Honduras expands deworming coverage of children in remote communities as part of vaccination campaign

Initiative helps prevent problems in children's physical and cognitive development

A year ago, Cleotilde Acosta's four children were having problems sleeping and eating. That was before the family, who live in Santa María del Carbón in the department of Olancho, Honduras, became part of a pilot project to deworm children aged 1 to 4.

"Before they received the deworming treatment, they would wake up frightened in the middle of the night," Acosta recalls. "Now their stomachs are better, they have healthy appetites, and the ones in school are learning to read."

Acosta's children were among those in the indigenous Pech community who received deworming treatment during Vaccination Week in the Americas in April 2012. Thanks to the initiative—carried out by health workers with support from the community and municipal authorities—deworming coverage of preschool children increased 55% in San Esteban that year.

An estimated 2.6 million children aged 1 to 4 in Honduras are at risk of intestinal worms, known as geohelminths, according to 2012 data from the Pan American Health Organization/World Health Organization (PAHO/WHO). The estimate is based on the percentage of the population that lacks access to improved sanitation, one of the main risk factors for these parasites. The worms can cause loss of appetite, inattention, and anemia and can eventually can affect physical and cognitive development.

According to a 2011 national survey conducted by the Ministry of Health with technical support from PAHO/WHO, prevalence of infection in schoolchildren (5—14 years old) averaged 43.5%, and anemia averaged 19.2% in the same age group.

The deworming initiative, which was combined with other interventions to fight neglected diseases, was promoted by Honduras's Ministry of Health and the Technical Committee on Neglected Diseases, with technical and financial support from PAHO/WHO.

Gina Watson, PAHO/WHO representative in Honduras, said that the San Esteban deworming initiative shows "the importance and value-added of community work that is coordinated with the education sector." She said that integrating such actions into the country's national immunization campaign "contributes significantly to health improvement activities and the reduction of infant mortality."

During the 2013 Vaccination Week in the Americas, deworming activities were expanded to six more municipalities in four priority departments: Copán, Comayagua, Choluteca and Olancho.

At a May 13-14 meeting in Bogotá, Colombia, Honduras shared these experiences with representatives of 18 countries in the Americas that want expand integrated efforts to control parasitic infections. The goal of the meeting was to increase coordination among partners and governments to expand deworming coverage, avoid duplication of efforts, improve data quality and promote complementary actions such as ensuring access to water and sanitation.

Deworming initiatives are a priority in Honduras's national strategic plan for the prevention, management, control, and elimination of neglected diseases. Officially launched in 2012, it is the first plan in the Americas that seeks to integrate different public health interventions and engage a range of stakeholders (government, municipalities, nongovernmental organizations) in actions to eliminate neglected diseases.

The plan is supported by Honduras's Technical Committee on Neglected Diseases, whose members include representatives of the Department of Public Health Risks (Subsecretaría de Riesgos Poblacionales), neglected disease programs, and the National Public Health Laboratory. PAHO/WHO also provides support for the committee's work.

Tamara Mancero, PAHO/WHO advisor on health surveillance and disease prevention and control in Honduras, said that training provided on the design of comprehensive plans for neglected infectious diseases produced an important shift in the outlook of different disease program directors.

"They realized that it was an opportunity to support all programs. This was the case in the leprosy and leishmaniasis programs, for example, which lacked the funds and visibility of other programs that had more technical and financial resources. Solidarity and collective thinking were set in motion to work with the neediest populations."

The deworming initiative carried out as part of Honduras's national vaccination campaign was one of the first steps in the country's comprehensive strategic plan. The Ministry of Health coordinated the organization of activities, the search for partners, and training for staff. PAHO/WHO supported the ntegrated vaccination/deworming campaign by helping Honduras purchase antiparasitic drugs and develop educational materials, among other assistance. The Canadian International Development Agency (CIDA) also provided funds to support these activities.

The dedication and commitment of Honduran health workers were essential for the initiative's success. Many had to travel long distances to reach the most remote areas, and most took on additional workloads to administer the vaccines and deworming medication.

"Health workers have made an enormous effort to reach the most neglected areas," said Enma Figueroa, coordinator of the Comprehensive Child Care Program in the department of Olancho. "To get to places where there are no roads for vehicles, they came on horseback or by foot."

In Santa María del Carbón, nursing assistants of Pech origin working in the rural health center were the ones who successfully persuaded mothers such as Cleotilde Acosta about the benefits of deworming their children.

"I thank the people who have come here, because it benefits children as well as parents, because their children are healthy and alive," said Acosta. "I am willing to come any time to deworm my children, because that is a parent's responsibility."

Links

• PAHO- Honduras
• PAHO NID