- Email: [email protected]
Deworming: adding public health education to the equation
Update
TRENDS in Parasitology
Vol.22 No.1 January 2006
7
Letters
Deworming: adding public health education to the equation Ishaya H. Nock1, Thelma Aken’Ova1 and Musa Galadima2 1 2
Department of Biological Sciences, Ahmadu Bello University, Zaria, Nigeria Department of Microbiology, Ahmadu Bello University, Zaria, Nigeria
Key elements of resolution WHA 54.19 of the 54th World Health Assembly (www.who.int/entity/wormcontrol/ documents/wha/en) include regular deworming of schoolage children, access to safe water, sanitation and health education. This resolution is an embodiment of good health for the developing nations through the control of intestinal parasitoses; the benefits derivable from the worm-control programme and the anticipated research into helminths have been well articulated [1–4]. Ideally, deworming should be accompanied by the simultaneous provision of safe water, sanitation infrastructure and health education. For most poor nations, the provision of safe water and sanitation infrastructure is, undoubtedly, a huge and costly undertaking that cannot be met within a short time. In such a situation, deworming and health education can proceed, which explains why the Partners for Parasite Control (http://www.who.int/ wormcontrol/en/) have developed health education materials to accompany deworming. However, it seems that health education is trailing behind in the scheme because of the small number of countries (15) that has organized health education materials for integration into the programme. It is reasonable to speculate that many countries are rather preoccupied with meeting the target of delivering anthelmintic drugs to at least 75% of school-age children by 2010, as spelt out in resolution WHA 54.19. We feel that health education, being an all-embracing aspect of worm control, should be well projected and integrated from the onset of the scheme if the benefits of deworming are to be achieved and maximized. Colley et al. [1] and Nematian et al. [5] have highlighted the importance of health education in worm control but the lessons of its importance can be learnt better from the Japan International Cooperation Agency [JICA (http:// www.jica.go.jp/english/)] [6]. The JICA worm-control programme operates on the platform of education and training. Jimba et al. [6] conveyed how the programme had transformed people from health recipients to health partners. In Japan, the tradition of tailoring health education to worm control has a long-standing history [7], and the gains from this formula have reached the shores of neighbouring Indonesia [8] and China [9]. All this is a testament to the importance of health education in worm control. Deworming is only one (albeit important) aspect of the problem of intestinal parasitoses. A worm-free Corresponding author: Nock, I.H. ([email protected]). Available online 21 November 2005 www.sciencedirect.com
environment would be attained and sustained, to a large extent, through improved sanitation that hinged on health education. A health education programme – whether run through the school system, training workshops or, informally, through printed handbills and posters, television, radio and newspaper advertisements – can greatly improve the hygiene habits and general sanitation of a people. Health education defines the problem, the cause, the route, the solution and, ultimately, the prevention of disease. It is, therefore, a suitable companion to deworming. Our studies of intestinal parasitoses in parts of Kaduna State, Nigeria, led us to advocate a health education programme because we observed parasite eggs in the environment and the diseases in humans [10,11]; furthermore, we observed that 65.5% (548 out of 800) of school pupils (6–15 years of age) and 51% of adults (156 out of 304) were ignorant of the worm disease process (I.H. Nock et al., unpublished). Legislation and its enforcement against indiscriminate disposal of faeces could also contribute to good sanitary practices. The fact remains that an uninformed people would continue to practise poor hygiene habits even in the face of drug administration, such that the problem of discharging tons of untreated excreta containing millions of parasite cysts and eggs onto the earth’s surface and in water bodies (http://www.who. int/ceh/publications/05sanitation.pdf) would not only remain but also be a major source of contraction of intestinal parasitoses. Health education could help to change all this and bring greater benefits to the overall deworming exercise. JICA has proved that health education can be a propelling force behind the success of a worm-control programme. Accordingly, we urge the Partners for Parasite Control to feature health education prominently alongside a drug regimen in the pursuit of a wormless society. In this regard, it would be necessary to network the ministries of health, education and information of affected countries. The ministry of information would have the task of using newspapers, radio and television for education, social mobilization and advocacy. Deworming without health education could leave many related problems unsolved and might not be sustainable. References 1 Colley, D.G. et al. (2001) Medical helminthology in the 21st century. Science 293, 1437–1438 2 Hagan, P. (2001) This wormless world. Trends Parasitol. 17, 569 3 Markus, M.B. (2002) Helminthiasis: new medical significance. Trends Parasitol. 18, 205
Update
8
TRENDS in Parasitology
4 The Lancet. (2004) Thinking beyond deworming. Lancet 364, 1993–1994 5 Nematian, J. et al. (2004) Prevalence of intestinal parasitic infections and their relation with socio-economic factors and hygiene habits in Tehran primary school students. Acta Trop. 92, 179–186 6 Jimba, M. et al. (2005) Beyond deworming. Lancet 365, 751–752 7 Hara, T. (1998) Large-scale control of intestinal helminthic infections in Japan, with special reference to the activities of Japan Association of Parasite Control. Parasitol. Int. 47(Suppl.), 95 8 Margono, S.S. (1998) Mass treatment of soil-transmitted helminthoses in school children in Indonesia. Parasitol. Int. 47, 95
Vol.22 No.1 January 2006
9 Zheng, F. (1998) Cognition of parasitoses prevention and hygiene habits in the integrated project area of family planning in China. Parasitol. Int. 47, 95 10 Nock, I.H. and Geneve, A.I. (2002) Public health significance of parasite cysts and eggs on water-closet handles. Nigerian J. Parasitol. 23, 91–94 11 Nock, I.H. et al. (2004) Prevalence of geohelminth eggs in the soil and stool of pupils in some primary schools in Samaru, Zaria. Nigerian J. Parasitol. 24, 115–122
1471-4922/$ - see front matter Q 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.pt.2005.11.002
Two words colliding: resistance to changes in the scientific names of animals – Aedes vs Stegomyia Andrew Polaszek International Commission on Zoological Nomenclature, c/o Natural History Museum, London, UK, SW7 5BD
The advent of molecular systematics, large-scale relational databasing, innovative imaging systems and other advances in bioinformatics is currently causing a positive revolution in animal taxonomy. Despite this revolution, hierarchical classifications (e.g. the grouping of species into genera), especially above the species level, remain almost entirely subjective. With peer review of articles and improved communication, taxonomists aim to produce classifications that are both accurate and useful. Character analyses regularly lead to hierarchical shifts, especially when phylogenetic (cladistic) methods of analysis are used. In the near future, it might be that analysis of a suite of nuclear and mitochondrial genes will provide a more objective measure of phylogenetic relationships than anything available so far. Until then, the large amount of subjectivity in this area must be acknowledged. Applied biologists are often resistant to changes to the scientific names of organisms with which they work regularly, particularly when a name change is seen as unnecessary: for example, when an infrequently used senior synonym (an older name for the same animal) is unearthed to replace a name in widespread use. When organisms of medical, veterinary or other economical importance are involved, a large amount of extra work is likely to be necessitated by such a change. Legislative documentation associated with, for example, quarantine, forensics or conservation might also require expensive changes. However, taxonomy and systematics must be allowed to function as dynamic disciplines, and scientific names of taxa must sometimes change when continuing investigation and analysis require this. Corresponding author: Polaszek, A. ([email protected]). Available online 21 November 2005 www.sciencedirect.com
Scientific names of animals are regulated by the International Code of Zoological Nomenclature [1], first published in 1961 and now in its fourth edition (http:// www.iczn.org/iczn/index.jsp). It should be emphasized that the Code and the commission responsible for its implementation and periodic revision [the International Commission on Zoological Nomenclature (ICZN; http:// www.iczn.org/)] govern only the nomenclatural aspects of zoological taxonomy, not subjective taxonomic decisions. In the latest version of the Code, the articles dealing with ‘prevailing usage’ (particularly articles 23.9.1.1 and 23.9.1.2) are important provisions. These articles permit the conservation of widely used junior synonyms either if the corresponding senior synonyms have not been used since 1899 (or earlier) or if it can be proved that the junior name has been used a specified number of times. Despite these and other provisions, widely used names are still often changed, much to the annoyance of many of their users. The recent example from the world of tropical medicine – the transfer of the wellknown mosquito vector of dengue and yellow fever Aedes aegypti to Stegomyia aegypti [2] – is such a case. This change has outraged many medical dipterists, and the reaction of the Journal of Medical Entomology has been to encourage authors dealing with aedine mosquitoes to continue to use the traditional names (http://www.entsoc.org/pubs/Periodicals/JME/mosquito_ name_policy.htm). Although understandable from one perspective, this directive effectively encourages people to ignore a taxonomic act that is perfectly valid under the present Code – something that is undesirable from the point of view of maintaining stability in animal nomenclature generally. A. aegypti was among the species whose generic placement was changed by Reinert et al. [2] either elevating or reinstating 30 subgenera to generic rank. These reassignments are
TRENDS in Parasitology
Vol.22 No.1 January 2006
7
Letters
Deworming: adding public health education to the equation Ishaya H. Nock1, Thelma Aken’Ova1 and Musa Galadima2 1 2
Department of Biological Sciences, Ahmadu Bello University, Zaria, Nigeria Department of Microbiology, Ahmadu Bello University, Zaria, Nigeria
Key elements of resolution WHA 54.19 of the 54th World Health Assembly (www.who.int/entity/wormcontrol/ documents/wha/en) include regular deworming of schoolage children, access to safe water, sanitation and health education. This resolution is an embodiment of good health for the developing nations through the control of intestinal parasitoses; the benefits derivable from the worm-control programme and the anticipated research into helminths have been well articulated [1–4]. Ideally, deworming should be accompanied by the simultaneous provision of safe water, sanitation infrastructure and health education. For most poor nations, the provision of safe water and sanitation infrastructure is, undoubtedly, a huge and costly undertaking that cannot be met within a short time. In such a situation, deworming and health education can proceed, which explains why the Partners for Parasite Control (http://www.who.int/ wormcontrol/en/) have developed health education materials to accompany deworming. However, it seems that health education is trailing behind in the scheme because of the small number of countries (15) that has organized health education materials for integration into the programme. It is reasonable to speculate that many countries are rather preoccupied with meeting the target of delivering anthelmintic drugs to at least 75% of school-age children by 2010, as spelt out in resolution WHA 54.19. We feel that health education, being an all-embracing aspect of worm control, should be well projected and integrated from the onset of the scheme if the benefits of deworming are to be achieved and maximized. Colley et al. [1] and Nematian et al. [5] have highlighted the importance of health education in worm control but the lessons of its importance can be learnt better from the Japan International Cooperation Agency [JICA (http:// www.jica.go.jp/english/)] [6]. The JICA worm-control programme operates on the platform of education and training. Jimba et al. [6] conveyed how the programme had transformed people from health recipients to health partners. In Japan, the tradition of tailoring health education to worm control has a long-standing history [7], and the gains from this formula have reached the shores of neighbouring Indonesia [8] and China [9]. All this is a testament to the importance of health education in worm control. Deworming is only one (albeit important) aspect of the problem of intestinal parasitoses. A worm-free Corresponding author: Nock, I.H. ([email protected]). Available online 21 November 2005 www.sciencedirect.com
environment would be attained and sustained, to a large extent, through improved sanitation that hinged on health education. A health education programme – whether run through the school system, training workshops or, informally, through printed handbills and posters, television, radio and newspaper advertisements – can greatly improve the hygiene habits and general sanitation of a people. Health education defines the problem, the cause, the route, the solution and, ultimately, the prevention of disease. It is, therefore, a suitable companion to deworming. Our studies of intestinal parasitoses in parts of Kaduna State, Nigeria, led us to advocate a health education programme because we observed parasite eggs in the environment and the diseases in humans [10,11]; furthermore, we observed that 65.5% (548 out of 800) of school pupils (6–15 years of age) and 51% of adults (156 out of 304) were ignorant of the worm disease process (I.H. Nock et al., unpublished). Legislation and its enforcement against indiscriminate disposal of faeces could also contribute to good sanitary practices. The fact remains that an uninformed people would continue to practise poor hygiene habits even in the face of drug administration, such that the problem of discharging tons of untreated excreta containing millions of parasite cysts and eggs onto the earth’s surface and in water bodies (http://www.who. int/ceh/publications/05sanitation.pdf) would not only remain but also be a major source of contraction of intestinal parasitoses. Health education could help to change all this and bring greater benefits to the overall deworming exercise. JICA has proved that health education can be a propelling force behind the success of a worm-control programme. Accordingly, we urge the Partners for Parasite Control to feature health education prominently alongside a drug regimen in the pursuit of a wormless society. In this regard, it would be necessary to network the ministries of health, education and information of affected countries. The ministry of information would have the task of using newspapers, radio and television for education, social mobilization and advocacy. Deworming without health education could leave many related problems unsolved and might not be sustainable. References 1 Colley, D.G. et al. (2001) Medical helminthology in the 21st century. Science 293, 1437–1438 2 Hagan, P. (2001) This wormless world. Trends Parasitol. 17, 569 3 Markus, M.B. (2002) Helminthiasis: new medical significance. Trends Parasitol. 18, 205
Update
8
TRENDS in Parasitology
4 The Lancet. (2004) Thinking beyond deworming. Lancet 364, 1993–1994 5 Nematian, J. et al. (2004) Prevalence of intestinal parasitic infections and their relation with socio-economic factors and hygiene habits in Tehran primary school students. Acta Trop. 92, 179–186 6 Jimba, M. et al. (2005) Beyond deworming. Lancet 365, 751–752 7 Hara, T. (1998) Large-scale control of intestinal helminthic infections in Japan, with special reference to the activities of Japan Association of Parasite Control. Parasitol. Int. 47(Suppl.), 95 8 Margono, S.S. (1998) Mass treatment of soil-transmitted helminthoses in school children in Indonesia. Parasitol. Int. 47, 95
Vol.22 No.1 January 2006
9 Zheng, F. (1998) Cognition of parasitoses prevention and hygiene habits in the integrated project area of family planning in China. Parasitol. Int. 47, 95 10 Nock, I.H. and Geneve, A.I. (2002) Public health significance of parasite cysts and eggs on water-closet handles. Nigerian J. Parasitol. 23, 91–94 11 Nock, I.H. et al. (2004) Prevalence of geohelminth eggs in the soil and stool of pupils in some primary schools in Samaru, Zaria. Nigerian J. Parasitol. 24, 115–122
1471-4922/$ - see front matter Q 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.pt.2005.11.002
Two words colliding: resistance to changes in the scientific names of animals – Aedes vs Stegomyia Andrew Polaszek International Commission on Zoological Nomenclature, c/o Natural History Museum, London, UK, SW7 5BD
The advent of molecular systematics, large-scale relational databasing, innovative imaging systems and other advances in bioinformatics is currently causing a positive revolution in animal taxonomy. Despite this revolution, hierarchical classifications (e.g. the grouping of species into genera), especially above the species level, remain almost entirely subjective. With peer review of articles and improved communication, taxonomists aim to produce classifications that are both accurate and useful. Character analyses regularly lead to hierarchical shifts, especially when phylogenetic (cladistic) methods of analysis are used. In the near future, it might be that analysis of a suite of nuclear and mitochondrial genes will provide a more objective measure of phylogenetic relationships than anything available so far. Until then, the large amount of subjectivity in this area must be acknowledged. Applied biologists are often resistant to changes to the scientific names of organisms with which they work regularly, particularly when a name change is seen as unnecessary: for example, when an infrequently used senior synonym (an older name for the same animal) is unearthed to replace a name in widespread use. When organisms of medical, veterinary or other economical importance are involved, a large amount of extra work is likely to be necessitated by such a change. Legislative documentation associated with, for example, quarantine, forensics or conservation might also require expensive changes. However, taxonomy and systematics must be allowed to function as dynamic disciplines, and scientific names of taxa must sometimes change when continuing investigation and analysis require this. Corresponding author: Polaszek, A. ([email protected]). Available online 21 November 2005 www.sciencedirect.com
Scientific names of animals are regulated by the International Code of Zoological Nomenclature [1], first published in 1961 and now in its fourth edition (http:// www.iczn.org/iczn/index.jsp). It should be emphasized that the Code and the commission responsible for its implementation and periodic revision [the International Commission on Zoological Nomenclature (ICZN; http:// www.iczn.org/)] govern only the nomenclatural aspects of zoological taxonomy, not subjective taxonomic decisions. In the latest version of the Code, the articles dealing with ‘prevailing usage’ (particularly articles 23.9.1.1 and 23.9.1.2) are important provisions. These articles permit the conservation of widely used junior synonyms either if the corresponding senior synonyms have not been used since 1899 (or earlier) or if it can be proved that the junior name has been used a specified number of times. Despite these and other provisions, widely used names are still often changed, much to the annoyance of many of their users. The recent example from the world of tropical medicine – the transfer of the wellknown mosquito vector of dengue and yellow fever Aedes aegypti to Stegomyia aegypti [2] – is such a case. This change has outraged many medical dipterists, and the reaction of the Journal of Medical Entomology has been to encourage authors dealing with aedine mosquitoes to continue to use the traditional names (http://www.entsoc.org/pubs/Periodicals/JME/mosquito_ name_policy.htm). Although understandable from one perspective, this directive effectively encourages people to ignore a taxonomic act that is perfectly valid under the present Code – something that is undesirable from the point of view of maintaining stability in animal nomenclature generally. A. aegypti was among the species whose generic placement was changed by Reinert et al. [2] either elevating or reinstating 30 subgenera to generic rank. These reassignments are