Deworming reduces absenteeism, improves learners' performance

Worms have been a public health threat for Kenya’s children for many decades, with the worst hit being pupils in primary schools who carry the heaviest disease burden.

The attendant absenteeism results in poor academic performance, besides diseases affecting their nutrition intake.  In rural areas, most play barefoot unaware that playgrounds could have soil-transmitted schistosomiasis and helminthes commonly caused by roundworms, hookworms and whipworms.

Programmes to eliminate worms have faced myriad challenges, including negative perceptions. Some parents believed deworming was intertwined with devil worship, or was a form of birth control, while some pupils had low tolerance to medicines.   

“At first when we began, 10 years back, so many children vomited worms, had diarrhoea with worms and some worms coming through the mouth,” says Agneta Juma, the in-charge of health programmes at St Mary’s Primary School in Busia.

Ms Agneta recalls that these occurrences led to misconceptions that almost derailed the initiative.

“People alleged that (deworming programmes) were bringing devil worshipping and some resisted, but we sensitised parents that the drugs had good impact,” she says.

Worse still, pupils did not tolerate praziquantel, one of the medicines against schistosomiasis (bilharzia), but with continued sensitisation, they embraced deworming.

“They used to have stomach problems, and miss school,” says Moses Ouma, a parent at Rabuor Primary School in Kisumu County. “Taking them to hospital was expensive but nowadays, the illnesses are not related to water like bilharzia.”

Dorcas Opiyo, the last born of six girls, has never missed a deworming exercise since she joined Rabuor Primary. The KCPE candidate says she takes deworming medication and “I didn’t experience stomach pains. I felt so good and sometimes I liked to eat many fruits.”

RISK OF BILHARZIA

For many, deworming meant more time in school without sickness interrupting learning. For some like Adrian Wilson, 12, deworming affected food rations as “the food I ate before and after deworming reduced a little bit.”

Rabuor area in Kadibo sub-County is prone to flooding, which increases the risk of bilharzia caused by parasitic worms that thrive in freshwater contaminated by human faeces.

But since deworming started “the rate of infection of the worms has gone down. We do not experience a lot of absenteeism,” says Dick Awuonda, the head teacher at Rabuor Primary School. Mr Awuonda says that enrolment improved from 640 to 1,154 pupils, while regular attendance means the mean score has improved from 239 to 280.

In 2012, the ministries of Health and Education entered a five-year Programme Implementation and Partnership Framework Agreement with Evidence Action to scale deworming in all high-risk counties. The aim was to reach about 6.7 million children aged between two to 14 at risk of soil-transmitted helminthes and schistosomiasis.

According to the World Health Organization (WHO), soil-transmitted helminthes, commonly caused by roundworms, hookworms and whipworms, are parasitic worms transmitted by eggs present in human faeces that contaminate the soil in areas with poor sanitation. Experts say pupils aged between five and 15 bear the biggest brunt of the worm burden; harbouring 70 to 80 per cent of the disease burden that affects them nutritionally and physically.

Kenya Medical Research Institute Senior Principal Research Scientist Charles Mwandawiro explains that areas with dense population and intense agricultural activity have high prevalence of worms.

“The worm burden is mostly found in Western Kenya, Luo Nyanza, some parts Rift Valley and the Coast. Other areas like North Eastern or Northern Kenya are too dry for worms to survive,” says Dr Mwandawiro, who is also the officer in charge of monitoring and evaluation of the deworming programme.

The National School Based Deworming Programme has been a success in counties with high worm burden like Busia in Western Kenya.

Julian Anyango, a 42-year-old mother of seven and a parent at St Mary’s Nambale Primary School in Busia, has seen five of her seven children transit successfully to secondary school.

“When a child is dewormed, their health improves. They are attentive in class and hardly miss school because of ill health,” she says, adding that two of her children are in university while three are in secondary school, a success she attributes to the deworming programme.

Chrispin Owaga, the Kenya Country Director of Evidence Action, the main organisation supporting school deworming, says the programme has economic benefits as “recent research indicates adults who received two or three rounds of deworming get higher incomes up to 13 per cent more than the ones who did not.”