Pre-school age children account for 10%–20% of the 2 billion people worldwide who are infected with soil-transmitted helminths (STHs): Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and Ancylostoma duodenale/Necator americanus (hookworms). Through a systematic review of the published literature and using information collated at World Health Organization headquarters, this paper summarizes the available evidence to support the recommendation that pre-school children should be included in regular deworming programmes. The first section describes the burden of STH disease in this age group, followed by a summary of how infection impacts iron status, growth, vitamin A status, and cognitive development and how STHs may exacerbate other high mortality infections. The second section explores the safety of the drugs themselves, given alone or co-administered, drug efficacy, and the importance of safe administration. The third section provides country-based evidence to demonstrate improved health outcomes after STH treatment. The final section provides country experiences in scaling up coverage of pre-school children by using other large scale public health interventions, including vitamin A programmes, immunization campaigns, and Child Health days. The paper concludes with a number of open research questions and a summary of some of the operational challenges that still need to be addressed.

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SummaryIn 2001, WHO developed a pole for the administration of praziquantel without the use of weighing scales with encouraging results in African populations. In the present study, the pole was tested on height/weight data from 9,354 individuals from 11 non-African countries. In more than 98% of the individuals (C.I. 97.8-98-4) the pole estimated an acceptable dosage (30-60 mg/kg) -a performance not statistically different from the one observed in African populations. Reproducing the present pole in the form of a strip of paper and including it in each container of praziquantel would greatly facilitate the administration of the drug in large-scale interventions. Keywords Praziquantel administration; WHO dose poleThe regular treatment of vulnerable groups with praziquantel is WHO's principal strategy for schistosomiasis control (WHO 2003). The drug administration is simple, but, as the individual dose of praziquantel is given according to body weight, reliable weighing scales are necessary in the field, which can be problematic and expensive. Hall et al (1999) therefore suggested the use of a pole, which estimates the number of tablets needed for treatment according to an individual's height. Three poles based on data from Ghana, Malawi and Tanzania were developed and tested in each country (n=1,803, n=2,069 and n= 2,078 respectively) with positive results (Hall et al. 1999 The present study was conducted to investigate the validity of the WHO dose pole to indicate dosage of praziquantel in non-African populations. Our analysis was conducted on height-weight data previously randomly collected from 11 countries. The total number of records was 9,356, of which 7,453 were children aged between 6 and 15 years (school age).Seven data sets originated from schistosomiasis-endemic countries (including all major nonAfrican endemic countries). Four data sets, from non-endemic countries were, also included in the analysis to further confirm the worldwide validity of the WHO dose pole. Sixteen records (0.17%) were excluded from the analysis as suspected data entry errors since the weight was more than 3 standard deviations from the expected value for height.Two height intervals: between 94 cm and 110 cm (corresponding to 1 tablet) and over 178 cm (5 tablets) were added to the WHO pole (Figure 1). These new thresholds were calculated using the same equation used to define the original thresholds between 110 and 178 cm [y = 0.005x 2 -0.7909x + 44.647] .Each person's height was classified using the pole's intervals and the number of tablets and the total dose (in mg) indicated by the pole was recorded. The individual dosage was then calculated by dividing the total dose by the weight of each individual registered in the data set (in mg/kg).A dosage between 40 -60 mg/kg was considered optimal (WHO 2004) and a dosage between 30-60 mg/kg was considered acceptable for the significant activities demonstrated by praziquantel at this dosage (Taylor et al 1988).The average dose provided by the WHO pole was 44.74 mg/Kg (range 42.06 mg/...

SummaryPrevious surveys in Myanmar indicate that soil-transmitted helminths (STH) are a significant public health problem. However the majority of these surveys are small scale or hospital based. To date there has been no countrywide assessment of the prevalence and intensity of STH infection. We conducted a survey (June 2002-June 2003 to assess the magnitude of STH infection in school age children in each of the different ecological areas of the country. In each area, five schools were selected and from each one, 50 children were randomly chosen. Parasitological and nutritional data were collected from each child. We found an overall prevalence of infection of 69%: 18% had a moderate-heavy intensity of infection, 22% were anaemic. A pilot exercise to treat 25 000 school age children in the 200 schools of Nyangdone Township tested the strategy before scaling up and to generate some rough costings. A crude calculation of the expenditure to buy and deliver the drugs, including the costs incurred in the teacher training, concluded that the cost per child was approximately 0.05 USD.

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