WORMS ATTACK MR. KWASI’S FAMILY GETTING RID OF PARASITES FOR BETTER LIFE

WEST AFRICA CENTRE FOR INTERNATIONAL PARASITE CONTROL

NOGUCHI MEMORIAL INSTITUTE FOR MEDICAL RESEARCH, UNIVERSITY OF GHANA

Worms Attack Mr. Kwasi’s Family

Do you see the worried looks on the faces of the boy and the girl? They are worried because the boy is urinating blood and the girl is very ill.

What is tickling my buttocks?

Worms?! Oh! No…o!

A different type of worm is the cause of the bloody urine. The children in this picture are from the same family.

Is the older girl also sick with worms? Worms! They look terrible.

Let us follow the story of how worms attacked this family

Worms Attack Mr. Kwasi’s Family

Do you see the worried looks on the faces of the boy and the girl? They are worried because the boy is urinating blood and the girl is very ill.

What is tickling my buttocks?

Worms?! Oh! No…o!

A different type of worm is the cause of the bloody urine. The children in this picture are from the same family.

Is the older girl also sick with worms? Worms! They look terrible.

Let us follow the story of how worms attacked this family

INTRODUCTION OF CHARACTERS This is a story about a family living in a village somewhere in Africa. This boy is Lawoe, and this is his twin sister, Attah. They are both 10 years old.

Lawoe is a naughty boy. He likes to play around with his friends, and doesn’t like studying at school. Attah is a good girl, helping her mother at home. She likes going to school.

This is their younger sister, Tawiah. She is 7 years old. Tawiah also likes going to school, but she doesn’t like studying very hard.

This is their younger brother, Abbam. Abbam is 2 years old.

Their father is Mr. Kwasi. Mr. Kwasi is a good farmer, working very hard in his farm all day long.

This is their mother, Auntie Afua. Auntie Afua is a kenkey seller. She makes kenkey at home and sells them in the market.

Their house is a small compound without a toilet or piped water, but the family is very happy living together.

ATTAH IS GOING TO FETCH WATER IN THE MORNING Every morning, Attah goes to fetch water from the river, because their house has no piped water. Look at her feet. She is wearing no shoes; the water washes the dirt on her feet when she enters the river. The bucket is very heavy but she can carry it on her head and walk a long way home. So she is helping her mother very well. She is a good girl isn’t she? But she has been feeling tired these days. She doesn’t know why. Today the bucket seems heavier than usual. Lawoe defecates in the bush, for that is his habit. Abbam imitates his elder brother, and also defecates under the tree.

TAWIAH PLAYS COOKING GAMES WITH FRIENDS IN THE SOIL What is Tawiah doing? Yes, she is playing a cooking game with a friend. They are making mud balls with their hands. The balls look like Tawiah’s mother’s balls of kenkey, don’t they? Attah is helping her mother to cook kenkey. Can you see a cat behind them? Small girls are talking like their mothers in the market; “How much is one Madam? Well, one is a thousand cedis. Two are for one thousand five hundred, Madam. Okay, I will buy two, so will you give me one for DASH?” You see Abbam is crawling to his sister. He wants to play with them. Look at their dirty hands.

BOYS ARE URINATING AT THE RIVERSIDE Do you know what they are doing? Yes, Lawoe and his friend are playing a urinating game. They are competing on the distance of their urine into the river. Do you think this is a good practice or a bad practice? If bad, why? “Hey”, Lawoe said. “Your urine is red!” Lawoe laughs at his friend because his urine is red. Do you know why the urine is red? Well, it may be blood in the urine. Can you tell me why there is blood in the urine? Okay, I will tell you later. But it seems that these boys don’t care about it. The stream goes down slowly and the water looks clear and fresh. Some boys are swimming as usual. They swim very well like fish. Then they forget themselves and swim for a long time.

AT DINNER TIME, TAWIAH HAS POOR APPETITE Now it is dinner time. Their mother has prepared many balls of kenkey with fish. “Wow!!! It looks like those mud balls you made this afternoon!” Attah said to Tawiah. But Tawiah has poor appetite. She doesn’t know why. Can you guess why she has poor appetite? On the contrary, Lawoe is hungry after playing in the river, so he is jumping for the food. “Wait! Did you wash your hands?” the father asked. ‘Yes, yes, I’ve washed them already”, Lawoe answered. Tawiah didn’t answer. But in fact, Tawiah has not washed her hands after making mud balls. She doesn’t usually wash her hands before eating. Is this good practice, or bad practice? They started eating. Tawiah ate only one bite and said, “Mom, I don’t want to eat.” She feels so sick and tired. So she left the table, and went to bed earlier than usual.

IN THE CLASSROOM Next morning, children go to school. “Good morning, Miss.” “Good morning children!” They sit in the classroom, but there are some empty seats along the tables. Can you see Attah is absent? “Where is Attah?” the teacher asked Lawoe. “She is sick, staying at home, Miss.” Lawoe answered. Do you remember Attah has been feeling tired these days? Today, Attah could not wake up in the morning. She felt so tired, and could not carry a bucket of water all by herself. “Oh, what happened to her?” Teacher frowned, because Attah has never been absent before. How about the other pupils? Some of them look tired, and some are even sleeping. Children, don’t sleep in the classroom!” she said. But one boy answered in a dull voice, “Miss, I’m tired, and I don’t feel well.” Then the teacher started teaching. She asked some simple questions, but the children couldn’t answer. “Oh, this is a very easy one. I am disappointed.” She looks round her pupils, but they don’t have the energy to think well. She suspects that these children may be infected with intestinal worms that cause anaemia and loss of energy.

DIAGRAM OF INTESTINAL WORMS Look at the picture. What is this? This is a picture to explain the transmission cycle of worms. Let’s start from this picture of somebody defecating. There are tiny tiny dots coming out from the faeces, can you see? These are eggs of the worms. People who are infected with these worms excrete worm eggs in their faeces. So if such a person defecates on the ground, his faeces contaminate the soil with worm eggs!

• One type of worm eggs actually hatch in the soil and become baby worms. • The other types don’t hatch but remain as live eggs in the soil for a very long time.

Here two children are playing on the ground. Can you see their hands and legs are dirty with contaminated soil? Now you see, these baby worms are entering the body through the skin. And this boy is eating with dirty hands, so he is eating these eggs, too. Then worms grow up and live in the intestines or other parts of body. They steal your food and energy, and suck your blood making you sick like this child. You can also spread their eggs if you defecate in the bush. And this cycle goes on and on if we don’t break it at some point. Do you understand?

LESSONS LEARNT FROM DIAGRAM Now what lesson have you learnt? Yes, we shouldn’t defecate in the bush.

We should wash our hands with soap under running water before eating. Washing hands after toilet is also important.

Can you tell me why? And what else? Yes, we should wear sandals or shoes so that baby worms don’t enter our body, isn’t it? When we do these things we are trying to break the transmission cycle to prevent infection. Remember, did Tawiah wash her hands before eating? So why is she sick? Don’t you think Tawiah has swallowed worm eggs because of her dirty hands? How about her sister, Attah? Did she wear shoes? She has been tired these days. She may have gotten infected with baby worms through the skin, isn’t it? Okay, let’s continue the story.

MASS DEWORMING DAY The class teacher mentioned the pupils’ absenteeism and dullness in class at the staff meeting. Other teachers agreed that the same was happening in their class. The school reported this matter to the District Education Office (DEO). The DEO collaborated with the Health Office for support. After the Health Office had conducted their investigations, they decided to conduct a mass de-worming at the school, because they found many children were infected with worms and had lost their energy. Here are Lawoe and Tawiah going to school. But Attah is still sick and stays home. Do you know what is de-worming?

• It is getting rid of worms from the body with medicine. There are many other children who are not enrolled in the school. But they are also invited to the school for de-worming.

TAWIAH FOUND WORMS Do you remember Tawiah didn’t have appetite? Two days after de-worming, she is feeling strange and ticklish around her buttocks. “Help me mom! I have worms!” She cried. You see, she has been infected with worms because of her dirty hands. Auntie Afua ran to her and saw the worms. She was shocked and said to herself, “She could have died from the worms.” She then shouted, “Oh, you are a naughty girl! You have not been washing your hands before eating, have you?” “I’m sorry, Mom.” Mother continued: “Did you always wash your hands after toilet?” Tawiah answered in a very weak voice, “No Mom. I’m so sorry.” “I have told you so many times that you should wash your hands after toilet and before eating! But you didn’t follow my instructions. Look, these worms are a result of your bad practice.” Tawiah regretted so much. Well, how about Lawoe and Attah? Lawoe didn’t expel big worms after de-worming. But is he healthy? Attah didn’t go to school on the de-worming day because she was sick. Does she also have worms?

LAWOE HAS URINATED BLOOD In fact, Lawoe has started urinating blood recently, just like his friend whom he teased at the riverside. Lawoe never told his parents this until now, but he got so scared because Tawiah got infected with worms and Attah was also sick. So, he said to his mother, “Mom, my urine has become red. I don’t know why. Is this a sign of manhood? My friend tells me so. But I don’t know. I’m scared.” Attah is still feeling tired. She looks very pale. Her tongue and conjunctiva are whitish. Do you remember she was absent on the de-worming day? Their mother decided to take Lawoe and Attah to the Health Centre.

AT THE HEALTH CENTER At the Health centre, a laboratory technician examined Attah’s stool, and found many eggs of the worm called Hookworm, which enters the human body through the skin. Do you remember? Attah does not wear shoes. So she got worms from her bare feet. The Doctor said, “Hookworms are very small worms and live in your gut. They suck blood from your gut wall everyday, so if you have many Hookworms in your gut, you lose much blood and become anaemic.” That’s why Attah looked pale and didn’t feel well. The doctor also examined Lawoe’s urine, and then asked, “Boy, you have another worm called Schistosome. Have you swum in the river?” “Yes sir, I always swim in the river. I like swimming very much”, Lawoe answered. “Oh, don’t you know there are a lot of baby Schistosomes swimming around you in the fresh-water?” Lawoe got surprised and shouted. “But the river looked very clean! I didn’t see any worms.” “Okay, I will explain how Schistosomes get into your body.”

AT THE HEALTH CENTER At the Health centre, a laboratory technician examined Attah’s stool, and found many eggs of the worm called Hookworm, which enters the human body through the skin. Do you remember? Attah does not wear shoes. So she got worms from her bare feet. The Doctor said, “Hookworms are very small worms and live in your gut. They suck blood from your gut wall everyday, so if you have many Hookworms in your gut, you lose much blood and become anaemic.” That’s why Attah looked pale and didn’t feel well. The doctor also examined Lawoe’s urine, and then asked, “Boy, you have another worm called Schistosome. Have you swum in the river?” “Yes sir, I always swim in the river. I like swimming very much”, Lawoe answered. “Oh, don’t you know there are a lot of baby Schistosomes swimming around you in the fresh-water?” Lawoe got surprised and shouted. “But the river looked very clean! I didn’t see any worms.” “Okay, I will explain how Schistosomes get into your body.”

DIAGRAMS OF SCHISTOSOMIASIS Doctor said, “Unfortunately, in our region, there are a lot of Schistosomes in the river. The water looks clean, but they live in the clean water. So it is not advisable to swim in such a contaminated river. But do you know who brought these worms into our river? It is humans who carry Schistosome eggs, just like you. Well, call such people who are living with worms, carriers. When a carrier urinates into the river, he spreads Schistosome eggs in the water even though his urine looks normal without blood. Then Schistosome eggs hatch and become baby worms in the water. These baby Schistosomes grow up in special small water snails and become child Schistosomes. These child Schistosomes come out of the snails and swim in the water and infect you through the skin when you come into the water. You cannot see these child worms with your naked eyes because they are very small. After they infect you, they become adult Schistosomes and live in the blood vessels, and start laying eggs in your body. Blood in urine is just one of the symptoms. If you don’t treat it, the disease becomes more serious. Do you understand, boy?” “Oh no! Am I going to die, Doctor?” Lawoe is so shocked. “Don’t worry. I will give you some medicine, but don’t swim in the river until we have controlled Schistosomes in our region. The most important thing is to stop spreading Schistosome eggs in the river. Do not urinate into the river and tell your friends also. Even if their urine is not red, they may be carrying Schistosomes in their bodies. It is also important not to defecate near the river, because there is another type of Schistosome which comes out of faeces.”

CHILDREN REGRET THEIR BEHAVIOUR Lawoe, Attah and Tawiah regretted their bad behaviour so much. Lawoe said, “I never thought that there are such terrible worms in the river. I don’t think I will swim in the river again.” And I regret that I did not wear shoes. I was infected with worms because of my bare feet. So I became anaemic and lost my energy.” But there must be someone else who defecated on the soil, spreading worms in our neighbourhood,” Attah said with low voice and looked at her sister Tawiah who had worms. Tawiah started weeping, “No, no, it’s not me. I don’t defecate on the ground.” Well, I think we need to tell other children not to defecate in the bush, anyway”, Attah said. “Yes, I will also tell them not to defecate or urinate at the riverside and not to swim in the river”, Lawoe added. Tawiah also promised, “I will wash my hands before eating.” “Anything else?” asked Attah. “Don’t forget to wash your hands after toilet as well!” Then, their small brother Abbam also wanted to join them. “Brother and sister! Are you playing?” He was crawling on the soil.

HAPPY FAMILY “Oh no! You may get worms from the soil!” Everybody stood up and run to him. Then Attah held him in her arms. After this, Lawoe, Attah, Tawiah and small Abbam never got worms, because they kept their promises. They became very healthy children and learnt well in school. They studied hard and helped their parents at home. Mr. Kwasi and Auntie Afua became so proud of their children.

THE END

Copyright Illustrations: Noriko KOMA

Writer/Editors: Mrs. Judith STEPHENS, Prof. Michael WILSON, Dr. Toshiki AWAZAWA, Dr. Irene AYI

Acknowledgements Prof. OFORI-ADJEI, Prof. BOAKYE, Mr. ANYAN, Prof. BOSOMPEM, Mr. APPAWU, WACIPAC secretariat

Ghana Education Service Dangme-East District