Worms could mess up your child’s performance

By Wachira Kigotho"If a lizard lies flat on its back, then someone knows it has a bellyache" the late Prof Olawale Rotimi, the Nigerian social critic who explained societal issues through Yoruba traditional wisdom, used to tell his students at Obafemi Awolowo University.Ironically, that seemed to be the case of James Omuse – not his real name – a boy, 12, at Sio Port Primary School in Busia whose teachers were worried his academic progress had hit rock bottom. Four years down the line, the boy had become anaemic, stunted and lethargic. Subsequently, he had lost interest in school.According to his teachers, Omuse had developed a potbelly that his spider legs seemed hard to support. The once exuberant boy had lost weight and he frequently suffered from diarrhoea and listlessness, conditions that forced him to be absent from school.Examined by clinical officers from the Kenya Primary School Deworming Programme, Omuse was diagnosed with multiple parasitic intestinal worms that included hookworms, whipworms and roundworms. He was one of the 30,000 pupils in 75 schools in Busia that were treated of intestinal worms in a pilot programme that is now viewed as a success story that could be replicated elsewhere in sub-Saharan Africa.Recently, World Bank panel of experts attending a conference in Washington on school-based deworming in developing countries, revisited outcomes of the programme that was sponsored by the International Child Support Africa. According to Michael Kremer, Gates Professor of Developing Societies at the Department of Economics in Harvard University, the Kenyan initiative reduced school absenteeism in Busia by 25 per cent.Kremer, who was the team leader in the Busia pilot programme, told the meeting there is new evidence on long run benefits of deworming beyond reducing absenteeism. "In addition to improving school participation, deworming can reduce class repetition and above all increase test scores and other learning outcomes," said Kremer.The emerging evidence is that sick children are not ready to learn. Intestinal worms in children cause anaemia, stunted growth, lethargy, impaired cognitive development, poor short-term memory and low school attendance. Prone areas"Long term worm infections can lead to an average intelligence quotient (IQ) loss of 3.75 points per child," says World Bank Education Specialist Tara O’Connell.For decades, educational researchers had been fully aware of social benefits that could be accrued by healthier children, who are able to make better use of schooling, but they were divided on the way forward on how to reduce worm burdens among pupils.The problem is that globally one in four people are infected by one of the four main intestinal worms that comprise bilharzias, hookworms, roundworms and whipworms. However, the situation is worse in sub-Saharan Africa, South East Asia and peri-urban slums, where infection is on average higher than in other areas. According to the World Health Organisation’s Department of Neglected Tropical Diseases, more than 80 million people in sub-Saharan Africa alone are infected by bilharzias. Locally, studies carried by the Kenya Medical Research Institute indicate worm infections are higher in coastal and lake regions and in slums of Nairobi.Basically, parasitic intestinal worms are transmitted by eggs excreted in human faeces and urine, which contaminate the soil or water sources in areas with poor sanitation. Subsequently, most school going-age children are at risk, but whereas only in rare instances that intestinal invaders cause death, the infection is chronic and can affect a child’s health, cognitive development, learning access, educational access and achievement.In Kenya, as elsewhere in sub-Saharan Africa, school children have some of the highest intensity of worm infections of any age group, consequently, raising concerns about pupils’ academic performance in areas that are heavily contaminated.Granted that worm infections have capacity to limit pupils’ ability to concentrate and learn in school, few children and their parents consider the problem as a significant barrier to education. "Even then, only until recently few educational experts would have mentioned worms as key barriers to education," says Abdul Latif Jameel of Department of Economics at the Massachusetts Institute of Technology.Using data collected from the Kenyan pilot programme that has finally been integrated into the national education strategy, World Bank has plans to popularise deworming of school children and other groups at risk in other developing countries. So far, the programme has been replicated in India where 35 million children have been treated of intestinal parasites. Other countries that are replicating the programme with assistance from WB are Gambia, Liberia and Sierra Leone.Mass dewormingLesley Drake, the Executive Director of ‘Deworm the World’, an initiative of WB, says more than 400 million children in developing countries are chronically infected with intestinal worms. "The challenge facing us is to mount mass deworming of school-age children to achieve learning for all," WB Education Director Elizabeth King told the panel of experts.However, the beauty of the initiative is that treatment is cheap and schools are centrally placed to enable delivery of those services. Linking deworming with education has been identified by WHO as the only sustainable way to expand coverage and reach more than 75 per cent of all the children in most affected countries.Experts estimate one dose of albendazole, the common deworming drug of choice, can be used to treat a child every year. But for now, many children are symbolically still lying flat on their backs and their parents are not even aware why their children’s academic performance has dropped or why those children are keen to stay away from school. If Prof Rotimi was still around, probably he would be asking, "For how long must feverish birds tremble in silence before their keepers?"

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