With the recent completion of its latest treatment campaign against intestinal parasites, Cambodia has become the first country to protect three out of four school-aged children against intestinal parasites and reach WHO's anti-parasite target – six years ahead of schedule.
Just five years ago, more than 70% of Cambodian children were infected with intestinal worms. The impact of these parasites is stark. Not only do affected children weigh as much as two kilograms less than healthy children, they also have a much higher chance of becoming anaemic. Once anti-parasite treatment is administered, infected children show a dramatic increase in their short-and long-term memory, as well as their reasoning capacity and reading comprehension. School absenteeism drops by as much as 25%.
In 2001, WHO set a target of covering at least 75% of school-aged children with regular treatment as the global goal for parasite control for 2010. According to reports sent in from the more than 6500 schools where the campaign took place, more than 75% of Cambodia's nearly three million school-aged children have now been treated.
"This is a huge step forward not only for Cambodia, but for all countries working to control intestinal parasitic diseases," said Dr Lorenzo Savioli, WHO's Coordinator of Parasitic Diseases Control. "Cambodia's experience provides hard evidence that it is completely within the realm of possibility to protect the vast majority of children against parasites. Cambodia has done it, and so can other countries."
Intestinal worm infections affect at least two billion people worldwide and are a significant public health threat in regions where sanitation and hygiene levels are inadequate. These worms can be contracted when skin comes into contact with contaminated water, soil or through ingestion. Heavy infection can impede intellectual and physical development. Symptoms include fever, chills, and muscle aches, and if left untreated, leads to irreversible organ damage. Treatment is with cheap, single dose and effective drugs between three times a year and once every two years, depending on the prevalence of infection in the area.
Cambodia's success follows a progressive expansion to the national level, which now involves a twice-yearly anti-parasite campaign. Drugs are administered across all 24 provinces by thousands of teachers, who distribute the pills to students in classrooms. The campaigns were conducted by the Cambodian Ministry of Health, Education and Sport, with the support of WHO, together with UNICEF, the Japanese Embassy in Cambodia, and the Sasakawa Memorial Health Foundation.
"This clearly wouldn't have been possible without the strong commitment of Cambodia's Ministry of Health," said Dr Kevin Palmer, Regional Adviser in Parasitic Diseases for the Western Pacific Regional Office of WHO. "Reaching the target this early wasn't accidental. It demonstrates what can be achieved when the political will is there together with financial support from donors and partners."
To promote campaigns against parasites in other affected countries, WHO together with UNICEF recommends that such campaigns simply be integrated into other disease campaigns. "We will never control parasitic infections until the global community starts to think and act on a large scale," said Dr Hiroyoshi Endo, WHO's Director of the Control, Prevention and Eradication of Communicable Diseases. "The best way to treat as many people as possible is to piggyback onto other disease initiatives."
It is a remarkably cost-effective strategy. Anti-parasite pills cost only about two cents per tablet. "That's a very small price to pay for helping to control a public health problem," said Dr Savioli. WHO hopes that Cambodia's early success will generate momentum for other countries to combat parasitic infections. "Cambodia undoubtedly wins the race to reach the 2010 anti-parasite target," said Dr Savioli. "Now it is up to other countries to duplicate their success formula."