The evidence is in: deworming helps meet theMillennium Development Goals
Schistosomes and soil-transmitted helminths have Today, control of these infections can be achieved through
few rivals in terms of prevalence. They occur
regular treatment with inexpensive, single-dose and
throughout the developing world, but are most
highly effective drugs so safe they can be given to all
commonly seen in the poorest communities. WHO
groups at risk. Deworming drugs are almost irresistibly
Preschool child receiving a deworming tablet in the Lao People’s Democratic Republic
and impaired cognitive function. They do so at a critical
settings is now feasible. Few other conditions, associated
time in life: infection reaches maximum intensity in the
with poverty and perpetuating poverty, can be so easily
alleviated, for a fistful of pennies per person.1
Goal 1: Eradicate extreme poverty and hunger
Deworming boosts the prospects of school-age children to earn their way out of poverty.2,3 The improvements in
intellectual development and cognition that follow deworming have been shown to have a substantial impact on
professional income later in life. Studies conducted in the USA estimated the benefits of a hookworm-free
childhood at around 45% of adult wages.4 When these estimates are applied to a developing country like Kenya,
studies show that deworming could raise per capita income from the present US$ 337 per person to approxi-
mately US$ 490 per person.4,5 In Japan, successful deworming programmes in the 1950s are considered one
reason for the country’s subsequent economic boom.6
The impact of inadequate nutrient intake is amplified by worm infections, which interfere with nutrient uptake
and are a major cause of anaemia.7,8 Malnourished children become more malnourished when infected with
worms. The effects of deworming are dramatic, as illustrated by a large study conducted in India. Six-monthly
deworming was able – within two years – to prevent 82% of the stunting that occurs without intervention;
dewormed children showed a 35% greater weight gain.9
Goal 2: Achieve universal primary education
In 2003, a report to the United States Congress on the world economic situation concluded that in developing
countries treatment of schoolchildren with deworming drugs can reduce primary school absenteeism by 25%,
leading ultimately to higher wages.10 This finding agrees with data on United States schoolchildren, which
showed a 23% drop in school attendance in children infected with hookworm.4 Moreover, when compared with
other measures for improving school attendance, deworming was ranked as by far the most cost effective.2,3
The evidence is most compelling when viewed at the global level. Of the estimated 562 million school-aged
children in the developing world, worm infections are estimated to cause around 16 million cases of mental
retardation in primary school children and 200 million years of lost primary schooling.11
Goal 3: Promote gender equality and empower women
A girl’s best head-start in life is a good education. It is also her best chance of finding employment outside the
agricultural sector. Although the gender gap in education is slowly closing in the developing world, the percent-
age of boys in schools still outnumbers that of girls. Deworming programmes, especially when associated with
other simple measures such as school meals and take-home rations, have been shown to contribute to school
The evidence is in: deworming helps meet the Millennium Development Goals
1 Savioli L et al. Schistosomiasis and soil-transmitted helminth
enrolment by girls and to improve their drop-out and retention rates. In 2000 a
infections: forging control efforts. Transactions of the Royal
pilot project in Nepali schools, involving deworming tablets, a hot noon meal and
Society of Tropical Medicine and Hygiene, 2002, 96:577–579.
2 Miguel E, Kremer M. Worms: identifying impacts on education
food gifts for girls to take home, resulted in a 43% growth in school enrolment
and health in the presence of treatment externalities (National
by girls. In addition, anaemia vanished.12
Bureau of Economic Research Working Paper, 8481, 2001).
Goals 4, 5: Reduce child mortality, improve maternal health
3 Kremer M. Randomized evaluations of educational programs in
Worm infection weakens very young children in ways that increase their
developing countries: some lessons. American Economic Re-
view Papers and Proceedings (forthcoming).
vulnerability to infectious diseases. Recent studies conducted in areas where
4 Bleakley H. Disease and development: evidence from the Ameri-
malaria is a major childhood killer show that deworming and the resulting
can South. Journal of the European Economic Association, 2003,
reductions in anaemia improve the chances of surviving severe malaria. The large
5 http://www.nationmaster.com/red/graph-B eco_gro_nat_
reductions in wasting malnutrition and anaemia that followed deworming
contributed to the survival as well as development of these children.13–15
6 Hashimoto R, Former Prime Minister, Senior Foreign Policy Advi-
Poor nutrition in general and anaemia in particular are the main underlying
sor to the Prime Minister, Japan. Keynote speech – G8 Follow-UpInternational Symposium: Hashimoto Initiative – Global parasite
causes of poor pregnancy outcomes in the developing world. By reducing
control for the 21st century meeting report 27 March 2000.
anaemia, deworming drugs – which can be safely administered during pregnancy – contribute directly to
7 Stephenson L et al. Malnutrition and parasitic helminth infec-
maternal survival.16,17 In anaemic women, the risk of dying during pregnancy or childbirth is up to 3.5 times
tions. Parasitology, 2000, 121:S23–38.
8 Crompton DWT, Nesheim MC. Nutritional impact of intestinal
higher than in non-anaemic women.18 Abundant evidence shows that regular deworming reduces anaemia in
helminthiasis during the human life cycle. Annual Review of
adolescent girls and women of childbearing age, thus preparing them for a healthier pregnancy.19 A large
study of pregnant women in Nepal has shown that women given a deworming drug (albendazole, for
Awasthi S et al. Effectiveness and cost-effectiveness of albendazolein improving nutritional status of pre-school children in urban
treatment of soil-transmitted helminths) in the second trimester of pregnancy had a lower rate of severe
slums. Indian Pediatrics, 2000, 37:19–29.
10 Annual report of the council of economic advisers. Economic
Deworming also improves birth outcome. In 1989, a large study in Guatemala involving some 15 000
report of the President. Transmitted to the Congress February2003. Washington, United States Government Printing Office,
pregnant women found a clear link between worm infection and retarded fetal growth.21 In the Nepal study,
birth weight of infants born to women receiving two doses of albendazole rose by 59 g. More important,
11 Bundy DAP et al. School health and nutrition programs. In:
infant mortality at 6 months fell by 41%.20 In Sri Lanka, a study showed that deworming during pregnancy
Disease control priorities in developing countries, 2nd ed. WorldBank and Oxford University Press, in press:chapter 61.
resulted in a 42% reduction in the proportions of stillbirths and perinatal deaths and a 52% reduction in
12 Khanal P, Walgate R. Nepal deworming programme ready to go
worldwide. Bulletin of the World Health Organization, 2002,80:423–424.
The evidence is even more compelling for schistosomiasis, which affects an estimated 10 million pregnant
13 Stoltzfus RJ et al. Effects of the Zanzibar school-based deworming
women in Africa alone. Recent studies show that half of these women suffer from anaemia.23 These figures
program on iron status of children. American Journal of Clinical
demonstrate the enormous scale of the impact that deworming can have on the survival of both pregnant
women and their babies. Fortunately, praziquantel, the drug of choice for schistosomiasis, can be safely
Stoltzfus RJ et al. Malaria, hookworms and recent fever are re-lated to anaemia and iron status indicators in 0- to 5-y old Zanzibari
given to women at any time during their pregnancy.24,25
children and these relationships change with age. Journal ofNutrition, 2000, 130:1724–1733.
Goal 6: Combat HIV/AIDS, malaria and other diseases
15 Stoltzfus RJ et al. Low dose daily iron supplementation improves
While worm infections do not cause the same high mortality as that of AIDS and malaria, they do number
iron status and appetite but not anemia, whereas quarterly anthelmin-thic treatment improves growth, appetite and anemia in Zanzibari
among the “other diseases” that impair the health, physical and mental development, and productivity of huge
preschool children. Journal of Nutrition, 2004, 134:348–356.
numbers of the poor. In so doing, they anchor large populations in poverty. Reducing worm infections and other
16 Reduction of maternal mortality (a joint WHO/UNFPA/UNICEF/
ancient companions of poverty builds the very foundation for good health and – in the spirit of the Millennium
World Bank statement). Geneva, World Health Organization, 1999.
17 Savioli L et al. Use of anthelminthic drugs during pregnancy.
Development Goals – contributes to human progress.
American Journal of Obstetrics and Gynecology, 2003, 17:29–31.
Evidence that worm infections may influence the clinical burden of AIDS and malaria is just beginning to emerge.
18 Brabin B et al. Anaemia prevention for reduction of mortality in
One recent study indicates that worm infections disrupt the immune response in ways that could hasten the
mothers and children. Transactions of the Royal Society of Tropi-cal Medicine and Hygiene, 2003, 97:36–38.
progression from HIV infection to AIDS.26 The impact of deworming on improved educational outcome also
19 Report of the WHO informal consultation on hookworm infection
contributes to the “social vaccination” against HIV infection.27 Another recent study found that malaria attacks
and anaemia in girls and women, 5–7 December 1994. Geneva,
were more frequent in persons infected with intestinal worms.28 While these studies need to be confirmed, the role
World Health Organization, 1996 (WHO/CTD/SIP/96.1).
20 Christian P et al. Antenatal anthelminthic treatment, birthweight,
of deworming in building good health during a critical period of life has been amply demonstrated.
and infant survival in rural Nepal. Lancet, 2004, 364:981–983.
21 Villar J et al. The effect on fetal growth of protozoan and helmin-
Goal 8: Develop a global partnership for development
thic infection during pregnancy. Obstetrics and Gynecology, 1989,
This goal includes a target, to be achieved in cooperation with
pharmaceutical companies, of access to affordable, essential drugs in
De Silva NR et al. Effect of mebendazole therapy during pregnancyon birth outcome. Lancet, 1999, 353:1145–1149.
developing countries. For worm infections, many studies have clearly
23 King C et al. Re-gauging the cost of chronic helminthic infec-
shown that morbidity can be significantly reduced through repeated
tion: meta-analysis of disability-related outcomes in endemic
and regular treatment with single-dose drugs delivered through school
24 Report of the WHO informal consultation on the use of praziquantel
health programmes. The drugs are safe, inexpensive and simple to
during pregnancy/lactation and albendazole/mebendazole in
administer, and thus ideally suited for mass administration.
children under 24 months, 8–9 April 2002. Geneva, World HealthOrganization, 2002 (WHO/CDS/CPE/PVC/2002.4).
Because such huge numbers are affected, the benefits of bringing
Olds GR. Administration of praziquantel to pregnant and lactating
these drugs to the masses in need is likewise huge. Systematic
women. Acta Tropica, 2003, 86:185–195.
delivery of deworming drugs in sustainable ways is a pro-poor
Healthy worm-free schoolchildren in Uganda
26 Fincham JE et al. Could control of soil-transmitted helminthic
strategy with great potential for development. That potential is
infections influence the HIV/AIDS pandemic. Acta Tropica, 2003,86:315–333.
further amplified by its suitability for integration with other mass-treatment programmes for diseases of the
27 De Walque D. How does the impact of an HIV/AIDS information
poor – onchocerciasis, lymphatic filariasis, blinding trachoma, and the foodborne trematode infections.29
campaign vary with educational attainment? Evidence from rural
As these are diseases of the poor, they frequently overlap, thriving under the conditions of poor hygiene and
Uganda. World Bank, Development Research Group, WorkingPaper No. 3289, April 2004.
sanitation seen throughout the developing world. The challenge now is to rationalize existing control
28 Spiegel A et al. Increased frequency of malaria attacks in subjects
programmes through integrated approaches that streamline delivery and bring down costs, thus allowing
co-infected by intestinal worms and Plasmodium falciparum
more of the world’s poor to benefit from essential drugs for ancient diseases.
malaria. Transactions of the Royal Society of Tropical Medicineand Hygiene, 2003, 97:198–199.
We would like to thank The Bill & Melinda Gates
29 Molyneux DH, Nantulya VM. Linking disease control programmes
Foundation for their generous financial assistance
in rural Africa: a pro-poor strategy to reach Abuja targets and
which has made this publication possible.
millennium development goals. BMJ, 2004, 328:1129–1132.
World Health Organization 2005
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15 DECEMBRE 2013. - Arrêté royal fixant la liste des prescriptions médicamenteuses pouvant être rédigées de manière autonome par les sages- femmes dans le cadre du suivi de la grossesse normale, de la pratique des accouchements eutociques et des soins aux nouveau-nés bien portants dans ou en dehors d'un hôpital PHILIPPE, Roi des Belges, A tous, présents et à venir, S
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