National Deworming Day- August 2018

1. National Deworming Day- August 2018 Training of Block Officials (Health, Education and ICDS) For use at District-Level Trainings Ministry of Health and Family Welfare | National Deworming Day (August 2018)

2. Session Details Ministry of Health and Family Welfare | National Deworming Day (August 2018) 1

3. National Deworming Day Overview • Fixed day approach for the deworming program Objective: Deworm all children (boys and girls) aged 1-19 at schools and anganwadis for improved child health, nutritional status, access to education, and quality of life. Stakeholders: Department of Health and Family Welfare, Department of Education, Department of Women and Child Development (ICDS); , Department of Urban Development, Development of Rural Development; Department of Tribal Development; Department of Drinking Water and Sanitation; Department of Panchayati Raj; Department of Human Resource Development; Evidence Action-Deworm the World Initiative; Development partners Ministry of Health and Family Welfare | National Deworming Day (August 2018) 2

4. Common Behaviours in the Community • Playing barefoot outside • Not washing hands before eating food • Defecating in the open • Not washing hands after using the toilet • Eating fruits and vegetables without washing • Not keeping food covered, which may result in food contamination Ministry of Health and Family Welfare | National Deworming Day (August 2018) 3

5. Types of Worms Worms are parasites that thrive on nutrition from the human intestine Hook worm How do worms spread? • Worm infections result from poor sanitation and hygiene conditions • Worm transmit through contact with infected soil Whip worm Round worm 4 Ministry of Health and Family Welfare | National Deworming Day (August 2018)

6. Symptoms of Worm Infections • The greater the amount of worms in a child (intensity), the more symptoms the infected individual will have • Severe infections can cause a range of symptoms including diarrhoea, abdominal pain, weakness, vomiting, and loss of appetite • Children with mild infections usually show no symptoms Ministry of Health and Family Welfare | National Deworming Day (August 2018) 5

7. Worm Transmission Cycle • An infected child contaminates soil with faeces containing worm eggs. These eggs develop into larvae in the soil 2. Other children are infected by eggs ingested through food or dirty hands, or by larvae penetrating the skin 3. In an infected child, eggs and larvae develop into adult worms, which produce eggs and have an ill effect on the child's health Ministry of Health and Family Welfare | National Deworming Day (August 2018) 6

8. Impact of Worms on Health and Nutrition Worm infections impair the nutritional status of the people they infect in multiple ways: • Worms feed on host tissues, including blood, which leads to anemia. • The nutritional impairment has significant impact on growth and physical development. • Worms consume nutrients meant for the human body and cause blood loss, poor nutrition and stunted growth. • Roundworm may compete for vitamin A in the intestine. Ministry of Health and Family Welfare | National Deworming Day (August 2018) 7

9. Impact of Worms on Children’s Education and Long Term Productivity • Due to heavy infection, children are often too sick or tired to concentrate at school or attend school/anganwadi. • Worm infection negatively affect children’s physical and cognitive development, which could have long term negative impact on their work potential and wages in adulthood. Studies show that absenteeism in schools decreases by 25% with regular deworming. Ministry of Health and Family Welfare | National Deworming Day (August 2018) 8

10. Preventing Worm Infection Ministry of Health and Family Welfare | National Deworming Day (August 2018) 9

11. How to Treat Worms Deworming Drug- Albendazole 400 mg (available free-of-cost) Albendazole should be administered to all children aged 1 to 19 in age-specific doses. Albendazole is a safe drug for both children and adults and has been used to treat millions of people across the world for Soil Transmitted Helminths. Albendazole tablets that are not chewed or crushed may have significantly lower effectiveness. 10 Ministry of Health and Family Welfare | National Deworming Day (August 2018)

12. Benefits of Deworming Direct Benefits: • Controls anemia • Improves nutritional uptake Indirect Benefits: • Helps improve concentration, capacity to learn, and attendance at school and anganwadi. • Helps improve work potential and livelihood opportunity. • Benefits the community by reducing worms in the environment . Ministry of Health and Family Welfare | National Deworming Day (August 2018) 11

13. Benefits of School-based Deworming Schools: • Offer a unique opportunity and platform to deliver deworming drug to a large number of children in a safe manner • Enable the program to reach high coverage in a single day as majority of targeted children are available at the schools Teachers: • Are an invaluable resource for administering deworming drug • Can pass on knowledge about prevention and treatment for worm infections as they are highly respected by the community, including parents and children Ministry of Health and Family Welfare | National Deworming Day (August 2018) 12

14. Benefits of Anganwadi-based Deworming Anganwadis: • Offer a unique opportunity and platform to deliver deworming drug to a large number of children in a safe manner • Enable the program to reach high coverage in a single day as majority of targeted children are available at the anganwadis. Anganwadi Workers (AWWs): • Are an invaluable resource for administering deworming drug • Can pass on knowledge about prevention and treatment for worm infections as they are highly respected by the community, including parents and children Ministry of Health and Family Welfare | National Deworming Day (August 2018) 12

15. National Deworming Day and Mop-up Day • Albendazole will be administered on National Deworming Day (NDD), 10 August 2018, across all schools and anganwadis for all children aged 1 to 19. • Teachers will administer Albendazole to all school-enrolled children aged 6-19 years at the school. • AWWs will administer Albendazole to all children aged 1-5 years and unregistered, out-of-school children aged 1-19 years at the anganwadis. • Unregistered and non-enrolled children will be mobilized to the nearest anganwadi for deworming with support from the ASHA. • Children who are sick or are on medication should not be administered the tablet. These children should be advised to have the Albendazole upon recovery. • Children who could not be dewormed on NDD must be administered the drug on mop-up day (MUD) on 17 August 2018. Ministry of Health and Family Welfare | National Deworming Day (August 2018) 13

16. Community Awareness and Mobilization Ministry of Health and Family Welfare | National Deworming Day (August 2018) 14

17. Community Awareness and Mobilization Teachers should - • Inform community about benefits of deworming and NDD • Inform the children at the morning assembly and in the classroom about deworming and having Albendazole on NDD • Motivate all parents, relatives to get their children to school on NDD for deworming. Share the messages at the School Management Committees and parent-teacher meetings • Provide adequate information to the parents or children on how the tablet should be administered and consumed • Inform students and parents about the benefits of deworming and dates of deworming • Inform parents, children, and community members about deworming messages appearing in newspapers, radio, and TV that they should watch/listen to carefully Ministry of Health and Family Welfare | National Deworming Day (August 2018) 15

18. Community Awareness and Mobilization Anganwadi workers should - • Inform community about the benefits of deworming and dates of deworming • Motivate parents and relatives who come to the centre, to bring their children to the anganwadi on NDD • Provide adequate information to the parents or children on how the tablet should be administered and consumed • Inform children about deworming and NDD when they come to the centre • Support/guide ASHAs to mobilize community members through Gram Panchayats and at VHSNC meeting • Inform community members about deworming messages appearing in newspapers, radio, and TV that they should watch/listen to carefully Ministry of Health and Family Welfare | National Deworming Day (August 2018) 16

19. Adverse Events and Its Management Role of the Teacher/ AWW: • Use a spoon to administer Albendazole to the child yourself and not give it to the parents to take home • Do not forcefully administer the tablet to any child • Inform parents about mild side effects and that it is expected only in children with high worm load • Build confidence in parents that the child will be taken under observation and care if they show any serious side effects • Must be prepared to take care of the child during any adverse event • Call_____ for any medical assistance What are Adverse Events? • Deworming has very few side effects on children • Events such as nausea, vomiting, diarrhoea, and weakness may occur among few children especially those with high worm infections • Any adverse events are temporary and generally can be managed easily at the anganwadi. Ministry of Health and Family Welfare | National Deworming Day (August 2018) 17

20. Adverse Event Management Albendazole is safe for both children and adults: • Albendazole is an easily chewable tablet • Choking is not to be considered a serious adverse event and is a medication error • Instruct older children to chew the tablet properly. Ensure safe drinking water is available Albendazole tablets that are not chewed or crushed may have significantly lower effectiveness. • Still, if the child chokes on part of the tablet, make the child bend over on your lap and pat the child on the back till the tablet comes out • Take the child to an open and shaded place and allow the child to lie down and rest • Call ______ for any medical assistance Manage the Adverse Events as per protocol- call Toll Free Number of Pharmacovigilance Programme of India (PVPI) 1800 180 3024 for assistance in reporting of Adverse Drug Reactions (ADR) and its management. Ministry of Health and Family Welfare | National Deworming Day (August 2018) 18

21. Adverse Event Management • Additionally, physicians must fill PVPI suspected ADR reporting form for all the ADRs (for proper analysis of ADRs) • Anganwadi and ANM workers to fill the Consumer PVPI forms, provided in local languages also such as Hindi, Assamese, Oriya, Bengali, Kannada, Tamil, Telegu, Malayalam and Marathi for any kind of ADR • List of adverse drug reaction Monitoring Centres (AMCs) for all the states is provided for support to fill in the above mentioned forms. • Hyperlink PVPI Suspected Adverse drug reaction reporting form Medicine side effect reporting form Ministry of Health and Family Welfare | National Deworming Day (August 2018) 19

22. Steps to be Followed at the Schools/AWCs on NDD and MUD 1. Before NDD – Checklist • Ensure availability of sufficient drugs • Keep the phone number of the nearest PHC, MO- Block PHC, ANM handy for Adverse Event Management support • NDD reporting forms • Inform children, parents, and community about NDD • Properly display banner, posters, and other IEC NDD kit= Tablets+ Training handout + IEC+ Reporting form • Take the list of out-of-school children (ASHA Reporting Form) aged 1-19 years from ASHA. Prior to NDD, ASHAs will prepare list of these children. • Use the list prepared by ASHAs (ASHA Reporting Form) to update the list of adolescent girls Ministry of Health and Family Welfare | National Deworming Day (August 2018) 20

23. Steps to be Followed at the AWC on NDD and MUD 2. Albendazole Administration • Teachers/Anganwadi workers must use a spoon to administer Albendazole to the child themselves and not give it to the parents to be given at home • Teachers/Anganwadi workers must never administer the tablet to children who are sick or are on any other medication • Call______ for any medical assistance. Manage the AE as per protocol and also use of Toll Free Number of Pharmacovigilance Programme of India 1800 180 3024 for reporting the AE. You may also contact the nearby ADR Monitoring Centre Ministry of Health and Family Welfare | National Deworming Day (August 2018) 21

24. Steps to be Followed at the Schools/AWC on NDD and MUD 3. Recording • Teacher/Anganwadi worker: • On National Deworming Day, along with administering the tablet, teacher/AWW must ensure that they mark a single tick (√ ) next to each dewormed child’s name in the register • AWW also to record in the ASHA Reporting Form • On mop-up day mark a double tick (√ √ ) next to the child's name. NDD MUD Ministry of Health and Family Welfare | National Deworming Day (August 2018) 22

25. Reporting - Schools • Every teacher will count the number of ticks on the form after National Deworming Day and mop-up day separately and report this number to the headmaster • The headmaster must ensure the accuracy of the reported data before filling it into the form. Seek help from teacher from your school for cross checking the calculations before submitting the form • After mop-up day, headmaster should report all data in the NDD School Reporting Form and submit to ANM by 22 August 2018 • Keep one copy of the form in your school for records and verification purposes • ANM to only collect the reporting form and submit it to the MO-BPHC Ministry of Health and Family Welfare | National Deworming Day (August 2018) 23

26. Reporting - Anganwadi • AWW should count separately the details from National Deworming Day and mop-up day • AWW should cross check the details carefully before entering details into the Anganwadi Reporting Form. Ensure that the form is filled correctly and completely. • After mop-up day, anganwadi worker should enter the details and submit the completed form to the ANM by 22 August 2018. Also submit the ASHA Reporting Form along with this. • The anganwadi worker should keep a copy of the filled reporting form carefully at the anganwadi for records and verification purposes • ANM to only collect the reporting form and submit it to the MO-BPHC Ministry of Health and Family Welfare | National Deworming Day (August 2018) 24

27. Role of ASHA Revisit household with a list to follow up with children who could not be dewormed on National Deworming Day (due to sickness and absenteeism) and encourage them to have the deworming tablet on mop-up day Recording and Reporting • Before NDD, prepare a list of out-of-school, unregistered children aged 1-19 years (ASHA Reporting Form) and share with the anganwadi worker • Record details of unregistered, out-of-school children who were dewormed by anganwadi worker in the ASHA Reporting Format • AWW will compile all records of National Deworming Day and mop-up day with support from ASHA and submit it to the ANM Ministry of Health and Family Welfare | National Deworming Day (August 2018) 25

28. Reporting- Block/ District/ State Common Reporting Form • After receiving all school and anganwadi reporting forms from ANM, Block Medical Officer will compile all the school and anganwadi reporting forms in Block Common Reporting Format and submit to District M&E officer • District M&E officer will compile data of all BPHCs in District-level Common Reporting format and submit to State Nodal Officer • State Nodal Officer will compile the reports of all districts in State Common Reporting Format and submit to MoHFW • Two officials at Block/District/State-level should review the quality of coverage data provided in the Common Reporting Format before submission Ministry of Health and Family Welfare | National Deworming Day (August 2018) 26

29. NDD Mobile/Web Application • To be used at block-level for data entry • To be used at district-level for data review and approval • To be used at state-level for data viewing and analysis and submission of NDD August 2018 coverage report • 2 versions: 1) mobile based (android app) 2) web version • Paper based reporting will also continue along with the submission of data through NDD app Paper based reporting National NDD mobile/ web reporting *Refer to NDD manual for more information on NDD app Ministry of Health and Family Welfare | National Deworming Day (August 2018) 27

30. Reporting Cascade Ministry of Health and Family Welfare | National Deworming Day (August 2018) 28

31. NDD Monitoring Form (Block/ District/ State) • All monitoring teams from block, district, state levels including development partners will use the NDD monitoring form for field monitoring of NDD • All monitoring forms used by officials/ teams will be submitted to nodal officer at health department along with NDD coverage data Ministry of Health and Family Welfare | National Deworming Day (August 2018) 29

32. National Deworming Day 10 August 2018 and Mop-up Day 17August 2018. All teachers and anganwadi workers should fulfil their role in this program with enthusiasm and play a part in giving children a brighter future. Ministry of Health and Family Welfare | National Deworming Day (August 2018) 30

33. Thank You Ministry of Health and Family Welfare | National Deworming Day (August 2018)