National Deworming Day August 2017 Training of Frontline

National Deworming Day- August 2017 Training of Frontline Workers from ICDS National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India

Session Details 1. National Deworming Day Overview 2. Types of Worms and Symptoms Impact of Worms on Health, Nutrition, Education 3 Benefits of Deworming Benefits of Anganwadi-based Deworming 4 Community Awareness and Mobilization 5 National Deworming Day and Mop-up Day 6 Adverse Events and Adverse Event Management (AEM) 7 Steps to be Followed by the AWC on NDD and MUD 8 Recording and Reporting National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 1

National Deworming Day Overview Fixed day approach for the deworming program Objective: Deworm all children (boys and girls) aged 1 -19 at schools and anganwadis for improved child health, nutritional status, access to education, and quality of life. Stakeholders: Department of Health and Family Welfare, Department of Education, Department of Women and Child Development (ICDS); , Department of Urban Development, Development of Rural Development; Department of Tribal Development; Department of Drinking Water and Sanitation; Department of Panchayati Raj; Department of Human Resource Development; Evidence Action-Deworm the World Initiative; Development partners National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 2

Common Behaviours in the Community • Playing barefoot outside • Not washing hands before eating food • Defecating in the open • Not washing hands after using the toilet • Eating fruits and vegetables without washing • Not keeping food covered, which may result in food contamination National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 3

Types of Worms are parasites that thrive on nutrition from the human intestine How do worms spread? § § Worm infections result from poor sanitation and hygiene conditions Hook worm Whip worm Worm transmit through contact with infected soil Round worm National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 4

Symptoms of Worm Infections § The greater the amount of worms in a child (intensity), the more symptoms the infected individual will have § Severe infections can cause a range of symptoms including diarrhoea, abdominal pain, weakness, vomiting, and loss of appetite § Children with mild infections usually show no symptoms National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 5

Worm Transmission Cycle 1. An infected child contaminates soil with faeces containing worm eggs. These eggs develop into larvae in the soil 2. Other children are infected by eggs ingested through food or dirty hands, or by larvae penetrating the skin 3. In an infected child, eggs and larvae develop into adult worms, which produce eggs and have an ill effect on the child's health National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 6

Impact of Worms on Health and Nutrition Worm infections impair the nutritional status of the people they infect in multiple ways: § Worms feed on host tissues, including blood, which leads to anemia. § The nutritional impairment has significant impact on growth and physical development. § Worms consume nutrients meant for the human body and cause blood loss, poor nutrition and stunted growth. § Roundworm may compete for vitamin A in the intestine. National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 7

Impact of Worms on Children’s Education and Long Term Productivity § Due to heavy infection, children are often too sick or tired to concentrate at school or attend school/anganwadi. § Worm infection negatively affect children’s physical and cognitive development, which could have long term negative impact on their work potential and wages in adulthood. Studies show that absenteeism in schools decreases by 25% with regular deworming. National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 8

Preventing Worm Infection National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 9

How to Treat Worms Deworming Drug- Albendazole 400 mg (available free-of-cost) Albendazole should be administered to all children aged 1 to 19 in age-specific doses. Albendazole is a safe drug for both children and adults and has been used to treat millions of people across the world for Soil Transmitted Helminths. Albendazole tablets that are not chewed or crushed may have significantly lower effectiveness. National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 10

Benefits of Deworming Direct Benefits: Indirect Benefits: • • Controls anemia Improves nutritional uptake • Helps improve concentration, capacity to learn, and attendance at school and anganwadi. • Helps improve work potential and livelihood opportunity. • Benefits the community by reducing worms in the environment. National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 11

Benefits of Anganwadi-based Deworming Anganwadis: • • Offer a unique opportunity and platform to deliver deworming drug to a large number of children in a safe manner Enable the program to reach high coverage in a single day as majority of targeted children are available at the anganwadis. Anganwadi Workers (AWWs): • • Are an invaluable resource for administering deworming drug Can pass on knowledge about prevention and treatment for worm infections as they are highly respected by the community, including parents and children National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 12

National Deworming Day and Mop-up Day • Albendazole will be administered on National Deworming Day (NDD), 10 August 2017, across all schools and anganwadis for all children aged 1 to 19. • Teachers will administer Albendazole to all school-enrolled children aged 6 -19 years at the school. • AWWs will administer Albendazole to all children aged 1 -5 years and unregistered, out-of-school children aged 1 -19 years at the anganwadis. • Unregistered and non-enrolled children will be mobilized to the nearest anganwadi for deworming with support from the ASHA. • Children who are sick or are on medication should not be administered the tablet. These children should be advised to have the Albendazole upon recovery. • Children who could not be dewormed on NDD must be administered the drug on mop-up day (MUD) on 17 August 2017. National Deworming Day-August 2017 |Ministry of Health and Family Welfare, Government of India 13

Community Awareness and Mobilization National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 14

Community Awareness and Mobilization Anganwadi workers should • Inform community about the benefits of deworming and dates of deworming • Motivate parents and relatives who come to the centre, to bring their children to the anganwadi on NDD • Provide adequate information to the parents or children on how the tablet should be administered and consumed • Inform children about deworming and NDD when they come to the centre • Support/guide ASHAs to mobilize community members through Gram Panchayats and at VHSNC meeting • Inform community members about deworming messages appearing in newspapers, radio, and TV that they should watch/listen to carefully National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 15

Adverse Events and Its Management What are Adverse Events? • Deworming has very few side effects on children • Events such as nausea, vomiting, diarrhoea, and weakness may occur among few children especially those with high worm infections • Any adverse events are temporary and generally can be managed easily at the anganwadi. Role of the AWW: • Use a spoon to administer Albendazole to the child yourself and not give it to the parents to take home • Do not forcefully administer the tablet to any child • Inform parents about mild side effects and that it is expected only in children with high worm load • Build confidence in parents that the child will be taken under observation and care if they show any serious side effects • Must be prepared to take care of the child during any adverse event • Call_____ for any medical assistance National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 16

Adverse Event Management Albendazole is safe for both children and adults: • • • Albendazole is an easily chewable tablet Choking is not to be considered a serious adverse event and is a medication error Instruct older children to chew the tablet properly. Ensure safe drinking water is available Albendazole tablets that are not chewed or crushed may have significantly lower effectiveness. Still, if the child chokes on part of the tablet, make the child bend over on your lap and pat the child on the back till the tablet comes out Take the child to an open and shaded place and allow the child to lie down and rest Call ______ for any medical assistance Do’s Don’ts Always ask children to chew the tablet. Never administer the tablet to children Ensure safe drinking water is available. who are sick or are on any other medication Use a spoon to administer Albendazole Do not instruct children to swallow the to the child themselves tablet Do not allow the child to take the tablet home DO NOT PANIC AND FOLLOW PROTOCOL Do not forcefully administer the tablet to any child Manage the Adverse Events as per protocol- call Toll Free Number of Pharmacovigilance Programme of India (PVPI) 1800 180 3024 for assistance in reporting of Adverse Drug Reactions (ADR) and its management. National Deworming Day- August 2017 |Ministry of Health and Family Welfare, Government of India 17

Steps to be Followed at the Schools/AWCs on NDD and MUD 1. Before NDD – Checklist • Ensure availability of sufficient drugs • Keep the phone number of the nearest PHC, MO- Block PHC, ANM handy for Adverse Event Management support • NDD reporting forms • Inform children, parents, and community about NDD kit= Tablets+ Training handout + IEC+ Reporting form • Properly display banner, posters, and other IEC • Take the list of out-of-school children (ASHA Reporting Form) aged 1 -19 years from ASHA. Prior to NDD, ASHAs will prepare list of these children. Use the list prepared by ASHAs (ASHA Reporting Form) to update the list of adolescent girls • National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 18

Steps to be Followed at the AWC on NDD and MUD 2. Albendazole Administration • Teachers/Anganwadi workers must use a spoon to administer Albendazole to the child themselves and not give it to the parents to be given at home • Teachers/Anganwadi workers must never administer the tablet to children who are sick or are on any other medication • Call______ for any medical assistance. Manage the AE as per protocol and also use of Toll Free Number of Pharmacovigilance Programme of India 1800 180 3024 for reporting the AE. You may also contact the nearby ADR Monitoring Centre National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 19

Steps to be Followed at the Schools/AWC on NDD and MUD 3. Recording Anganwadi worker: • On National Deworming Day, along with administering the tablet, teacher/AWW must ensure that they mark a single tick (√ ) next to each dewormed child’s name in the register • AWW also to record in the ASHA Reporting Form • On mop-up day mark a double tick (√ √ ) next to the child's name. NDD MUD National Deworming Day- August 2017 |Ministry of Health and Family Welfare, Government of India 20

Role of ASHA Revisit household with a list to follow up with children who could not be dewormed on National Deworming Day (due to sickness and absenteeism) and encourage them to have the deworming tablet on mop-up day Recording and Reporting • Before NDD, prepare a list of out-of-school, unregistered children aged 1 -19 years (ASHA Reporting Form) and share with the anganwadi worker • Record details of unregistered, out-of-school children who were dewormed by anganwadi worker in the ASHA Reporting Format • AWW will compile all records of National Deworming Day and mop-up day with support from ASHA and submit it to the ANM National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 21

Reporting - Anganwadi • AWW should count separately the details from National Deworming Day and mop-up day • AWW should cross check the details carefully before entering details into the Anganwadi Reporting Form. Ensure that the form is filled correctly and completely. • After mop-up day, anganwadi worker should enter the details and submit the completed form to the ANM by 22 August 2017. Also submit the ASHA Reporting Form along with this. • The anganwadi worker should keep a copy of the filled reporting form carefully at the anganwadi for records and verification purposes • ANM to only collect the reporting form and submit it to the MO-BPHC National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 22

Reporting Cascade AWW, ASHA to ANM by 22 August ANM to MO-BPHC by 29 August MO-BPHC to District M&E officer by 9 September District M&E Officer to State Nodal Officer by 16 September State Nodal Officer to Child Health, Mo. HFW by 27 September National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 23

National Deworming Day 10 August 2017 and Mop-up Day 17 August 2017. All anganwadi workers should fulfil their role in this program with enthusiasm and play a part in giving children a brighter future. National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 24

Thank You National Deworming Day - August 2017 |Ministry of Health and Family Welfare, Government of India 25