Mass Deworming Programs in Middle Childhood and Adolescence

The current debate on deworming presents an interesting public health paradox. Self-treatment for intestinal worm infection is among the most common self-administered public health interventions, and the delivery of donated drugs through mass drug administration (MDA) programs for soil-transmitted helminths (STHs) exceeds 1 billion doses annually. The clinical literature, especially the older historical work, shows significant impacts of intense STH infection on health; a burgeoning economics literature shows the long-run consequences for development (see, for example, chapter 29 in this volume, Ahuja and others 2017; Fitzpatrick and others 2017). Yet, the literature on clinical trials shows conflicting results, and the resulting controversy has been characterized as the worm wars. The two previous editions of Disease Control Priorities contain chapters on STH and deworming programs (Hotez and others 2006; Warren and others 1993). Much of the biological and clinical understanding reflected in those chapters remains largely unchanged. This chapter presents current estimates of the numbers infected and the disease burden attributable to STH infections to illuminate current program efforts, advances in the understanding of epidemiology and program design, and the controversy regarding the measurement of impact. Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy, de Silva, and others 2017).