School-Based Health Education Targeting Intestinal Worms—Further Support for Integrated Control

Our report, which describes success in preventing soil-transmitted helminth (STH) infections in Chinese schoolchildren through the use of a health education package that includes a 12-minute cartoon, ‘‘The Magic Glasses,’’ may thus prove timely. The results from the cluster randomized intervention trial, conducted in 38 rural Chinese schools and involving 1,718 children, showed that the videobased health education package had 50% efficacy in preventing new STH infections after treatment [2]. This study established proof of principle that health education can indeed increase knowledge and change behavior, resulting in fewer intestinal worm infections. However, we have a ways to go before we can show broad application, and we appreciate that these findings will require further validation in other epidemiological and cultural settings. With a third of the world’s population infected [3], STHs are the most widespread and disabling chronic infections globally and the most common of the neglected tropical diseases (NTDs). The most recent estimate (2010) of the worldwide burden of infection with STHs is 5.2 million disability-adjusted life years (DALYs) [4]. Children have the greatest risk of morbidity due to STHs [5], which have a particularly debilitating effect on their health and cognitive development, causing anemia, malnutrition, stunted growth, and learning delays [3]. Almost half of the global disease burden due to these worm infections is borne by children 5 to 14 years of age [5]. A recent study has shown that this age group can contribute up to 50% of the Ascaris lumbricoides burden in the community [6]. In 2012, the announcement of the World Health Organization (WHO) roadmap [7] galvanized public and private support in the fight against the NTDs. Major pharmaceutical companies; the Bill & Melinda Gates Foundation; the governments of the United States, United Kingdom, and United Arab Emirates; and the World Bank have announced substantial funding to accelerate the control, elimination, and possibly the eradication of the NTDs. Measures mainly include sustaining or expanding current mass drug administration (MDA) programs to meet the United Nations (UN) Millennium Development Goals by 2020 and promoting research and development of new drugs and drug targets by sharing expertise and compounds. All partners endorsed the ‘‘London Declaration on Neglected Tropical Diseases,’’ through which they pledged new levels of collaborative effort and tracking of progress in tackling ten of the 17 NTDs currently on WHO’s list [8]. The WHO strategy for STH control is to treat all preschooland school-age children and women of childbearing age living in endemic areas. Treatment frequency depends on the STH prevalence in a particular community. When the prevalence of intestinal worm infection exceeds 20%, mass treatment should be given to major risk groups once a year; two treatments per year are recommended when the prevalence is greater than 50%. In addition to MDA, WHO recommends health education and the provision of clean water and adequate sanitation to reduce reinfection [9]. Significant progress has been made in controlling STH infections over the past 10 years, with over 300 million preschoolage and school-age children dewormed in 2011 (representing 30% of all children in the world at risk of STH infection due to living in endemic areas) [10]. However, the UN Millennium Development Goal of treating 75% of school-age children at risk of STH infection by 2010 was not achieved. In the WHO roadmap to overcome the global impact of NTDs, released in January 2012, the goal for STH was reset to 75% treatment coverage for children in endemic areas by 2020 [7]. Even if this ambitious goal is achieved by 2020, concerns regarding the effectiveness and sustainability of MDA remain. The efficacy of the available drugs, albendazole and mebendazole, is high for A. lumbricoides, moderate to high for hookworm, but