Helminth Elimination in the Pursuit of Sustainable Development Goals: A “Worm Index” for Human Development. PLoS NTDs, April 2015.
Authors: Peter J. Hotez , Jennifer R. Herricks
A new “worm index” confirms a strong association between helminth infections and impaired human development. In June 2012, a landmark United Nations conference on sustainable development was held in Rio de Janeiro, Brazil. Known as Rio+20, the conference focused on a new set of sustainable development goals (SDGs) that would begin following the sunset of the Millennium Development Goals (MDGs) in 2015 [1]. Like the MDGs, the SDGs will focus on poverty reduction, gender equality, and human and economic development, but in addition the SDGs will also emphasize food security and key issues related to the environment, such as climate change, the oceans, and biodiversity .
To date, unlike MDG 6, which includes combatting “AIDS, malaria, and other diseases,” the preliminary SDGs outlined at Rio+20 do not list specific diseases. Yet over the last decade, increasing evidence links the major neglected tropical diseases (NTDs) to a significant adverse impact on both human and economic development, especially for the major helminth infections, i.e., hookworm and the intestinal helminth infections, schistosomiasis, and lymphatic filariasis [2]. According to the Global Burden of Disease Study 2010 (GBD 2010), these helminth infections rank among the leading NTDs in terms of disability-adjusted life years (DALYs), accounting for approximately 10 million DALYs.
Helminth infections exert major effects on the essential components that comprise human development indices. Established by the economists Amartya Sen and Mahbub ul Haq and their colleagues in the 1990s , the human development index (HDI) is a summary of measure of the major dimensions of human development, including standard of living, educational attainment and years of schooling, and years of life lived with good health. There is evidence linking lymphedema from lymphatic filariasis to diminished labor and worker productivity, as well as excessive health care burdens especially in rural areas. In addition, data emerging over the last two decades indicate that intestinal helminth infections and schistosomiasis diminish or reduce childhood nutrition, development, cognition, and education.
With regards to educational effects, Miguel and Kremer found that in Kenya, school-based deworming (for intestinal helminths and schistosomes) led to a 7.5 percentage point average gain in primary school participation and a reduction in school absenteeism by at least 25%. Moreover, persistent hookworm infections in childhood in early 20th century America were shown to depress eventual educational attainment by more than two years, and future wage earning by 40%, while in Kenya, adults who received deworming treatment as children were also found to be more productive in terms of average working hours and wage-earning. However, the extent to which deworming improves education and other aspects of human development has been questioned and is undergoing re-evaluation. Finally, there are potent interactions between the helminth infections highlighted above and malaria or HIV/AIDS, which may further affect human development.
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