A Comprehensive Strategy for STH Control

CWW advocates for a comprehensive strategy to break the cycle of reinfection with soil-transmitted helminths, which includes preventing re-infection following treatment with albendazole or Vermox® (mebendazole) by promoting improved hygiene practices and increasing access to water and sanitation. CWW refers to this four-component strategy—Water, Sanitation, Hygiene Education, and Deworming—as the WASHED Framework.

Intestinal Worm Infection in Children Infographic

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Treating School-Age Children

CWW targets children of school age at risk of soil-transmitted helminthiasis (STH). When a child suffers from STH infection, not only does the infection cause the child physical discomfort, but it also impairs a child's ability to attend school and learn. As the child grows into adulthood, his or her ability to contribute to the community is lessened—a factor that has long-term socio-economic impacts on the community. In essence, the cycle of STH infection also contributes to a cycle of poverty. By reducing the impact of STH infection early in a child's life, the child experiences a happier, healthier childhood and has the opportunity to be a healthy, productive member of the community as an adult.

A School-based Approach

Schools provide the mechanism for CWW to implement both its STH treatment and prevention activities. The schools provide the infrastructure needed to treat both enrolled and non-enrolled school-age children with Albendazole and Vermox (mebendazole) and a place where children can learn the importance of washing their hands and using sanitary latrines.

CWW collaborates with the Ministries of Health and Education in its program countries to administer the medication in school-based mass drug administrations. CWW also works with these governmental agencies to identify in-country, non-governmental organizations (NGOs) to institute hygiene education in regular curricula and to install and maintain water and sanitation facilities.

Deworming with Albendazole/Vermox®

Regular deworming is a critical component of an STH control strategy because it reduces infection intensity in affected individuals. Albendazole and Vermox belong to the family of medicines called anthelmintics (pronounced: ant-hel-MIN-tiks) that are used to treat STH. Albendazole and Vermox disrupt the intestinal system of the worm, eventually causing its death and elimination from an infected person's intestinal system. Albendazole and Vermox are safe, efficacious and easy to administer. Children 12 months and older can be treated with a single 500 mg tablet of Vermox or a 400 mg tablet of albendazole taken orally. This treatment is needed once or twice a year depending on the prevalence and intensity of infection in the community.

An Emphasis on The WASHED Framework

Deworming alone cannot break the cycle of disease. CWW advocates for use of a comprehensive approach, such as the WASHED Framework, to break the cycle of reinfection. The following bullet point list outlines how each of the four WASHED Framework components work together to break the cycle of reinfection.

  • Water - Access to potable water for handwashing and cleaning of food stuffs minimizes reinfection.
  • Sanitation - Sanitary latrines keep infected human excreta from the areas where people live, work, and play, further minimizing the risk of re-infection in treated individuals and preventing new infections.
  • Hygiene Education - Hygiene education promotes personal and environmental hygiene in communities where STH is endemic. When the members of these communities use good hygiene, they reduce the risk of re-infection of treated individuals and prevent new infections.
  • Deworming - Deworming with broad-spectrum anthelmintic drugs like albendazole and Vermox kills intestinal worms in infected individuals, thereby reducing the number of individuals with high-intensity infections who can spread infection to others.

How CWW Advocates for the WASHED Framework

CWW leverages its partners' strengths to build a stronger, more collaborative STH control community and to advocate for implementation of the WASHED framework by:

  • Donating albendazole and Vermox to national STH control programs that combine treatment with hygiene education and increased access to potable water and use of sanitary latrines.
  • Advocating for resources to promote hygiene education and access to potable water and sanitation facilities.
  • Partnering with organizations that work in the hygiene education and water and sanitation sectors to ensure donated albendazole and Vermox is distributed in an environment that optimizes its impact.

This strategy also promotes sustainable STH infection control through cost-effective use of financial and technical resources.

Increasing Collaboration with the WASH Sector

As a part of our work to promote the WASHED Framework, CWW has been at the forefront of recent efforts to increase collaboration and encourage dialogue between the WASH and neglected tropical disease (NTD) sectors. You can learn more about these activities using the links below.

WASH & NTDs - Moving Collaboration Forward - article, CWW Quarterly Dose newsletter

Report - WASH & NTD Roundtable, The Bill & Melinda Gates Foundation, December 2012 (PDF file)

Report - WASH & NTD Symposium, UNC Water and Health Conference, November 2012