Treatment of schoolchildren in Tanzania

A private donor’s generous donation of $500,000 was used to fund the first-ever round of treatment of school-age children for schistosomiasis and STHs.

A private donor’s generous donation of $500,000 was used to fund the first-ever round of treatment of school-age children for schistosomiasis and STHs in six endemic regions: Rukwa, Morogoro, Singida, Manyara, Kilimanjaro and Arusha. This campaign was thus a valuable addition to the existing national program that treats children aged 1-5 countrywide for measles, polio, and STHs. The medicines for it—PZQ and mebendazole—were bought and cleared through the Tanzanian port and were then distributed to the target regions and subsequently to each of the 34 districts within them. The treatment campaign itself took place from August 29th to September 2nd, 2008, targeting 1.95 million children. Since school-aged children are at the highest risk of infection, trained primary school teachers led the drug distribution process.

On the 1st-3rd of July, 2008, a training session for regional and district school health coordinators took place in Morogoro Town (see photograph below). During this session, 82 participants—including 67 district school health coordinators, 11 regional school health coordinators, and 4 zonal reproductive and child health coordinators—were taught how to implement school deworming programs. These “trainers of trainers” then held district-level training sessions for schoolteachers and health care workers in the six targeted regions throughout July.

Campaign Results

The 2008 deworming campaign was a remarkable success, achieving high rates of coverage in the six targeted regions and serving to raise significant awareness about NTDs across Tanzania. Average treatment coverage with Praziquantel and Mebendazole among registered pupils in participating schools was:

• Arusha, 86.3%
• Kilimanjaro, 75.7%
• Manyara, 82.5%
• Morogoro, 47.6%
• Rukwa, 65.3%
• Singida, 75%

This means that of the 1.95 million children targeted for treatment, approximately 1.4 million (71.5%) received needed drugs for NTDs.

In addition, the extensive training of health care workers and teachers included in the campaign serves as a foundation for future deworming efforts. Communities in these regions have been empowered to take greater ownership of their own health care. Those who have been trained can now sustain local NTD control by running further treatment campaigns with less need for outside assistance, and teachers, now aware of the signs of infection with NTDs, can play a more integral role in children’s health. Moreover, the recent campaign was critical in raising general public awareness of the prominence of NTDs in Tanzanian communities (particularly among school-aged children) and the importance and benefits of obtaining treatment.

,p>Unfortunately, an incident occurred that affected treatment in two of the six targeted regions that led treatment coverage there to be somewhat lower than coverage in the other four targeted regions. In Morogoro and Rukwa, adverse rumours about the deworming medications led parents to take their children out of school and refuse to allow the treatment of those that had not yet been treated. The distribution of drugs was stopped in Morogoro, though this was after most children had already received treatment. In-country SCI representatives, including Dr. Alice Norton, were in Morogoro during the campaign and visited the regional hospital to meet the few children admitted with mild symptoms resulting from praziquantel treatment, likely caused by insufficient food consumption prior to taking the medication. Later that night, the Minister of Health made television and radio statements that the drugs were safe and that the reports of death from treatment were false. On August 30th, at the joint launch of the deworming, vitamin A distribution and measles vaccination campaigns in Tanga, the Minister re-emphasized the importance and safety of praziquantel. After that, and with advice from the MoHSW, drug distribution was resumed in the two districts, with parents bringing their children for treatment

Ultimately, the rumour incident increased awareness of the campaign in both the government and the general Tanzanian population. The team on the ground does not believe it will have detrimental effects on future NTD control efforts. In fact, the Minister of Health’s response may have further increased recognition of the importance of the deworming drugs for the health and well-being of children in endemic regions.

Remaining Need

Still, limited funding and resources have inhibited access to critical treatment for NTDs for many Tanzanians. While significant strides have been made, these diseases remain untreated—or inadequately treated—in many of the various regions of Tanzania. The table below highlights the availability of drugs and funding for NTD control as of this year (mid-2008).

The move underway towards integrated NTD control is a step in the right direction, because it utilizes synergies in disease prevalences and control approaches to reduce costs and improve efficiency of programs. Implementation of the recently-developed national plan for integrated NTD control will require an additional U.S. $10.5 million over three years in external funding, besides the $6 million pledged by the Tanzanian government. If executed successfully, the plan’s expanded geographic and demographic scope has the capacity to reach many as-yet-untreated Tanzanians. Putting the situation into context, the 2008 deworming campaign targeted about 2 million people, whereas this plan targets 17 million.

Looking to the Future

Tanzania is at a tipping point. There is much to be done to improve the health—and thus the lives—of its inhabitants, but key successes are within reach. Vertical programs targeting individual NTDs have made significant progress to-date; however, moving forward, integration is necessary to truly meet the country’s health needs. The political will is in place to continue the existing momentum on the ground. Given the necessary funding to continue programs underway and to scale up integrated NTD control, including treatment with the Rapid Impact Package, the public health burden of NTDs in Tanzania can be substantially reduced, even potentially to the point of country-wide elimination.

By funding NTD control in six endemic districts, this donation not only taught valuable lessons in NTD prevention and control and treated 1.4 million children, but it also enabled these children to lead healthier lives and reach their full potential – to attend school, learn, and grow into productive members of society who can contribute meaningfully to their communities and to the world. This is a critical first step to empowering all Tanzanians to break out of the unending cycle of poverty and disease and enabling the country of Tanzania to achieve the UN Millennium Development Goals.