Frequently Asked Questions
Submitted by admin on Wed, 04/27/2011 - 01:55
- How does deworming work?
- Why deworm through schools?
- How do you determine which regions require deworming?
- Which drugs are used in deworming treatment?
- What is the correct dosage if a child has a height that is below the lowest mark on the tablet pole?
- How frequently should you treat the children?
- How long does a deworming program have to last?
- At what time of day should the treatment be given? Should it be taken alone or with food?
- Should pregnant girls be dewormed?
- At what age can you start deworming a child?
- I have noticed in the past, several children might hide the tablets in their mouths and spit them out later. What can we do about this?
- Is it safe for children to receive two consecutive treatments in close succession? For example, if a child goes to hospital and receives treatment for worms and then, shortly afterwards, is dewormed at school?
- Are there any side-effects of taking deworming tablets?
- What happens in the event of an overdose?
- Is it all right to give deworming drugs at the same time as other health interventions?
- Is it all right to deworm a child who is sick?
- Do worm infections make you more likely to get other illnesses?
Deworming is cheap, easy and safe. All the common worm infections in school-age children can be treated effectively with two single-dose pills: one for all the common intestinal worms (hookworms, roundworms, and whipworms) and the other for schistosomiasis (bilharzia). The treatment is safe, even when given to uninfected children. The tablets are administered orally and only a few people will experience side-effects such as transient abdominal pain and diarrhea. All school-aged children are encouraged to come to school on that day, where their name and age is recorded, and their height and weight (where possible) is measured, before being treated.
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In many areas of the world, health infrastructure is under-developed. Health facilities may be few and far between, requiring patients to travel long distances. All too often clinics in rural areas are closed because health professionals are absent or the fees that are charged make health services inaccessible to the poor.
With more schools than clinics, and more teachers than health workers, the existing and extensive education infrastructure provides the most efficient way to reach the highest number of school-age children. With the support from the local health system, teachers can administer treatment to large numbers of school-age children with minimal training.
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An extensive mapping process is conducted to determine where deworming is required in any given region. This process involves the collection of existing data and surveys in order to provide detailed prevalence maps from which treatment plans can be developed. Mapping allows targeting to those who need treatment thus, maximizing cost-effectiveness.
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The most commonly used drugs for the treatment of common intestinal worms are albendazole (400 mg) or mebendazole (500 mg). They are administered as a single tablet to all children, regardless of size or age. One pill can cost as little as US$0.02 and only in the most highly infected communities is treatment required more than once a year.
Praziquantel, the drug of choice to treat schistosomiasis, is slightly more expensive – on average US$0.20 per treatment for a school aged child. Treatment once a year is sufficient even in the most infected communities. Praziquantel is given as a single dose, but the number of pills has to be adjusted to the size of the child. However, height can be used as a proxy for weight. The preferred method for schoolchildren is an inexpensive height "dose-pole".
For Mebendazole and Albendazole, no tablet pole is used and the set dosages are safe for any child over one year, regardless of height or weight.
For Praziquantel, if the child is shorter than the height pole, use the weight scale and calculate the dose which will deal with short children. It goes down as low as 10 KG - 1 tablet. Most school-age children should be 10 KG or more. To get the weight calculator, click here.
The frequency of the treatment will depend on the prevalence and intensity of infection. In other words, it depends on the proportion of school-age children who are infected as well as the magnitude of infection in each child. The WHO recommends the following treatment guidelines:
For STH, schools with high prevalence of infection (>50%) should deworm twice per year. Schools with moderate prevalence of infection (20% to 50%) should deworm once per year. Schools with low prevalence of infection (<20%) do not need to implement mass drug administration, but should emphasize education campaigns and behavior change, and encourage children to seek treatment at a health center if they suspect they are infected.
For schistosomes, schools with high prevalence of infection (>50%) should deworm once per year. Schools with moderate prevalence of infection (10% to 50%) should deworm once every two years. Schools with low prevalence of infection (<10%) should deworm twice during primary school (for example, once at entry and once at exit).
If the prevalence of infection remains above a certain level, children should continue to be dewormed every year until the sanitation facilities are improved enough so that re-infection no longer occurs. In the long term, improved sanitation will help to reduce these prevalence levels.
The drugs can be taken at any time of the day. However, it is advisable to deliver the drugs with water and a small amount of food.
According to WHO, pregnant girls can be treated with Mebendazole, but only after their first trimester (12 weeks). Albendazole is not recommended for pregnant women.
Children from the age of 12 months and onwards can be safely treated for STH (which includes hookworms, roundworms, and whipworms). For schistosomes, children over 4 years of age can be safely treated with praziquantel.
One way is to make sure the child chews the tablet in front of you. Providing water to swallow the tablet also can help.
Although overlapping of treatment like this should be avoided, accidental “over treatment” with several times the recommended dose has been reported with no serious side-effects. Therefore, two consecutive treatments in quick succession should be considered harmless.
Side-effects are rare, minor and transitory, for example, feeling nauseated. However, if children have extremely high worm loads, the first round of treatment can cause abdominal pain. If an area is known to be severely affected, the potential for side-effects should be explained to teachers and families so that they clearly understand that the pain is not the result of the drugs, but due to the dying worms being expelled. The teacher should ask the child to lie down in the shade until they feel better, and if possible, to give them clean water to drink. The recommended doses of albendazole/mebendazole have been given to millions of children in different countries worldwide with very few adverse reactions reported.
Deworming is simple and safe, and overdoses are highly uncommon. Nevertheless, if an overdose for either Mebendazole or Albendazole does occur and is more than twice the recommended dosage, or if a child starts showing serious side effects, it is advisable to take the child to a health care facility for observation and/or treatment.
Yes, deworming drugs can be delivered with other large scale health programs such as child health days, distribution of insecticide treated bed nets, immunizations (polio and measles), and vitamin A campaigns. Integrating deworming with these health programs boosts campaign coverage and improves child health and development at minimal cost.
There is no danger in treating a sick child. However, it is strongly recommended that if a sick child arrives for deworming that you do not treat the sick child. The reason is that if the child becomes sicker due to the illness, the deworming drugs might be blamed, even if they had nothing to do with the worsening of the illness. This can seriously compromise the success of your campaign. It is much better to wait until the child is better and then to deworm them immediately.
Yes, a child with heavy worm infections is more likely to get other infections. Treating children for worms actually helps their natural body defenses to fight against other infections.