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Parasitic Infestations of Surgical Importance in Children 149

Historical School-based health education for the control of soil-
significance/ transmitted helminthiases in Kanchanaburi province, Thailand
comments Anantaphruti MT, Waikagul J, Maipanich W, et al. T Ann
Trop Med Parasitol 2008;102(6):521–528.
Department of Helminthology, Faculty of Tropical Medicine,
Mahidol University, 420/6 Ratchawithi Road, Bangkok 10400,
Thailand
Soil-transmitted helminthiases (STHs) are major parasitic
diseases that cause health problems worldwide. School-based
health education is one of several basic interventions currently
recommended by the World Health Organization for the control
of these infections. A 3-year programme of health education
for the control of STHs has recently been completed in four
primary schools in the Hauykayeng subdistrict of Thong Pha
Phum district, in the Kanchanaburi province of Thailand.
Overall, the percentage of the schoolchildren infected with
STH increased between the start of year 1 of the intervention
(16.6%) and the end of year 2 (23.8%), but showed signs of
falling by the end of year 3 (19.4%). Although none of these
year-on-year changes in overall prevalence was statistically
significant, some significant trends were detected when the six
school grades (i.e., age groups) were considered separately. The
grade showing the highest prevalence of STH infection changed,
from grade 6 (representing the oldest children investigated) at the
start of year 1 (when grade 1 children were excluded from the
survey) to grade 1 (representing the youngest children) at the ends
of years 2 and 3. By the end of year 3, the children in grades 5 and
6 had significantly lower prevalences of infection than the grade 1
subjects. The prevalence of STH infection in the grade 1 children
was significantly higher than that in any of the older grades at
the end of year 2 and significantly higher than that in grades
3–6 at the end of year 3.
These results indicate that health education had a
greater impact on the children in the higher grades (who,
presumably had better levels of understanding and practised
better personal infection prevention) than on the younger
children. Although school-based interventions can serve as
a useful entry point for parasite control, more effort, including
anthelminthic treatment, may be required among the youngest
children. The activities need to be sustainable and supported
by appropriate school health policies.

Key Summary Points

1. Parasitic infestations are a tropical disease with huge public 3. The surgical relevance is the treatment of the complication
health implications. of the disease (i.e., abscess formation, acute abdomen, and
2. Parasitic infestations are associated with poor sanitation, low bowel obstruction).
socioeconomic communities, and lack of primary health care. 4. A combination of medical and surgical treatment is pertinent;
however, the focus for this disease should be on prevention.

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