*Dr. Vandana Jatav
India is observing its third National Deworming Day today. It is the world’s largest deworming programme covering 340 million children under-19 years of age across 36 states/ UTs. The deworming programme is India’s commitment to a comprehensive national response to the public health threat posed by worms.
India carries the highest burden of worm infestation and 64 per cent of Indian population less than 14 years of age are at risk of Soil Transmitted Helminths (STH) or worms’ infestation (WHO). Soil Transmitted Helminths (STH) interfere with nutrients uptake in children; can lead to anaemia, malnourishment and impaired mental and physical development. The situation of undernutrition and anaemia which is linked to STH ranges from 40 per cent to 70 per cent in different population groups across the country (WHO). They also pose a serious threat to children’s education and productivity later in life.
Assessing the problem:
To assess the exact burden of STH or worms in India, Ministry of Health & Family Welfare has appointed National Centre for Disease Control (NCDC) as a nodal agency to conduct nationwide STH mapping. NCDC in partnership with other agencies has done STH mapping across the country. The data show varied prevalence range from 85% in Tamil Nadu to 12.5 % in Madhya Pradesh during 2015. The brief State wise detail of prevalence is as follows:-
|> 50% (14 States-High Prevalence)||Arunachal Pradesh, Assam, Chhattisgarh, Dadra & Nagar Haveli, Daman & Diu, J&K, Lakhsadweep, Mizoram, Nagaland, Sikkim, Tamil Nadu, Telangana, UP and Uttarakhand|
|20% – 50 % (19 States-Moderate Prevalence)||A&N , Andhra Pradesh, Bihar, Delhi, Goa, Gujarat, Haryana, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Maharashtra, Manipur, Meghalaya, Odisha, Puducherry, Punjab, West Bengal and Tripura|
|< 20% (2 States-Low Prevalence)||Madhya Pradesh and Rajasthan|
In 2015, the MoHFW created a technical expert group to advice on frequency of deworming based on the STH prevalence data. The expert group suggested implementing bi-annual round of deworming in the States where prevalence of STH infection is more than 20% and annual round in other (less than 20% prevalence) states. Only two States namely Rajasthan and Madhya Pradesh have reported less than 20% prevalence and recommended for annual round. All the remaining States/UTs will implement bi-annual round of deworming.
National deworming programme
To combat STH infections, government has adopted a single day strategy called NATIONAL DEWORMING DAY (NDD). The programme is being implemented through the combined efforts of Department of School Education and Literacy under Ministry of Human Resource and Development, Ministry of Women and Child Development and Ministry of Drinking Water and Sanitation.
During NDD single dose of Albendazole is administered to children from under 1 to 19 years of age group through the platforms of schools and aanganwadi centers. Albendazole is an extremely safe drug that has been used for decades by millions of people around the world and in India, with no or minimal side effects. Side effects such as nausea and vomiting can manifest in the children with high worm load.
To manage adverse events, Indian Pharmacopoeia Commission (IPC) is supporting and assisting in monitoring through the robust system of Pharmacovigilance Programme of India (PvPI) which has established 210 Adverse Drug Reaction Monitoring Centres (AMCs) across the country.
The first round of NDD was observed in February 2015. The brief snapshot of previous rounds is as follows:
|NDD Round||States/UTs covered||Target (in crores)||Covered (in crores)||Coverage (Percentage)|
Building on this success, the target for February 2017 is 34 crore children under 1 to 19 years of age group. The following new initiatives have been taken for this round:
1. 7.8 crore children are targeted in private schools across the country for the first time.
2. 4.3 crore out of school children will be covered through aanganwadi workers and ASHAs.
3.MOHFW has developed NDD app for quick and better data collection.
Community mobilisation and awareness
For Community Mobilisation and Awareness, the Child Health Division has provided a package of updated materials and guidelines on its usage for different levels of the cascade to the States/UTs. (Soft copy uploaded on the website (http://www.nrhm.gov.in/). This contains NDD operational and financial guidelines; NDD brief note; NDD training toolkit; NDD IEC toolkit; letters; timelines; reporting forms; monitoring forms etc.
In order to monitor and supervise the implementation of NDD program at the field level, National monitors have been deputed for the States/UTs. They will visit the States on the date of implementation of NDD.
National deworming DAY is a commendable step that will go a long way in ensuring healthy India. On India’s glorious record sheet of eradicating Polio, Guinea worm, Small pox, Maternal and neonatal tetanus, this may become yet another entry. Together as a nation we have an obligation to put sunshine into the lives of our little ones. They deserve all that life can offer. This can be best expressed in these words:
“ghar se masjid hai bahut duur chalo yuuñ kar leñ
kisī rote hue bachche ko hañsāyā jaa.e”
* Author is an Indian Information Service Officer.