National Deworming Day 2016 Fact Sheet

What is National Deworming Day?

The Ministry of Health and Family Welfare (MoHFW) Government of India is implementing the National Deworming Day in schools and preschools (anganwadis) across India on 10 February 2016.

To combat parasitic worm infections among preschool (anganwadi) and school-age children, albendezole 400 mg chewable tablets will be administered to children at government, government-aided, and private schools, and anganwadis. Out-of-school children will be administered the deworming tablet at anganwadis.

The National Deworming Day will be followed by a mop-up day on February 15, 2016 to administer the deworming tablet to children who were absent from the school or anganwadi on 10 February.

What is the goal of National Deworming Day?

The goal of National Deworming Day is to deworm all preschool and school-age children between the ages of 1-19 years at schools and anganwadi centres in order to improve their overall health, nutritional status, cognitive development, and quality of life.

Why do children need deworming?

Worm infections interfere with nutrient uptake; can lead to anemia, malnourishment and impaired mental and physical development; and pose a serious threat to children’s health, education, and productivity. Infected children are often too sick or tired to concentrate at school, or to attend at all. Treatment with a deworming tablet is universally recognized as a safe and cost-effective solution. School-based deworming programs leverage the existing and extensive infrastructure of schools and the documented importance of convenience in achieving high take-up of preventive healthcare.

Why do we need a deworming program in India?

WHO indicates that India has the highest burden of soil-transmitted helminths (STH) in the world, with 220 million children aged 1-14 estimated to be at risk of worm infections[1]. Almost 7 in 10 children between 6 month and 5 years are anaemic, with even higher rates of anaemia in rural areas, according to the 2006 National Family Health Survey.

There are at least two randomized trials in India in the last decade that demonstrate the positive impact of deworming in the country. A health intervention that provided iron, Vitamin A, and deworming drugs to Indian preschool children in the slums of Delhi found a significant gain in children’s weight and school participation compared to intervention with Vitamin A alone. Absenteeism was reduced by one-fifth in the treatment group (Bobonis et al, 2006). A cluster-randomized controlled trial found children aged 1-5 that were treated with five rounds of the deworming drug, resulted in a greater weight gain compared to non-treated groups (Awasthi S. et al 2008).

Who is organizing National Deworming Day?

National Deworming Day is led by the Ministry of Health and Family Welfare (MoHFW). The Department of School Education and Literacy under the Ministry of Human Resource Development and the Ministry of Women and Child Development collaborate to implement the National Deworming Day. Other key stakeholders are: the Ministries of Panchayati Raj, Drinking Water and Sanitation, Tribal Affairs, Rural Development, and Urban Development.

WHO, National Centre for Disease Control, and Evidence Action’s Deworm the World Initiative are the technical assistance partners to the Ministry of Health and Family Welfare, Government of India.

What are the ages of children treated on National Deworming Day?

All children in the age-group of 1-19 are treated. Children aged 1-5 are administered the tablet at the anganwadi. Children aged 6-19 are given the tablet in their school. Children who are unregistered at anganwadis and out-of-school children are also included in this program and will receive the tablet at the anganwadi.

What dosage of the deworming tablet do children receive?

Children aged 1-2 are given half a tablet of albendazole (400mg), crushed and mixed in drinking water. Children above the age of 2 are given 1 full tablet of albendazole (400mg) to chew. The tablet should always be administered under supervision.

Does the deworming treatment have side effects?

The health and safety of children is of utmost importance. Albendazole, the tablet used for deworming, has been used widely for decades all around the world. It is very safe and has very few side effects. When side effects occur, they are typically a sign of high infection (which makes taking the treatment all the more important). Side effects are mild (like nausea and diarrhea) and pass quickly.

All stakeholders involved take the health and well-being of children very seriously. As with any mass public health effort, there are stringent ‘adverse event protocol’ put in place. All involved - teachers, anganwadi workers, ASHAs, and other officials - are informed about what protocol to follow and who to report to in the unlikely event that a child falls ill. Teachers, anganwadi workers, and other officials received training and educational materials on all aspects of the deworming program.

What are Soil-Transmitted Helminths (STHs)?

Parasitic worms, or Soil-Transmitted Helminths (STH), are among the most common infections worldwide. The World Health Organization (WHO) estimates that 220 million children between the ages of 1 and 14 are at risk of STH infection in India.

Soil-Transmitted Helminths live in human intestines and consume nutrients meant for the human body. They produce thousands of eggs each day, which are passed in faeces and spread to others by contaminating soil in areas where open defecation is common and sanitation is poor.

Key Highlights of National Deworming Day 2015

● The Government of India launched phase 1 of the National Deworming Day in 2015. The National Deworming Day was implemented in 10 states and 1 union territory: Assam, Bihar, Chhattisgarh, Haryana, Rajasthan, Karnataka, Madhya Pradesh, Maharashtra, Tamil Nadu, Tripura, and Dadra and Nagar Haveli.

● During National Deworming Day 2015, 89 million children were dewormed in 4.70 lakh schools and 3.67 lakh anganwadi centres.

● More than 9.49 lakh frontline functionaries from the Department of Health and Family Welfare and Department of School Education and Literacy were trained as part of the program. 46% were school teachers/headmasters, 33% were anganwadi workers, and 21% were ASHAs.

Soil-transmitted helminth (STH) infections are among the most common infections worldwide and aect the poorest and most deprived communities. They are transmitted by eggs present in human faeces, which in turn contaminate soil in areas where sanitation is poor.

Several studies show the detrimental eects of STH on children’s educational performance and school attendance. Children with the highest intensity of STH infestation are often too sick or too tired to concentrate at school or attend school at all. STHs interfere with nutrient uptake in children; can lead to anaemia, malnourishment and impaired mental and physical development. Rigorous research has shown that they also pose a serious threat to children’s education and productivity later in life.

In areas where parasitic worms are endemic, administering safe, eective deworming drugs to children at schools and is a development “best buy” due to its impact on educational and economic outcomes and low cost. The evidence shows that mass deworming leads to significant improvement in outcomes related to education, earnings, and long-term well-being.*

NATIONAL DEWORMING DAY

India has the highest burden of STH in the world, with 241 million children at risk of parasitic worm infections. Under-nutrition and anaemia in children has been well documented in India: almost 7 in 10 children in the 6-59 months age-group are anaemic, with even higher rates of anaemia in rural areas.

To combat this situation, in February 2015, the Ministry of Health and Family Welfare (MoHFW) Government of India launched the National Deworming Day (NDD) as part of National Health Mission. NDD aims to deworm all children between the ages of 1-19 years through Government, Government-aided and private schools, and centres in order to improve their overall well-being, nutritional status, access to education and quality of life. Under this program, all school teachers and workers are provided training and resource material to eectively administer the deworming drug (Albendazole tablets) at school and centres.

The NDD has emerged as the world’s largest public health campaign for treatment of intestinal parasitic worms. After the unprecedented coverage of NDD with national coverage of more than 89 million children, the MoHFW mandated the observation of the NDD at pan-India level on 10 February 2016. The NDD will be followed by a mop-up day on 15 February to cover children who might be left out earlier due to sickness or absenteeism, and will ensure maximum coverage with optimal utilisation of resources. In addition, the fixed day strategy will prioritise deworming within and school health programs, increase awareness, and standardize campaign messages across the country.

STAKEHOLDERS
The Ministry of Health and Family Welfare, Government of India is the nodal agency for providing all States and UTs with operational guidelines related to NDD, with the Department of School Education and Literacy under the Ministry of Human Resource Development and Ministry of Women and Child Development (ICDS) as the key stakeholders for NDD implementation. Other key stakeholders are Ministries of Panchayati Raj, Tribal Welfare, Rural Development, Urban Development, Drinking Water and Sanitation. WHO, National Centre for Disease Control and Evidence Action's Deworm the World Initiative are the technical assistance partners to MoHFW, Government of India.

IMPLEMENTING NATIONAL DEWORMING DAY
Key components to implement a successful NDD include drug procurement and management, adverse event management systems, monitoring and supervision plan, and recording and reporting processes. Strategies have been put into place to ensure that these components are rolled out in a streamlined and eective manner. These strategies include:

** Steering Committee Meetings at States and Districts prior to NDD
** A robust integrated distribution of drugs, IEC, and training handouts during training at block, sector, and project level to ensure all material for the program are made available on time
** Community awareness and mobilization, with specific eorts towards ASHA engagement to include out-of-school children into the program
** Adverse Event Management protocols that provide clear instructions on the management of adverse events
** A monitoring and reporting cascade to ensure that NDD is being implemented as planned and to assess whether desired resulted are being achieved.