School Based Program

of DOH on Control of
Soil-Transmitted
Helminthiasis
Pacheco, Pelayo, Prudente, Quiñon,
Sacramento, Salvani, Santiago, Saputalo,
Sendaydiego, Ramos
 I. Introduction

OUTLINE: II. Integrated Helminth Control Program

III. Steps in Implementation of Diseases Prevention

and Control Program

IV. Approaches to Implementation of DPCP

Today's Agenda
V. LGU and Education Sector, Prevention and
Control, War on Worms

VI. Washed Framework

Categories for Community Diagnosis

I. Administration Order 2015-0030

Role of School

II. Mass Drug Administration

III. Surveillance and Monitoring

 ABBREVIATIONS
• DPCP – Diseases Prevention and Control Program
• MDA – Mass Drug Administration
• MDAP – Mass Drug Administration Provider
• STH – Soil-transmitted Helminthiasis
• NSSD – National School Deworming Day
I. INTRODUCTION
 HELMINTH
are parasitic worms; are large
multicellular organisms which can be
generally seen with the naked eye
HELMINTHIASIS
HELMINTHIASIS
infestation with or disease caused by
parasitic worms
• Soil-transmitted helminthiasis (STH) can cause poor
physical growth, poor intellectual development,
and impaired cognitive functions in children and can
result to anemia and malnutrition

• The highest intensity of infection has been

documented among children aged 1-12 years old.

• Pre-school children (1-4 years old) suffer the greatest

morbidity

• School- aged children (5-12 years old) harbor the

greatest load of infection
• Deworming in schools has been found to be a good strategy to reduce the burden of STH

• The National School Deworming Day (NSDD) was designed to improve health care service
delivery for all school-aged children enrolled in public elementary schools

• In 2016, a Harmonized Schedule and Integrated Mass Drug Administration (HSIMDA) was
launched.
 THE 3 MAJOR CAUSES OF INTESTINAL PARASITISM IN
THE PHILIPPPINES:
1. Ascariasis or roundworm infection
2. Trichuriasis or whipworm infection
3. Hook worm Infection
 ASCARIS LUMBRICOIDES
• Human roundworm
• Ascariasis
• Ascaris species are very large nematodes that
parasitize the human intestine.
• People with ascariasis often show no symptoms.
• If symptoms occur they can be light; abdominal
discomfort or pain. Other infection such as cough are
due to migration of worms through the body.
 TRICHURIS TRICHURIA
• Whipworm
• Trichuriasis
• Anterior end: slender; Posterior end: thicker
• Infections with a low worm burden are usually
asymptomatic, but infections of moderate to heavy
worm loads present with lower abdominal pain,
distention, and diarrhea.
• Severe infection may lead to profuse bloody diarrhea,
cramps, tenesmus, urgency, and rectal prolapse
 HOOKWORM SPP.
• Hookworm Infection
• 2 main species: Ancylostoma duodenale and Necator
Americanus
• Itching and a localized rash are often the first signs of
infection. These symptoms occur when the larvae
penetrate the skin.
• light infection may have no symptoms
• heavy infection may experience abdominal pain,
diarrhea, loss of appetite, weight loss, fatigue and
anemia
ENTEROBIUS VERMICULARIS

• Human pinworm/seatworm/threadworm
• Enterobiasis or oxyuriasis
• Enterobiasis is frequently asymptomatic.
• The most typical symptom is perianal pruritus,
especially at night, which may lead to excoriations
and bacterial superinfection.
Scotch Tape Test (Graham’s Test):
Detection of Enterobious
vermicularis eggs
 FUNDAMENTALS OF THE TEST

• Adult forms of Enterobius vermicularis inhabit

the large intestine and the rectum; however, the
eggs are not commonly found in fecal material
because the adult females usually migrate at
night, through the anus to the perianal area,
where they lay the eggs.
• This process usually takes place overnight.

• The “Scotch tape” method gives the best

recovery of eggs if used before defecation,
bathing or dressing in the morning
 SPECIMEN COLLECTION

1. Firmly press the sticky side of a length of clear, transparent tape to the skin,
around the folds of the anus.
– Use clear, transparent tape ONLY. Cloudy, “magic” tape must not be used.
2. Apply the tape, sticky side down, to the clear section of the labeled
microscope slide. Cut off any excess tape that may overlap the edges of the
slide.
3. Label the slide in pencil with the patient name, medical record number, and
date and send to parasitology laboratory
4. The slide is observed under microscope to find characteristics shape of
pinworm eggs
5. Examine the slide under a microscope using the low power (10x) objective.
The eggs can be made more visible by detaching the tape from the slide,
adding a drop of xylene or toluene, and again affixing the tape.
OBSERVATION UNDER THE MICROSCOPE

• The eggs of E. vermicularis measure 50-60 micrometer x

20-30 micrometer and have a relatively thick, smooth shell
and an ovoid shape flattened on one side, much like a
flattened, partially inflated football.

• may contain a partially or fully developed larva

• Adult worms occasionally are seen in transparency tape

preparations.
– measures 1 cm long, have a pointed tail posteriorly and
transparent wings flanking the anterior end
 II. INTEGRATED
HELMINTH CONTROL
PROGRAM
 INTEGRATED HELMINTH
CONTROL PROGRAM (IHCP)
• Implemented by DOH in 2006
• Aim:
• To reduce the prevalence rates of
STH infections among the high risk IHCP MASS DRUG
groups
ADMINISTRATION PROPOSAL
• Community based approach for the Mass Drug
Administration (MDA) in children ages 12 to 71
months old (1 to 6 years old)
• School based strategy for MDA in children ages
6-12 years old
• As well as for individuals 2 – 65 years old for
lymphatic filariasis elimination in endemic areas
 INTEGRATED HELMINTH
CONTROL PROGRAM (IHCP)
The program gives emphasis on:
• Improvements on provision of safe
water, sanitation, hygiene, and
health education for the prevention
and control of intestinal helminthiasis IHCP AND WHO
(DOH, 2006)
Both adopted various helminth control strategies:
- Preventive chemotherapy
- Improvements in:
• Water, Sanitation And Hygiene (WASH)
- Through approaches including:
• Community-Led Total Sanitation (CLTS)
• Health promotion and Education
 III. STEPS IN
IMPLEMENTATION OF
DPCP
STEPS AND IMPLEMENTATION OF DPCP
 STEPS AND IMPLEMENTATION OF DPCP

A multi-sectoral approach is more useful when collaborating with a local action

committee or task force to provide a mechanism for intersectoral coordination and
collaboration with other committees.

1. DOH-CHD: STH coordinator, DSO, DOH representative/DOH Provincial Health Team Leader
2. LGUs: Governor, Mayor, Provincial STH. Coordinator, Provincial/ City/Municipal Health Officer,
PHN, DSOs, Health Education and Promotion Officer (HEPO), Sanitary Inspector (SI),
Information Officer (IO), President of the Association of Barangay Captains
3. DepEd: Division Superintendent, Division MO, District Supervisor, PTA Federation President
4. Concerned community groups: socio-civic groups, religious organizations, Barangay
Sanitation Volunteers
5. Representatives of government hospitals and other treatment facilities
 STEPS AND IMPLEMENTATION OF DPCP

The tasks of the local action committee or task force will include the following:
1. Coordinate program implementation and monitoring
2. Formulate an action plan
3. Define the roles and responsibilities of the stakeholders
4. Facilitate networking and collaboration among different sectors and agencies at the local
level
5. Review baseline and monitoring data, as well as trends of the diseases
6. Evaluate the implementation of the DPCP and ZODP using established parameters
7. Identify good practices and propose means to address challenges
STEPS AND IMPLEMENTATION OF DPCP

- done prior to the program implementation period

- information that will be gathered from the community assessment will help in formulation
of the action plan

- Data that will be gathered will include the following:

1.Morbidity and mortality due to soil-transmitted helminth infections and diarrheal
diseases
2.Procurement, quality control and coverage of interventions (antihelminthic drug, ORS
and zinc supplements)
3.facilities and capability
4.Health promotion and education
5. community empowerment and sustainability
6. Marketing
7. Knowledge, attitudes and practices of the community
the action plan to be developed and implemented by the local action committee with
the leadership of the LGU should include:
- how targets and expected outputs in the major areas in diseases prevention and control
such as diagnosis, treatment, prevention and control surveillance and monitoring as
well as advocacy and resource mobilization are going to be met by way of proposed
activities person responsible timelines and resources needed
- the DPCP advocates the complete package of the WASHED strategy and additional
strategies for diarrheal diseases including treatment regimens breastfeeding and
measles immunization .
- surveillance and monitoring of the diseases which aims for zero open defecation
 Advocacy of LGU and MO’s:
● Trained med techs performing WHO recommended lab techniques for specific
situations, including provision of support for baseline and parasitology surveys
● Mass treatment of other high risk groups (adolescent females, pregannat women, food
handles, and other occupational groups)
● Synchronized MDA schedules for STH infections and LF in endemic areas to increase
the efficiency of the program
● Health personnel who have received continuing education on the management of
diarrheal diseases providing the recommended management for dehydration and other
related complications of diarrheal diseases
 Advocacy of LGU and school officials with health staff:
● Integration of DPCP into school curriculum
● Educational campaign on hygiene
● Provision of adequate sanitary and water facilities
● High mass drug administration in school children
● Treatment of out of school youth through learning schemes
● DepEd being involved in baseline and follow up surveillance
 Advocacy of LGU and social welfare and development office and the social
welfare officer:
● Treatment of preschool children through day care workers, supervised by Local Health
Unit staff
● Treatment of Out of School Youth, including street children
Advocacy of LGU and collaborators, and potential partners at community level:
● Participation of collaborators and partners in the local action committee or task force in
performing assigned roles and responsibilities
● Information dissemination and increased exposure of the program to the community,
collaborators and potential partners
● To increase awareness
● To encourage participation in the program
● Done through LGU’s in collaboration with its partners through creative and innovative
means

● Examples of marketing strategies:

1. DPCP launched through a public event
2. Declaration of dates of awareness campaign; “diarrheal diseases awareness day”,
“Mass drug administration day”, “Sanitation day”
3. Contests on slogan, poster making, and jingles are conducted in collaboration with
partners
● Local action committee will use established parameters in conducting monitoring and
evaluation
● Mainly done in collaboration with DOH, DepEd, and other partners
● Results is presented and discussed in local action committee, where good practices are
recognized and challenges are tacked to help ensure that these are managed and will
lead to favorable outcomes
IV. APPROACHES AND
IMPLEMENTATION
Who will lead the implementation of DPCP?
üLGU (Local Government Unit) will lead in the implementation
and control including surveillance.

In collaboration with its partners (depED), they will oversee the ff.:
• baseline assessment and;
• implementation of strategies for prevention and control, surveillance and
monitoring.
 Builds upon values of solidarity and cooperation

- Other sectors and partners at the community level are

encouraged to collaborate towards effective disease prevention
and control.

- Examples of collaborations may include:

• LGU and Education Sector
 V. LGU & EDUCATION
SECTOR, PREVENTION and
CONTROL,
WAR ON WORMS
LGU AND EDUCATION SECTOR

• Trained health staff and school health

staff may provide training opportunities
for teachers to get engaged in the health
education and information dissemination
of the STH infections.

• Trained teachers may assist in

anthelminthic administration during MDA
among elementary school pupils

• Parents- Teachers Association may be

tapped to help increase compliance to
MDA through the conduct of PTA advocacy
meetings.
 PREVENTION AND CONTROL

• Mass drug administration assisted

by the teachers in school-based is
recommended control strategy for
soil transmitted helminth
infections.

• Their program is called WOW

(War on Worms)
 NATIONAL DEWORMING MONTH

• distribute anti-helminthic drugs during the National Deworming Month

(NDM), a twice a year campaign held during the months of January and
July
• The NDM is done by synchronizing the schedules of Mass Drug
Administration for Soil Transmitted Helminths (STH) in the schools and
the community
 TEN COMPONENTS OF NDM

1. National School-Deworming Month (NSDM)

• The NSDM is a massive and simultaneous school-based effort to
deworm school-aged children ages 5-18 y/o enrolled in public
schools this July

2. Community Based Deworming Month (CBDM)

• CBDM is deworming of pre-school children ages 1-4 y/o and
school-aged children not enrolled in public schools in various
health centers and rural health units under the Local Government
all over the country
 WAR ON WORMS

• Key interventions for control and

prevention of STH infections as outlined in
water, sanitation, hygiene, education and
deworming (WASHED) framework

• Long term interventions include

improvements in access to safe water,
sanitation, and personal hygiene, with
emphasis on the prevention of open
defecation.
VI. WASHED FRAMEWORK,
CATEGORY FOR
COMMUNITY DIAGNOSIS
 CATEGORIES FOR COMMUNITY DIAGNOSIS AND
SELECTION OF CONTROL MEASURES FOR STH INFECTIONS
 TARGET POPULATION AND SCHEDULES OF MDA FOR STHI

Children 6-12 years of age enrolled in elementary schools may be given anthelminthics by trained
school teachers under the supervision of trained school nurses.
TARGET POPULATIONS AND DRUG REGIMENS OF MDA
FOR STH INFECTION
VII. ADMINISTRATION
ORDER 2015-0030
ROLE OF SCHOOL
 DEFINITION

The AO defined ‘deworming’ as:

Administration of Albendazole (or

Mebendazole) without prior diagnosis of
current infection, to control and treat
intestinal helminth infections such as
hookworm, Ascaris, and Trichuris.
 GOAL
• The Department of Health (DOH) aims to
deworm 16M students nationwide to
reduce the burden of Soil Transmitted
Helminthiasis (STH)

• The initiative will be a prelude to the 2016

harmonized schedule and integrated mass
drug administration for the prevention,
control, and treatment of lymphatic
filariasis, schistosomiasis, and STH.
 GOAL
• Students in 38, 656 public elementary schools
will undergo deworming (by MDAP) in one day
through the National School Deworming
Initiative.

• MDAP is assisted by Barangay and Community

Health teams and supervised by Regional,
Provincial, and Rural Health Office Health
Pesonnel.

• A National School Deworming Day (NSDD) shall

be held targeting public school students from
Kindergarten to Grade 6, aged 5-12.
• Children in private schools were encouraged
to participate.
 Understanding
ROLE OF SCHOOL
the Lesson
 GOAL
WHY TARGET PUBLIC SCHOOLS?
• According to the WHO, Schistosomiasis and STH infections are
diseases of poverty which impair the physical and intellectual
growth of children and diminish the work capacity and
productivity of adults.

• School-age children are an important high-risk group for

schistosomiasis and STH infections because the infections occur:

• during a period of intense physical growth and rapid metabolism

resulting in increased nutritional needs; when these needs are not
adequately met, growth is impaired and children are more
susceptible to infection;
• during a period of intense learning; when children are infected,
learning capacities are significantly diminished;
• in a setting of continuous exposure to contaminated soil and
water; children generally lack awareness of the need for good
personal hygiene and like to play with soil and water
 GOAL
WHAT THE SCHOOL CAN DO:
• Prepares the Masterlists of children to be
dewormed
• Orients and coordinates with the Parent-
Teacher Association (PTA) and other
stakeholders in the conduct of the NSDD
• Ensures collection of Parent’s consent
• Administer the deworming drug supervised
by a healthworker
• Prepares & submits report
VIII. MASS DRUG
ADMINISTRATION
 GOAL
The DOH recommends the following drugs for mass
treatment:
• Albendazole – 400 mg chewable, • Mebendazole – 500 mg chewable,
flavoured tablet flavoured tablet
 GOAL
Precautionary measures on Mass Deworming

• Albendazole and Mebendazole are not

recommended if the child has any of the
following conditions:
• Seriously ill
• Experiencing abdominal pain
• With diarrhea
• Previously suffered hypersensitivity
to the drug

MDAP shall ensure the children will take deworming drugs on full stomach
PRE DEWORMING DEWORMING POST DEWORMING

• Preparation of • Ensure that the required • The class teacher

enrollment list number of drugs are shall make sure that
• Ensure availability of available all children listed in
deworming and • Clean drinking water should the master list were
supportive drugs be available at the school on given deworming
the treatment day drugs
• Each learner shall receive • NSSD point person to
one tablet of deworming collate and submit
drug report
• The MDA providers should
ensure that each child
swallows/chew tablet
• Ensure all RHUs and
hospitals are ready for SAE
referrals
In the four MDA rounds of the WOW Western Visayas (Figure 1)
in 2008 and 2009, the drug coverage rates were consistently above 80%.
• After two years of implementation, the prevalence of heavy intensity infections was
significantly reduced by 90.4%, from a baseline of 40.5% to 3.9%.
• The overall cumulative prevalence of STH infections also decreased significantly by
40.1%, from a baseline of 71.1% to 42.6%.

• Heavy intensity infections were significantly reduced by 93.1% in Aklan, 94.6% in

Antique, and 85.3% in Capiz.
• There were also significant reductions in the cumulative prevalence of STH
infections in Aklan (25.3%), Antique (47.4%), and Capiz (47.8%).

• The WOW Western Visayas was well accepted by the local population and local
governments in Aklan, Antique, and Capiz. This led to the drafting of resolutions on
prioritization and continuation of school-based control strategies in the program.
VIII. SURVEILLANCE AND
MONITORING
 GOAL
GLOBAL DISTRIBUTION AND PREVALENCE

• More than 1.5 billion people, or 24% of the world’s population, are infected with soil-
transmitted helminth infections worldwide.

• Infections are widely distributed in tropical and subtropical areas, with the greatest
numbers occurring in sub-Saharan Africa, the Americas, China and East Asia.

• Over 267 million preschool-age children and over 568 million school-age children live
in areas where these parasites are intensively transmitted, and are in need of
treatment and preventive interventions.
 GOAL
GLOBAL DISTRIBUTION AND PREVALENCE
 GOAL
GLOBAL TARGET

There are six 2030 global targets for soil-transmitted helminthiases:

1. Achieve and maintain elimination of STH morbidity in pre-school and school age
children
2. Reduce the number of tablets needed in preventive chemotherapy for STH
3. Increase domestic financial support to preventive chemotherapy for STH
4. Establish an efficient STH control programme in adolescent, pregnant and
lactating women
5. Establish an efficient strongyloidiasis control programme in school age children
6. Ensure universal access to at least basic sanitation and hygiene by 2030 in STH-
endemic areas
 GOAL
WHO STRATEGY FOR CONTROL

In 2001, delegates at the World Health Assembly unanimously endorsed a resolution (WHA54.19)
urging endemic countries to start seriously tackling worms, specifically schistosomiasis and soil-
transmitted helminths.

People at risk are:

• preschool children
• school-age children
• women of reproductive age (including pregnant women in the second and third trimesters and
breastfeeding women)
• adults in certain high-risk occupations such as tea-pickers or miners
 GOAL
WHO STRATEGY FOR CONTROL

WHO recommends periodic medicinal treatment (deworming) without previous individual

diagnosis to all at-risk people living in endemic areas.

This intervention reduces morbidity by reducing the worm burden.

In addition:
• health and hygiene education reduces transmission and reinfection by encouraging healthy
behaviours; and
• provision of adequate sanitation is also important but not always possible in resource-poor
settings.
 CHED, DOH SEEK TO
ELIMINATE NEGLECTED
TROPICAL DISEASES
THROUGH PH HEALTH
WORKFORCE
DOH UPDATE AS OF MARCH 11,2021
• The Commission on Higher Education (CHED) and the
Department of Health (DOH) will equip the country’s
future health workforce by integrating Neglected Tropical
Diseases (NTDs) in the pre-practice curricula of all
Philippine colleges and universities, offering courses in
Medicine, Nursing, Medical Technology, Midwifery, and
Physical Therapy.
• Through this agreement, interns will be provided an initial
understanding of the different NTDs of public health
importance in the country in preparation for their
encounters on actual cases and dynamic scenarios in the
community.
• NTDs like, Lymphatic Filariasis, Schistosomiasis, Leprosy,
Soil-Transmitted Helminthiasis, Food-Borne Trematodes,
and Rabies are termed “neglected” because those
afflicted with NTDs remain to be hidden, thus responses
and resources don’t receive equal attention
• “strategic shift” of investments and focus from clinical –
individual-based curative/rehabilitative services that
have been in the school curricula since time, to a
progressive, proactive, collective, population-based
preventive model
• To reach out to the marginalized and those left behind
• Education, ending the neglect of NTDs through Universal
Health Care addresses the common purpose of poverty
alleviation and development.
• A Joint Working Committee between the DOH and CHED
will be formed following the agreement to provide policy
and technical guidance to the integration, which will be
pioneered in strategic areas and state universities where
there is evidence of the burden of NTDs.
REFERENCES:
• https://www.who.int/news-room/fact-
sheets/detail/soil-transmitted-helminth-
infections

• https://www.iamat.org/country/philippin
es/risk/intestinal-parasites-soil-
transmitted-helminths

• https://doh.gov.ph/Health-Advisory/Soil-
Transmitted-Helminthiasis-and-
Parasitoses