Science

Free pills don’t reach the vulnerable

Worm pills that are handed out free of charge in Uganda fail to reach the most vulnerable groups. And a lasting reduction in worm infections is impossible if the pills are not being administered widely.
Rob Ramaker

These findings are reported by development economist Erwin Bulte and chief researcher Goylette Chami together with English and Ugandan colleagues in the journal Clinical Infectious Diseases.

Infection with hookworms or Schistosoma worms affect hundreds of millions of people, mainly in Africa. The worms spread via polluted water and eventually cause problems such as anaemia, protein deficiency and damage to the urinary tract. Between 10,000 and 200,000 people die every year from worm infections and associated complications. The infections have a big social impact too. Infected children attend school less while infected adults are less productive.

Since 2003, the World Health Organization (WHO) has been handing out free pills that kill the worms. Bulte’s results show that this programme has difficulty reaching minorities – such as Muslims in a mainly Christian area – and the poor. The imperfect cover makes the programme much less effective, says Bulte. ‘To really eradicate worms from the system, you need to reach 80 percent of the people. Otherwise the group that has been treated will be infected again by the untreated group in no time.’

Bulte is surprised by the findings. The study took place in 17 small villages with about 60 to 70 households each. In each village, two trained but unpaid inhabitants are given the task of doling out pills. Before and after the distribution of the pills, a check was made for worm eggs in the excrement of all the inhabitants. ‘You would expect news to travel fast when a "distributor" gets the medicine,’ says Bulte, ‘and that everyone would turn up within the next two to three weeks.’ But in practice the information spreads in a very uneven way. The ‘distributors’ don’t seem to be selling the pills; they just remain unused.

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