The epidemiology of soil-transmitted helminths in Bihar State, India.

BACKGROUND: Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. METHODS: A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. RESULTS: In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. CONCLUSIONS: STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases

Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT

OBJECTIVES: Poor early childhood development in low- and middle-income countries is a major public health problem. Efficacy trials have shown the potential of early childhood development interventions but scaling up is costly and challenging. Guidance on effective interventions' delivery is needed. In an open-label cluster-randomized control trial, we compared the effectiveness of weekly home visits and weekly mother-child group sessions. Both included nutritional education, whose effectiveness was tested separately. METHODS: In Odisha, India, 192 villages were randomly assigned to control, nutritional education, nutritional education and home visiting, or nutritional education and group sessions. Mothers with children aged 7 to 16 months were enrolled (n = 1449). Trained local women ran the two-year interventions, which comprised demonstrations and interactions and targeted improved play and nutrition. Primary outcomes, measured at baseline, midline (12 months), and endline (24 months), were child cognition, language, motor development, growth and morbidity. RESULTS: Home visiting and group sessions had similar positive average (intention-to-treat) impacts on cognition (home visiting: 0.324 SD, 95% confidence interval [CI]: 0.152 to 0.496, P = .001; group sessions: 0.281 SD, 95% CI: 0.100 to 0.463, P = .007) and language (home visiting: 0.239 SD, 95% CI: 0.072 to 0.407, P = .009; group sessions: 0.302 SD, 95% CI: 0.136 to 0.468, P = .001). Most benefits occurred in the first year. Nutrition-education had no benefit. There were no consistent effects on any other primary outcomes. CONCLUSIONS: Group sessions cost $38 per child per year and were as effective on average as home visiting, which cost$135, implying an increase by a factor of 3.5 in the returns to investment with group sessions, offering a more scalable model. Impacts materialize in the first year, having important design implications

Prevalence of soil-transmitted helminth infections among primary school children in the four surveyed districts (N = 1157).

<p>* denominators vary due to missing data</p><p>^{^} refers to number of children positive for at least one species of soil transmitted helminth</p><p>^# Percentages calculated using the total number of children with double infections</p><p>Prevalence of soil-transmitted helminth infections among primary school children in the four surveyed districts (N = 1157).</p

Risk factors for hookworm and <i>A</i>. <i>lumbricoides</i> infection, Bihar India (N = 1157).

<p>RR = risk ratio, 95%CI = 95% confidence interval, P = p value. Univariate analysis takes account of clustering within schools. The model was restricted to two districts (Aurangabad and Gopalganj) due to data collection errors for some variables in the other districts.</p><p>For caste classification see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003790#pntd.0003790.t001" target="_blank">Table 1</a>. Castes 5 and 6 were combined for analysis due to small numbers. Muslims were excluded from the caste classification and are therefore presented collectively and separately.</p><p>Maternal education (literacy) was assessed by asking the child whether their mother can read their hindi textbook. The proportions of literate mothers were similar for muslims and hindus, even in urdu speaking schools. All responses are therefore included in analysis.</p><p>Defecation practice: variable created from questions pertaining to frequency (usually, sometimes, never) of use of an open field, river, jungle or latrine for defecation. Almost all open defecation (98%) takes place in an open field.</p><p>Hand-hygiene practice: 95% of individuals within the "soil, ash or water" category use only soil to hand-wash after using the toilet.</p><p>Risk factors for hookworm and <i>A</i>. <i>lumbricoides</i> infection, Bihar India (N = 1157).</p

A positive consequence of the COVID-19 pandemic: how the counterfactual experience of school closures is accelerating a multisectoral response to the treatment of neglected tropical diseases

Global access to deworming treatment is one of the public health success stories of low-income countries in the 21st Century. Parasitic worm infections are among the most ubiquitous chronic infections of humans, and early success with mass treatment programmes for these infections was the key catalyst for the Neglected Tropical Disease (NTD) agenda. Since the launch of the “London Declaration” in 2012, school-based deworming programmes have become the world’s largest public health interventions. WHO estimates that by 2020, some 3.3 billion school-based drug treatments had been delivered. The success of this approach was brought to a dramatic halt in April 2020 when schools were closed worldwide to minimize COVID-19 pandemic transmission. These closures immediately excluded 1.5 billion children not only from access to education but also from all school-based health services, including deworming. WHO PULSE surveys in 2021 identified NTD treatment as among the most negatively affected health interventions worldwide, second only to mental health interventions. In reaction, governments created a global Coalition with the twin aims of reopening schools and of rebuilding more resilient school-based health systems. Today, some 75 countries, comprising more than half the world’s population, are delivering on this response, and school-based coverage of some key school-based programmes exceeds 2020 levels. This paper explores how science, and a combination of new policy and epidemiological perspectives, led to the exceptional growth in school-based NTD programmes after 2012, and are again driving new momentum in response to the COVID-19 pandemic

Local caste classification and adopted categories used to describe castes.

<p>Local caste classification and adopted categories used to describe castes.</p

Prevalence of soil-transmitted helminths in the 20 schools in Bihar.

<p>Prevalence of soil-transmitted helminths in the 20 schools in Bihar.</p

Disruptions, restorations and adaptations to health and nutrition service delivery in multiple states across India over the course of the COVID-19 pandemic in 2020: An observational study.

BackgroundModeling studies estimated severe impacts of potential service delivery disruptions due to COVID-19 pandemic on maternal and child nutrition outcomes. Although anecdotal evidence exists on disruptions, little is known about the actual state of service delivery at scale. We studied disruptions and restorations, challenges and adaptations in health and nutrition service delivery by frontline workers (FLWs) in India during COVID-19 in 2020.MethodsWe conducted phone surveys with 5500 FLWs (among them 3118 Anganwadi Workers) in seven states between August-October 2020, asking about service delivery during April 2020 (T1) and in August-October (T2), and analyzed changes between T1 and T2. We also analyzed health systems administrative data from 704 districts on disruptions and restoration of services between pre-pandemic (December 2019, T0), T1 and T2.ResultsIn April 2020 (T1), village centers, fixed day events, child growth monitoring, and immunization were provided by ConclusionsServices to mothers and children were disrupted during stringent lockdown but restored thereafter, albeit not to pre-pandemic levels. Rapid policy guidance and adaptations by FLWs enabled restoration but little remains known about uptake by client populations. As COVID-19 continues to surge in India, focused attention to ensuring essential services is critical to mitigate these major indirect impacts of the pandemic

Structure of the state government ministries and offices and respective roles in the deworming programme in Bihar state.

<p>Leveraging of the existing state government structures was critical for the successful rollout of large-scale operations, including drug procurement and delivery, training, community sensitization, and reporting.</p