Where children undergo surgery to expel worms

by Amref Health Africa

About a month ago at her matrimonial home in Kakamega, Maureen Oketch, 30, watched her four-year-old son dash outside the house to play with his friends. He was back two hours later, hungry. After feeding, he resumed playing.  But a few minutes later, he run back home crying.

A worried Ms Oketch rushed her son to Matungu Sub-district Hospital, where she was told to take him to the laboratory. After an X-ray scan, she was informed that her son had worms in his stomach, and that the reason he was irritable was because he couldn’t pass stool.

They were referred to a different facility, and Ms Oketch carried her son, who wouldn’t stop crying, to Bungoma County Referral Hospital, where he would eventually end up on the surgeon’s table.

Ms Lydia Akumu, the boy’s grandmother, says: “I met my grandson and his aunt at the hospital a few days after admission.

She had stepped in to relieve the mother who had an infant, and I took over his care. Drugs would be administered through his anus twice a day and he would poop out worms.”

After a fortnight, Ms Akumu explains that her grandson’s stomach was still swollen, and as they entered the third week, a surgery was performed.

“The doctor said his intestines had been perforated, and that a surgery was inevitable. We stayed at the hospital for a week to enable his recovery, and he was discharged as the month came to an end,” explains Ms Akumu.

Her grandson would be one of the three children under the age of five who have undergone surgery at the hospital this year due to intestinal obstruction complications.

It’s been three weeks post-surgery now, explains Ms Akumu. She reveals that her grandson had enrolled in baby class (PP1), but the illness has necessitated that he skips school to recover.

Aged 52, she says this is the first time she has witnessed a person, leave alone her own grandchild, go under the knife because of parasitic worms.

“We live far from each other so I don’t know if my grandchild has ever been dewormed. But I was taught the importance of maintaining hygiene and routine deworming upon discharge from hospital,” says Ms Akumu.

Ms Oketch explains that she has been religiously deworming her son, and that she has always made sure he is dewormed when health officials visited his school for the exercise.

Dr David Wanikina, the hospital superintendent at Bungoma County Referral Hospital, who is also a family and emergency physician, explains that the surgical department conducts one surgery every three months related to worms. “In September this year, we performed 20 surgeries due to intestinal obstructions, inclusive of adults and children. Five were children, out of which two had roundworms,” he reveals.

The obstructions experienced by the 15 adults were caused by factors such as abnormal twisting of a part of the large or small intestines,  adhesions from previous surgical scares, malfunction in the nerves and muscles in the intestine that impairs digestive movement.

The surgeries of the children were also attributed to malfunction in the nerves and muscles in the intestine that impairs digestive movement and intussusception, a serious condition in which part of the intestine slides into an adjacent part of the intestine, which mostly manifests with small intestines getting into the large intestine.

Intestinal obstructions can also be caused by intestinal perforations , constipation and drugs. “Sometimes you can find a whole ball of tangled worms from a patient’s stomach, which can weigh up to a kilogramme or more. Once it is removed, the patient thrives.

 “A surgery is the last intervention for a person affected by worms,  and the most extreme consequence  is death, says Dr Wanikina.

He observes that the situation is dire in the region, with 15 to 20 per cent of children being malnourished. Bumula Sub-county is the most affected.  Some worms have serious ramifications, he explains. Roundworms can cause anaemia, necessitating recurrent blood transfusions without which a patient could die.

“They can perforate intestines, and if there is no intervention, a patient can die. Tapeworms can travel all the way to the brain, leading to convulsions. They can also travel to the lungs and liver, causing complications and possibly death. Migratory worms can also embarrass you because they can get out through the nose, “explains Dr Wanikina.

“The success of the diagnosis -how fast a doctor can link difficulty in breathing or other complications to worms – depends on the doctor you are seeing. If antibiotics aren’t working, a doctor should think about worms,” he said.

Preliminary results of a survey carried out by Amref Health Africa in Bungoma County between September 4 and October 8 this year revealed that the highest prevalence of soil transmitted human parasitic worms was at 29 per cent in Cheptais Sub-county, Kapkateny Ward.

The same percentage was recorded in Madaraka , Webuye East for bilharzia, a disease caused by parasitic worms.

The World Health Organization (WHO) records that worm-related diseases, categorised under neglected tropical diseases (NTDs), are known to persist in conditions of poverty. WHO reports that the chronic disabling infections affect more than one billion people. Mainly concentrated in Africa, they mostly affect those living in remote rural areas, urban slums or conflict zones.

Since they receive relatively much less funding or attention from national governments, medical and donor communities as compared to other diseases, NTDs contribute to an ongoing cycle of poverty and stigma that leaves people unable to work, go to school or participate fully in family and community life.

Even as the Health ministry urges Kenyans to undergo regular deworming —  at least once a year to avoid complications brought about by intestinal worms —  Dr Wanikina emphasises the need to educate people about positive health seeking behaviour and how to maintain hygiene.

“Worms are still a menace and people need to take necessary precautions. Doctors, community workers and clinicians still need to think about worms as one of the possible causes of morbidity within communities. We still encourage schools to ensure people deworm at least twice every year. Worms don’t just affect children – they also affect adults and people need to take precau-tions so that they do not suffer the indignities of having worms.”

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