Faq

“Helminth” is a technical word for a type of worm. There are three species of soil-transmitted helminths (STH) that are important in terms of public health: roundworms (Ascaris lumbricoides), whipworms (Trichuris trichuria) or hookworms (Ancylostoma duodenale and Necator americanus). STH are also known simply as a common intestinal worm.

Globally, up to 1.2 billion people, of which, a third are children, are infected or at-risk of being infected with STH. The populations most at risk of infection are those living in the poorest areas of tropical and sub-tropical countries of the world, where the humidity, warm soil, and inadequate sanitation support the lifecycle of the helminth and thus, facilitate transmission.

STH infections are spread through eating food that has been contaminated by eggs in an infected person’s feces or by larvae, through penetration of the skin, particularly the feet, if shoes are not worn.

There are three critical health interventions that need to be implemented to achieve comprehensive and sustainable STH control:

• Deworming with broad-spectrum anthelminthic drugs, such as mebendazole, at appropriate intervals for a prescribed length of time to kill and prevent transmission of the worms
• Health education to promote personal and environmental hygiene to reduce the risk of re-infection in treated individuals and to prevent new infections
• Improved sanitation such as access to clean water for hand washing and safe and sanitary latrines to keep infected human excreta from the areas where people live, work and play

Mebendazole is one of a class of medicines known as anthelminthics that are used to treat numerous worm infections (roundworm, hookworm, pinworm, whipworm and threadworm). Mebendazole prevents the worm from absorbing glucose (sugar), causing it to lose energy and eventually die. The drug has been proven safe and effective and is on the WHO list of Essential Medicines. Side effects may include stomach pain or upset; diarrhea; nausea; dizziness; hair loss; headache, fever; skin rash or itching; sore throat and fever; or unusual tiredness and weakness.

Mebendazole is approved for the mass treatment of STH infections in adults and children who are at least 12 months old.

The vision of Children Without Worms is to free all the world’s children of intestinal worms so they can grow, play, learn and enrich their communities. Our mission is fourfold:

1. To reduce and control the global burden of childhood STH infections through equitable access to mebendazole
2. To be a catalyst for development of effective strategies to treat, control and prevent STH infections in order to enhance health and education
   
3. To assist communities to achieve sustainable control of STH infections
   
4. To mobilize multisectoral coalitions of partners at global, national and local levels for STH control
   

The objective of Children Without Worms is to promote comprehensive and sustainable STH control strategies by:

• Reducing the heavy worm burden and its associated morbidities, enhancing education and promoting child development
• Establishing a policy that combines mass treatment with the promotion of health behavior change
• Promoting effective partnerships for STH control

The program envisions an ultimate shift in emphasis from regular mass deworming to provision of hygiene education and increased sanitation to reduce transmission and eliminate the need for perpetual treatment.

Children Without Worms leverages the donation of mebendazole from Johnson & Johnson to promote comprehensive and sustainable control of STH that entails:

• Regular mass deworming of at-risk groups
• Hygiene education
• Environmental sanitation
  

Children Without Worms leverages the donation by:

• donating mebendazole to national STH control programs that combine treatment (i.e., regular mass deworming) with prevention (i.e., hygiene education and environmental sanitation);
• advocating and fundraising for resources to promote hygiene education and access to water and improved sanitation facilities; and 3) partnering with organizations already working in hygiene education and sanitation to ensure that donated mebendazole is distributed in a context that maximizes positive impact.

This disease impacts children hardest because it occurs at a critical period during their physical and intellectual development. Infection can cause anemia, malnutrition, increased susceptibility to other serious infections, and stunted growth. If children are not treated, the disease may lead to impaired cognitive development, reduced school attendance and performance, and ultimately, decreased productivity as adults. In severe cases, the disease can lead to death.

Children Without Worms, together with the Mebendazole Advisory Committee, partner UN agencies, and the governments of countries receiving donated mebendazole, is implementing a monitoring and evaluation plan to assess the progress and impact of the donation. This evaluation will include all aspects of the three-prong approach (i.e., regular mass deworming, hygiene education, and environmental sanitation). Lessons learned from monitoring and evaluation activities will ensure continuous improvement of the program.

Comprehensive and sustainable STH control can only be assured by promoting interventions in health and hygiene education and improved sanitation. The program leverages the donation of mebendazole to galvanize partnerships with governments, nongovernmental organizations, international development agencies, foundations and other corporations with expertise in those areas to complement the delivery of the drug.

Children Without Worms partners with governments of STH-endemic countries, nongovernmental organizations, the World Health Organization (WHO), the World Food Program (WFP) and the United Nations Children’s Fund (UNICEF). Children Without Worms also works to promote partnerships at the national and international levels to control STH infections.

The program is one of several based at The Task Force for Child Survival and Development, which is a nonprofit organization working since 1984 to improve health and human development around the world. It has a legacy of creating successful partnerships that address international and domestic health problems. The Task Force works with leaders and organizations to advance public health by creating coalitions, reaching consensus, and leveraging scarce resources. It has expertise in the areas of infectious diseases, informatics, child health and development, and injury control.

The Mebendazole Advisory Committee serves as an independent, authoritative body to advise Children Without Worms on strategic, technical and operational issues.

In February 2006, the Children Without Worms sent out a request for nominations to UN agencies and international NGOs working in STH control. While all the nominees were highly qualified, the initial six Mebendazole Advisory Committee members were selected to ensure that their areas of expertise were complementary and their geographical experiences diverse enough to mirror the global outlook of the initiative. The program has since increased the total number of members to eight to bring in additional expertise in hygiene education and water and sanitation.

In 2007, the Mebendazole Advisory Committee (MAC) approved donations of mebendazole to Bangladesh, Cameroon, Uganda and Zambia. This year, they approved donations of mebendazole to four additional countries: Cambodia, Cape Verde, Laos, and Nicaragua.

• High prevalence of STH infections
  
• National ownership and commitment
  
• Safe and effective mass distribution strategies
  
• Capacity to increase the scope of or accelerate STH control program as a result of the donation
  
• Effective strategies for sustainability of STH control program
  
• Multi-sectoral partnerships for STH deworming and transmission control activities

One of the program objectives is to have maximum impact on children most severely affected by the burden of STH infections. Therefore, the Mebendazole Advisory Committee makes recommendations based largely on epidemiological data demonstrating the size and needs of the target population. In addition to need, there must also be evidence that the country program has the capacity to distribute the drug safely and effectively.

Children Without Worms has selected eight countries to validate and refine program strategies. The lessons learned will provide insight to how best to move the program forward. Plans for expanding the program to other countries will be developed after the results of the current donation recipients are received and analyzed. Until that time, Children Without Worms will not be accepting applications for donated mebendazole.

The total commitment from J&J is up to 50 million doses per year. Approximately 30 million doses were donated to strategic recipients in 2007. The program will use lessons learned from the first year of operation to systematically grow to capacity and achieve maximum impact.

Currently, the mebendazole tablets that are available for donation are non-chewable, but it is anticipated that chewable tablets will be available for donation by the end of 2008.

The program will closely monitor and evaluate the success of the recipient countries’ deworming campaigns to determine how best to continue to have an impact on the lives of children burdened by intestinal worms.