Bookworms, not hookworms: Preventing an overlooked disease can help children grow and learn

It’s back to school time again in the U.S., which means mixed emotions for lots of students and parents. On one hand, there’s the pride of seeing children grow up and the excitement of learning and making new friends. On the other, some families and children could be facing hardships that make this time of the year a challenge. One thing that most American families don’t have to worry about—but is a major concern for millions of students and parents in poor countries around the world—is parasitic worms. 

You may have heard of one such worm infection called schistosomiasis under a different name. In the U.S. we call it “swimmer’s itch,” but the species we have here is mild compared to the one transmitted by freshwater snails, which is widespread in many parts of Africa, Asia, and Latin America. The World Health Organization estimates that 206 million people are at risk of being infected with this serious form of schistosomiasis. Chronic infection can result in irreversible damage to the liver and spleen, cause bladder cancer, and increase the risk of HIV transmission. School-aged children harbor the heaviest parasite burden due to having the greatest contact with freshwater when playing and washing, and therefore the highest risk of infection.   

Early and repeated treatment of schoolchildren at risk of schistosomiasis should be thought of as a vital part of their educational development, just as learning to read is. A recently published review demonstrated a clear link between infection with schistosomiasis and educational outcomes. It took all available, high-quality studies—encompassing almost 40,000 children across 14 countries—to show that infection with schistosomiasis is significantly associated with learning and memory deficits in school-aged children. Additionally, infection with schistosomiasis and other neglected tropical diseases—which affects more than 1 billion people around the world—causes children to miss school and therefore suffer learning losses. One study found that treatment against soil-transmitted helminths (also known as intestinal worms) reduced school absenteeism by as much as 25 percent. In addition to missed opportunities to learn, children who do not attend school are more likely to spend time in areas where they are exposed to infection (such as fields and rice paddies), thereby increasing transmission. 

Great progress is being made in controlling schistosomiasis. Thanks to support from the United States Agency for International Development, the United Kingdom’s Department for International Development, other funders, and generous donations of the drug praziquantel by the pharmaceutical company EMD Serono, treatment is steadily reaching more and more of those in need. Last year, 54 percent of children who required treatment received it. This is a meaningful increase from 32 percent in 2012. However, we have some way to go to reach the World Health Organization’s target of 75 percent by 2020 and the ultimate aim of treating every child who needs it. Working in our favor is the fact that the availability of free, effective medicine like praziquantel makes deworming a low-cost, high-impact intervention.  

A child’s health and education are closely tied in many ways beyond schistosomiasis. The first five years of a child’s life set the foundation for later outcomes in health, learning, and social-emotional well-being. Ninety percent of brain development occurs by the age of five, and the care children receive in their early years can have lifelong effects on education and income. The Lancet estimates that some 250 million are at risk of failing to meet their developmental potential, a crisis affecting 43 percent of children in low- and middle-income countries.  

Given the interdependence of a child’s health and education, they must be addressed together. It will take bold thinking—and bold actions—to break down current silos and forge an integrated path forward.  

Development interventions are typically designed to teach children to read, or protect them from diseases, or provide them with healthy food. But a child needs all of these, and more, to learn and grow. Practitioners must identify—and donors must support—long-term, country-owned, sustainable approaches that combine literacy, deworming, and other proven early childhood development interventions. RTI’s work in collaboration with the governments of Kenya, Uganda, and the Philippines has shown that integrated programming is more than the sum of its parts. To help every child reach their developmental potential we need to be ambitious enough to support children holistically, not just through isolated, sector-based interventions.         

Back to school time is a reminder that development interventions must reflect the reality that children experience every day, whether they are at risk for schistosomiasis or not: their health and education depend on one another. Their future (and ours) depends on our ability to ensure all children survive and thrive.