During the past decade there have been major efforts to plan, Controlling disease due to helminth infections implement, and sustain measures for reducing the burden of human ControllingControlling diseasedisease disease that accompanies helminth infections. Further impetus was provided at the Fifty-fourth World Health Assembly, when WHO duedue toto Member States were urged to ensure access to essential anthelminthic drugs in health services located where the parasites – schistosomes, roundworms, hookworms, and whipworms – are endemic. The helminthhelminth infectionsinfections Assembly stressed that provision should be made for the regular anthelminthic treatment of school-age children living wherever schistosomes and soil-transmitted nematodes are entrenched. This book emerged from a conference held in Bali under the auspices of the Government of Indonesia and WHO. It reviews the science that underpins the practical approach to helminth control based on deworming. There are articles dealing with the public health significance of helminth infections, with strategies for disease control, and with aspects of anthelminthic chemotherapy using high-quality recommended drugs. Other articles summarize the experience gained in national and local control programmes in countries around the world. Deworming is an affordable, cost-effective public health measure that can be readily integrated with existing health care programmes; as such, it deserves high priority. Sustaining the benefits of deworming depends on having dedicated health professionals, combined with political commitment, community involvement, health education, and investment in sanitation. "Let it be remembered how many lives and what edited by a fearful amount of suffering have been saved by D.W.T. Crompton the knowledge gained of parasitic worms through A. Montresor the experiments of Virchow and others…" M.C. Nesheim Charles Darwin L. Savioli The Times (London) 18 April 1881 World Health Organization WHO Geneva Additional reading The attention of readers is drawn to the following recent publications, which are closely concerned with the control of disease due to helminth infections: Crompton DWT et al., eds (2003) Preparing to control schistosomiasis and soil-transmitted helminthiasis in the twenty-first century. Acta Tropica, 86(2–3):121–347. Drake L et al. (2002) School-age children: their nutrition and health. SCN News, 25:4–30. Montresor A et al. (2002). Helminth control in school-age children: a guide for managers of control programmes. Geneva, World Health Organization. Stephenson LS, Holland CV, Otteson EA, eds. (2000) Controlling intestinal helminths while eliminating lymphatic filariasis. Cambridge, Cambridge University Press (supplement to Parasitology, 121). WHO (2002) Prevention and control of schistosomiasis and soil- transmitted helminthiasis. Report of a WHO Expert Committee. Geneva, World Health Organization (WHO Technical Report Series, No. 912). WHO (2002) Success in Africa: the Onchocerciasis Control Programme in West Africa, 1974–2002. Geneva, World Health Organization. Front cover: original painting by D.W.T. Crompton Controlling disease due to helminth infections edited by D.W.T. Crompton A. Montresor M.C. Nesheim L. Savioli WORLD HEALTH ORGANIZATION GENEVA Controlling disease due to helminth infections edited by D.W.T. Crompton WHO Collaborating Centre for Soil-transmitted Helminthiases Institute of Biomedical and Life Sciences University of Glasgow, Glasgow, Scotland A. Montresor Strategy Development and Monitoring for Parasitic Diseases and Vector Control Control, Prevention and Eradication World Health Organization, Geneva, Switzerland M.C. Nesheim Division of Nutritional Sciences Cornell University, Ithaca, NY, USA L. Savioli Strategy Development and Monitoring for Parasitic Diseases and Vector Control Control, Prevention and Eradication World Health Organization, Geneva, Switzerland WORLD HEALTH ORGANIZATION GENEVA 2003 WHO Library Cataloguing-in-Publication data Controlling disease due to helminth infections / edited by D. W. T. Crompton . [et al.]. 1.Helminthiasis—prevention and control 2.Helminthiasis—drug therapy 3.Anthelmintics— pharmacology 4.National health programs 5.Epidemiologic studies 6.Evaluation studies I.Crompton, David W. T. II.Controlling Disease due to Helminth Infections (2000 : Bali, Indonesia) ISBN 92 4 156239 0 (NLM classification: WC 800) © World Health Organization 2003 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications—whether for sale or for noncommercial distribution— should be addressed to Publications, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The named authors and editors alone are responsible for the views expressed in this publication. Designed by minimum graphics New Zealand Typeset by SNP Best-set Typesetter Ltd., Hong Kong Printed by Interpint, Malta hen Carlo Urbani took it upon himself to investi- Wgate the new and deadly disease we now know as SARS (severe acute respiratory syndrome) and so alert the world to this emerging danger, he did so without the slightest regard for his own health and safety. He died of SARS in Bangkok on 29 March 2003 aged 46, at the pinnacle of his career – first and foremost as a physician but also as an authority on the prevention and control of parasitic disease. Carlo Urbani now stands shoulder to shoulder with Edward Jenner, Ignaz Semmelweis, Louis Pasteur, Robert Koch, Rudolph Virchow, Matthew Lukwiya and other giants of public health whose efforts have relieved us from the burden of infectious disease. Carlo contributed to this volume, which is dedicated to his memory with affection and admiration. Contents Preface vii Opening address ix The Bali Declaration xi List of participants and contributors xii Part I Public health significance 1 Important human helminthiasis in Indonesia Sri S. Margono 3 Schistosomiasis D. Engels, L. Chitsulo 15 Hookworm infection and iron status D.W.T. Crompton, H. Torlesse, M.E. Hodges 23 Helminth infections, growth, and anaemia: lessons from Zanzibar Hababu M. Chwaya, Rebecca J. Stoltzfus 33 Impact of deworming on the growth of schoolchildren in Yangon Thein Hlaing, Win Win Khine, Tin Tin Than, Myo Khin, Than Saw, San Shwe, Ma Ma Gyi, Aung Tun, Hkwar Nyo Zin, Phyu Phyu Aye 43 Parasites, nutrition, child development, and public policy J.D. Kvalsvig 55 The effect of soil-transmitted helminth infection on the cognitive function of schoolchildren S.A.N. Abidin, P. Hadidjaja 67 Part II Strategies and major programmes for the control of disease due to helminth infections 73 Strategies for the control of intestinal helminths and lymphatic filariasis: initiatives in the WHO Western Pacific Region K. Palmer, K. Ichimori 75 The Hashimoto Initiative and the control of soil-transmitted helminth infections: the Japanese challenge Tsutomu Takeuchi, Takeshi Kasai, Takaaki Hara 81 A deworming programme in Nepal supported by the World Food Programme Gian Petro Bordignon, Deepak Raj Shakya 87 Partnership for Child Development: an international programme to improve the health of school-age children by school-based health services including deworming Satoto, Sri Hendratno, Herbanto Subagyo, Zen Rafilluddin, Michael Mogensen, Andrew Hall, Don Bundy 93 Focusing resources on effective school health: a FRESH start to improving the quality and equity of education D.A.P. Bundy 99 v CONTROLLING DISEASE DUE TO HELMINTH INFECTIONS Part III Anthelminthic chemotherapy 107 Treatment of soil-transmitted helminth infection: prescribing information for disease control Marco Albonico 109 Control of intestinal helminthiasis in pregnancy—the Sri Lankan experience M.M. Ismail, T.M.S. Atukorala, T.S. Naotunne, N.R. de Silva, I. Hettiarachchi 127 Anthelminthic treatment during pregnancy H. Torlesse, D.W.T. Crompton, L. Savioli 135 The efficacy of anthelminthics: past, present, and future J. Horton 143 Effectiveness of selective treatment in the control of soil-transmitted helminthiases Hoang Thi Kim, Nguyen Van De, Nguyen Van Tien, Nguyen Thi Dang, Pham Thi Tuyet, Nguyen Thi Mai, Hoang Van Tan, Nguyen Thi Duc, Nguyen Thi Viet Hoa 157 Part IV Experience from national control programmes 169 Control of schistosomiasis due to Schistosoma mekongi in Khong District, 1989–1999 T. Khamkeo, K. Pholsena 171 Community-managed control of soil-transmitted