The Case for Maternal Postpartum Deworming

Worms and Women Infection with Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and Necator americanus and Ancylostoma duodenale (hookworms)—collectively referred to as the soiltransmitted helminths (STHs)—are among the most prevalent infections of humankind, cooccurring on all inhabited continents [1]. Those most vulnerable, who reside in endemic areas where adverse health, social, and economic conditions predominate, carry the greatest STHattributable disease burden [2]. STHs contribute to malnutrition through blood loss, iron deficiency anemia, and nutrient malabsorption [3]. STHs have been linked to impaired growth, cognitive deficits, lower educational achievement, and reduced economic productivity in adulthood [4], thus perpetuating the cycle of poverty into future generations. Periodic preventive chemotherapy (PC) with anthelminthic drugs (i.e., deworming) is the cornerstone of prevention and control measures against STH infections in highly endemic areas [2]. The World Health Organization (WHO) has recommended that PC programs target the three groups at highest risk of infection: school-aged children (SAC), preschool-aged children (pre-SAC), and women of reproductive age (WRA). The WHO Preventive Chemotherapy Databank reports on deworming coverage for SAC and pre-SAC; however, no coverage estimates are available for deworming in WRA, and few countries include this risk group among deworming activities. In fact, the disease burden of STHs in WRA is largely unknown. In sub-Saharan Africa alone, it has been estimated that almost 40 million WRA are infected with hookworm, including more than a quarter of pregnant women (26.7%) [5]. Here, we discuss the need for including WRA in large-scale national deworming programs as a means of improving their own health, the health of their children, and as a strategy to complement global strategic plans for STH control.