Mail&Guardian (Johannesburg) - August 28, 2001
Charlene Smith
A failure to spend 60c to rid a person of worms can cost the state up to R100 000 in HIV treatments during the individual's shortened life, or in the private sector it can cost close to R700 000.
The Medical Research Council (MRC) has warned that worm infestations could render a future Aids vaccine ineffective - because the immune system has been so debilitated by successive worm infestations.
The cholera vaccine was rendered ineffective in much of Southern Africa during last year's epidemic for the same reason, according to Dr John Fincham, a senior specialist scientist at the Amoebiasis Research Unit of the MRC's National Programme for Infection and Immunity.
In schools around Cape Town, for example, up to 96% of children have worm infestation.
"The huge amounts of money that are being use to develop vaccines against HIV may well be wasted if worm infections are not brought under control. To achieve such control is entirely feasible and affordable," Fincham said.
It would cost about R10-million a year to eradicate worms, but little funding goes to worm eradication programmes either from the state or private sector. Fincham says giving children the one-tablet remedy also becomes a task in hopelessness unless sanitation is improved in schools, homes and informal settlements.
"In some schools there are either no toilets, or they are permanently blocked and sewage spills on to the floors. Sanitation in many areas is either inadequate or lacking, which means that millions of worm eggs are passed in faeces to pollute the environment, to the extent they reach the food people eat and the water they drink. Children who play on the ground are particularly exposed to infection."
An MRC statement noted that worm infestation "could also hasten progression of [HIV], reduce the effectiveness of vaccines and impair anti-retroviral therapy. It is well known that vaccines against tuberculosis, cholera and some other diseases do not work in less-developed countries whereas the same vaccines are effective in developed countries where worm infestations have either been eliminated or are under control."
Among children worm infestations can rise to close to 100% especially in poorly sanitised communities such as informal settlements like Khayelitsha, where MRC researchers say they are fighting a losing battle against worm infestation in children.
Fincham says "children who live in shacks in parts of Cape Town where sanitation is inadequate or totally lacking nearly all have worms. In another Cape Town suburb where people are poor but live in houses, 74% of teenagers who were 14 years of age had worms."
New research shows that a failure to launch extensive - and cheap - programmes to fight worms aids HIV and tuberculosis by depressing immune systems. Not only is the body of the individual too weak to stage an attack against HIV, but pregnant mothers with worm infestations are more likely to pass on the virus to their babies.
A workshop hosted by the MRC at Gordons Bay on September 10 will bring together scientists from Germany, Ethiopia, Uganda, Kenya, the United Kingdom and South Africa to debate these and other findings.
Worm infestation in children leads to stunting, and heightens the risk of epidemic enteric diseases such as cholera, typhoid, colibacillosis and shigellosis, amoebiasis and other illnesses.
The MRC advises people to regularly examine their own stools or those of their children for tapeworm segments: "in fresh stools these are similar to soft, whole, melon seeds and they also move slowly".
Fincham recommends that every South African take a generic dewormer twice a year, D-Worm SD.
A child ill with worm infestation experiences severe abdominal pain, vomiting and acute weight loss; and stops eating and battles to concentrate. Portions of the intestine can also die and surgery to remove the worms and cut away the section of dead intestine is necessary.
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