NAIROBI, Kenya, Jun 15- Kenya celebrates 10 years of deworming under the National School-Based Deworming Programme (NSBDP), jointly led by the Ministry of Health and the Ministry of Education with technical support from the global non-profit Evidence Action. Children aged 2-14 years, regardless of their enrollment status, are provided with free deworming treatment by teachers at schools.
Treatment is conducted in at-risk areas for two types of parasitic worm infections, soil-transmitted helminths and schistosomiasis, which are neglected tropical diseases that impede children’s health and access to education.
With 2022 marking the tenth year of deworming, the NSBDP has to date conducted a total of 9 rounds of school-based deworming treatment, reaching up to 6 million children annually across 27 counties.
Speaking ahead of the National School-Based Deworming Programme 10-year celebration activities, Principal Secretary, Early Learning & Basic Education, at the Ministry of Education, Dr. Julius Jwan says, “Research shows that if deworming is not done, there is up to 25 per cent absenteeism by learners, something which greatly affects their overall performance.”
The National School-Based Deworming Programme is a Kenya Vision 2030 flagship program which has provided over 52 million treatments to school going children over 9 years. After a disruptive COVID year in 2020, the program resumed full-scale operations and dewormed over 6.4 million children in 2021 across 21 counties.
“In addition to us allocating funds for deworming, we are also going further to ensure that all the resources of the government that are directed towards procuring dewormers, go to local manufacturers,” said the Principal Secretary at the Ministry of Health, Susan Mochache.
This year, the NSBDP aims to achieve deworming across 17 counties and 112 sub-counties, targeting 5.7 million children.
The Ministry of Health is procuring a record 5.9 million Albendazole tablets for the treatment. Since 2009, the program has consistently treated over 6 million children in the targeted age bracket, in both public and private primary schools and Early Childhood Development.
All children in targeted areas, regardless of their enrollment status, are able to receive treatment for free. The medicines are safe, effective, and recommended by the World Health Organization.
Rigorous data and research underpin the National School-Based Deworming Programme rationale, design, and treatment strategy: studies conducted from as early as the 2000s in Kenya by Nobel Laureate Michael Kremer and Professor Ted Miguel found that regular deworming can help reduce school absenteeism by up to 25%.
The Kenya Medical Research Institute (KEMRI) closely monitors the NSBDP, tracking its impact on worm prevalence rates across endemic areas. Programme impact data released by KEMRI shows a decrease in the prevalence of Soil-transmitted helminthiasis (STH) and S. haematobium have experienced substantial reductions in prevalence over the course of the programme while S. mansoni has remained low.
Prevalence surveys have been conducted at baseline (2012), midline (2015), endline (2017), and follow-up (2018) estimating the overall prevalence of any STH to shift from 33.6%, 18.6%, 15.2%, and to 12.9% over the course of the programme. S. haematobium has been estimated at 14.8%, 6.8%, 2.4%, and 0.3% while S. mansoni 2.1%, 1.5%, 1.7% and 2.2% over the same time periods.
After six rounds of MDA, prevalence of STH has significantly declined among both PSAC and SAC, however prevalence of moderate and heavy intensity infections for both classes of parasite are yet to decrease below 2%, the point at which they are no longer considered a public health problem.
The programme has been highly effective, contributing to a reduction of 60.0% in the total number of people infected with any STH and of 97.9% for S. haematobium.
“Ensuring that no primary schooling is lost because of worm infections that pose a serious threat to the health, education and productivity of children, remains an urgent challenge that deworming can help solve.” enthused Chrispin Owaga, Evidence Action Country Director – Kenya.
In counties where Evidence Action supports deworming, the average cost per child per treatment was 35 shillings in 2021 and has routinely been at or below 50 shillings throughout the last several years, a testament to the cost-effectiveness and sustainability of these efforts, and what remains a top priority for scaling evidence-based programmes into the next decade.
Over 6 million children in Kenya are at risk of parasitic worm infection. Worm infection inhibits children’s uptake of nutrients and can cause malnutrition, diarrhea, anemia, and compromised immunity. Randomized evaluations[1] conducted by global development economists have shown that deworming primary school children can improve their cognition, physical development and school attendance, while increasing Kenya Certificate of Primary Education pass rates among girls.
The impact of deworming on children goes beyond health and education outcomes.
A new landmark study published in 2021 by a team of economists, led by Edward Miguel and Nobel laureate Michael Kremer, offers new evidence of the long-term benefits of school-based deworming.
According to the study, which followed a group of Kenyan students every 5 years over a 20-year period, receiving two to three additional years of deworming increased their income by 13% and consumption by 14% decades after treatment.
An extra two to three years of deworming treatments in school also significantly increased odds (by 9%) of working outside of agriculture and in urban areas, which presents more opportunity for jobs that largely pay better and offer more opportunity for growth.
The study also calculates that the investment in deworming Kenya’s children has so far had a 37% annualized rate of return.
School-based deworming is widely recognized as the most cost-effective and efficient way to reach at-risk children in countries where school enrollment rates are high and these efforts need to continue to avoid bounceback to maintain high impact towards elimination efforts.
To sustain the gains that have been made over the years, increased government commitment, including domestic financing will be the cornerstone for program sustainability in the next phase.
The NSBDP is already benefiting from local procurement of deworming medicines at the cost of about 70 Million Ksh annually.
Additionally, in 2022 the programme is mainstreaming data into NEMIS and DHIS by having schools reporting health-related data to the Kenya Health Informations Systems Portal.
This showcases the unique inter-ministerial collaboration between the Ministry of Health and the Ministry of Education towards programme sustainability.
The treatment strategy for the next five years will be informed by parasitological impact surveys currently underway, which will reflect the latest prevalence rates across the country.
These will be used to update the treatment strategy and geography in accordance with WHO guidelines.
The importance of deworming children cannot be gainsaid, deworming treatment leads to significant weight gains and allows more energy to be focused on child growth and development.
A study in Uganda, for example, found that deworming treatment increased child weight by 10% for children who received treatment twice per year, and by 5% for children who received treatment annually.
School-based mass deworming has also been shown to reduce school absenteeism more cost-effectively than alternative ways of boosting school attendance.
In Kenya, school-based mass deworming reduced school absenteeism by 25% for those in treatment schools.
Furthermore, deworming has spillover effects for untreated school-age and preschool children. In Kenya, young sibling of those treated, as well as children who lived nearby treatment schools but were too young to be dewormed, showed gains in cognitive development equal to half a year of schooling when evaluated ten years later.
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