District Level Management NTD Training Course

Module 1 Part B Introduction to targeted NTDs

Session 4.

Soil Transmitted Helminthiasis (STH) Epidemiology and Control

District Level Management NTD Training Course Meeting NTD STAG, 29-30 April 2013, Geneva, Switzerland 2

District Level Management NTD Training Course

Objective

• Remind district NTD programme managers of basic epidemiology and recommended interventions for diseases targeted with preventive chemotherapy – Soil-transmitted helminthiasis

– Control goal

District Level Management NTD Training Course Meeting NTD STAG, 29-30 April 2013, Geneva, Switzerland 3

District Level Management NTD Training Course

Map of STH Distribution in Tanzania

District Level Management NTD Training Course

• >2 Billion infected and

• 300 M with severe morbidity

Global STH burden

• >130,000 attributable deaths

• >600 M school-age children (SAC)

• >40 M pregnant women at risk of serious consequences

STH Burden in Tanzania

District Level Management NTD Training Course

Common features of STHs

• Endemic in rural areas: most common diseases among the people leaving <$2/day

• Chronic diseases →long-term disability • ↑risks related to pregnancy (adverse outcomes) • Affect adult productive capacity • In children

• hinder normal growth • intellectual & cognitive development

• Geographically confined • although communicable • strictly linked to the environment • complex reproductive cycles

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District Level Management NTD Training Course

STHs: why treat them?

• To cure and prevent chronic morbidity by reducing the worm ‘burden’

• To prevent healthy people becoming infected by reducing the source of infection (interrupting transmission)

• To promote health education and integration with other programmes

District Level Management NTD Training Course Meeting NTD STAG, 29-30 April 2013, Geneva, Switzerland 7

District Level Management NTD Training Course

STHs targeted in PC Ascariasis (Ascaris lumbricoides) Roundworm

Trichuriasis (Trichuris trichiura) Whipworm

Hookworm disease (Ancylostoma duodenale, Necator americanus)

Nigeria WHO Integrated NTD Programme Managers’ Course

Abuja, Nigeria 3-8 February

TREATMENT

SANITATION

HEALTH EDUCATION

Control Options

District Level Management NTD Training Course Meeting NTD STAG, 29-30 April 2013, Geneva, Switzerland 9

District Level Management NTD Training Course

Albendazole (ALB) 400mgs

I tablet

Mebendazole (MBD)

500mgs I tablet

Pyrantel 10mg/kg Single dose for school-aged children (SAC): 80 mg

Levamizole 2.5mg/kg

WHO recommended PC for STH

District Level Management NTD Training Course

Category Prevalence of any STH in

SAC

Action Also treat

High ≥50% Treat all SAC enrolled and non-enrolled twice yearly

PSC WCBA including pregnant women in 2nd and 3rd trimester At risk workers: farmers, miners, etc

Low 20-50% Treat all SAC enrolled and non-enrolled annually

PSC WCBA including pregnant women in 2nd and 3rd trimester At risk workers: farmers, miners, etc

<20% Case by case treatment

WHO recommended PC for STH

District Level Management NTD Training Course

Benefits of STH treatment

• ↓School absenteeism by 25% • ↓Wasting malnutrition by 60% • ↓Moderate anaemia by 59% • Improvement of growth

• 20% in weight • 7% in height

• Control of STH can contribute to poverty reduction • Benefits of a hookworm-free childhood: increase in per

capita income by 45%

District Level Management NTD Training Course

Target populations

• School-aged children (SAC, 5<15 years)

• Pre-school children (PSC) 1-4 years

• Women of childbearing age (15-39 years)

• Women in ANCs in 2nd and 3rd trimesters

District Level Management NTD Training Course

What do you think are the key messages from this session?

District Level Management NTD Training Course

Key messages

• STH are endemic not only in tropical settings, but are diseases of poverty

• Transmission is by faecal contamination of soil and is facilitated by poor hygiene and sanitation

• PC targeted to high risk groups is the most cost-effective control measure

• ALB and MBD are the most cost effective broad-spectrum anthelminthics against STHs

• Main goal of MDA is to avoid the severe consequences of infections