deputy Prime fight against worms. We hope that this partnership mebendazole or albendazole with food, usually a bun. Over the next 5 years, these cohorts will be Minister, Brigadier Moses Ali, in Nebbi District on the north- and similar ones elsewhere will result in the re-examined and treated annually; in 4 years’ time, the impact of the whole programme will be ern shore of Lake Albert. The choice of this district, which is HOW CHEAP IS IT TO DEWORM? prevention of unnecessary suffering and disability assessed. In fact, there is already extensive evidence of the cost-effectiveness and enormous health particularly badly affected, was especially appropriate – the for many millions of people.” benefits of deworming programmes – but additional evidence of success is always valuable, especially local Member of Parliament, the Honourable Fred Omach, To treat both schistosomiasis and STH if we want to encourage other countries to follow the Uganda example. infections costs less than US$ 0.50 has campaigned tirelessly for more attention to be paid to bil- per child/year. Arriving guests were greeted by a harzia in his constituency. lively procession of local To treat only STH costs less US$ 0.25 schoolchildren and a musical fanfare per child/year. from a trumpet and drum band. An insecticide-treated bednet for preventing malaria costs US$ 3*.

Five days of paediatric antibiotic Tonya primary school Runga primary school Kibiiro primary school treatment costs US$ 0.27*.

To administer 1 dose of measles Taking vaccine costs US$ 0.26*. measurements at Kibaywa The Vector Control Division *Massive Effort against diseases of school poverty.Winterthur Health Forum 2000 Exhibition stand showing (WHO/CDS/2000.3) education materials and Brigadier Moses Ali, Ugandan Deputy Prime Minister, gives the first dose of information on schistosomiasis Children in Hoima school look praziquantel to a schoolchild, watched by the Minister of Health, Jim Muwhezi, as well as field microscopes to at their treatment ID cards at the launch of the National Bilharzia and Intestinal Worm Control Programme. show visitors the parasite eggs.

2 At the World Health Assembly, resolution WHA54.19 was passed, outlining clear strategy on how to deliver deworming 1 BASELINE DATA UGANDA’S LAUNCH UGANDA’S Based in the Department of Infectious Disease Epidemiology, Imperial College, London, England. programmes. See: www.who.int/wormcontrol ACTION AGAINST WORMS 2 ACTION AGAINST WORMS 3 ACTION AGAINST WORMS 4

THE “SNOWBALL” OF MOMENTUM The launch ceremony was attended by the Ministers of THE “NUTS AND BOLTS” Health and Education, officials from central government Districts selected for baseline data collection and IN WORM CONTROL and endemic districts, and overseas guests from SCI, OF THE PROGRAMME implementation by the Uganda National Bilharzia and Intestinal Worm Control Programme. WHO, DBL, the UK Department for International Following the commitment by the Government of Uganda to Uganda’s worm control programme has three Development (DFID), and Save the Children Fund (SCF). The # tackle the problem of worm infections, WHO and the Danish primary objectives, which support the global targets # # Kitgum entire day was marked by a carnival atmosphere, the local 2 oyo M Bilharziasis Laboratory (DBL) stepped in to assess the nature set by WHO: to ensure that deworming drugs are # ## community having turned out in force to watch their children Arua of an appropriate strategy. As a part of their work, they pro- regularly and efficiently supplied to the districts; to # Adjumani Pader perform dances, songs, and poems and to support their MP, Gulu vided training to district health teams in integrating deworm- regularly treat at least 75% of school-age children in # ## the charismatic Fred Omach. Nebbi Lira ing activities into their regular work. And this is exactly what endemic areas; and provide mass treatment to the # # the new strategy is all about – delivering deworming treat- entire community in areas where more than 50% of # Apac Lake Albert ## Masindi # # # ment through existing infrastructures rather than setting up the people are infected. # # N # # ak as Lake Kyoga Hon Minister Jim Muhwezi Hoima on costly new programmes. go la Kayunga Jinja “Bilharzia is very close to malaria and HIV/AIDS in the threat of yo To achieve these objectives and evaluate the ug Kibale ib After the training, a “snowball” effect became apparent, with d Bugiri un public health. But it is never given the prominence it deserves partly B intervention, four main activities are planned: # health personnel from some of the high-burden areas motivating Wakiso Mukono # Busia # # because the infected people do not know about it. In addition many baseline data collection, health education and ## local aid agencies and NGOs to also invest in worm control. For # community sensitization, regular treatment starting Mayuge example, the Italian Ministry of Foreign Affairs came on board in of them are in rural areas, and it affects the poorest of the poor. The people who are poor are likely to be unhealthy, and the people who in 18 selected high-burden districts, and monitoring Nebbi District, the Italian NGO Collegio Universitario Aspiranti Fred Omach, Lake Victoria are unhealthy will definitely be poor, and poorer. So we need really to by re-examination of the baseline cohort. Medici Missionari in Arua District, and the Victory Outreach MP for Jonam fight the disease in order to break this vicious trap”. Church (United Kingdom) and New Covenant Church (Uganda) County in Apac, Kotido, and Lira. At the same time, the World Food BASELINE DATA COLLECTION: Implementation Programme (WFP) was instrumental in shaping the programme, Children are often infected at a very early age and DEWORMING DRUGS AND BUNS sharing its infrastructure, staff, and resources. However, the great- develop chronic disease, with severe complications Implementation and baseline data collection Dr Alan Fenwick, Director of SCI, described his est boost to the programme came in June 2002, when the as adults. In 8 of the 18 districts selected, baseline data # Sentinel schools Schistosomiasis Control Initiative1 (SCI; see www.schisto.org) personal pleasure in being able to support Uganda’s collection has already been completed (see map chose Uganda to be the first recipient of a grant from the Bill and National Worm Control Programme. “By creating a above). The process was as follows: five schools Melinda Gates Foundation award for worm control in Africa. successful prevention and treatment programme that with a total of 120 children per school in aged cohorts were identified. In addition at least one can be replicated in countries around the world, we Uganda’s programme was officially named the National community in each district was chosen, and 120 members of that community were selected. Each Bilharzia and Intestinal Worm Control Programme. It was for- have the opportunity to make a major impact in the person was then examined, given a treatment card and a single dose of praziquantel and either mally launched on 4 March 2003 by the Deputy Prime fight against worms. We hope that this partnership mebendazole or albendazole with food, usually a bun. Over the next 5 years, these cohorts will be Minister, Brigadier Moses Ali, in Nebbi District on the north- and similar ones elsewhere will result in the re-examined and treated annually; in 4 years’ time, the impact of the whole programme will be ern shore of Lake Albert. The choice of this district, which is HOW CHEAP IS IT TO DEWORM? prevention of unnecessary suffering and disability assessed. In fact, there is already extensive evidence of the cost-effectiveness and enormous health particularly badly affected, was especially appropriate – the for many millions of people.” benefits of deworming programmes – but additional evidence of success is always valuable, especially local Member of Parliament, the Honourable Fred Omach, To treat both schistosomiasis and STH if we want to encourage other countries to follow the Uganda example. infections costs less than US$ 0.50 has campaigned tirelessly for more attention to be paid to bil- per child/year. Arriving guests were greeted by a harzia in his constituency. lively procession of local To treat only STH costs less US$ 0.25 schoolchildren and a musical fanfare per child/year. from a trumpet and drum band. An insecticide-treated bednet for preventing malaria costs US$ 3*.

Five days of paediatric antibiotic Tonya primary school Runga primary school Kibiiro primary school treatment costs US$ 0.27*.

To administer 1 dose of measles Taking vaccine costs US$ 0.26*. measurements at Kibaywa The Vector Control Division *Massive Effort against diseases of school poverty.Winterthur Health Forum 2000 Exhibition stand showing (WHO/CDS/2000.3) education materials and Brigadier Moses Ali, Ugandan Deputy Prime Minister, gives the first dose of information on schistosomiasis Children in Hoima school look praziquantel to a schoolchild, watched by the Minister of Health, Jim Muwhezi, as well as field microscopes to at their treatment ID cards at the launch of the National Bilharzia and Intestinal Worm Control Programme. show visitors the parasite eggs.

2 At the World Health Assembly, resolution WHA54.19 was passed, outlining clear strategy on how to deliver deworming 1 BASELINE DATA UGANDA’S LAUNCH UGANDA’S Based in the Department of Infectious Disease Epidemiology, Imperial College, London, England. programmes. See: www.who.int/wormcontrol ACTION AGAINST WORMS 2 ACTION AGAINST WORMS 3 ACTION AGAINST WORMS 4

THE “SNOWBALL” OF MOMENTUM The launch ceremony was attended by the Ministers of THE “NUTS AND BOLTS” Health and Education, officials from central government Districts selected for baseline data collection and IN WORM CONTROL and endemic districts, and overseas guests from SCI, OF THE PROGRAMME implementation by the Uganda National Bilharzia and Intestinal Worm Control Programme. WHO, DBL, the UK Department for International Following the commitment by the Government of Uganda to Uganda’s worm control programme has three Development (DFID), and Save the Children Fund (SCF). The # tackle the problem of worm infections, WHO and the Danish primary objectives, which support the global targets # # Kitgum entire day was marked by a carnival atmosphere, the local 2 oyo M Bilharziasis Laboratory (DBL) stepped in to assess the nature set by WHO: to ensure that deworming drugs are # ## community having turned out in force to watch their children Arua of an appropriate strategy. As a part of their work, they pro- regularly and efficiently supplied to the districts; to # Adjumani Pader perform dances, songs, and poems and to support their MP, Gulu vided training to district health teams in integrating deworm- regularly treat at least 75% of school-age children in # ## the charismatic Fred Omach. Nebbi Lira ing activities into their regular work. And this is exactly what endemic areas; and provide mass treatment to the # # the new strategy is all about – delivering deworming treat- entire community in areas where more than 50% of # Apac Lake Albert ## Masindi # # # ment through existing infrastructures rather than setting up the people are infected. # # N # # ak as Lake Kyoga Hon Minister Jim Muhwezi Hoima on costly new programmes. go la Kayunga Jinja “Bilharzia is very close to malaria and HIV/AIDS in the threat of yo To achieve these objectives and evaluate the ug Kibale ib After the training, a “snowball” effect became apparent, with d Bugiri un public health. But it is never given the prominence it deserves partly B intervention, four main activities are planned: # health personnel from some of the high-burden areas motivating Wakiso Mukono # Busia # # because the infected people do not know about it. In addition many baseline data collection, health education and ## local aid agencies and NGOs to also invest in worm control. For # community sensitization, regular treatment starting Mayuge example, the Italian Ministry of Foreign Affairs came on board in of them are in rural areas, and it affects the poorest of the poor. The people who are poor are likely to be unhealthy, and the people who in 18 selected high-burden districts, and monitoring Nebbi District, the Italian NGO Collegio Universitario Aspiranti Fred Omach, Lake Victoria are unhealthy will definitely be poor, and poorer. So we need really to by re-examination of the baseline cohort. Medici Missionari in Arua District, and the Victory Outreach MP for Jonam fight the disease in order to break this vicious trap”. Church (United Kingdom) and New Covenant Church (Uganda) County in Apac, Kotido, and Lira. At the same time, the World Food BASELINE DATA COLLECTION: Implementation Programme (WFP) was instrumental in shaping the programme, Children are often infected at a very early age and DEWORMING DRUGS AND BUNS sharing its infrastructure, staff, and resources. However, the great- develop chronic disease, with severe complications Implementation and baseline data collection Dr Alan Fenwick, Director of SCI, described his est boost to the programme came in June 2002, when the as adults. In 8 of the 18 districts selected, baseline data # Sentinel schools Schistosomiasis Control Initiative1 (SCI; see www.schisto.org) personal pleasure in being able to support Uganda’s collection has already been completed (see map chose Uganda to be the first recipient of a grant from the Bill and National Worm Control Programme. “By creating a above). The process was as follows: five schools Melinda Gates Foundation award for worm control in Africa. successful prevention and treatment programme that with a total of 120 children per school in aged cohorts were identified. In addition at least one can be replicated in countries around the world, we Uganda’s programme was officially named the National community in each district was chosen, and 120 members of that community were selected. Each Bilharzia and Intestinal Worm Control Programme. It was for- have the opportunity to make a major impact in the person was then examined, given a treatment card and a single dose of praziquantel and either mally launched on 4 March 2003 by the Deputy Prime fight against worms. We hope that this partnership mebendazole or albendazole with food, usually a bun. Over the next 5 years, these cohorts will be Minister, Brigadier Moses Ali, in Nebbi District on the north- and similar ones elsewhere will result in the re-examined and treated annually; in 4 years’ time, the impact of the whole programme will be ern shore of Lake Albert. The choice of this district, which is HOW CHEAP IS IT TO DEWORM? prevention of unnecessary suffering and disability assessed. In fact, there is already extensive evidence of the cost-effectiveness and enormous health particularly badly affected, was especially appropriate – the for many millions of people.” benefits of deworming programmes – but additional evidence of success is always valuable, especially local Member of Parliament, the Honourable Fred Omach, To treat both schistosomiasis and STH if we want to encourage other countries to follow the Uganda example. infections costs less than US$ 0.50 has campaigned tirelessly for more attention to be paid to bil- per child/year. Arriving guests were greeted by a harzia in his constituency. lively procession of local To treat only STH costs less US$ 0.25 schoolchildren and a musical fanfare per child/year. from a trumpet and drum band. An insecticide-treated bednet for preventing malaria costs US$ 3*.

Five days of paediatric antibiotic Tonya primary school Runga primary school Kibiiro primary school treatment costs US$ 0.27*.

To administer 1 dose of measles Taking vaccine costs US$ 0.26*. measurements at Kibaywa The Vector Control Division *Massive Effort against diseases of school poverty.Winterthur Health Forum 2000 Exhibition stand showing (WHO/CDS/2000.3) education materials and Brigadier Moses Ali, Ugandan Deputy Prime Minister, gives the first dose of information on schistosomiasis Children in Hoima school look praziquantel to a schoolchild, watched by the Minister of Health, Jim Muwhezi, as well as field microscopes to at their treatment ID cards at the launch of the National Bilharzia and Intestinal Worm Control Programme. show visitors the parasite eggs.

2 At the World Health Assembly, resolution WHA54.19 was passed, outlining clear strategy on how to deliver deworming 1 BASELINE DATA UGANDA’S LAUNCH UGANDA’S Based in the Department of Infectious Disease Epidemiology, Imperial College, London, England. programmes. See: www.who.int/wormcontrol ACTION AGAINST EDUCATION witchcraft” and“traditionalmedicinecancurebilharzia”. about schistosomiasis,suchas“thediseaseiscausedby Uganda, thatcounterssomeofthecommonmisconceptions special “Question&Answer”booklet,speciallydesignedfor how toavoidhelminthinfectionareavailable,aswella postersandpamphletson teachers explainallaboutworms, oftheactualtreatmentday.now astandardpart To helpthe healtheducationsessionis officers. Intheschools,aformal nurses, districthealthstaffandcommunitydevelopment communities byschoolteachers,communityhealthworkers, Health educationwascarriedoutintheschoolsand COMMUNITY SENSITIZATION HEALTH EDUCATION AND is fittingallthetrainers,districtofficialsandsuppliesinto thevehicleatsametime! waslongoverdue.Generally,Uganda, thissimpletypeofhealthintervention theworstproblemexperienced campaignhasalwaysmadesuchprogrammesespeciallypopularwithcommunities–and,for deworming So far, theresponsefromcommunitieshasbeendramatic.Thefeelingofwell-beingthatrapidlyfollowsa another 1millionindividuals,andre-treatmentofthe800000treatedin2003. the sub-countiesofsame18districts.Thethirdphase,scheduledfor2004,willinvolvetreatment The secondphaseisscheduledforlate2003whenanother500000individualswillbetreatedinall the drugs.Thisphasebeganon10April2003andcoveredmorethan300000adultschildren. each ofthe18districts,trainingallschoolandcommunitydrugadministrators,thendistributing first, orpilot,phasehasbeencompleted;itinvolvedselectingoneoftheworst-affectedsub-countiesin W IMPLEMENTATION: SCALINGUPBYDISTRICT Hoima District teamdescendingtothe shorelineofLakeAlbert, The survey ith baselinedatacollectioncomplete,implementationbegins!Aphasedapproachisbeingused.The

WORMS 5 A member of the survey teamtalking withschoolchildren A memberofthesurvey T raining atHoima ACTION AGAINST support. support. ordonorcouldhopeto thatanygovernment interventions oneofthemostoverdueand beneficial health to “kick-start” As inUganda,anextrainjectionoffundswouldsurely help Niger, Nigeria,UnitedRepublicofTanzania andZambia. Burkina Faso,Cameroon,Ghana,Kenya,Malawi,Mali, are can“piggy-back”.Thecountriesconcerned deworming the essentialinfrastructureisalreadyinplaceonwhich of thesecountries.Thisisamajoradvantageandmeansthat see www.who.int/wormcontrol) arealreadyworkinginmost forParasiteControl(PPC; fromthePartners several partners national planandappliedtoSCIforfunding.Whatismore, hasprepareda development. Alreadyeachgovernment control.Thisisanextremelyexciting commitment toworm their closely watchingitsroll-out,havenowconfirmed 10 morecountriesinsub-SaharanAfrica,whichhavebeen The Ugandanprogrammeisprovingsosuccessfulthat SPIN-OFFS FROMTHEUGANDAEXPERIENCE see www.freshschools.org/). component (accordingtotheFRESHframework; for schoolhealthprojectsthatincludeadeworming likely tobeamajorcontributor, providing support new diagnostictechniques.EventuallytheWorld Bankis Union, andtheUniversityofBangor, Wales, isworkingon outamorbiditystudyfunded bytheEuropean carrying helped toimprovelaboratories.CambridgeUniversityis System(GIS)mapping. DFIDhas Geographical Information of HygieneandTropical Medicineisinvolvedwith provides fundsforadditionalresearch.TheLondonSchool provides extensivetrainingatalllevels.TheWellcome Trust DevelopmentAgency) DANIDA (DanishInternational inNakasongolaDistrict. TheDBL,fundedby delivery of itsschoolfeedingactivities.SCFisassistingwithdrug tabletsaspart givingoutdeworming has started DevelopmentAgency),WFP CIDA (CanadianInternational controlinUgandaisgrowing.Withworm assistancefrom T WORKING TOGETHER Photo credits:thewriters the SchistosomiasisControlInitiative (SCI). Fenwick, RussellStothard,Howard Thompson,andNarcisKabatereineof This issueof © WORLDHEALTH ORGANIZATION 2003 oday, thenumberofdonorsandagencies workingin at least15millionpeopleoverthenext4years. The targetagreedwiththeBill&MelindaGates with commercial purposes. ©World HealthOrganization2003. orinwhole, butnotforsaleoruse This newslettermay befreelyreviewed,abstracted, reproducedandtranslated,inpart Action AgainstWorms Foundation bySCIistotreatregularly

WORMS was writtenbyCaraKamenka,Alan 6 WHERE WEAREGOING and itiswithinourpowertocontrolentirely. examined withultrasound.Thistypeofsufferingisunacceptable, WHERE WEARE Foundation fortheirgenerousfinancialassistancewhich THE BILL&MELINDAGATES FOUNDATION We

would liketothanktheBill&MelindaGates ... Achildwithsevereschistosomiasisbeing has madethispublicationpossible ... Healthyworm-freechildren.

in conjunction . ACTION AGAINST and thosewhocannotavoidcontactwithwater, suchaswomenduringdomesticworkandfishermen. The prevalenceandintensityof www.who.int/wormcontrol ineast-centralAfrica.Lyinglocked country eastoftheGreatRiftValley, part itforms Uganda, describedbyWinston Churchillas“trulythepearlofAfrica”,isaland- WELCOME TOUGANDA! SEPTEMBER 2003ISSUE3 the intermediate snailhostof the intermediate Vi Edward,GeorgeandKyoga–twomajorriversthe Albert, of thecentralAfricanplateau.Thecountry’s fivemajorlakes–Victoria, tions with soil-transmitted helminths (STH), particularly hookworm. hookworm. tions withsoil-transmittedhelminths(STH),particularly with schistosomiasis,madeworseinmanycasesbyconcurrentinfec- had changed:thelatestdataindicatethat4millionpeopleareinfected years peoplehavesuffereditsdamagingeffects.Untilrecently, nothing harzia). SchistosomiasisisnonewcomertoUganda–forthepast50 responsible fortheAfricanintestinaltypeofschistosomiasis(orbil- prehensive worm control activities. prehensive worm toembark oncom- vinced thegovernment (see bined withthenewandsimplified strategy threat topeople’s health.Thisfact,com- that schistosomiasisalonewas thebiggest from isolatedfishingcommunities showed attention? Theanswerissimple.Evidence tuberculosis, arecommandingsomuch weight” diseases,HIV/AIDS,malaria, trol –butwhy, whenthethree“heavy- Now, con- Ugandahaswokenuptoworm IN 5YEARS UP ANDRUNNING CONTROL PROGRAMME A NATIONAL WORM ctoria and Albert and the White Nile – provide the perfect habitatfor andtheWhite Nile–providetheperfect ctoria andAlbert Action Against Worms, S. mansoni infection areparticularlyhighamongthosewholiveclosetothelakesandrivers NTI ISSUE THIS IN Issue 1),con- Schistosoma mansoni

: not hesitateto contact usbye-mailat: be coveredin thefuture,pleasedo gestions forareasyouwould liketo comments onexistingissues orsug- Ifyouhaveany and informative. Against Worms We WORMS [email protected] H GNASTORY UGANDA THE

very muchhopethat very • •W •T •T •A •W Spin offs of theprogramme momentum in 5years he nutsandbolts he snowballof orking together elcome toUganda! national programme . Thisorganismis is bothenjoyable Action PPC NEWSLETTER ACTION AGAINST EDUCATION is fittingallthetrainers,districtofficialsandsuppliesinto thevehicleatsametime! waslongoverdue.Generally,Uganda, thissimpletypeofhealthintervention theworstproblemexperienced campaignhasalwaysmadesuchprogrammesespeciallypopularwithcommunities–and,for deworming So far, theresponsefromcommunitieshasbeendramatic.Thefeelingofwell-beingthatrapidlyfollowsa another 1millionindividuals,andre-treatmentofthe800000treatedin2003. the sub-countiesofsame18districts.Thethirdphase,scheduledfor2004,willinvolvetreatment The secondphaseisscheduledforlate2003whenanother500000individualswillbetreatedinall the drugs.Thisphasebeganon10April2003andcoveredmorethan300000adultschildren. each ofthe18districts,trainingallschoolandcommunitydrugadministrators,thendistributing first, orpilot,phasehasbeencompleted;itinvolvedselectingoneoftheworst-affectedsub-countiesin W IMPLEMENTATION: SCALINGUPBYDISTRICT witchcraft” and“traditionalmedicinecancurebilharzia”. about schistosomiasis,suchas“thediseaseiscausedby Uganda, thatcounterssomeofthecommonmisconceptions special “Question&Answer”booklet,speciallydesignedfor how toavoidhelminthinfectionareavailable,aswella postersandpamphletson teachers explainallaboutworms, oftheactualtreatmentday.now astandardpart To helpthe healtheducationsessionis officers. Intheschools,aformal nurses, districthealthstaffandcommunitydevelopment communities byschoolteachers,communityhealthworkers, Health educationwascarriedoutintheschoolsand COMMUNITY SENSITIZATION HEALTH EDUCATION AND Hoima District teamdescendingtothe shorelineofLakeAlbert, The survey ith baselinedatacollectioncomplete,implementationbegins!Aphasedapproachisbeingused.The

WORMS 5 A member of the survey teamtalking withschoolchildren A memberofthesurvey T raining atHoima ACTION AGAINST support. support. ordonorcouldhopeto thatanygovernment interventions oneofthemostoverdueand beneficial health to “kick-start” As inUganda,anextrainjectionoffundswouldsurely help Niger, Nigeria,UnitedRepublicofTanzania andZambia. Burkina Faso,Cameroon,Ghana,Kenya,Malawi,Mali, are can“piggy-back”.Thecountriesconcerned deworming the essentialinfrastructureisalreadyinplaceonwhich of thesecountries.Thisisamajoradvantageandmeansthat see www.who.int/wormcontrol) arealreadyworkinginmost forParasiteControl(PPC; fromthePartners several partners national planandappliedtoSCIforfunding.Whatismore, hasprepareda development. Alreadyeachgovernment control.Thisisanextremelyexciting commitment toworm their closely watchingitsroll-out,havenowconfirmed 10 morecountriesinsub-SaharanAfrica,whichhavebeen The Ugandanprogrammeisprovingsosuccessfulthat SPIN-OFFS FROMTHEUGANDAEXPERIENCE see www.freshschools.org/). component (accordingtotheFRESHframework; for schoolhealthprojectsthatincludeadeworming likely tobeamajorcontributor, providing support new diagnostictechniques.EventuallytheWorld Bankis Union, andtheUniversityofBangor, Wales, isworkingon outamorbiditystudyfunded bytheEuropean carrying helped toimprovelaboratories.CambridgeUniversityis System(GIS)mapping. DFIDhas Geographical Information of HygieneandTropical Medicineisinvolvedwith provides fundsforadditionalresearch.TheLondonSchool provides extensivetrainingatalllevels.TheWellcome Trust DevelopmentAgency) DANIDA (DanishInternational inNakasongolaDistrict. TheDBL,fundedby delivery of itsschoolfeedingactivities.SCFisassistingwithdrug tabletsaspart givingoutdeworming has started DevelopmentAgency),WFP CIDA (CanadianInternational controlinUgandaisgrowing.Withworm assistancefrom T WORKING TOGETHER Photo credits:thewriters the SchistosomiasisControlInitiative (SCI). Fenwick, RussellStothard,Howard Thompson,andNarcisKabatereineof This issueof © WORLDHEALTH ORGANIZATION 2003 oday, thenumberofdonorsandagencies workingin at least15millionpeopleoverthenext4years. The targetagreedwiththeBill&MelindaGates with commercial purposes. ©World HealthOrganization2003. orinwhole, butnotforsaleoruse This newslettermay befreelyreviewed,abstracted, reproducedandtranslated,inpart Action AgainstWorms Foundation bySCIistotreatregularly

WORMS was writtenbyCaraKamenka,Alan 6 WHERE WEAREGOING and itiswithinourpowertocontrolentirely. examined withultrasound.Thistypeofsufferingisunacceptable, WHERE WEARE Foundation fortheirgenerousfinancialassistancewhich THE BILL&MELINDAGATES FOUNDATION We

would liketothanktheBill&MelindaGates ... Achildwithsevereschistosomiasisbeing has madethispublicationpossible ... Healthyworm-freechildren.

in conjunction . ACTION AGAINST and thosewhocannotavoidcontactwithwater, suchaswomenduringdomesticworkandfishermen. The prevalenceandintensityof www.who.int/wormcontrol ineast-centralAfrica.Lyinglocked country eastoftheGreatRiftValley, part itforms Uganda, describedbyWinston Churchillas“trulythepearlofAfrica”,isaland- WELCOME TOUGANDA! SEPTEMBER 2003ISSUE3 the intermediate snailhostof the intermediate Vi Edward,GeorgeandKyoga–twomajorriversthe Albert, of thecentralAfricanplateau.Thecountry’s fivemajorlakes–Victoria, tions with soil-transmitted helminths (STH), particularly hookworm. hookworm. tions withsoil-transmittedhelminths(STH),particularly with schistosomiasis,madeworseinmanycasesbyconcurrentinfec- had changed:thelatestdataindicatethat4millionpeopleareinfected years peoplehavesuffereditsdamagingeffects.Untilrecently, nothing harzia). SchistosomiasisisnonewcomertoUganda–forthepast50 responsible fortheAfricanintestinaltypeofschistosomiasis(orbil- prehensive worm control activities. prehensive worm toembark oncom- vinced thegovernment (see bined withthenewandsimplified strategy threat topeople’s health.Thisfact,com- that schistosomiasisalonewas thebiggest from isolatedfishingcommunities showed attention? Theanswerissimple.Evidence tuberculosis, arecommandingsomuch weight” diseases,HIV/AIDS,malaria, trol –butwhy, whenthethree“heavy- Now, con- Ugandahaswokenuptoworm IN 5YEARS UP ANDRUNNING CONTROL PROGRAMME A NATIONAL WORM ctoria and Albert and the White Nile – provide the perfect habitatfor andtheWhite Nile–providetheperfect ctoria andAlbert Action Against Worms, S. mansoni infection areparticularlyhighamongthosewholiveclosetothelakesandrivers NTI ISSUE THIS IN Issue 1),con- Schistosoma mansoni

: not hesitateto contact usbye-mailat: be coveredin thefuture,pleasedo gestions forareasyouwould liketo comments onexistingissues orsug- Ifyouhaveany and informative. Against Worms We WORMS [email protected] H GNASTORY UGANDA THE

very muchhopethat very • •W •T •T •A •W Spin offs of theprogramme momentum in 5years he nutsandbolts he snowballof orking together elcome toUganda! national programme . Thisorganismis is bothenjoyable Action PPC NEWSLETTER