Got Worms? The High Cost of Neglecting Parasitic Infections in Ecuador

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If asked which parasitic disease were responsible for the greatest burden of morbidity, the majority of us would likely respond with HIV or perhaps malaria. In actuality, the biggest cause of Disability-Adjusted Life Years (DALYs) are due to what health expert Dr. Peter Hotez refers to as “the unholy trinity”: RoundwormWhipworm, and Hookworm. Collectively, these worms are known as “Soil-Transmitted Helminths” or STHs. Current data show that up to 35% of people in the Amazon region are chronically infected by STHs (up to 75% in some villages!), many of them children. STH infection can be especially pernicious in the young, due the detrimental effects of parasitic burden – chiefly anemia – which result in reduced cognitive and physical function and compromised academic performance. Moreover, these infections trend highly with impoverished and underprivileged populations.

Fortunately, there exist clear and cost-effective interventions for STH infections. Mass Drug Administration (MDA) with anti-helminthic medications remains the gold standard, is cheap to implement, and has a proven track record of effectiveness in numerous countries. In order to complete a successful intervention in Ecuador, it will be necessary to engage stakeholders at all levels of involvement. Organizations like the Bill and Melinda Gates Foundation and the Sabin Institute can provide required funding and strategic planning, with branches devoted entirely to neglected tropical diseases. PAHO can also help with active implementation of deworming efforts, but interventions will require cooperation from indigenous nations (CONFENIAE) and Ecuador’s Ministry of Health. By strategically combining the resources and aims of these key stakeholders, a successful deworming campaign could finally end the vicious cycle of helminth infection that disproportionately affects the impoverished young and perpetuates their socioeconomic handicap.

"The Unholy Trinity"

Details about the infection with STH.

By Paola Santacruz, Justin Price

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7 Responses to “Got Worms? The High Cost of Neglecting Parasitic Infections in Ecuador”

  1. jacquelinewoodrum Says:

    The Sabin Institute link connects to a highly informative page! I actually spent a lot of time maneuvering on this link ; good choice. However, the PAHO link in Spanish is meaningless if the reader isn’t fluent in that language.

  2. drnsacharya Says:

    I think you have hit the nail on the head here. Considering that the cost per person for control is so low, it is remarkable that mass drug administration on a periodic basis is not carried out. In fact GSK would probably give it out for free as it does in nearly 50 countries already. It is time the powers that be stop neglecting these worms which while not life threatening, steal the nation’s future by compromising the mental and physical growth of its next generation.

  3. karinswihart Says:

    You have helped influence my thinking! While knowing the prevalence of ‘the unholy trinity,’ I never put together the greater impact these have on development. Thanks so much for your article.

    I also appreciated your CDC graph of the culprits. I wonder what the recurrence of the worms would be and how that would influence the treatment of them as well as how the Ecuadorians would respond to treatment. In my work with malaria, with it being a part of life, the Ugandans didn’t always get help or use their nets religiously.

  4. menchen2014 Says:

    Great job! The posting is very concise and concentrated. The graph specially presented clear epidemiological characteristics of STH infections.

    CDC showed a heavy disease burden of STHs in Amazon region. However, according to Pullan. R., the Global Burden of Disease Study 2010 showed that the vast majority of STH infections (67%) and YLDs (68%) occurred in Asia.

    I agree that MDA with financial and policy support nationally and internationally should be the gold standard for STH prevention. However, globally, although substantive effort made on STH control contributed to substantial declines in some regions, the general infection level over the past twenty years have remained unacceptably high. Meanwhile, Brooker S said that quality data on infection prevalence of some regions are still notably lackig.

    Thus, a better understanding of STH distribution and burden are highly required. Researches showed that improvement in the cartography of helminth infection, combined with mathematical modeling approaches could be contemporary estimator of burden of STH.

  5. margaretkuder Says:

    Well-written post! Very informative and very clear outline of a possible policy that could lead to a solution. My question is about the distribution of the medication when its available. I worked with an organization in Honduras that distributed albendazole and mebendazole yearly to community members. It can often be difficult to get full adherence to treatment, even if it is just one pill once or twice a year. I would be interested to learn more about how successful organizations are in implementing de-worming efforts in these areas in terms of treatment adherence.

  6. rachellcurrie Says:

    This post inspired me to look further into STH and mass drug administration, so thanks for alerting me to the issue. I’m glad to learn that the Bill and Melinda Gates Foundation also works on other parasitic infections beyond malaria.

    However, I found conflicting reports on the effectiveness of mass treatment in terms of impacting the health and productivity of the population. From this synopsis from Give Well, it sounds like the study that concluded mass treatment to children increased their productivity was done in the southern US and other deworming tactics were used: http://www.givewell.org/international/technical/programs/deworming. Therefore, this tactic might have to be used in combination with other measures to achieve the desired elimination of the infections.

  7. jayabhat123 Says:

    Very well presented Paola and Justine.
    I agree with others that u made all your efforts to provide a clear and concise information. We almost always focus on HIV and Malaria and these parasites are neglected. You have raised a great policy issue that is of low cost, achievable and have greater success.
    I was just wondering, what efforts are being taken to create public awareness? How well are they educated regarding the spread, impact and the information of available solution? what is the adherence rate in countries where this policy has already been implemented? Are there any issues of drug resistance and if so how are they handled?
    Thanks again for the great post

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