046:127 Pharmaceutical Management for Underserved Populations

School-Based Health Programs: Developing Countries

Class Period #8, 7 March 2007

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Role of Health Programs in Child Development

1. Good health before and during school age is essential for life cycle good health

2. Educational system/infrastructure is more cost effective to deliver simple health interventions than the health system

3. Good health/nutrition: prerequisites for effective learning

4. Child must be present, ready and able to learn to take advantage of schools/textbooks/teachers

5. Education that promotes positive health behaviors contributes to prevention of HIV/AIDS (social vaccine)

Age Distribution of Infection-Specific Morbidity

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Helminth Infections

• 25-35 % school aged children infected with worms

• Geohelminths:– Roundworm (Ascaris)– Whipworm (Trichuris)– Hookworm (Ancylostoma,

Necator)

• Schistosomes (Schistosoma)• Account for 12% disease

burden of children

5

Disability adjusted life years (DALY)DALYs for a disease are the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition. The DALY is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of 'healthy' life lost in states of less than full health, broadly termed disability. One DALY represents the loss of one year of equivalent full health. [WHO definition]

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Effects of STH in Humans• Hookworms (Ancylostoma, Necator):

– Intestinal bleeding, anemia• Roundworm (Ascaris)

– Malabsorption of nutrients– Competition for micronutrients– Impaired growth– Loss of appetite– Intestinal obstruction

• Whipworm (Trichuris)– Diarrhea– Reduction in fluency and memory– Rectal prolapse

WHO Action Against Worms, Jan 2006http://www.who.int/wormcontrol/newsletter/PPC6_Eng.pdf

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Evidence

• Kenya: deworming raise per capita income from US$337/person to US$490/person

• Deworming drugs can reduce primary school absenteeism by 20%

• Oral antimalarial treatment reduced school absenteeism by 50% in Ghana

• South Africa: increase of 1 SD in literacy and numeracy scores was associated with 35% increase in wages [0.25SD increase in IQ 5-10% increase in wages]

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Why Schools?

• Cost per DALY of school health programs estimated at US$20 to US$34 – a public health “Best Buy”

• Developing countries: 68-98% of eligible children attend primary school (480 million)

• In school programs reach out of school children, preschoolers and women (high risk groups)

• Schools are readily available, skilled workforce, more teachers than nurses

• Sustainability