Mail from Mauritania : deworning and child malnutrition
Mail from Mauritania André Briend 25.09.2001
re: Mail from Mauritania Liane Adams 26.09.2001
Re: Mail from Mauritania Ingrid Hindarmanto 26.09.2001
Re: Mail from Mauritania Rae Galloway 26.09.2001
RE: Mail from Mauritania Rebecca Stoltzfus 27.09.2001
RE: Mail from Mauritania Ellen Muehlhoff 19.10.2001


Date: Tue, 25 Sep 2001 14:53:13 +0200
From: "André Briend" <briendaatcnam.fr>
Subject: Mail from Mauritania

Dear N'GONUT


During the National Immunisation Day, Mauritania wishes to introduce for the first time a treatment by Mebendazole (for the second round due in November). We have, however, some urgent questions:

1- Has anybody similar experience ?
2-Can we have feedback on feasibility ?
3- Which age group should receive Mebendazole ? All chilren from 0-5 will be seen for oral polio and all those 6m to 4 years will receive vitamin A.

Looking forward to receiving your comments,

Cheikh Mohamed El Hafed Ould Dehah
Consultant Chargé Programme Nutrition
OMS, Mauritanie
BP : 320 Nouakchott
Cell : (00222) 641 28 30 / 525 24 02 (OMS)
dehahatuniv-nkc.mr

André Briend, MD, PhD
U 557 INSERM (UMR INSERM/INRA/CNAM)
ISTNA/CNAM
75003 Paris, France
tel : 33-1-53 01 80 36 fax : 33-1 53 01 80 05 5 rue du Vertbois,


Date: Wed, 26 Sep 2001 10:26:55 -0400
Cc: <dehahatuniv-nkc.mr>
From: "Liane Adams" <ladamsatusaid.gov>
Subject: re: Mail from Mauritania


This issue was raised here in Nigeria, and was promptly discarded as unrealistic. Of course it's a good idea for children to receive mebendazole, but the NIDs is (at least here, and I suspect it's similar in most places) not a good forum for delivery. We here all agreed that schools (a school health program for example) are the best mechanism for delivery of that kind of health care. Our teams and partners have quite enough to worry about during NIDs with OPV and vitamin A and just doing a good job with dispensing those.
Good luck with your decision....

Liane Adams
Child Survival Advisor
USAID/Nigeria
Metro Plaza
Plot 992 Zakaria Maimalari Ave.
Central Area,
P.M.B. 519, Garki
Abuja, Nigeria
Email: ladamsatusaid.gov
lianeadamsathotmail.comlianeadamsathotmail.com
Office Phone: 234-9-413-8374/5
Residence phone: 234-09-413-8079


Date: Wed, 26 Sep 2001 17:57:24 -0400
From: ihindarmantoatunicef.org (Ingrid Hindarmanto)
Subject: Re: Mail from Mauritania
Cc: dehahatuniv-nkc.mr

In DPR Korea we apply Vermox Tabl 500mg (Mebendazole Tabl 500 mg) in conjunction with Vitamin A and polio immunization.
For Mebendazole the target group is 2 - 5 years, one tabl. every 6 months.
Sometimes they give 1/2 tablet for the children 1 -2 years.
For Vitamin A: children 6 months - 1 year, 100.000 IU
children 1 year - 5 years, 200.000 IU Not all children can chew the Mebendazole tablet, therefore it was grinned before and given with water.

Hope the information are useful.


Date: Wed, 26 Sep 2001 08:14:10 -0400
Subject: Re: Mail from Mauritania
From: rgallowayatworldbank.org
Cc: "André Briend" <briendaatcnam.fr>, dehahatuniv-nkc.mr


Just to follow up on this. I didn't answer right away because I thought others making international recommendations on the use of mebendazole would respond.
The International Nutritional Anemia Consultative Group (INACG), World Health Organization (WHO) and United Nations Children's Fund (UNICEF) put out the "Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia" (authors Rebecca Stoltzfus and Michele Dreyfuss) in 1998. This document also gives recommendations for complementary measures to improve iron status such as parasite control measures. Treatment with mebendazole is recommended for children above 5 years of age. If others know of a change in the international recommendations for use of mebendazole it would be good to get those circulated. The intensity of the worm burden for hookworm peaks in adults so targeting adults would reduce the worm burden in the entire population, even in groups where the intensity of infection is lower.


Rae Galloway
Nutrition Specialist
Human Development Network
The World Bank
1818 H Street, NW Room G-3-046
Washington, DC 20433


Date: Thu, 27 Sep 2001 14:04:01 -0400
From: Rebecca Stoltzfus <rstoltzfatjhsph.edu>
Subject: RE: Mail from Mauritania
Cc: dehahatuniv-nkc.mr

As part of our WHO Collaborating Center on Intestinal Parasites and Human Nutrition, I have been part of a collaborative research group looking at the issue of anthelminthic treatment of preschool children in Zanzibar. At the moment, there is a lack of clear policy about large-scale programs in this younger age group. Up till now, policies have focussed on school-age children because they harbor heavier worm loads. However, in many environments preschool children do accumulate significant worm burdens and this may affect their nutrient metabolism and/or immune development.

In the context of a research trial, we gave single dose (500 mg) mebendazole to children 6 months to 5 years old. We found no adverse reactions in the children, even the children < 2 years old. We expected older preschoolers to benefit more than younger preschoolers (because of their greater worms burdens), but in fact we found just the opposite. The younger children (<30 months at start of treatment) were the ones who benefited most in nutrition outcomes, and the benefit was mainly seen in reduction of wasting malnutrition (low weight-for-height and arm circumference). More research is needed to replicate these results, and to clarify the situations in which these benefits might be predicted (e.g. intensity of transmission, worm species, risk of malnutrition).

Based on this experience, I would suggest that single dose mebendazole could be safely given to children 6 months-5 years. The tablets will need to be crushed and suspended in the case of children too young to chew. In Zanzibar the treatments were well accepted by mothers and by the community.

If you would like further guidance, I encourage you to contact Dr. Lorenzo Savioli of the WHO (saviolilatwho.ch). He is very much aware of the issues in this age group and also familiar with programs in Africa.

Best regards,
Rebecca Stoltzfus

Rebecca Stoltzfus, Ph.D.
Associate Professor
Center for Human Nutrition
Department of International Health
School of Public Health
The Johns Hopkins University
615 N. Wolfe Street
Baltimore, MD 21209
Phone: 410-955-2786
Fax: 410-955-0196
email: rstoltzfatjhsph.edu


Date: Fri, 19 Oct 2001 19:37:46 +0200
From: "Muehlhoff, Ellen (ESNP)" <Ellen.Muehlhoffatfao.org>
Subject: RE: Mail from Mauritania
Cc: "'HFS-Zambia'" <ihfsanatzamnet.zm>


From : Don Kayembe
Senior Nutritionist and Dietician, Luapula Province, Zambia


Subject: Deworming and Child Malnutrition (Ngonut: Mail from Mauritania)

Referring to the above mail from Mauritania, I would like to intervene by making the following comments and suggestions:-

The deworming programme is a vital exercise in combating malnutrition especially in rural area and in all areas at large. This programme is being carried out by our project since last year (2000). It is focusing only school going children for the following reasons:
1) They are easy to identify and to monitor programme performance.
2) The programme can be well planned in terms of duration between the two doses to be given yearly.

In Luapula, we have not found an easy way of involving the other age groups like 0-5 years. May be with the suggestion from Mauritania to integrate it in NIDS. All the same drug effect will not be easily evaluated.

But my big concern is about deworming 6 months old infants. This need a big debate.

1) Like in Zambia, we are promoting and supporting exclusive breastfeeding up to 6 months. I believe that this is the same in Mauritania. If so, it is well known that breastmilk has some immunological factors which protect a baby against infestations of intestines (Ig. A).
Also bringing the idea of deworming a 6 months old child will bring confusion in the message of safety of breastmilk addressed to communities. Through experience, communities even those in rural areas are trying to get and implement the message of exclusive breastfeeding upto 6 months.

2) My suggestion is that the deworming should consider children from 8 months old to school going children.

Reasons are:
- From 8 months an infant starts crawling it is exposed to many thing which are contaminated.
- The infant starts eating other foods, which may contaminate it and drink water which may be contaminated.
These and more others, may justify why to start deworming children at this age.

In conclusion, I would like to express my surprise that in Zanzibar the deworming programme had involved even young infants of 6 months old. If Madam Rebecca Stolzfus can elaborate a little more on selection criteria and the result. This will be for us a very good learning experience.

Many thanks,

Don Kayembe
(Please reply to: Ellen.Muehlhoffatfao.org; and ihfsanatzamnet.zm)