By Dr. Laurence Slutsker
Growing children already have a big job to do: fight disease, grow long bones and strong muscles, and build the sharp minds they’ll need to be teachers, leaders, and possibly parents someday.
Yet worldwide, many little bodies are being held back by supporting parasitic worms.
Imagine a child with two plates to fill—and only enough food for one. Intestinal worms, or helminths, are small thieves that do big harm. They sap the blood and nutrients bodies need to stay strong. They leave children too tired to learn in school and play at home. And they open the door to other diseases.
At PATH, my team, like parents and teachers worldwide, know that’s unacceptable.
The good news? Helminths can be stopped. PATH is working with countries and partners worldwide to turn up the heat on these unwelcome guests: finding the best ways to deploy the worm-fighting tools we already have, advancing new tools, and tackling the root causes of infection so that children and communities can thrive.
The sanitation connection
Soil-transmitted helminths (STHs), especially roundworm, whipworm, and hookworm, are a fact of life for billions of people—almost all of them in communities with very few resources. The World Health Organization estimates that STH infections affect 1.5 billon people—nearly a quarter of the world’s population. Globally, an estimated 880 million children are in need of treatment.
So, what is the connection between poverty and helminths? One answer is poor sanitation. It’s not easy to talk about, but worms are transmitted through human feces. In communities without reliable sanitation, eggs or larvae from infected people enter soil and water, where other people pick them up from their hands, food, or bare feet. That cycle—from soil to person to soil—keeps the infection going. Combined with limited access to medical care, poor sanitation puts billions of people at risk of STH infection: perpetuating long-standing patterns of poverty and poor health and curbing potential.
Small thieves do big harm
Helminths can be fatal, but more often, they’re patient thieves: sucking small amounts of blood and stealing nutrients for months or years. In fact, one of the most dangerous things about STH infections is that they are so commonplace. Many communities view them as unavoidable.
Yet over time, the constant drain of parasitic infection brings enormous harm—adding one more knock against people’s potential to live full and healthy lives. STH infection can cause weakness, abdominal pain, and diarrhea. Repeated and chronic infections contribute to malnutrition, which can stunt children’s growth, make them less likely to attend school, and impair their cognitive development. Infection is also one of several causes of anemia (low blood iron), which is particularly dangerous for pregnant women and newborns. Women with anemia are more vulnerable to fatal blood loss during delivery, and their babies are more likely to be born premature or underweight.
Breaking the cycle
Fortunately, country and global leaders know what it takes to stop STH infection. At PATH, we’re part of a coalition mobilizing public- and private-sector experts to overcome the barriers that stand in the way.
Treatment is our greatest ally against STH infection. Safe and effective antiworm (or anthelmintic) drugs are available, and they can usually clear most worms from the body in just one or two doses. In fact, some child nutrition programs provide both food and treatment so that, as one worker told me, “We’re feeding children, not worms.” Another proven approach is to treat every single person in a community, a method called mass drug administration or MDA. By taking worms out of every person, MDA also takes them out of the environment—breaking the cycle of transmission.
MDA and treatment have improved millions of lives, but gaps are slowing us down. First, some worms may be developing resistance to the most commonly used drugs. In addition, current diagnostic tools aren’t always sensitive enough to find the very low levels of infection left after years of MDA. That makes it hard for communities to know when to stop MDA and can leave pockets of infection. Finally, without better sanitation, it’s still too easy for worms—no matter how few—to get back into circulation, sparking resurgence.
To get ahead of resistance, PATH is leading an international public-private partnership to investigate new treatments. One exciting candidate, a protein found in nature, is thought to be so safe and effective that someday even infants and expecting mothers could use it. There is also evidence that worms are less likely to develop resistance.
In addition, PATH is advancing practical and sensitive diagnostic tools to help programs monitor low-level infection and make better decisions about MDA and other responses. We are also helping countries and communities improve water, sanitation, and hygiene by encouraging hand-washing and other healthy behaviors, developing affordable and appealing household water filters and water purification devices, raising awareness of the cost of poor sanitation, and advocating for government investment in sanitation infrastructure.
Taking a leap toward healthier futures
Global and country leaders are also paying more attention to STH infection. As a result, we’re learning that the extent of infection, and the burden on health, are much greater than we previously thought. We’re understanding the deadly connection between STH infection, malnutrition, and other infectious disease. And we’re finding new strategies to deliver treatment to the community.
No community, no pregnant woman, and especially no child should have to carry these unwelcome parasites. The hard work children’s little bodies do belongs to them.
It’s time to take parasitic worms out of childhood. Together with our partners, PATH is helping the world get closer than ever to that goal.
Dr. Laurence Slutsker is the director of the Malaria and Neglected Tropical Diseases programs at PATH and an ASTMH Councilor.
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