Sometimes, worm infestation may worsen malaria in children —Experts

COLDS. Vomiting. Malaria. Worms. Diarrhoea. Nobody likes dealing with these nasties, especially in babies. But children under five years of age are one of the most vulnerable groups affected by many of these problems.

Conversely, children sometimes are affected by two of these problems at once. They may have malaria and a runny nose or runny a fever while also stooling.

Mrs Helen Adekola’s son had malaria and she was advised by a friend to also give him a worm expeller. Her friend said this would afford the child a quicker recovery from malaria.

“Worm expellers are cheap. All I wanted was to see my little boy running all over the house. So, for me, buying the worm expeller was not a big deal,” she recounted.

Malaria and worms are common parasitic illnesses in children.  In fact, children under five years of age are one of the most vulnerable groups affected by malaria. In Africa, about 285 000 children died before their fifth birthdays in 2016.

Dr Adebola Orimadegun, a consultant paediatrician, University College Hospital (UCH), Ibadan, described intestinal worms and malaria as tropical diseases that sometimes go hand-in-hand.

He declared: “those that have intestinal worms are also likely to suffer from severe malaria compared to those who do not have the two at the same time.

“It is coincident; there is no reason for that. Everybody leaving in the tropic is exposed to the two, depending on their level of hygiene as well as socio-economic status. Malaria is a disease of poverty and so is worm infestation.”

Moreover, Olugbemi Mokuolu, a Professor of Paediatrics, College of Health Sciences, University of Ilorin, Ilorin, said worm are varied and occurs in children from eating contaminated foods and drinks, walking barefooted and playing with pets.

He said different worms could have different health implications, adding that its health consequences in children can vary from anaemia, poor weight gain, malnutrition and impaired mental and physical development.

Worms, being parasites, he said develop at the expense of its carrier, so they cause distress to health.

For instance, children who have frequent hookworm infections can experience slow growth and mental development from losing a lot of iron and protein.

Roundworms can cause a dry cough and wheezing. In their large numbers, roundworm can obstruct the intestinal tract, such that at a surgery may need to be performed to bring them out.

Howbeit, the presence of worm may not directly worsen malaria in children and as having children with malaria take worm expellers in combination with their antimalarial medication is not necessary.

According to Professor Mokuolu, “they are not interrelated; and as paediatricians we do not promote such a practice. Yes, there is the possibility of a co-existence of malaria and worm infestation in an individual because of the related environmental circumstances; we do not routinely treat worm when we are treating malaria.”

The expert said mothers are not even expected to routinely deworm their children. “Those who have worm, they will deworm. But people just do it as a routine, that is something that we do not promote,” he added.

He said a blanket statement that children should be dewormed every three months is wrong considering that children’s exposure to things that they can get infected with a worm from varies from one community to another as well as one social class to another.

“I am a paediatrician, in all my life and today, I have never given worm expeller to any of my children. And they are graduates in the University now, not one bottle, “he added.

Professor Mokuolu said the idea of routinely deworming children is handed down from one generation of women to another.

He said, “Mothers have their various beliefs and practices that they passed on . But in many cases, they are either exaggerated or the circumstances are the same.

“Now we should not forget that women generally like to raise children believing that drugs are a necessary part of raising them. At every point in time, there is always some specification for drugs, from the beginning of life. What just happens is that they keep changing the reason over time.

“From newborn, you will see some mothers have what is called  ajogba, a big bowl having different drugs, that they keep giving almost on a daily basis. In the beginning, they give gripe water. So when they are through with that, then they start to give teething powder.

“So almost at every stage, they have to give one medication or the other. It is not just a worm issue; it is a general prevailing belief that people’s system is not sufficient except they are augmented by some drugs. And if they do not give the orthodox ones, they give the unorthodox ones in the form of agbo.”

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Now, in the past decade, there has been an increasing number of studies on co-infections between worms and malaria. However, this increased interest has yielded results that have been at times conflicting and made it difficult to clearly grasp the outcome of this interaction.

Ascaris lumbricoides (roundworms) emerges mostly as protective from malaria and its severe manifestations, whereas hookworm seems to increase malaria incidence.

Although deworming may provide net health benefits to human populations, the study, published in the journal Ecology Letters, suggested that hookworms could reduce the intensity of malaria caused by the Plasmodium vivax parasite two- to three-fold.

The researcher declared:  “in areas where malaria, particularly P. vivax is common and where resources permit, individuals should be tested and treated for malaria before given routine deworming medications. Otherwise, the deworming may exacerbate the malaria infection”.

However, Professor Mokuolu said more study is needed to prove that worms generally make malaria worse, adding that worms as parasite live on their host, and thus cause lowering of the body immunity and as such making its host more susceptible to many infections, malaria inclusive.

“By the time worms are present, you may then have the child capacity to respond to infection generally become compromised, connoting a lowered immunity. Whatever that child has is currently being taken up silently to fight against the worm. As such, they cannot fight other infections so well. It is what can be termed insult on top of injury.”