Philippines one of Asia’s ‘wormiest’ countries

We are in a state of war. This was what speakers declared during a forum on parasites held July 18 at the University of the Philippines Manila.

In “Kontra Bulate Para sa Kalusugang Pangkalahatan,” Doctors Vicente Belizario Jr. and Marissa Alejandria of the UP National Institutes of Health said the Philippines is one of the “wormiest” countries in Asia, with the highest prevalence of schistosomiasis in the continent.

Belizario said: “Touch a child in school, that child probably has schistosomiasis… It is happening.”

He also cited the alarming figures on soil-transmitted helminth infections (STHs), the most common of which are ascaris, trichuris and hookworm.

“These are old, old diseases that have been around since the ancient times; neglected and therefore passed on to us in the modern times,” Belizario said. Of these neglected tropical diseases or NTDs, “children are most vulnerable.”

The helminth infections occur with poor hygienic practices such as open defecation and eating without washing hands. Walking barefoot increases  hookworm infectivity.

Meanwhile, schistosomiasis, also known as snail fever, is caused by Schistosoma japonicum, the only one in the country of five known species, found in snail-infested waters.

Because of inequity and lack of access to clean water and public services, poverty is a risk factor, with schistosomiasis endemic in “the poorest, poorest provinces,” Belizario declared.

Ignorance, refusal

NTDs can cause stunted growth, absenteeism and poor school performance in children. In adults, they affect productivity. Bloodsuckers such as the hookworm and trichuris cause anemia, a potential precursor for serious complications.

Schistosomiasis also has a “point of no return,” Belizario said. According to Alejandria, this is close when the shistosoma worms move to the lungs, the brain or the liver.

People can die of bleeding or dysfunctional organs. The brain infection is often misdiagnosed as a tumor and needlessly operated on.

“We have the bullets,” he mentioned, referring to the free deworming services in elementary schools two times a year and in health units in the country. But he admitted that many are unaware of the disease or the treatment. Some also snub the cure.

Belizario said: “For the first time in history, there is no more shortage in drugs. But parents and children … refuse.”

He cited novel reasons for this. A cult in Butuan City, he said, bans the treatment. In Capiz, one said he could not take the medications because of the full moon. In yet another case, one refused because it was raining.

In some instances, parents are discouraged because “walang lumabas (nothing came out)”  referring to worms that should supposedly come out of the anus. Belizario said some worms are microscopic.

In the pipeline

According to Belizario, about 14 million of 30 million children have STHs.

He said that statistics of the 2009 survey of four demographic groups—preschoolchildren, school-age children, adolescent women and pregnant women—are way above the less-than-20-percent mark by the World Health Organization.

The gravest statistics came from Leyte. It recorded 67 percent, 61 percent, 62 percent and 76 percent, respectively.

Belizario said soldiers report the most cases of STH in the country.  “That’s shameful. I wonder if they can win battles if they suffer from this,” he added.

In some areas of Agusan del Sur, the infection rate for schistosomiasis in school-age children is 31.8 percent, a far cry from the less-than-one-percent ideal set by WHO.

Belizario said some 28 provinces have cases of the disease, with Cagayan and Negros Occidental as the newest in the roster. Among these, 12 are classified “high endemic areas,” which are all poor provinces.

Alejandria said farmers and fishermen are the most susceptible to snail fever in the workforce.

Belizario wants a mass drug administration implemented, which would allow medications for all regardless if they have the NTDs or not. He said teachers must be deputized to administer this “mass chemotherapy” in schools, even high schools.

He also wants to put a stop to open defecation, which is still practiced by 7 million households.

On the other hand, Alejandria said the schistosomiasis program must address some gaps. “There’s a lot that we need to know,” she admitted.

She said that in three months, people can be reinfected. Hence, she is pushing for studies on why people are exposed and their perceptions of the diseases and the treatments, among others.