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National School Deworming Month

STUDENT’S ORIENTATIONJune 14, 2016

Ernesto Rondon High School

What is National School

Deworming Month?

- a massive, one month, simultaneous school-based deworming effort to approximately 16 million school-aged children enrolled in public schools this coming July 1 -29, 2016.


What are intestinal worm infections?

Intestinal worms are parasites that live in the human intestines or in the veins around the bladder.

These worms are transmitted by eggs excreted in human feces or urine, which contaminate the soil or water sources in areas that lack adequate sanitation.

The worms consume part of the nutrients and vitamins that children ingest.


Why do children need deworming?

Children are most vulnerable to worm infections, as their immune system is not yet fully developed.

Untreated worm infections prevent children’s healthy growth, cause poor nutrition and reduce their capacity to concentrate and learn.

The treatment is simple, safe, effective and free of charge. A single dose of deworming treatment drastically reduces the number of worms in each child.


Regular treatment contributes to good health and nutrition for children of school age, which in turn leads to increased enrolment and attendance, reduced class repetition and better educational attainment.

Children need these deworming medicines to grow healthier and learn better in school.


How to prevent these infections?

Always use a toilet or latrine. This will prevent feces from contaminating the soil.

Always wash hands with soap after using the latrine, and keep hands clean.

Wash fruits and vegetables with clean water.

Always wear shoes and slippers and avoid walking barefoot.

Take deworming tablets at least once a year.


Backgroundand

Rationale

The Department of Health (DOH), in partnership with the Department of

Education (DepEd) through the Health and Nutrition Center (HNC), will conduct the National School

Deworming Month (NSDM) starting on July 1 -29, 2016.


Backgroundand

Rationale

The NSDM aims to deworm approximately 16 million school-

aged children enrolled in all public elementary and high schools in one month, to reduce the burden of Soil

Transmitted Helminthiasis (STH) infections with a positive impact on

children’s education and health.


Definitions

ALBENDAZOLE- the drug of choice for the control, prevention, and treatment of helminth infections

DEWORMING- the administration of albendazole (or mebendazole), without prior diagnosis of current infection, to control and treat intestinal helminth infecions, such as hookworm, Ascaris, and Trichuris

ELIGIBLE POPULATION- a group of individuals qualified for deworming; target population for single day deworming will be children age 5-18 years old or K- Grade 12 enrolled in public elementary schools


Definitions

MASS DRUG ADMINISTRATION (MDA)- a strategy to provide deworming drugs to the eligible population without the requirement of prior diagnosis of current infection

MASS DRUG ADMINISTRATION PROVIDER (MDAP)- a person who administer the deworming drugs. This can be any teacher supervised by a health worker from the department of health (DOH), Department of education (DepEd), Local Government Units (LGU), or volunteer groups (with prior approval from DOH Regional Office) who have the capacity and background in health, administration of deworming drugs, and management of adverse events.



Objectives

General: To deworm approximately 16 million school-aged children enrolled in 38,659 public elementary schools in one (1) day through the National School Deworming Day initiative.

Specific: To increase and scale-up the MDA coverage for

school-aged children (5-12 years old or Kindergarten to Grade 12) enrolled in public elementary schools

To facilitate and ensure timely reporting of deworming intervention

To promote partnership in all levels in the implementation of deworming for school-aged children enrolled in public elementary and high schools

The NSDM is a nationwide effort targeting all 5 to 18 years old (Kindergarten to Grade 12) children enrolled in public elementary schools.

School-aged children enrolled in private schools and children who are not enrolled are encouraged to participate. They can inform the DepEd Regional Office regarding their willingness to participate and in turn, the DepEd Regional Office can refer them to the DOH Regional Office.

SCOPE AND

COVERAGE


Expected Outcome

Improved and better health outcome which is among the targets in the Roadmap of the Kalusugan Pangkalahatan or Universal Health Care through High Impact Breakthrough.


GENERAL GUIDELINE

S

NSDM guidelines and protocols set by the DOH-CO in collaboration with the Department of Education (DepEd) shall provide direction and serve as a roadmap for Mass Drug Administration Providers (MDAPs) in the implementation of NSDD.


IMPLEMENTATION

The NSDD Implementers shall consist of the following: i. Category 1: Health workers to oversee the MDA Regional, Provincial and Municipal Health Office Staff (Rural

Health Physicians, Public Health Nurses, Rural Health Midwives) DepEd school physicians and nurses Nurses and midwives from the Nurse Deployment Program/ Rural

Health Midwife Placement Program

ii. Category 2: Front liners in the MDA School Teachers and clinic teachers will distribute the deworming

drugs Members of the Parent Teachers Community Association (PTCA)

will assist in the school deworming Barangay Health Workers will assist in the school deworming Community Health Teams will assist in the school deworming


Before dewormin

g day

All children without other illness should be treated during a school deworming day.Teachers must inform parents of the importance of deworming so that parental consent to treat their children is obtained before the deworming day.Inform parents by means of group meeting. When this is not possible, students are asked to hand a notification letter to their parents.


The NSDM is a nationwide effort targeting all 5 to 18 years old (Kindergarten to Grade 12) children enrolled in public elementary schools.

School-aged children enrolled in private schools and children who are not enrolled are encouraged to participate. They can inform the DepEd Regional Office regarding their willingness to participate and in turn, the DepEd Regional Office can refer them to the DOH Regional Office.

SCOPE AND

COVERAGE


MDAP Guide

1. Pre-dewormingPrepare enrollment listEnsure availability of deworming & supportive drugs The Mass Drug Administration Provider must be familiar with the following information:

Recommended drug for Mass Drug Administration

The DOH recommends the following drugs for mass treatment:Albendazole 400mg chewable,flavoured tabletMebendazole 500mg chewable,flavoured tablet


MDAP Guide

Precautionary Measures on Mass DewormingAlbendazole or Mebendazole is not recommended if the child has any of the following conditions:Seriously ill child Children experiencing abdominal pain Children with diarrhea Children who previously suffered hypersensitivity to the drug Serious Adverse Events (SAE) following dewormingMDAP shall ensure that the children will take deworming drugs on Full Stomach


. MDAP Guide

2. DewormingClean drinking-water should be available at the school on the treatment day

Each learner shall receive one tablet of deworming drug.

The MDA providers should ensure that each child swallows/chew the tablet.


MDAP Guide

The names of the children who are absent on NSDD should be recorded by the teacher and these children should be treated when they return to school. Children who are ill on treatment day should not receive drugs. This is not because of any danger of adverse effects, but to prevent the potential misperception that the deworming medicine caused the illness. These children should be given the anthelminthic drug later when they are well againEnsure all RHUs and hospitals are ready for SAE referralsEnsure that the required number of drugs is available


MDAP Guide

3. Post DewormingThe class teachers shall make sure that all children listed in the masterlist were given deworming drugs.

NSDD point person to collate and submit report (Please see flow of reporting)


NSSD Form 1

Form 1National School Deworming DayClassroom Level

Province: Division: District:School: School Address:Total Enrolment: Grade Level & Section:Name of

ChildEnrolment Hand

washing Done

Feeding Done

Dewormed Tooth brushing

Done

Remarks Actions Taken

4Ps Non 4Ps

1.2.

Accomplished by: Noted:

Class Adviser Grade Level Chairman Date:


NSSD Form 2

Form 2National School Deworming DaySchool Level

Province: Division: District:School: School Address:

Grade Level

Enrolment Total Enrolment

No. of Children

Dewormed

Dewormed Total No. of Children

Dewormed

Remarks

4Ps Non 4Ps

4Ps Non 4Ps

Total Accomplished by: Noted:

School Principal PSDSDate:


NSSD Form 3

Form 3National School Deworming DayDistrict Level Reporting Form

Region Province: Division:District:Name of Schools

Enrolment Total Enrolment

No. of Children

Dewormed

Dewormed Total No. of Children

Dewormed

Remarks

4Ps Non 4Ps

4Ps Non 4Ps

Total Accomplished by: Noted:

PSDS SDSDate:


Mebendazole 500mg, chewable,

flavored tablet

Albendazole 400 mg, chewable,

flavored tablet


I. Recommended drugs for mass deworming

All individual ages 1yo and above can take the deworming tablet regardless of the schedule of their last deworming.

It should not be taken on an empty stomach

AO 2010-0023


Dosage and Estimated Effectiveness of Drugs

in Current Use in Intestinal Helminth Infections (Based on Drugs Used in Parasitic Diseases,

WHO)Albendazole1 (400

mg)Levimasole1 (2.5

mg/kg)Mebendazole1 (500

mg)Pyrantel1 (10

mg/kg)

Roundworm Whipworm Hookworm+++

+

+++

+++

++ - +++

++

++ - +++2

+++

++ - +++

++ - +++2

++ - +++++++ Highly effective+++ Effective++ Effective in light to moderate infections

1 In single dose2 The usual dose of Mebendazole is 100 mg BID for 3 days. Single dose of 500 mg

National School Deworming MonthWhy is albendazole or mebendazole the drug of choice in

the mass tx of STH? • Included in the WHO model list of

essential medicines for single dose treatment of STH

• Safe, economical and simple because it is given as a single dose

• Efficacy varies as a function of such factors as pre-existing diarrhea, gastrointestinal transit time, degree of infection, and helminth strain


II. Drug dosages and frequency of deworming by target groupsTarget groups Drug Dosage Frequency

12—23 months Ãlbendazole: 200 mg or ½ tabletMebendazole: 500 mg tablet

Every 6 months

2 yrs old and above (preschoolers, school children, pregnant, lactating adults, women of child bearing age, special population and special groups)

Albendazole: 400mg or 1 tablet Mebendazole: 500 mg tablet

Every 6 months

Pre-school aged children and unenrolled school-aged children should be given deworming drugs at the Rural Health Unit or Municipal Health Center.

Enrolled school-aged children are given deworming drugs in schools

AO 2010-0023


III. Adverse events following deworming (AEFD) AO 2010-0023

Common Adverse Effects How to Manage*

Local sensitivity or allergy Give antihistamineMild abdominal pain Give antispasmodic

Diarrhea Give oral rehydration solution plus Zinc

Erratic worm migration Pull out the worms from mouth/nose and dispose worm properly

Parents/caregivers are allowed to manage the adverse reactions, but if these reactions persist, a doctor shall be consulted and any of the AEFD team shall be informed

National School Deworming MonthWhy do we say that adverse effects are

relatively mild?Poorly absorbed Primary metabolite, sulfoxide, is rapidly metabolized to sulfone

Negligible or undetectable in the plasma 24 hours after ingestion

Half life of the sulfoxide is about 8.5 hours No treatment is necessary if the child experienced any of the adverse reactions since they are mild and transient

National School Deworming MonthRecommended Drugs for the management of

Adverse Events Following Deworming (AEFD)For local hypersensitivity and allergy:

Drug DoseDiphenhydramine For oral dosage forms: Syrup

12.5mg/5ml • Children younger than 6 years of age:

½ tsp to 1 tsp every 6 – 8 hours until symptoms subside

• Children 6 to 12 years of age: 1tsp to

2 tsp every 6 – 8 hours until symptoms subside


Adverse Events Following Deworming (AEFD)For abdominal pain:

Drug Dose

Dicycloverine GI spasm:For oral dosage forms: Syrup 10 mg/5ml • Children 6 months – 2 years old: ½ tsp to 1 tsp every

6 – 8 hours.• Children 2 – 12 years old: 1 tsp every 6 – 8 hours.

* Dicycloverine: May be taken with or without food. (May be taken before or after meals.)


Adverse Events Following Deworming (AEFD)For abdominal pain:

Drug DoseHyoscine N-

butylbromide

Acute attacks of colicky pain: For oral dosage forms: Syrup 5 mg/5ml or Tablet 10mg • Children ≥ 6 years: I tablet every 6 – 8 hours or 2

tsp every 6 – 8 hours.


IV. Precautionary Measures on Mass DewormingAO 2010-0023

Category ResponseSeriously ill childChildren experiencing abdominal painChildren with diarrheaChildren who previously suffered hypersensitivity to the drug

Manage existing condition prior to administration of deworming drug

Severely malnourished children Assess for presence or absence of medical complication and edema of both feet.

If present, manage medical complications before deworming. (Source: Community-based Management of Acute Malnutrition) For uncomplicated severe malnutrition, (absence of medical complication and edema) children may be dewormed .

REMEMBER!Target clients or caregivers should be

adequately informed of the possible adverse reaction to the drug and how to manage it in case it occurs

Adverse reactions should be accurately recorded and proper authorities (AEFD team) informed

Health personnel at the community level should be informed of the on-going deworming activity. Support drugs should be available at the nearest health facility

When to report SAE?Any Serious Adverse Event (SAE) experienced by the client within 8-10 hours after ingestion of the drug should be reported immediately to the appropriate authority.

Any AEFD or non-serious adverse event shall also be recorded for reference.

Any AEFD or non-serious adverse event reported after 10 hours since the administration of the drug should be investigated and managed appropriately.

Whom to report SAE?Municipal Level Provincial Level Regional Level National Levela. Municipal HealthOfficer

b. Municipal Epidemiology Surveillance Officer (if available)

c. IHCP Coordinator

d. DOH Rep

e. School Health Coordinator

a. Provincial HealthOfficer

b. Provincial Epidemiology Surveillance Officer (if available)

c. IHCP Coordinator

d. DOH representative

e. School Health Coordinator (for school based deworming)

a. Regional IHCPCoordinator

b. Regional Epidemiology Surveillance Officer

c. Food and Drug Administration Officer

d. School Health Coordinator (for school based deworming)

a. DiseasePrevention and Control Bureaub. Epidemiology Bureau

c. Food and Drug Administration

d. Department of Education (for school based deworming)

DOH/DFA/DepEd Recommend appropriate action

RESU / Regional Coordinator/DepEd School Governance and Operations Division Confirms and validate

investigation findings Assist in investigation if

needed Recommends appropriate

action

Municipal/ Provincial/ City Health Office/ DepEd Division Office Conducts and confirms initial investigation using adverse reaction

reporting form and submits to next level

Recommends appropriate action

Health Worker/ Parent/Teacher Reports any SAE in the area to higher level

Flow of SAE Report and Investigation

INTEGRATED HELMINTH CONTROL PROGRAM Adverse Events Following deworming

REPORTING FORM

To be filled in by the Physician/Midwife/Barangay Health Worker or Teacher as needed during every mass deworming campaign

Region: ______________________Province: ________ Municipality: _______________________

Service outlet: (Please check and indicate name of RHU, School, Daycare

______ Barangay Health Station/RHU: ________________ School:_________________

______ Day Care Center: _____________________

Date of deworming: ___________ Time of Deworming _____

Name of patient AgeComplete Address Chief Complaint Action

REMARKS

and time of onset of signs and

symptoms Taken

Accomplished by: _______________________________ Print name and signature Date: ________________________

Support to DOH Regional Offices for AEFD and SAE

The Integrated Helminth Control Program shall sub-allot the amount of Fifty Thousand Pesos (PhP 50,000 – 100, 000) to each DOH Regional Office annually to help defray the expenses incurred related to the occurrence of AEFD or SAE during the conduct of deworming activity.

AO 2010-0023

THANK YOU FOR LISTENING!

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