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Field Notes from Mexico: Treatment and infection rate updates

Simply Smiles blog

Follow our blog and read insights from Simply Smiles staff, volunteers and other individuals whose lives are affected by our work!

Field Notes from Mexico: Treatment and infection rate updates

Timothy Nurnberger

By Gil L'Italien

I’ve just returned from my third trip with Simply Smiles, Inc. to the mountains of southern Oaxaca, Mexico, where I have been spear-heading an effort to eradicate intestinal worms among a population of 3,000+ individuals. Simply Smiles has approached this problem scientifically, and I am pleased to report that, after a year of efforts, we have been able to measure a profound drop in infection rates.

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On November 3, 2014, I traveled with a medical team comprising of two pediatric nurses, and MD/MPH student, five Simply Smiles staffers, and four volunteers from Germany to began the arduous journey through the mountains to the village of Santa Maria Tepexipana where Simply Smiles bases its Village Project programs. As we had done a year ago in 2013 and again in the winter of 2014, our plan was to treat the entire population of this region for soil transmitted helminthes – more commonly known as intestinal worms. But on this trip we would also be testing a random sampling of the children for infection. This testing, when compared to the testing we conducted before we began our treatment/prevention efforts, would allow us to both measure the effectiveness of our programs and also pinpoint where the infection rates are greatest and therefore where the greatest prevention efforts are needed. (Our original testing also revealed that the infection was soil transmitted helminthes, not water born schistosomiasis or otherwise, allowing us to treat specifically and accurately).

Using the carrot of offering a month’s supply of food staples for each individual person, we have seen approximately 3,000 patients attend each of our three clinics. This time was no different. We’ve developed an efficient means of treating and testing a population of this size. Splitting the clinic across three days allows us to take the time necessary with each patient. The medical team, accompanied by the local physician and translators, explains what the medicine is for and the potential side-effects (which are minimal). We are treating with branded Albendazole; 200mg suspension and 400mg tablets. Since Albendazole is approved for treatment of soil transmitted helminthes in Mexico, we followed the labeled dosing per World Health Organization guidelines. Pregnant mothers, nursing mothers, and children less than two years-old were not treated. Informed consent for treatment was obtained from all adults and parents.

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Special thanks to our Simply Smiles supporters - specifically the financial contribution of Dr. Marianne Yood of Episource, Inc., and Dr. Javier Coindreau of Mexico City for making possible the purchase and shipment of the medications.

For testing we randomly obtained stool samples from approximately 10% of the children ages 2-12. Again, parental consent was required and obtained for collecting a stool specimen. Children were rewarded for a bowel movement with a chocolate egg containing a toy. Our staff was well trained in staining/reading the samples and identifying the presence of intestinal ova thanks to training provided by the Parasitology Lab of The University of Connecticut. The medical grade microscopes we used were also graciously supplied by the University of Connecticut.

Our findings

As with our previous two treatments, no children or adults experienced any adverse effects from the consumption of the albendazole.

The medical team and I are still analyzing the data but we are very pleased with the initial results. Thanks to the treatment, educational programs, and prevention tactics put into place over the past year, we are seeing significant reductions in the infection rates in each individual village of between 35% and 55%.

One of the things that makes the Simply Smiles approach different and worthy of our support is the time and effort taken to conduct the collection of scientific data. With this information, we are not guessing or hoping that our efforts are successful - it allows us to clearly measure our results and therefore the impact of our supporters.

What this means for the people

Based upon some hard science, we’ve clearly demonstrated that our efforts have had a positive and significant impact on the children suffering from the threat and detrimental impacts of intestinal worms, which is extremely exciting. We’ve shown that our intervention is working!!

To my knowledge, this is the first study of its kind to demonstrate a quantitative impact, admittedly in the small confined population of the nine villages and 3,000 people comprising the study.

But we cannot and will not rest on our laurels. Our goal is to drive these rates even lower, to less than 10%, to make sure that our friends in Oaxaca are happy, healthy, and have one less major obstacle on their paths to the bright futures they deserve.

Respectfully,

Gil

Dr. Gil L'Italien is an epidemiologist and Member, Board of Directors, Simply Smiles Inc.