Lack of toilets, clean running water and education around the storage and display of fresh meat and vegetables, is leading to adults and children being reinfected with whipworm and roundworm eggs, cysts of other intestinal parasites, bacteria and viruses.

The community has now joined forces with the Medical Research Council (MRC), Public Health Programme at the University of the Western Cape (UWC), the Western Cape departments of health and education as well as the City of Tygerberg in an effort to address the degradation of their environment.

“It is a slow process, but it is happening,” said Dr Mickey Chopra of the UWC, which is responsible for facilitating the community mobilisation and education process.

“We are doing more that just giving tablets to get rid of the worms,” Chopra said.

It all started in October 1995 when MRC researcher Dr John Fincham and his team began surveying worms at schools and found that between 91 and 100% of school children tested had worms.

Intervention, which involved deworming the school children, has since seen significant drops in the prevalence of worm eggs in the stools.

The current intervention is targeting 12 primary schools in sites B and C of Khayelitsha (about                 12 000 children) with plans to expand.

The intervention, which is in line with World Health Organisation guidelines, involves deworming the children via the school system.

Teachers are taught how to gather stool samples from the children for testing, keep a register and administer the medication.

This has proved to be successful with significant reductions in the prevalence of worm eggs per gram of faeces. At some schools, roundworm has been eradicated completely.

The eggs survive for many years in the soil and ultimately reach the hands of children, the food they eat and water they drink.

“School teachers are an essential component in delivery because they are the only human resource able to implement mass therapy and keep treatment registers,” said Fincham.

He said there was clear need to extend the programme to other primary schools and to investigate the status of preschoolers and adults with regard to infection by intestinal parasites.

Future intervention involves health education and promotion (washing hands regularly, etc) and what is proving to be the toughest hurdle, environmental intervention.

UWC and the Western Cape Health Department started working with the teachers and community once the deworming had started.

“We looked at the causes, why this is happening,” said Keith Cloete of the Western Cape Health Department.

Community members were given disposable cameras to record their environments and assist in assessing their surroundings.

The other important part of the intervention is the design of school curriculum material.

“It is slowly happening and we will soon be piloting the curriculum at some of the schools,” Cloete said.

Regional Environmental Health Offficer from the City of Tygerberg, Andile Zimba, said the project went hand in hand with sanitation, but that it “cannot happen overnight”.

“We submitted reports to all the relevant standing committees in November, but have had no feedback,” he said.

Zimba said the issue of services was complicated by the fact that some of the occupied land in Khayelitsha did not belong to Tygerberg, but to organisations such as Denel or Spoornet.

“We can’€™t just go onto this land and provide services,” he said.

Parents and teachers recently attending a meeting in Khayelitsha, told Zimba that there had also been not effort to ensure that those toilets provided to school, were in working order.

“They are always blocked, forcing the children to use the veld,” said a parent.