The lasting impact of deworming

Evidence for a ‘best buy in development’ gets even better

Deworming programmes are often considered to be one of the ‘best buys in development’. This is because the sustainable benefits they produce in developing countries significantly outweigh the financial investment required. In the case of programmes supported by SCI Foundation (SCIF), the investment is as little as £0.33 per child per year on average.

A recent study published by the National Bureau of Economic Research has made the case for deworming programmes even more strongly. A team of development economists including Edward Miguel and Nobel prize winner Michael Kremer found that children who received continued treatment against common helminth (worm) infections have better standards of living and greater work opportunities as adults compared to those who received fewer treatments.

The study followed groups of Kenyans who received deworming treatment in schools as children and evaluated their standards of living over a 20-year period. They found that, as adults, children from schools that had received additional treatment rounds (average of 2.41 years) have “an increase of 14% in consumption expenditure, 13% in hourly earnings, 9% in non-agricultural work hours, and are 9% more likely to live in urban areas”. Overall, the authors conservatively estimate this produced a 37% rate of return on investment.

This study provides further strong evidence of a lasting economic benefit for children who receive consistent deworming treatments and shows that the impact of these programmes may reverberate long into the future.

SCI Foundation’s approach to evaluating cost effectiveness

The programmes supported by SCIF often treat common soil-transmitted helminth infections—like those that were primarily studied in the research above—as well as schistosomiasis.

Helminth infections can have a lasting impact on immediate and long-term health outcomes, including stunting, anaemia and lasting internal organ damage, and have an implication on an individual’s ability to grow, learn and be economically active. The fact that children routinely receive treatments to combat additional diseases may imply that the benefits of SCIF-supported programmes are even greater overall than those observed in the study.

As an organisation focused on the implementation of programmes in endemic countries, we are in a position to ensure that the findings of this kind of study are acted upon. Through our work with MoH to deliver treatments, we are ensuring children can reap the economic benefits observed in the study. SCI Foundation is at the nexus of research and its practical application in delivering deworming treatments through its: 1) evidence based approach, 2) authorship of peer reviewed publications, 3) role in shaping international guidance, and 4) routine collection of critical data.

More specifically, we are dedicated to understanding the full range of programme outcomes through its Monitoring, Evaluation, and Research (MER) work in order to validate that continual progress is being made to eliminate preventable worm infections.

To evaluate the impact of programmes beyond the epidemiological effects, SCIF’s MER team monitors programmes in terms of economy, efficiency, effectiveness, and equity as part of its approach to Value for Money (VfM). Viewing programmes through this lens allows an assessment of 1) how well resources are converted into immediate outputs and long-term outcomes and 2) how benefits are distributed within communities. Findings are used to continuously adapt programmes and improve the return on investment delivered.

Improving health, unlocking potential

Building on progress

SCI Foundation is committed to ‘improving health, unlocking potential.’ To achieve those ends and ensure gains persist, innovative and systemwide solutions are likely required.

SCIF contributes to and supports initiatives that promote a holistic approach to addressing preventable worm infections. This includes water, sanitation and hygiene (WASH), behaviour change, and partnerships with those working to treat co-endemic diseases. Collaborative work in these cross-cutting areas builds on the foundation established by regular treatment to reduce the underlying conditions that exacerbate the problem of worm infections. SCIF’s contributions to intersectoral solutions further widen its impact.

The way forward in turbulent times

Treatment works. It is very cost effective. The benefits are far reaching and enduring. But treatment must be consistently delivered and accompanied by efforts to reduce transmission and improve programme delivery for these benefits to be sustained.

This new research underscores the importance of sustaining regular treatment frequencies over time. However, the COVID-19 pandemic presents significant challenges to ensuring this happens. Distribution methods, safety protocols, resource requirements (e.g. personal protective equipment), etc. must all be adapted to safely deliver treatments while the pandemic is ongoing. Partnerships and progress in cross cutting areas cannot be lost. Commitment to deworming must remain steady if we are to sow the seeds for future prosperity in the lives of the children we serve.