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. Evidence Action, J-PAL's partner organization dedicated to bringing cost-effective and evidence-based interventions to scale, is leading the push for the scale-up of school-based deworming through its Deworm the World Initiative in partnership with Innovations for Poverty Action in Kenya and Action Foundation for Social Services in India.

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
  
Over 400 million school-aged children are infected with parasitic worms.1  Intestinal worms are so widespread that infections are often not even recognized as a medical problem. 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.

Evaluation

In 1998 J-PAL researchers 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 “preventative” 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 the incidence of infection by 25 percentage points and reduced school absenteeism by 25 percent. For more about this project, see the related evaluation page and the related cost-effectiveness page.

Informing the Debate

Given the strength of this evidence, school-based deworming has become an education policy priority. The World Health Organization (WHO) argues that school-based deworming is a strategy to help meet the Millennium Development Goals, including the achievement of universal primary education.2 School-based deworming is also now recognized by the Fast Track Initiative (FTI) as a significant contributor to the achievement of Education for All. In FTI 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.3

Deworm the World (DtW) was launched in 2007 as an initiative of the Young Global Leaders Economic Forum in Davos, Switzerland. A partnership of Innovations for Poverty Action (IPA) and the Partnership for Child Development, and sister organization to J-PAL, DtW is committed to the promotion and sustainable implementation of deworming through advocacy, program coordination and in-depth technical assistance. Well-designed health programs in schools often face the barrier of limited access to deworming tablets. DtW has coordinated the donation of deworming tablets, reaching over 13 million children in 26 countries around the world in 2009 and close to 12 million children in 2010. For more about this initiative, visit dewormtheworld.org.

The World Food Programme (WFP) announced a partnership with DtW at the World Economic Forum Annual Meeting in 2009. The WFP decided to extend school-based deworming in all of its school feeding programs in locations where parasitic worms are prevalent. This initiative increases WFP deworming coverage to treat an additional twelve countries in 2009 under their school-feeding programs.

Scaled-Up Projects

Kenya: Following discussions between the government, donors and stakeholders including DtW, Prime Minister Raila Odinga of Kenya announced a commitment to deworm 3 million children in the most at-risk areas of the country at a DtW event at the World Economic Forum’s Annual Meeting in 2009.4 The government allocated funds to the Ministry of Education to scale up a national school-based deworming program, monetarily supported through the Kenya Education Sector Support Programme (KESSP).

DtW and the London School of Hygiene and Tropical Medicine mapped the country for the prevalence of soil-transmitted helminths. The Ministry of Education, in cooperation with the Ministry of Health, coordinated training programs at the national, district, and local levels. With support from health workers, teachers were trained to administer deworming drugs, which were provided free by Feed the Children and distributed in over 8,200 schools most affected by worms. In just six months the program surpassed its goal,5  deworming 3.65 million children. Preparations are underway for the next round of deworming, expected to take place in 2012, which will include treatment for both soil-transmitted helminths and schistosomiasis.

Andhra Pradesh, India: 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, India: Evidence on the effectiveness of school-based deworming, as well as the scale-up experience from Andhra Pradesh, was presented to the Government of Bihar during J-PAL’s regional development and policy conference in January 2010. Based on discussions with J-PAL and DtW immediately following the event, the Government of Bihar agreed to conduct a massive school-based deworming campaign. The campaign was launched under the direction of the State School Health Coordination Committee (SSHCC), an inter-sectoral committee between the State Health Society Bihar (SHSB) and Bihar Education Project Council (BEPC), in collaboration with DtW.

The Bihar deworming campaign, conducted from February through April 2011, targeted all school-age children in the Indian State of Bihar, which suffers from a high rate of parasitic worm infection—exceeding 50 percent in most districts (survey by DtW). The government of Bihar reported that 17 million children received deworming treatment through a network of over 67,000 government schools statewide, making this one of the world’s largest school-based deworming campaigns to date. Based on the success of the 2011 deworming campaign, the SSHCC is actively considering implementing a second round of deworming in 2012.

1 United Nations-ECOSOC, “Children without Worms: Partnership for Treating and Preventing Intestinal Worms.” http://esango.un.org/innovationfair/?page=viewProject&nr=4.
2 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
3 “Education for All, Fast Track Initiative Newsletter,” Vol.1:3 March 13, 2009. http://www.educationfasttrack.org/media/library/Final_EFA_FTI_newsletter...
4 Kaberia, Judie, “Kenya Commits to Deworm Children,” Capital News, March 21, 2009. http://www.capitalfm.co.ke/news/newsPrint.php?newsID=3750.
5 “Young Global Leaders’ Deworming Program Reaches Millions of Children,” World Economic Forum Newsletter. http://www.weforum.org/docs/pnl/0909/WorldEconomicForumNewsletter-Septem....