India fights parasite-induced anaemia: How deworming, open defecation-free spaces help

The Union Government introduced National Deworming Day to bring down the infestation of worms in children, which causes malnutrition.
India fights parasite-induced anaemia: How deworming, open defecation-free spaces help
India fights parasite-induced anaemia: How deworming, open defecation-free spaces help

Malnutrition continues to plague many children in the nation. As of 2015, around 20 million children in India, all below the age of 6, were found to be malnourished. However, one particularly peculiar cause of anaemia is parasite infestations, which has been found to be among the leading causes of malnourishment in young children.

In order to combat this, the Union Government introduced the National Deworming Day programme in 2015. Experts have noted that since the introduction of the scheme, the number of children affected by worm infestations has gone down drastically.

Children presenting with anaemia were sometimes given multivitamins and iron supplements to improve the levels of iron in their blood. However, many doctors were puzzled to see that no amount of supplementation seemed to improve their nutrition status.

“At one point, they might be pumped with all the essential nutrients and vitamins, but it did not markedly change their haemoglobin values. They would continue to be malnourished,” explains Villupuram-based pediatrician Dr Santanakumar, adding, “It was later when the children were diagnosed for anaemia that the problem of parasitic worms even emerged.”    

While the overall prevalence of parasitic diseases that cause anaemia and malnutrition has come down significantly, it is an issue that still needs to be addressed. Parasites have known to be transmitted due to lack of footwear and through a number of other means.

Once these worms enter the human body, they find their way into the intestines, where they absorb all the nutrients and energy that the person assimilates. As a result, the individual often develops anaemia and is often undernourished.

Worms that can affect

Tapeworms, roundworms and hookworms are some of the most prevalent worms seen in these parasitic infestations.

Hookworms are one of the common parasites to affect children. The eggs of these worms are passed in the stool of an already infected individual and larvae hatch within a few days. These then mature in the feces and are released into the soil during open defecation. The third stage of development takes place in the soil, where they become what is known as the ‘filariform’ larvae, which are the infective form. The worm can then be transmitted through the contaminated soil to a person without footwear.

Once the hookworm has entered the individual’s blood stream, it makes its way to the intestine, where nutrients from food are absorbed. In someone who has a parasite infestation, the presence of the worms in their intestines will hinder the absorption of these nutrients.

Ascaris lumbricoides or roundworms are among some of the common parasites to affect people. They can be passed from animals to humans. The larval form of the worm penetrates the duodenum, a part of the small intestine, and enters the bloodstream in this manner. The eggs of these worms are resistant to several chemicals and as a result, can remain viable in the soil for months without being affected.

There are two common types of tapeworms: Taenia solium, the pork tapeworm and Taenia saginata, the beef tapeworm. When a person ingests improperly cooked beef or pork, the eggs of the worms can invade the intestines and travel to other parts of the body. They then mature into another form known as 'cysticerci’ and can remain in this form for long periods of time. These forms then develop into a tapeworm, which in turn releases anywhere from 1,000 to 2,000 eggs, which can be released in the stools.

Once there is an infestation, children may show symptoms such as nausea, vomiting or loose stools, or even a combination of these. Some may feel lethargic and tired and may have a loss of appetite. When they are not treated for the infestation, they may present with anaemia, says Dr Senthil Kumar, the Deputy Director of Health Services for Tamil Nadu's Kanchipuram district.

Usually a child presents with anemia at first, which is a problem in itself, and is seen in many young kids. Often, they are treated and examined only for anemia. Doctors take time to understand that worm infestation has induced anemia in a child, unless they have symptoms suggestive of the same.

Dr Udayakumar, a practicing paediatrician in Chennai, says that while there has been a significant decline in the overall number of cases in the city, there have been more recurrences.

“There has been a drastic decrease in the number of cases presenting with worm infestations that we used to see on a weekly or a monthly basis. However, we are also seeing the same child getting a recurrent infection,” he says.  

Eliminating open-air defecation can reduce worm infestation

In 2015, the Union government introduced National Deworming Day, which falls on August 10, to combat this issue. Experts have stated that ever since this programme was introduced, the number of children affected by worm infestations has reduced.

“If a person has worm infestation, he/she will have stunted growth. Stunted growth is because of malnutrition. And secondly, it will cause anaemia. Due to loss of appetite, they do not take proper food or skip food. And thirdly, the productivity of the adolescent and the adult will get reduced, thus increasing the socio-economic burden,” Dr Senthil Kumar says.

The government conducts a ‘mop-up’ day on August 17 of every year to ensure that children, who may not have received deworming tablets in the initial phase, are covered. In addition to providing albendazole tablets for deworming, children are also taught proper hand washing techniques and other hygienic measures to prevent parasitic infestations in young children.

“It’s not enough that we teach them these self-care measures, but it is important that we also recognise some other factors that may be contributing to the problem,” says Angeline Prince, director of the NGO Candles based in Chennai.

“One of the things we do is teach people about the ill-effects of open-air defecation. In several rural areas, we have noticed that people develop such health issues as many don’t have access toilets. Even the ones who have toilets, sometimes, are unable to use them due to inaccess to water,” explains Angeline.

She further explained how several children are often sent to lake beds and riversides to relieve themselves. The soil in this region is often lush and ridden with worms, which may be contracted by children.

“Even if the mud in these areas is being used to thatch roofs or for any house work, there’s a chance that people are exposed to harmful parasites,” she says, adding, “So it not only becomes important to build toilets with proper facilities, but also to educate them about the importance of having toilets. We have to make them understand the harmful effects of not doing so.”

She also stresses that it is important to teach children proper hygiene habits and teach them to use toilets from a young age so that they get acclimatised to the idea of using toilets and are discouraged from open-air defecation practices.

Open-air defecation practices are directly linked to the prevalence of worm infestations. The worms can enter through an open wound on a barefoot individual and eventually enter the bloodstream of the individual.

“We have to start with the younger children, because it becomes easy to condition them to implement these healthy practices in their lives. That way, when they grow up, they are still going to be inclined to using toilets. Eliminating open-air defecation will significantly bring down the transmission of parasite infestations,” adds Angeline.

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