MBABANE, 5 October 2009 (IRIN) - A public health campaign to rid Swazi school children of potentially fatal parasitic worms has been halted by an inter-ministerial spat over the reasons for hospitalizing hundreds of children.

The health ministry had not released any official figures, but local media reported that between 400 and 800 children had fallen ill after taking deworming and bilharzia tablets administered at their schools in late September, fanning fears that teachers were administering the medication without proper instruction, and the combination of treatments was making children sick.

Bilharzia, or schistosomiasis, is caused by parasitic flukes, or worms, that are carried by freshwater snails and enter through the skin when people walk or bathe in infected water. It can become chronic and damage internal organs, and can also impair growth and cognitive development in children.

"Each drug - albebdazole and praziquantel - has an excellent safety record and can be safely co-administered," the World Health Organization (WHO) Resident Representative to Swaziland, Owen Kaluwa, told the media at a joint press conference called by the Ministry of Health and Social Welfare (MoHSW) and WHO to allay fears that the medicines were making children ill.

Ministerial infighting

Minister of Health Benedict Xaba said side effects like stomach cramps were normal reactions to the deworming process. "Children with heavy worm infestations tend to experience side effects to the treatment. In the process, the erosion of the gut occurs, resulting in severe pains, diarrhoea and vomiting."

But the Minister of Education, Wilson Ntshangase, was unmoved by the explanations and angrily denounced the campaign. "There is something wrong with these tablets, as many children have been affected. I have a serious problem with the way the whole exercise was done," he said.

"Teachers were going to take the blame, had these children died, and I just wonder why medical professionals like nurses were not dispatched to the schools to administer the taking of the drugs."

The public bickering between the ministers quickly turned into a ministerial blame game, leading Prime Minister Sibusiso Dlamini to suspend the campaign at the beginning of October. WHO in Swaziland and the MoHSW have both warned of the danger of halting the campaign and withholding treatment from infected children.

''Two cabinet ministers were clashing in public and government was embarrassed, so the life-saving treatments were halted''
"The children were reacting to side effects of the medicine because they were ill from worms, not because the medicines made them sick. They are lucky because they were treated. Our concern is the infected children who the campaign has yet to reach," a government hospital nurse, who declined to be identified, told IRIN.

A teacher in Manzini, the county's second city, said the WHO guidelines for administering the medicines had been followed. "Two cabinet ministers were clashing in public and government was embarrassed, so the life-saving treatments were halted - the suspension was not done for medical reasons. The education minister should himself be educated."

Bilharzia affects some 200 to 300 million people in the tropics and subtropics and ranks second only to malaria among human parasitic diseases in terms of socio-economic and public health importance in the 74 countries where it is endemic.

According to the Swaziland Institute for Research in Traditional Medicine, the disease is common in rural communities and is increasing in both distribution and intensity, partly because of the creation of new water resources to meet the increasing demand for agricultural irrigation.


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