Author: Sushree Nibedita Panda, Public Health Researcher, ICMR-Regional Medical Research Centre , Bhubaneswar, Odisha, India. Lymphatic filariasis(LF) has been a significant public…
Combating Parasitic Worms in Ethiopia
Authors: Fikre Seife, National NTD Program Team Lead, Federal Ministry of Health of Ethiopia; and Karen Palacio and Tegan Mosugu, The END Fund
Health is Wealth
Health is wealth, yet so many people are unable to benefit from it. Throughout the years, various research studies have examined the effect that healthy citizens have on a nation’s economic well-being. Recently, a new report by the Economist Intelligence Unit revealed that $3.2 billion in productivity could be gained between 2021 – 2040 by eliminating two neglected tropical diseases (NTDs), soil-transmitted helminths or intestinal worms and schistosomiasis (bilharzia) in Ethiopia – where at least 75 million people require treatment for at least one NTD.
NTDs are a group of parasitic, bacteria, and viral diseases that affect more than 1.7 billion people, particularly, the most vulnerable and marginalized people in society. Mass drug administration campaigns are conducted in disease endemic countries in order to reduce morbidity, which in turn contributes to an improved quality of life – children who are able to go to school and people who are able to earn better wages.
Ethiopia’s National Deworming Program
Ethiopia has one of the highest burdens of parasites in the world, with approximately 12.3 million school-age children at risk for schistosomiasis and 9.1 million pre-school age and 25.3 million school-age children at risk for soil-transmitted helminths — types of parasitic worms. Schistosomiasis and intestinal worm infections impede nutrient absorption in children and lead to malnourishment, anemia and limit mental and physical development. These parasitic infections are a threat to children’s health and education.
In 2013, the Federal Ministry of Health, the Ethiopian Public Health Institute and development partners conducted disease mapping which informed the strategy for the implementation of preventive chemotherapy for schistosomiasis and soil-transmitted helminth infections.
Mass drug administration campaigns in schools began shortly thereafter, and in 2015 the Federal Ministry of Health launched its National Deworming Program to scale up treatment over a five-year period to over 20 million school aged children. This was done in collaboration with the END Fund, Children’s Investment Fund Foundation, the Schistosomiasis Control Initiative Foundation and the United Kingdom’s Foreign, Commonwealth & Development Office, among others.
Since the commencement of the program, annual and/or biannual treatment, depending on the disease and its prevalence, was conducted throughout the country. Although the rates of preventive chemotherapy (PCT) coverage against schistosomiasis have been increasing among children, Ethiopia is still yet to reach the 75% needed for optimal effectiveness nationally (including adults) whereby schistosomiasis could be eliminated as a public health problem. Nonetheless, 2018 marked a milestone for Ethiopia. The country surpassed the 75% target level for PCT coverage against soil transmitted helminths among school-age children . Despite the progress made, there is more work needed to be done so that Ethiopia is on track to achieve World Health Organization (WHO) 2030 NTD targets, which also leads to a reduction in the number of school children affected by NTDs.
From 2015-2020, over 100 million treatments were distributed to school age children. A group of schools that were continuously monitored through data collection and analysis to compare and demonstrate the change in prevalence (the number of children infected) and the intensity of infection of those children (how serious of an infection a sick child is harboring due to the parasite), suggests that the program is on track to reduce morbidity resulting from STH and SCH in school-age children. This is encouraging as it could mean reduced infection among children, and could “shrink the map” for these parasitic diseases and result in reduced treatment needs moving forward.
COVID-19 and Additional Support
When the COVID-19 pandemic began, NTD programming – community and school mass drug administrations, training for health care workers, and community-based surveys – was paused in line with interim guidance from the World Health Organization (WHO) in order to prioritize the wellness of health workers and community members as well as to prevent further spread of COVID-19 in the community. The national government and other stakeholders, quickly pivoted to support COVID-19 prevention methods. National coordination mechanisms established by the government on WASH and NTDs at the national and regional levels provided a platform to build on for a coordinated approach. One example of this is a partnership between the END Fund and NALA Foundation to install hand washing stations with clean soap and water and community information on hygiene and disease prevention, a benefit to not only prevent COVID-19 transmission but also schistosomiasis and soil-transmitted helminths transmission. This type of engagement is supported by the national framework to guide the ongoing integration of WASH and NTDs.
With COVID-19 numbers reducing and safety protocols in place, mass drug administration campaigns safely began to resume in late 2020. Tools developed by WHO and partners guided the delivery of NTD treatments in a manner that incorporated social distancing, safe hygiene practices, and facemasks and/or coverings. At this time, the Federal Ministry of Health and Regional Health Bureaus conducted the second round of MDA in the fifth and final year of its current national deworming program targeting 11.4 million school-age children and 5.1 million adolescents throughout the country.
The Future Ambition of the National Deworming Program
Following the second annual World NTD Day, we reflect on the successes achieved by the Ethiopia National Deworming Program, one of the largest at-risk school-age populations in the world for parasitic worms. Through the leadership and commitment of the Federal Ministry of Health, millions of children are dewormed annually and a new, ambitious goal is set to expand the program to all populations in need of treatment to accelerate the elimination of these parasites. A recently formed partnership between the ministry, WHO, Johnson & Johnson and the END Fund’s Deworming Innovation Fund will provide an additional donation of VERMOX® Chewable (mebendazole 500mg) for the benefit of expanded community treatment.
Undoubtedly, many strides have been made in Ethiopia’s effort to control and eliminate several NTDs as public health problems and it is due to strong partnerships and collaboration between government, UN agencies, civil society, academia, donors and the private sector. These partnerships will continue to be required as the program enters a new era to maintain the gains and further expand to ensure no one is left behind. In the case of Ethiopia, the program is committed to utilize and follow the WHO 2030 NTD roadmap to strengthen cross-sectoral partnerships and test innovative approaches to accelerate the elimination of schistosomiasis and soil-transmitted helminths, among other NTDs.
 Ethiopia NTD Master Plan 2016-2020
 The Economist Intelligence Unit Report. Breaking The Cycle of Neglect
This is great. School Readiness Initiative(SRI ), a nonprofit NGO used to deworm preschool children until 2019 when health Bureaus in Addis and 4 other regions told us that the bureaus would carry out the deworming. That was was amazing to me. I was soo happy to realize that the health care system realized the significance of the problem and started taking action.