Volume 177 - Issue 6
Parasite elimination programs: home and away
Authors: Stuart C Garrow and James S McCarthy
Med J Aust 2002; 177 (6): 335-336. || doi: 10.5694/j.1326-5377.2002.tb04806.x
Published online: 16 September 2002
Published online: 16 September 2002
In reply: While specific details of control strategies for intestinal parasites vary according to parasite species, available anthelmintic agents and tools for environmental intervention, it is widely accepted that sustained, coordinated programs supported by government, community and health professionals with agreed methods and targets are the key to success.1 Prociv describes the outcome of just such a program for hookworm in Queensland, and the subsequent recrudescence of infection once the program was scrapped.
The program in northern Western Australia succeeded because of commitment by government, community involvement entailing community debate and ownership of the program,2 education, and behavioural change, and improvement in public sanitation facilities as well as chemotherapy.3 We believe that a critical determinant of the outcome of our program was the inclusion of the community in designing the program.
We agree with Prociv that control of filariasis and malaria was achieved in Australia by mosquito control; our statement about the role of sustained public health programs refers to the control of leprosy.4 With respect to the prospects for control of intestinal protozoa as well as helminths, a single-dose regimen with broad-spectrum activity would be ideal. While albendazole shows some useful clinical activity in giardiasis, single-dose regimens of this drug are insufficient to effect cure, as was observed in our study.
While the social and environmental hurdles may appear to "dwarf the capabilities of government", we believe that there is a continuing need for Aboriginal health organisations, health professions and health departments at state and national levels to tackle parasitic infections. The logical approach is to model wider programs on successful local programs, and to avoid drifting into policy and program nihilism.
References
- Albonico M, Crompton DWT, Savioli L. Control strategies for human intestinal nematode infections. Adv Parasitol 1999, 42: 277-341. 1
- Waina M, Unghango P, Williams D, et al. The prevalence of hookworm infection, iron deficiency and anaemia in an Aboriginal community in north-west Australia [letter]. Med J Aust 1997; 167: 554. 2
- Thompson RC, Reynoldson JA, Garrow SC, et al. Towards the eradication of hookworm in an isolated Australian community. Lancet 2001; 357: 770-771. 3
- Lush D, Hargrave JC, Merianos A. Leprosy control in the Northern Territory. Aust N Z J Public Health 1998; 22: 709-713 4