School-Based Deworming 

 

Research by J-PAL affiliates Michael Kremer and Edward Miguel has shown that school-based deworming is one of the most cost-effective methods of improving school participation. The evidence from their study has helped inform the debate and has contributed to the scale up of school-based deworming to over 95 million children since 2009. Evidence Action, a nonprofit organization that scales up cost-effective and evidence-based interventions, manages and implements school-based deworming in Kenya and India through its Deworm the World Initiative.

The table below displays the cumulative number of children treated across multiple rounds of school-based deworming. It is likely that some of the same children are dewormed in subsequent years, so the total should not be interpreted as the number of unique children dewormed. However, given the potential for reinfection, each round of deworming benefits the child, regardless of whether he or she was treated in a previous year.  

School-Based Deworming
Location Partner People Reached
Andhra Pradesh, India Government of Andhra Pradesh 2.06 million 2.06
Bihar, India Government of Bihar 49.60 million 51.66
Ethiopia Save the Children USA 0.38 million 52.04
Kenya Government of Kenya Ministry of Education, Science and Technology 16.04 million 68.08
The Gambia Gambia Ministry of Education 0.27 million 68.35
Delhi, India Government of Delhi 5.03 million 73.38
Rajasthan, India Government of Rajasthan 21.66 million 95.04
95.04 million

 

The Problem

The World Health Organization (WHO) estimates that over 880 millioni school-age children are in need of treatment for intestinal worms, which are transmitted through contact with contaminated water or soil. Worms reduce the absorption of nutrients in the body and cause internal bleeding, leading to anemia and malnutrition. As a result, children are often either too sick or too tired to attend school or concentrate in class. However, intestinal worms are so widespread that infections are often not even recognized as a medical problem.

Evaluation

IIn 1998 J-PAL affiliates Michael Kremer and Edward Miguel evaluated the Primary School Deworming Project in Kenya. This program provided medical treatment for soil-transmitted intestinal worms and schistosomiasis, as well as preventive health education to children in 75 primary schools in rural Busia, Kenya. At a cost of less than 50 cents per child per year, school-based deworming reduced serious worm infections by half and reduced school absenteeism by 25 percent. For more about this project, see the related evaluation page and the cost-effectiveness page

Informing the Debate

Given the strength of this evidence, school-based deworming has become an education policy priority. The WHO argues that school-based deworming is a strategy to help meet the Millennium Development Goals, including the achievement of universal primary education.ii School-based deworming is also recognized by the Global Partnership for Education as a significant contributor to achieving its goal of improving student enrollment and the quality of education. In Partnership countries where worms are a problem, school-based deworming is included in national education plans and these countries are eligible to receive financial support to address this issue.iii

In 2007, Michael Kremer presented evidence on the value of school-based deworming to the Young Global Leaders (YGL) Education Task Force at the World Economic Forum in Davos, Switzerland, which led to the launch of Deworm the World (DtW). DtW was incubated by Innovations for Poverty Action and is now led by Evidence Action. Evidence Action translates evidence into large-scale programs by providing technical assistance to launch, strengthen, and sustain school-based deworming programs and by advocating for school-based deworming to policymakers. For more about this initiative, visit www.evidenceaction.org.

Scaled-Up Programs 

Deworming programs scaled up by Evidence Action, local implementing partners, and other related organizations have reached over 95 million children across many countries, including the following:

KENYA

Kenya’s National School-Based Deworming Program was initiated in 2009, following an announcement by then-Prime Minister Odinga at the World Economic Forum Annual Meeting in Davos, Switzerland. In 2012, it expanded to a nationwide program aimed at treating all at-risk Kenyan children each year for at least five years. The program is implemented by the Ministry of Education, Science, and Technology and the Ministry of Health. With support of Evidence Action’s Deworm the World Initiative, the Government of Kenya successfully reached 5.9 million pre-school and school-age children in 2012 and 6.4 million children in 2013, surpassing targets by 18% and 12% respectively. Technical and operational assistance to the program will continue through 2017.

INDIA

Andhra Pradesh: In 2009, the Government of Andhra Pradesh piloted a school-based deworming program in six districts, resulting in the deworming of over 2 million children across 21,000 schools. The success of the initial pilot was key in setting the stage for a statewide scale up. DtW provided technical assistance to support the launch and scale up of the program, beginning with the development of a comprehensive school health policy that featured deworming as its flagship program. The Andhra Pradesh School-based Deworming Program is led by the Department of Health, Medical & Family Welfare, Department of Sarva Shiksha Abhiyan (Education for All), and the Department of Education.

Bihar: In 2009, J-PAL initiated a dialogue with the Government of Bihar, which culminated in a conference where J-PAL shared evidence on school-based deworming and other promising programs. Following these discussions, the Government of Bihar launched a state-wide deworming campaign in February-April 2011, which reached 17 million children.  The second round of the Bihar School-Based Mass Deworming Program was held in September 2012, and 16.3 million of the targeted 20 million school-age children in Bihar were treated across 69,376 government schools. Half a million of the treated children are un-enrolled, a population that is typically more difficult to reach. In the third round of the program conducted in January 2014, 85% of target age group children corresponding to 16.2 million children in the state were successfully dewormed. This included 736,000 non- enrolled children.

The Bihar program remains the largest school-based deworming program in the world to date and owes its continued success to a robust partnership between the Government of Bihar’s State Health Society Bihar (SHSB) and Bihar Education Project Council (BEPC) supported by Evidence Action’s Deworm the World Initiative.

Delhi: Delhi has completed two successful rounds of mass deworming through schools and anganwadis (pre-schools) in February 2012 and October 2013 with technical assistance from Evidence Action’s Deworm the World Initiative. The first round reached 2.65 million children across 2400 schools and 8200 anganwadis, or 73% of all children in Delhi. The second round reached 2.38 million children. Deworming in Delhi is implemented through the Weekly Iron and Folic Acid Supplement (WIFS) Program in collaboration with Government of Delhi (Department of Health and Family Welfare (DHFW), Department of Education, Department of Women and Child Development (WCD), Municipal Corporation of Delhi (MCD), the New Delhi Municipal Corporation (NDMC), the Cantonment Board of Delhi) and Deworm the World Initiative as a technical assistance partner.

Rajasthan: With support of Evidence Action’s Deworm the World Initiative, the state of Rajasthan launched a state-wide anganwadi and school-based deworming program in October 2012. The first round reached 10.8 million school-age and pre-school age children through 79,000 schools and 59,000 anganwadis.  The Government of Rajasthan’s Departments of Education, Medical Health and Family Welfare, and Women and Child Development, with DtWI and UNICEF, jointly implemented this program, which provided a second round of treatment in October 2013, reaching 10.8 million children.

 

[i] http://www.who.int/intestinal_worms/more/en/

[ii] WHO, Millennium Development Goals, “The Evidence is in: Deworming Helps Meet the Millennium Development Goals,” 2005. http://whqlibdoc.who.int/hq/2005/WHO_CDS_CPE_PVC_2005.12.pdf

[iii] “Education for All, Fast Track Initiative Newsletter,” Vol.1:3 March 13, 2009. http://www.educationfasttrack.org/media/library/Final_EFA_FTI_newsletter...