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Health Surveillance & Disease Prevention & Control / Communicable Diseases / Parasitic & Neglected Diseases

Control of Soil-Transmitted Helminth Infections in the English- and
French-Speaking Caribbean: Towards World Health Assembly Resolution 54.19

(Kingston, Jamaica, 15–17 May 2007)

Report (56 pp, PDF, 945 KB, with links to chapters in Table of Contents)

Introduction

Section I: STH Infections and the Health of School-Age Children

Epidemiology of Soil-Transmitted Helminths among School-Age Children
Effects on Growth and Development
Surgical Manifestations of Ascaris

Section II: Tools for the Development of National Deworming Plans of Action
Subregional Priorities
Resources Available for Effective Deworming in the Caribbean
Methods of Identifying and Estimating At-Risk Populations
Opportunities for Integration of Deworming into School Health Programs
Six Key Components of a National Deworming Plan

Section III: Draft National Deworming Plans of Action

- Guyana
- Anguilla
- Barbados
- St. Vincent & the Grenadines
- Trinidad & Tobago
- Jamaica

- St. Lucia
- Grenada
- St. Kitts & Nevis
- Belize
- Haiti
- Bahamas

Section IV: Recommendation and Action Points

PAHO Links
- Framework for a Regional Program for Control of Soil-Transmitted Helminth Infections and Schistosomiasis in the Americas
- Parasitic Diseases
- Neglected Diseases
- Regional Program

WHO Links
- Control of Neglected Tropical Diseases
- Partners in Parasite Control (PPC)
- Schistomiasis and Soil-Transmitted Parasite Infections: Preliminary Estimates of the Number of Children Treated with Albendazole or Mebendazole (WER, No. 16, 2006, 81, 145164)
- Schistosomiasis
- Intestinal Diseases, Parasitic
- Tropical Disease Research

Workshop Objectives   |   The Caribbean Context   |   Recommendations & Action Points

Globally, over 2 billion people are infected by schistosomes and soil-transmitted helminths, of which 300 million suffer severe morbidity or permanent impairment. These worm infections disproportionately affect the poor, particularly children. They also cause anemia and adversely affect children's growth and development, which contributes significantly to cognitive problems, school absenteeism, and poor scholastic performance. In response to this, the
54th World Health Assembly in 2001 put forth a resolution which urged endemic countries to promote preventive measures, ensure treatment and mobilize resources for control of schistosomiasis and soil-transmitted helminthiasis. Subsequently, Resolution 54.19 was endorsed by every single Member State. The resolution urges Member States to ensure access to essential drugs against schistosomiasis and soil-transmitted helminth (STH) infections with the goal of treating at least 75% and up to 100% of all school-age children at risk of morbidity by 2010. In addition to chemotherapy, preventative measures such as improving access to safe water, sanitation and health education are also encouraged. STH infection rates are particularly high among women and children living in poor communities, indigenous communities, migrant workers, fishers, and those living in rural areas and peri-urban slums. PAHO/WHO estimates that 20-30% of those living in Latin America and the Caribbean are infected with one of several intestinal helminths and/or schistosomiasis. The prevalence of intestinal worms in slums often reaches 50% and up to 95% in some Amerindian tribes. With up to 1/3 of the Region's workforce infected with worms, this group of parasites also lowers the work capacity of adults and is among the main causes of anemia among women of child-bearing age.

Workshop Objectives: Advocate towards WHA 54.19 (2001) goal

  • Raise the awareness of WHA 54.19 among the Caribbean countries and the 2010 goal to deworm 75% to 100% of school-age children at risk for worm infection and morbidity
  • Provide a forum for interchange on current deworming activities in each country attending the workshop
  • Provide an opportunity for countries to lay the ground work for the development of national plans of action for deworming of at-risk school-age children
  • Present an overview of technical resources available to each country from PAHO/WHO and other partners in the region

The Caribbean Context

Existing evidence on the prevalence of STH in the Caribbean subregion suggests that there is a lower burden of worms in the Caribbean than in the rest of Latin America. However, there does appear to be a difference across the Caribbean subregion which may be a reflection of differences in socio-economic status, access to safe water, sanitation and primary health care. In the Caribbean STH prevalence appears to be higher in certain countries, such as Guyana, Belize, and Jamaica. St. Lucia is the only country in the Caribbean that is currently reporting schistosomiasis infection.

However, an accurate estimate of STH and/or schistosomiasis burden is difficult to determine. STH infections are not subject to compulsory reporting in most countries, and are not perceived as major public health problems. Most of them do not lead to epidemiologic emergencies and consequently attract little attention from the media and the public sector. Also, for many of the countries in the Caribbean subregion, very few recent research studies, surveys or prevalence studies exist and often the most recent data available is over 20 or 30 years old.

Historically, STH control was an important health priority in the Caribbean. Its importance as a health program has decreased due to improved water sanitation in all urban and most rural areas and increased accessibility of cheap, effective, anti-helminthic drugs, which permits the population to self-medicate the illness. In the Caribbean, helminth infections are more likely to be an indicator of other social and economic problems such as poverty, inaccessibility to health care, or disruption of healthcare services.

Recommendation and Action Points: Several action points and recommendations came out of the discussions over the three-day workshop. This meeting provided an opportunity for countries to update the Regional Program on the STH situation among school age children and other at-risk groups in their countries. Among the findings of the workshop was the need to conduct assessments of the prevalence and intensity of these infections in the various countries in order to determine in a systematic way whether or not there is need for implementing new programs or scaling up existing ones. They are outlined below:

  1. Country representatives will expand on the draft outline national plans of action into full national programs, with assistance from the Regional Program where necessary. These draft national plans will explore opportunities for integrating deworming into existing or planned school based health initiatives and other health initiatives such as maternal and child health initiatives.
  2. Representatives will meet with key policy makers and colleagues within the Ministry of Health of their countries to assess their need for rapid assessments of the burden of soil transmitted helminths. The Regional Program will offer technical assistance to countries conducting these assessments as necessary.
  3. A rapid assessment will be conducted in St Mary which is the poorest parish in Jamaica, to determine the burden of soil-transmitted helminth infections and the need for a control program.
  4. The Regional Program will work through the Caribbean Community (CARICOM) Council for Human and Social Development (COHSOD) to strengthen advocacy at the policy level for subregional activities on the control of soil transmitted helminths.
  5. A follow-up meeting is to be held after one year to assess the progress of programs within countries.
  6. Over the next year, the Regional Program will also be undertaking a number of activities in the Caribbean to further assess the situation in individual countries, increase awareness among policy makers and offer technical support to countries which currently have deworming programs and those who are interested in planning such programs. A letter has been drafted and sent to the Chief Medical Officers of every country represented at the workshop (see Annex 4).