Over the past few decades, the World Health Organization has conducted large-scale prophylactic deworming of school children in developing nations in an attempt to eliminate the devastating health effects of intestinal parasites. Because it’s not considered cost effective to test for worms before treating, organizations have simply treated all school-age children in high infection areas with anti-parasitic medication whether they show signs of infection or not.
What Are the Benefits of Deworming?
Until now, it has been the general consensus that mass deworming is a cost-effective way to prevent this problem because the social and medical consequences of not treating children who suffer from intestinal parasites can be severe. Some of these consequences are:
- malnutrition that leads to inability to concentrate in school,
- increased susceptibility to diseases like malaria due to a weakened immune system, and
- poor attendance in school due to multiple illnesses.
Because the impacts of parasitic infections are considered serious and the side effects of deworming medications mild, it has been the policy of the WHO to recommend that all children in highly-afflicted areas be given prophylactic doses of deworming medications twice a year. In the 2014-2015 school year alone, this policy has ensured that over 96 million school age children received the treatment. Almost 200 million children have received deworming treatments in total. But it’s estimated that over 880 million children are infected with worms from contaminated water or soil and are badly in need of medication, especially in parts of Africa such as Kenya and South Africa.
A Cost-Effective Prevention or Waste of Resources?
Mass deworming costs roughly $0.30 per treatment. Recent studies have been attempting to evaluate whether the cost of mass treatment is effective when compared to its reported gains. One of the main measures of effectiveness is weight gain following treatments. This is thought to be a measure of total nutritional status. Other measures are school attendance and school performance. A recent study has shown very little affect on overall weight improvement. When compared to the cost effectiveness of school nutrition programs, the school nutrition programs were found to be 35 times more effective at improving weight gains in growing children. However, another study conducted roughly one year later disputed these findings, saying that deworming is safe for those without the infection and far too beneficial for those with the infection to write off the treatment.
Why are Some Agencies Reconsidering Mass Deworming?
This is a question of how to best spend limited healthcare funds in nations that lack a sufficient health care budget. When resources are limited, providers will attempt to use programs that provide the greatest health benefits for the most people for the least possible cost. In other words, they are attempting to get the best bang for their buck. Researchers that argue against the cost effectiveness of mass deworming point to studies showing statistically insignificant improvement in overall weight gain and school attendance following deworming treatments. They also question the wisdom of treating children en masse for conditions that they may not suffer from despite reports of the safety and efficacy of deworming medicines.
Yet those who want to continue deworming programs argue that the sampling methods of negative studies are flawed. This is because all children are added to the studies, whether they are infected with worms or not, so the positive results of infected children are diluted within a pool of otherwise healthy children. Additionally, the negative studies do not take into account the burden that treating severe infestations can place on an already taxed healthcare system.
Are There Practical Alternatives to Mass Deworming?
The 2015 study suggested that focusing on increasing nutrition programs has a greater positive impact on public health dollar for dollar than mass deworming. If deworming programs are found to be cost ineffective, the money currently being spent on the programs can be diverted to improving school nutrition programs and improving overall health care infrastructure. If better overall healthcare is available, many other common healthcare problems can be addressed while afflicted children will still be treated for parasitic infections. The jury is still out on this argument and many nations continue to move forward with their deworming programs, including a large scale 2017 project launched in the Philippines.