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9 May 2022
For the past few years, the ‘Worms Wars’ have taken centre stage in a heated policy debate over the effectiveness of mass-treatment for parasitic worm infections, specifically soil-transmitted helminths and schistosomiasis.
A health worker administers Praziquantel to a young girl in Democratic Republic of Congo. © SCI Foundation / Yao Armel Kouassi
A key question is whether consistent mass deworming of school-age children, in areas of high infection prevalence, is truly cost-effective and has a long-term impact on treated children and communities. The answer is yes. Evidence shows that supporting mass deworming programmes in low-income countries is one of the ‘best buys’ in human development. The sustainable benefits these programmes generate are much greater than the financial support they require.
A 2021 study by a team of development economists, including Nobel prize winner Michael Kremer, found that deworming treatments improved school participation in children and that some effects persisted into adulthood. Moreover, they found that individuals who received two to three additional years of deworming in childhood benefit from “an increase of 14% in consumer spending, 13% in hourly earnings, 9% in non-agricultural work hours, and are 9% more likely to live in urban areas”. The researchers suggest that mass deworming has an overall societal benefit by producing an estimated 37% rate of return on investment.
Globally, roughly two billion people are infected with parasitic worms. School-age children play a vital role in transmission and are often found to have the highest burden of disease, which relates to the number of worms they are infected with. Without treatment, infection can result in internal organ damage, malnutrition and impaired physical development.
Mebendazole, praziquantel, registers and other equipment needed for a deworming campaign in Madagascar. © SCI Foundation/END Fund/Viviane Rakotoarivony
Drugs are not expensive; in fact, treatment is cheaper than diagnosis. At SCI Foundation, we have calculated £0.33 as the average cost of treatment per child per year. Treatments are cost-effective because:
Regular and consistent treatment is critical to maintaining the benefits of deworming. However, the international aid and donor landscape has significantly challenged this requirement. Over the past several years, the overall number of donors investing in deworming initiatives has declined.
This lack of diversified funding challenges the sustainability and autonomy of programmes and risks hampering progress in reducing the burden of parasitic worm infections in marginalised communities. The Hamory et al study is therefore a powerful reminder of the detrimental impact that treatment interruptions due to funding cuts will have on children, who without treatment, may still be disadvantaged in twenty years’ time.
In Madagascar a health worker notes the name of a child, the medicine given to him and how much, according to his size. © SCI Foundation/END Fund/Viviane Rakotoarivony
Based on the UK average salary, a donation of a day’s wages could treat approximately 238 children* in countries where parasitic worms are endemic. A donation of any amount helps ensure children can live life to the fullest; hence, it is a worthwhile investment in their future earnings, growth and wellbeing.
SCIF currently supports Ministries of Health in 13 sub-Saharan African countries to deliver treatment for schistosomiasis and soil-transmitted helminth infections. Delivering programmes that are country-owned and led promotes sustainability and strengthens health systems – as highlighted recently by the World Health Organization.
SCIF’s focus on monitoring and evaluation ensures that the interventions we support continue to be cost-effective. We constantly assess the impact of programmes to inform future programming and work to increase access to treatment for those at risk, so that children in these communities can reap the economic benefits observed in the Hamory et al study.
For these reasons, GiveWell, a non-profit organisation that recommends high-impact giving opportunities, has recommended SCIF as a top charity for the past decade.
The immediate, mid- and long-term benefits associated with mass deworming programmes offer evidence of the cost-effectiveness of these health interventions. But if the continuity of deworming is lost, so too is the positive impact they generate. It is therefore critical that programmes continue to serve these at-risk populations without interruption.
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*Figure based on £1 treating 3 children on average, and an average weekly UK salary of £556 based on ONS figures
By Katie Fantaguzzi, Senior MER Advisor, Operational Excellence