Befriending parasites

Bulate ang aabutin mo kapag hindi ka nagtsinelas!” As children, we were always admonished to refrain from walking barefoot, most especially when playing outside the house. If you are looking for a scientific bases, there are.

Hookworms may find their way into your system through this route. However, parasitism may also occur through the ingestion of food or water that has been contaminated with feces that contain the eggs and larvae of intestinal worms, so no one is exempt from acquiring an infection. Think about dirty hands, vegetables, and fruits that have not been thoroughly washed or cooked.

In the past weeks, this column has featured dengue and tuberculosis as problems of immense public health concern. Let me add another, that of soil-transmitted helminthic infections or what is commonly known as STH that continues to be prevalent despite numerous interventions in place. Classified under neglected tropical diseases, it shares space with other conditions that may sound familiar, for the Philippines plays host to several. Neglected tropical diseases (NTDs) are largely found in impoverished countries as a consequence of challenges in hygiene, sanitation, and lack of access to health care. According to the WHO global report on neglected tropical diseases 2023, and this is a conservative estimate, “neglected tropical diseases account for 14.5 million disability-adjusted life years (DALYs), with significant variation among tropical and subtropical countries and developed and developing areas.”

As not to overwhelm, let us begin by focusing on STHs. The three most commonly found in the country are the roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), and hookworms (Necator americanus and Ancylostoma duodenale). For those who have been exposed through travel or community engagements and live in crowded communities with limited access to facilities that will ensure and encourage hygienic practices, you may probably have a close encounter with one of these. Back in college, a friend and I had volunteered to be a part of a medical mission with the Sisters of Charity and came away with an unforgettable experience: that of a child who threw up a bolus of Ascaris worms. At that specific moment, we both badly wanted to run away but prevented ourselves from doing so. Remembering never fails to bring back memories of how we struggled to retain a certain degree of composure and the slew of thoughts that accompanied us on the way back to attend an afternoon class, foremost, on how poverty greatly impacts one’s health. Relegated to the role of receptionist and assistant on that day, handing out deworming tablets suddenly had become more meaningful.

Manifestations of the disease may be varied according to the intensity of infection, from vomiting, abdominal pain, pallor, abdominal distention, and weight loss to rectal prolapse, bloody diarrhea, and intestinal obstruction and as a consequence, may greatly retard both physical and mental development. Though it is predominantly a condition that afflicts schoolchildren, pregnant mothers if infected are not only at risk from anemia, attributed mostly due to whipworms and hookworms, but are also vulnerable to experiencing adverse perinatal outcomes such as preterm labor or having small for gestational age babies. One may ask if there is a possibility of mixed or repeated infections. To both questions, the answer is a definite yes. Once in your system, these helminths may happily coexist, squat, and build a community in your gastrointestinal tract or being inherently restless, decide to wander into unusual territories unless prevented from doing so through prompt treatment and adherence to savory sanitary measures. While this is less than a palatable and a very lay description that may evoke symptoms of nausea or queasiness, it is very real.

How best to control and prevent? Several interventions exist and are incorporated into what is known as WASH, an acronym that stands for water, sanitation, and hygiene to augment deworming programs. With COVID no longer a public health emergency, we should rethink redirecting available resources to improve access and supply to clean water, provision of more sanitary facilities, draconian measures to eliminate open defecation as well as looking at long-term sustainability in implementing periodic deworming programs in the school and community. Together, we should be up in arms and openly declare war on worms.

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