Menu ENN Search

Deworming children at military healthcare facilities in a combat zone: an opportunity not to be missed?

The BMJ published a letter1 in response to the deworming article above. This letter (summarised below) is written by members of the Royal Centre for Defence Medicine, Royal Centre for Defence Medicine, Birmingham, UK and represents an interesting perspective from medical-military personnel. (Ed)

As military practitioners with expertise in infectious diseases and surgery, the authors have followed the ebb and flow of the mass deworming debate with great interest. Although reports conflict as to whether routine deworming leads to demonstrable benefit in cognition, school attendance, and school performance, the World Health Organisation (WHO) recommends annual anti-helminthic treatment of all school-age children in areas where the prevalence is >20% or twice a year when the prevalence is >50%. Survey data indicates that prevalence of soil-transmitted helminths (STH) in several regions of Afghanistan is 20% to 50%, with some areas around Kabul >50%. A high proportion of Afghans are children and they continue to suffer the consequences of repeated infestation despite attempted eradication programmes.

Coalition military healthcare facilities have now been deployed in Afghanistan for some years. During 2012, surgical teams in the Role 3 Hospital in southern Afghanistan noticed multiple patients with evidence of worm infestation during laparotomy for abdominal trauma. The biggest deworming campaign in Afghanistan to date was undertaken in 2004, when the United Nations World Food Programme (WFP) in collaboration with the WHO, UNICEF, and the Afghan Ministries of Health and Education were able to treat 4.5 million children. However, this fell short of the total number of school age children (approximately 9 million) because a large proportion of these children do not attend any school, as circumstances mitigate against attendance. School attendance is poor primarily due to problems with accessibility and security, however, there is gender imbalance and school restriction due to poverty, with children having to work or being excluded from education due to marriage. Further measures to treat these children will need to reach beyond a school-based approach and exploit other opportunities.

Although the primary function of deployed medical assets in a theatre of war is to provide life, limb and eyesight saving treatment, humanitarian aid in the form of non-emergency treatment is also commonly provided to the local civilian population. Such aid is not limited to hospitals, but also provided at forward operating bases (FOBs) and patrol bases (PBs) by medical assets that augment combat units on the front line. Although accurate records are not available, it is estimated that thousands of children have received humanitarian aid of this kind during operations in Afghanistan from medical facilities other than hospitals. Such a widespread network of ISAF outposts with medical facilities may offer an opportunity to deworm children.

During the recent conflict, children have represented approximately 3% - 15% of the patients treated at deployed military hospitals and contribute up to 25% of the bed occupancy. These children have often sustained battle trauma including blast and missile injuries. The majority require surgical intervention with as many as 40% requiring admission to critical care. Chronic malnutrition in children is a major public health problem in Afghanistan, with a lack of adequate household food intake and suboptimal infant and young child feeding and hygiene practices contributing to poor nutritional status.

Strategic success in the current war in Afghanistan is much more complex than the defeat of an identifiable enemy. NATO has stated that its mission includes the need to “facilitate improvements in governance and socio-economic development in order to provide a secure environment for sustainable stability”, and to “provide practical support for… humanitarian assistance efforts conducted by Afghan government organisations, international organisations, and nongovernmental organisations (NGOs)”. In 2010, the American National Security Strategy stated that there is a “moral and strategic interest in promoting global health” and that there is a need to “strengthen health systems and invest in interventions to address areas where progress has lagged, including maternal and child health”, and to seek the “elimination of important neglected tropical diseases”. It is therefore impossible, the authors feel, to consider the international mission in Afghanistan without also considering the current and future health of the nation, especially of its children.

The authors go on to argue that military medical facilities in Afghanistan provide an opportunity to integrate a policy of routine deworming of children into their existing programmes of humanitarian support. Such opportunistic treatment is feasible, relatively inexpensive, simple, and has a very small risk of harm. Most importantly it may improve the lives of the children who receive it – even if there is little evidence that it might help the entire population. Furthermore, as each ISAF base and outpost hands over control to Afghan security and medical personnel during the transition of power, the continuity of healthcare to the local communities can only be enhanced by the education and training that will result from this legacy.

They do not propose a population based or mass deworming programme run by the military, but rather opportunistic deworming of those patients who have had the misfortune to require humanitarian assistance. Although it is now clearer that mass deworming programmes alone are not a panacea, this proposed individualistic approach is, the authors conclude, inexpensive, simple, and achievable; it may allow these children to return home with a slightly better chance of un-hindered development and growth.

Show footnotes

1Naumann. D et al (2013). Deworming children at military healthcare facilities in a combat zone: an opportunity not to be missed? 10 January 2013

More like this

FEX: Civil-military coordination during humanitarian health action

Summary of position paper1 A recent position paper has been produced to guide country-level health clusters on how to apply Inter-Agency Standing Committee (IASC) civil...

Addressing maternal nutrition service delivery gaps in Afghanistan: Policy and programming opportunities

View this article as a pdf Dr Zakia Maroof is a Nutrition Specialist working with UNICEF Afghanistan. Dr Homayoun Ludin is an Afghan doctor working with the Ministry of...

FEX: Deworming Debunked

Summary of published article1 A recent article in the BMJ sets about debunking certain long-held beliefs about deworming which has been hailed as a simple, cheap, and...

FEX: Afghanistan: who is to blame?

"If you look at the past year or so, you could blame the Taliban, but you must look to the roots of the crisis" Anuradha Mittall, Institute for Food and Development Policy,...

FEX: MSF Close Their Afghanistan Programme

Nutritional Surveillance - Kabul On the 28th of July 2004 Médecins Sans Frontières (MSF) announced the closure of all medical programmes in Afghanistan. The decision was taken...

FEX: International Legal Consequences of the Conflict in Syria

By Natasha Harrington Natasha is a barrister (a member of the English Bar). She is currently working in Eversheds law firms' public international law and international...

FEX: Dr Nadera Hayat Burhani

By Carmel Dolan, ENN ENN interview with Dr. Nadera Hayat Burhani, Deputy Minister for Health Care Services Provision, Islamic Republic of Afghanistan Dr Burhani speaking at...

FEX: Food security assessment of high altitude villages of Badakhshan, Afghanistan

By Salim Sumar, Laila Naz Taj and Iqbal Kermali Dr Salim Sumar heads Focus Humanitarian Assistance Europe Foundation, which is an affiliate of the Aga Khan Development...

FEX: Screening for maternal and child malnutrition using sentinel-based national nutrition surveillance in Afghanistan

By Admire Chinjekure, Dr Mohammad Qasem Shams, Dr Abdul Baseer Qureshi, Dr Shafiqullah Safi and Dr Noor Rahman Noor View this article as a pdf Lisez cet article en...

FEX: Weekly menu for midday meal in Bangladeshi schools: Caregivers’ choices

By Abu Ahmed Shamim, Jannaty Mayna, Ishrat Jahan, Syed Muntasir Ridwan and Rudaba Khondker View this article as a pdf Abu Ahmed Shamim is the Nutrition Advisor (Consultant)...

FEX: The roll out of IMAM in Kenya’s urban slums

By Koki Kyalo, Claire Orengo, Regine Kopplow Koki Kyalo is the Urban Nutrition Programme Manager at Concern Worldwide, Kenya. She has worked with Concern Worldwide for five...

FEX: Contributing to the Infant and Young Child Feeding in Emergencies (IYCF-E) response in the Philippines: a local NGO perspective

By Romelei Camiling-Alfonso, Donna Isabel S. Capili, Katherine Ann V. Reyes, A.M. Francesca Tatad and Maria Asuncion Silvestre Romelei Camiling-Alfonso has worked for the...

FEX: Seminar in Oslo: Present and future nutritional relief and rehabilitation in Afghanistan

Norway took over as chair for the Afghanistan Support Group (ASG) of donors from January 1, 2002. As a preparation for this task, a one-day seminar addressing the current...

NEX: Addressing adolescent anaemia in Afghanistan through a school-based programme

Lisez cet article en français ici View this article as a pdf Dr Zakia Maroof is a nutrition specialist working with UNICEF Afghanistan. Dr M Homayoun Ludin is the...

FEX: Making a Difference for Afghan Women

Afghanistan - Afgani CARE staff starting a generator. "We must be courageous and speak out on issues that concern us. We must not bend under the weight of spurious arguments...

FEX: From emergency food aid to sustainable food security: 10 years of agricultural recovery in Afghanistan

By François Grunewald François Grunewald is an agricultural engineer specialising in the rural economy. He has worked in the field of crisis and post crisis operations since...

NEX: Community engagement through local leadership: Increasing access to nutrition services in a conflict setting in Yemen

Dr Fatima AK Sallam is a Project Manager with Soul for Development, a local Yemeni NGO. She is a qualified medical doctor. Khaled Albably is a Senior Project Officer with Soul...

FEX: Home Based Treatment of Severe Malnutrition in Kabul

By Muriele Therry Muriele Therry studied ethnology at Masters level. After two missions with ACF, one year in Sakhalin as food security officer and 6 months in Afghanistan as...

NEX: Strengthening sub-national capacity in Yemen to provide life-saving treatment

View this article as a pdf Lisez cet article en français ici Majid Hammed Alhaj is head of the Taybah Foundation for Development's Hodeida office, Yemen. He has...

FEX: Development of a maternal service package for mothers of children with severe acute malnutrition admitted to nutrition rehabilitation centres in India

View this article as a pdf Lisez cet article en français ici By Vani Sethi, Praveen Kumar and Arjan De Wagt Vani Sethi PhD is a public health nutritionist in the...

Close

Reference this page

Deworming children at military healthcare facilities in a combat zone: an opportunity not to be missed?. Field Exchange 45, May 2013. p32. www.ennonline.net/fex/45/deworming

(ENN_4383)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.