FRESH Tools for Effective School Health First Edition
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Teacher Training to Recognize and Respond to Helminth Infection at School
Description of tool:
This tool is meant to be used in a training workshop with teachers. It includes a short
questionnaire that teachers use to evaluate and share their knowledge about
helminths and helminth infections.
The information in this tool was adapted by UNESCO from the following publication:
Kenyan Ministry of Health and Ministry of Education, Science and Technology, 2004.
National Worm Control in School-Age Children: Teacher Training Kit.
http://www.who.int/wormcontrol/education_materials/en/Teacher_kit.pdf
Description of document:
This publication is one of a set of documents developed by the School Health Inter-
agency Co-ordinating Committee for the Ministry of Health and the Ministry of
Education, Science and Technology to guide the national worm control programme in
Kenya. It describes a training programme to prepare teachers to organize a drug
administration day at school and disseminate health education messages to reach
both enrolled and non-enrolled school-age children.
This information or activity supports Core
Component #4 of the FRESH framework
for effective school health: school health
services. It will have a greater impact if it
is reinforced by activities in the other three
components of the framework.
FRESH Tools for Effective School Health First Edition
http://www.unesco.org/education/fresh
Teacher Training to Recognize and Respond to Helminth Infection at School1
Background
Each teacher should know:
what the presence of worm and/or schistosome infections is in their area
how these infections damage health
how to prevent infection and illness
how to answer questions from children and parents
the safety of the drugs they will distribute
Each teacher should be able to:
to organize a drug administration at school
to disseminate health education messages
to reach non-enrolled school-age children during the campaign
to fill in the forms for reporting
INTRODUCTION TO THE QUESTIONNAIRE
The following questionnaire has been developed based on the assumption that most of the
teachers have sufficient knowledge about the presence of worms in their area, about the
diseases caused by worms and the appropriate methods to prevent infection.
The aim of the questionnaire is to:
establish an informal two-way communication with the facilitator.
encourage the teachers to express their own opinions about worms and freely
discuss with their colleagues and the facilitator.
For this reason the questionnaire should not by given a mark by the facilitator. Instead, the
answers should be discussed collegially in a friendly atmosphere. The group discussion,
guided by a facilitator, will help reinforce each teacher's knowledge and fill any gaps where
necessary.
Instructions for the Facilitator:
Completing the questionnaire: Ask the teachers to sit together in groups of 3 and fill out the
questionnaire. Tell them to circle any correct answers for each of the questions, and that the
group will discuss the results together when they have finished. Allow ten minutes for the
teachers to complete the questionnaire.
Correcting the questionnaire: Distribute the answer sheet and review the questionnaire with
the whole group. To encourage each teacher to contribute to the discussion, it is suggested
that the questionnaire be corrected by inviting individual teachers to indicate their choice of
answers to the different questions. The other teachers can be invited to comment or present
different possibilities. Note that in several cases, more than one answer is correct. This is
done on purpose to stimulate discussion among the teachers when the answers are given.
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FRESH Tools for Effective School Health First Edition
http://www.unesco.org/education/fresh
QUESTIONNAIRE
Instructions: Fill in the blanks or circle any correct answers for each of the following
questions.
1. What are the local names for:
Worms? __________________________
Schistosomes? __________________________
2. How do you get worm infection?
A. By eating unwashed food.
B. By drinking contaminated water.
C. By walking barefoot in a contaminated area.
D. By mosquito bite.
3. How do you get schistosome infection?
A. By eating unwashed food.
B. By walking barefoot in a contaminated area.
C. By contact with contaminated water.
D. By mosquito bite.
4. Why are worm and schistosome infections bad for your health?
A. Because they cause blood loss.
B. Because they cause anaemia and malnutrition.
C. Because they stop children growing well.
D. Because they stop children learning well.
E. If untreated for a long time they can cause severe diseases.
5. In your class, how many children do you think are infected by worms or schistosomes?
Number of children in the class: ________
Number of infected children: ________
6. How can children avoid getting these infections?
A. Defecating/urinating in latrines.
B. Washing their hands before eating.
C. Avoiding bathing in contaminated freshwater.
7. How can we improve the health of the infected children?
A. Distributing drug treatment periodically.
B. Giving health education.
C. Improving the number of latrines in the village.
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FRESH Tools for Effective School Health First Edition
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8. Why are schools good for de-worming programmes?
A. Many children are reached easily.
B. School-children are among the groups more infected.
C. Teachers are the best educators and can easily give drugs to the children.
9. Is it dangerous to treat children who are not infected?
A. Yes, treatment of uninfected can cause side effects like strong headache and
diarrhoea.
B. No, the drugs are normally poorly absorbed.
C. No, only a few children in a school will complain of side effects like light abdominal
discomfort or nausea.
10. What would you do if a child presented any of these symptoms?
A. It is important to refer the child to the nearest hospital as soon as possible.
B. These side effects do not need treatment and will disappear spontaneously in a few
hours.
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FRESH Tools for Effective School Health First Edition
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QUESTIONNAIRE
WITH ANSWERS
1. What are the local names for:
Worms? __________________________
Schistosomes? __________________________
Answer: The teachers should know well the local names. Help them to identify specific
information about the worms that cause local infections, e.g. the scientific names of the
worms and the diseases they cause, the symptoms of various worm infections, etc.
2. How do you get worm infection?
A. By eating unwashed food.
B. By drinking contaminated water.
C. By walking barefoot in a contaminated area.
D. By mosquito bite.
Answer: A, B and C are all correct.
Worm eggs stick to vegetables - if the vegetables are not carefully cooked, washed or
peeled, the eggs are eaten and the person becomes infected.
Young children play on the ground and put their hands in their mouths without
washing them. By eating the eggs, they become infection.
Drinking unclean water, which has worm eggs in it, leads to infection.
Walking barefoot: Hookworm eggs hatch into larvae, which can penetrate the skin of
people walking barefoot and cause infection.
3. How do you get schistosome infection?
A. By eating unwashed food.
B. By walking barefoot in a contaminated area.
C. By contact with contaminated water.
D. By mosquito bite.
Answer C is correct.
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FRESH Tools for Effective School Health First Edition
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4. Why are worm and schistosome infections bad for your health?
A. Because they cause blood loss.
B. Because they cause anaemia and malnutrition.
C. Because they stop children growing well.
D. Because they stop children learning well.
E. If untreated for a long time they can cause severe diseases.
Answer A, B, C, D and E are all correct.
Anaemia: Hookworms live in your intestine and feed on the blood. This blood loss
can cause anaemia.
Intestinal obstruction: If a child is constantly infected - the number of worms in
his/her intestine steadily increases until eventually the worms block the intestine and
the situation is serious. The only option is surgery to remove the worms.
Learning: Worm infected children are less able to concentrate or remember
information. They score less well in school tests than children who are not infected.
Vitamin A deficiency: In many countries, people's diets are deficient in vitamin A rich
foods. Vitamin A deficiency is associated with impaired growth and lowered disease
resistance; one of the first signs is night blindness. Worms also need Vitamin A to
survive and can take the little amount a person is eating which makes his/her
vitamin A status even worse.
Children infected with worms have been found to grow less well, learn less well and
be more likely to get other infections.
5. In your class, how many children do you think are infected by worms or schistosomes?
Number of children in the class: ________
Number of infected children: ________
The answer varies according the estimated prevalence of infection among children in the
area. For example, if the estimated prevalence is 80% and there are 50 children in the
class, 40 of them are assumed to be infected.
6. How can children avoid getting these infections?
A. Defecating/urinating in latrines.
B. Washing their hands before eating.
C. Avoiding bathing in contaminated freshwater.
Answers A and B are correct for soil-transmitted helminths (STH). Answer C is correct for
schistosomiasis. In addition everyone should:
Drink clean water and wash, cook or peel food carefully before eating it.
Wear shoes.
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FRESH Tools for Effective School Health First Edition
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7. How can we improve the health of the infected children?
A. Distributing drug treatment periodically.
B. Giving health education.
C. Improving the number of latrines in the village.
Answers A, B and C are all correct for different reasons.
A child living in a poor area with no sanitation will constantly get re-infected with
worms. Regular de-worming kills the majority of the worms at each round and
means the child does not become seriously ill.
Health education helps to teach a child how to change certain unhealthy behaviours.
Improving sanitation should be part of any worm control programme, but it takes
time. In the meantime, regular de-worming is cheap, easy and effective.
8. Why are schools good for de-worming programmes?
A. Many children are reached easily.
B. School-children are among the groups more infected.
C. Teachers are the best educators and can easily give drugs to the children.
Answers A, B and C are all correct for different reasons.
There are always more teachers than health staff and the drugs are safe and easy
to administer. By training teachers to give the de-worming drugs to the children, you
can reach more children, more quickly.
School children typically have the highest number of worms in a community and
therefore should be targeted in any control programme.
School children are at a particularly important time in their life for growing and
learning. If they are infected, their growth is compromised and their ability to learn is
dampened.
Worm infections can impact a child's health more severely than an adult's.
9. Is it dangerous to treat children who are not infected?
A. Yes, treatment of uninfected can cause side effects like strong headache and
diarrhoea.
B. No, the drugs are normally poorly absorbed.
C. No, only a few children in a school will complain of side effects like light
abdominal discomfort or nausea.
Answers B and C are correct.
It is not dangerous to treat anyone who is uninfected because the drug is safe and poorly
absorbed in the bloodstream. For people who live in highly endemic areas it is
recommended that they de-worm themselves 2-3 times a year, simply as a precaution.
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FRESH Tools for Effective School Health First Edition
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10. What would you do if a child presented any of these symptoms?
A. It is important to refer the child to the nearest hospital as soon as possible.
B. These side effects do not need treatment and will disappear spontaneously in a
few hours.
Answer B is correct.
Side effects after de-worming are usually rare and do not last long. However, if a child is
infected with a very high number of worms, they may experience abdominal pain after the
first round of drug distribution. If this happens, the person carrying out de-worming (in this
case, the teacher) should carefully explain to the child and the parents that the pain is due
to the dead worms being expelled by the body, not because of the drug, which is safe. The
child should be asked to lie down in the shade, and if possible, be given clean water to
drink.
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QUESTIONS & ANSWERS FROM PREVIOUS TEACHER TRAINING SESSIONS
De-worming drugs and young children:
Question: At what age can you start de-worming a child?
Answer: Children from the age of 1 year onwards can be safely treated for common
intestinal worms (which include hookworm, roundworm and whipworm).
Spitting out tablets:
Question: I have noticed in the past, several children might hide the tablets in their mouths
and spit them out later. What can we do about this?
Answer: One way is to make sure the child chews the tablet in front of you. Providing
water also can help.
A de-worming control programme:
Question: How long does a control programme have to last?
Answer: This is a good question, which is often asked. The simple answer is that if the
prevalence of infection is above a certain level children should be de-wormed
every year until the sanitation facilities are improved enough so that re-infection
no longer occurs. However, improving sanitation, especially in remote
communities, can take many years. In the meantime, regular de-worming is an
easy way to stop the disease becoming serious.
Question: How frequently should you treat the children?
Answer: The frequency of the treatment will depend on the prevalence and intensity of
infection. For example, when the situation is extremely severe, de-worming
should be carried out twice, maybe three times each year. If the situation is
classified as moderate, treatment can be carried out once per year. If the
situation is classified as low, the emphasis should be put on education
campaigns and changing behaviours rather than mass drug administrations. If
the situation is not severe, it is not harmful to de-worm more than once per year,
but there is no real benefit either and it will waste your resources.
Multiple treatment:
Question: Is it safe for children to receive 2 consecutive treatments in close succession?
For example, if a child goes to hospital and receives treatment for worms and
then, shortly afterwards, is de-wormed at school?
Answer: Although overlapping of treatment like this should be avoided, accidental “over
treatment” with several times the recommended dose has been reported with no
serious side effects. Therefore, 2 consecutive treatments in quick succession
should be considered harmless.
Example 1:
For the treatment of other diseases, the recommended dose for both
mebendazole and albendazole is 10 times higher than that recommended for de-
worming, and is administered for several consecutive days.
Example 2:
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There was also the case of a child in Zanzibar who liked the taste of the
mebendazole and found the bottle and ate approximately 25 tablets all at once.
No side effects were reported!
Question: At what time of day should the treatment be given? Should it be taken alone or
with food?
Answer: The drugs can be taken at any time of the day.
Side effects:
Question: Are there any side effects of taking de-worming tablets?
Answer: Side effects are rare, minor and transitory, for example, feeling nauseous.
However, if children have extremely high worm loads, the first round of treatment
can cause abdominal pain. If an area is known to be severely affected, the
potential for side effects should be explained to teachers and families so that they
clearly understand that the pain is not to do with the drugs, but due to the dying
worms being expelled. The teacher should ask the child to lie down in the shade
until he/she feels better. If possible, give him/her clean water to drink.
Millions of doses of albendazole and mebendazole have been given to children in
different countries worldwide with very few adverse reactions reported. Under the
Lymphatic Filariasis programme for example, over 41 million children have been
treated with albendazole and only a few and minor side effects have been
reported.
Combining de-worming with vaccination:
Question: Is it all right to give de-worming drugs at the same time as vaccinations?
Answer: Yes, many countries are already doing this. In fact, there is evidence that a child’s
immune reaction is boosted when worm treatment is combined with polio
vaccination.
De-worming a sick child:
Question: Is it all right to de-worm a child who is sick?
Answer: There is no danger in treating a sick child. However, it is strongly recommended
that if a sick child arrives for de-worming - you do not treat him or her. The reason
is that if the child becomes more sick due to the sickness, the de-worming drugs
might be blamed, even if they were nothing to do with the worsening illness. This
can seriously compromise the success of your campaign. It is much better to wait
until the child is better and then de-worm.
Question: Do worm infections make you more likely to get other illnesses?
Answer: Yes, a child with heavy worm infections is more likely to get other infections.
Treating children for worms actually helps their natural body defences to fight
against other infections.
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