Community de-worming

COMPETITION WINNER

by Lois Ooms.

We are involved in a community-based health programme and would like to share an idea which has proved very useful here and has also helped us to expand our community health work.

We work on the slopes of the Rift Valley in Western Kenya in an area where it rains nearly every day. We have found that nearly all the children here are infested with worms, especially roundworms (Ascaris). In the hospital we have often had cases of emergency surgery for bowel obstructions with the surgeon removing up to a bucketful of worms from one child. In addition to teaching about sanitation, hand washing and safe drinking water, we therefore found we had to do something about deworming children. As we taught people, we realised that most parents were aware their children had worms but found it difficult to bring them for treatment because they had to pay for public transport, a consultation fee, charges for a lab test and the worming medicine.

After much discussion we developed plans to help a whole community de-worm their children. De-worming not only removes the worms from the child but also really improves their general health. By treating all the children together, it will make it harder for the children to pick up worms again.

If a community decides it wants to do this, it sends representatives to our office to work out a suitable date. It must then provide twelve people to help us on the day selected. The community is also asked to provide lunch for our staff. The community representatives are responsible for letting people know the date. We also provide teaching for the community about the benefits of de-worming before the date chosen.

When we arrive, we usually work in four teams, with one community person to do the registration, one of our staff to be the cashier and two community people to help the children with swallowing the pills. We use levamisole (ketrax) which is a one dose tablet (see table above).

We charge for everyone we treat but the costs are very low indeed, ranging from KSh 3/= for children 1–2 years old to KSh 15/= for people over 15 years old (US $1 = KSh 70/=). However, even with such a low charge we can still cover the cost of the drug and our transport.

With good planning by the community leaders, we can treat over 2,000 people in one day. Those who plan well have the primary school children come class by class in the morning, and then mothers with younger children come in the afternoon, as they often have domestic duties in the morning.

In five communities, this exercise has led the people to ask us to begin a full community health teaching programme, teaching about other common sicknesses, training traditional birth attendants, AIDS prevention and other subjects.

Lois J Ooms is the community health coordinator at Litein Cottage Hospital, PO Box 200, Litein, Kenya.