Integrated programme for control of geohelminths: a perspective.

Infestation by geohelminths is an important public health problem in developing countries like India. It is a major cause of morbidity in school-age children who have the highest burden of worm infestation. Some of the morbid conditions attributed to intestinal helminthiasis are malnutrition, growth retardation, anaemia, vitamin A deficiency and impaired intellectual performance. Chemotherapy targeted at school-age children has been recommended as a cost-effective and feasible control programme for the control of geohelminths. To optimize resources a geohelminth control programme can be integrated with other existing national health programmes. The availability of drugs such as diethyl carbamazine (DEC) and albendazole, which have anthelminthic and antifilarial properties, opens the possibility of integrating a geohelminth control programme with a filaria control programme. However, co-administration of DEC and albendazole raises several issues of frequency of administration, efficacy, compliance and cost-effectiveness. Thus, integrating a geohelminth control programme with the existing mid-day meal or anaemia prophylaxis programme would be a more appropriate and cost-effective strategy to control geohelminths, alleviate the morbidity caused by them and improve the overall health of the community.

Intestinal geohelminthiasis in the developing world.

Intestinal parasitic helminths such as roundworms (Ascaris lumbricoides), hookworms (Ancylostoma doudenale and Necator americanus) and whipworm (Trichuris trichiura) are common in the developing world. Strongyloides stercoralis, though not so common, also contributes to health problems. The prevalence of intestinal worm infestation in India varies from 5% to 76%, which is similar to that in other developing countries. These parasitic infestations are acquired by ingestion, inhalation or penetration of the skin by the infective forms. Ascaris causes many intestinal and respiratory symptoms and plays an important role in precipitating protein-energy malnutrition in undernourished children. Hookworms cause anaemia and hypoproteinaemia. In areas where hookworm infestation is endemic, 90% of pregnant mothers are anaemic. Trichuriasis as a causative agent of human disease has only recently gained attention. Heavy infestation with T. trichiura can result in severe colitis and significant blood loss. This in turn can lead to impaired cognitive functions which are reversible on treatment. Though not as widely prevalent as the other geohelminths in India, Strongyloides stercoralis infestation can be fatal in debilitated and immunosuppressed children. So far, the impact of these parasites on the health of children has been underestimated and concentrated efforts to minimize the worm load and its consequences have not been given due importance in our health policies. This article reviews the pathophysiology, clinical impact and control options of the most commonly prevalent geohelminths in the developing world.

Loose stools in the early neonatal period.

During a two-year period, the various factors associated with loose stools in the early neonatal period were studied among hospital born babies. Low birth weight babies had a lower incidence of non-infective loose stools when compared to neonates with a birth weight of more than 2500 g (p < 0.001). Newborns delivered by Cesarean section (p < 0.001) and those born to women with more than two children (p < 0.02) had a greater frequency of loose stools. Initiation of supplementary feeding and administration of antibiotics were important factors in causing loose stools. Bacterial etiology could be found only in 9.3% of newborns having loose stools. A later onset of loose stools was noted in those, whose stool culture grew bacterial organisms. Only nine newborns with loose stools required antibiotic therapy. Although loose stools were less common among low birth weight babies, they often required treatment with antimicrobials. None of them developed any complications. Since majority of them are non-bacterial and non-infective, great caution must be exercised before administering antibiotics to newborns with loose stools.