The burden of worm Infections amongst children

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OPINION

By Dr Luch Amaniyo 

Worm infections, also known as helminth infections, are a common health concern among children worldwide.

Despite advances in sanitation and healthcare, these infections persist, particularly in environments where proper hygiene is challenging to maintain.

Parents, guardians, and caregivers play a crucial role in preventing and managing these infections. This sensitisation aims at providing a comprehensive overview of worm infections on children’s health and wellness. including types, causes, symptoms, treatments, and preventive strategies.

What are worm Infections?

Worm infections are caused by parasitic worm helminths that inhabit the intestines and sometimes other tissues of the body. The most common worm infections affecting children include roundworm, pinworm (threadworm), hookworm, and tapeworm.

These parasites can cause a range of health problems, from mild discomfort to serious complications if left untreated.

Epidemiology

Soil-transmitted helminth (STH) infections remain highly prevalent worldwide, with an estimated 25% of the world’s children currently living with intestinal worms.

In Uganda, more than 50% of surveyed school children were living with STH infections in the early 2000’s.

This prompted the launch of a national programme that included mass preventative chemotherapy (PC) and health education for children aged 1–14 years in 2003.

Recent population-based, cross-sectional household surveys conducted in five districts (Buikwe, Kassanda, Kiryandongo, Kisoro, and Rubanda) in March and May 2022 revealed that the prevalence of any infection remained high in Kisoro at or above 50% within all risk groups. In other districts, the prevalence of any infection ranged from approximately 5% to 23% among school-aged children (SAC) and 12% to 19% among women of reproductive age. Moderate-to-heavy intensity infection prevalence was highest in Kisoro (15–26%), followed by Rubanda (<5%), and was ≤1% in other districts.

Despite over twenty years of national-scale treatment, there are persistent hotspots of infection in Uganda, with district-level prevalence ranging from 1.8% to 90% 3.

Common Types of Worm Infections in Children

Pinworms (Threadworms)

Pinworm infection is the most common type of worm infection in children, especially those of school age. The tiny, white, thread-like worms live in the colon and rectum. They lay eggs around the anus, usually at night, causing intense itching.

Symptoms: Itching around the anus, restless sleep, irritability, and sometimes abdominal discomfort and pain, poor appetite, weight loss, and sometimes visible worms in the stool. Severe infections can cause intestinal blockages.

Transmission is spread by ingesting pinworm eggs, which can be transferred from contaminated hands, bedding, or clothing. Worms can also be spread through the ingestion of eggs present in contaminated soil, food, or water. 

Roundworms

Roundworm infection is more common in areas with poor sanitation. The adult worms can grow up to 35 cm in length and live in the intestines.

Hookworms are small, thin worms that attach to the walls of the intestine. They are less common but can cause more severe symptoms.

Symptoms include abdominal pain, diarrhea, anemia, fatigue, and, in severe cases, developmental delays due to blood loss.

Transmission through larvae penetrate the skin, often through bare feet, and migrates to the intestines.

Tapeworms

Tapeworm infections can result from eating undercooked or contaminated meat. The worms are flat and segmented.

Symptoms: Mild infections might be asymptomatic, but symptoms can include abdominal pain, nausea, and the presence of worm segments in the stool.

Transmission: Ingestion of eggs or larvae in contaminated food, water, or through contact with infected animals.

How do children get worm Infections?

Worm infections are primarily spread through the fecal-oral route. This means children become infected after accidentally ingesting worm eggs or larvae from contaminated hands, surfaces, food, or water. Some worms, such as hookworms, can penetrate the skin directly. Factors increasing the risk include: Lack of proper handwashing, especially after using the restroom or before eating. Playing barefoot in contaminated soil or sand.

Poor sanitation and crowded living conditions, eating undercooked or contaminated meats, and contact with infected pets or animals.

Recognizing the symptoms

Symptoms of worm infections can be subtle or obvious, and sometimes children may have no symptoms at all. Common signs include:

Itching around the anus, especially at night (pinworms).

 Unexplained abdominal pain, diarrhea, or constipation.

Weight loss or poor development despite adequate food intake.

Fatigue or unusual tiredness, restlessness, irritability, or sleep disturbances, visible worms or segments in the stool.

If parents notice any of these symptoms, especially persistent itching or visible worms, they should consult a healthcare professional for diagnosis and treatment.

Diagnosing Worm Infections

Diagnosis typically involves a combination of medical history, physical examination, and laboratory testing.

For pinworms, a simple tape test (The parent applies the sticky side of a piece of clear tape  briefly to the skin around the child's anus.) Any pinworms and/or eggs that are on the skin will stick to the tape.

This can be done at home or in a clinic to collect eggs from the anal area. Stool samples may be needed to detect other types of worms or eggs. Your paediatrician will recommend the best approach based on the child’s symptoms and exposure history.

Treatment Options

Most worm infections are easily treatable with prescription or over-the-counter anti-parasitic medications. Treatment is usually given to the infected child and may be extended to household members to prevent reinfection. It is crucial to follow the entire course of medication as prescribed.

In addition to medication, thorough cleaning of bedding, clothes, and the home environment helps reduce the risk of spreading or contracting the infection again.

Home Hygiene during treatment

Wash bedding, towels, and pyjamas daily during treatment.

Thoroughly clean bathrooms and frequently touched surfaces.

Trim children’s fingernails and discourage nail-biting or scratching.

Encourage regular handwashing with soap and water, especially after using the toilet and before eating.

Preventing Worm Infections

Prevention is always better than a cure. Here are some effective measures to minimise the risk of worm infections in children:

Teach and reinforce proper hand hygiene at home and school.

Ensure children wear shoes when playing outdoors, especially in sandy or soiled areas.

Wash fruits and vegetables thoroughly before consumption, cook meat thoroughly and store food safely.

Discourage children from putting dirty hands or objects in their mouths.

Regularly deworm pets and keep their living areas clean. 

Maintain clean and sanitised home and play environments.

When to Consult a Doctor

Parents should seek medical advice if symptoms persist despite treatment.

A child is experiencing severe abdominal pain, prolonged diarrhoea, or weight loss. Worms are visible in the stool or around the anus.

There are signs of anemia, such as fatigue, pale skin, or shortness of breath.

Doctors may recommend additional tests or specialist referrals if complications are suspected.

Frequently asked questions are worm infections dangerous?

Most worm infections in children are not life-threatening and respond well to treatment, but severe or repeated infections can affect growth, nutrition, and cognitive development. Rare complications may occur if worms migrate outside the intestines.

Should the whole family be treated? Yes, in the case of pinworm infections, it is common for everyone in the household to be treated simultaneously, even if not all members are showing symptoms.

Can children go to school during treatment?

Generally, children can attend school while being treated for worm infections, as long as they are feeling well and steps are taken to prevent spreading the infection to others.

Worm infections remain a common but manageable health concern for children. With awareness, prompt treatment, and diligent hygiene practices, most cases can be quickly resolved, and the risk of reinfection greatly reduced. By working together parents, schools, and communities we can help keep our children healthy, happy, and thriving.

The writer is the Head Paediatrician at Amani children’s clinic, Nansana and managing director, and team leader.