Most people could agree that as a child growing up it was not uncommon to get a "worm out" from your parents during the July/August vacation. Just as you would expect the new school bag, books and shoes for the new school term; it was seen as an essential step in many households to get a "worm out" before you went back out to school.
It was the one thing I remembered as a child that could darken my vacation period. Though it remains a common practice in Trinidad and Tobago today, Dr Sahir Patel goes in depth and looks at the whole issue of "worming out"/ purge that may have some parents having second thoughts.
To purge or not to purge, that is the question. If you decide to "worm out" or purge your children, keep in mind the possible risks which include: gastrointestinal disturbances, hearing damage, kidney damage, vision impairment, nausea, vomiting, headaches, heart blocks and even seizures. This depends on the medication used. Though side effects are rare, risks always have to be assessed before proceeding with any treatment, Dr Patel said.
"Clinically, when treating patients with intestinal worms, it is to rid the body of a parasite that can be causing, but not limited to weight loss, diarrhoea, anaemia, and/or intestinal obstruction.
"The World Health Organization (WHO) has prescribed to a worm out practice in the developing world as prevalence worldwide is close to 20 per cent of the population, by some accounts," he said.
"There are many kinds of intestinal worms, parasites and amoebas with each one having a specific region in the world where they are more prevalent. In this region, Enterobius vermicularis, Giardia lamblia, Ancylostoma duodenale, Necator americanus, and Entamoeba histolytica can be commonly found. Some of these are often referred to as hookworms, pinworms, whipworms, and tapeworms," he said
According to Dr Patel, once infected with worms, they can cause a number of significant ailments, including nausea, vomiting, malabsorption, diarrhoea, weight loss, blood loss, anaemia, intestinal ulcerations, bloody diarrhoea, fever, gastrointestinal obstruction, peritonitis, and abscesses.
He said, "Pinworms can also cause itch near the anus, so if you see your child scratching their backside, it would be advisable to have your child checked by a physician."
"Worming out or purges are based on a combination of historical illnesses and folk remedy. The "worm out" practice is based on historical science. There was significant evidence of hookworm infections in West Indies' cane field in the early 20th century. That specific infection is spread from faeces in fields and through the skin (usually through feet due to inadequate shoes at the time, in field workers)," he said.
While this may have been a much needed practice back then the level of urgency for it today has somewhat diminished, he added.
"In most parts of Trinidad and Tobago sewage systems have been implemented and the exposure to raw sewage is reduced, as well as reduction of bare feet to soils," he said.
When it comes to treatment, according to Dr Patel most patients are referred to anthelmintics medications and/or laxatives. Clinically, mebendazole is the most commonly prescribed drug, but again that is useful for a specific set of worms, not for all, he said.
"Other medications include other anthelmintics, antibiotics, and supplements depending on the parasite found," he added.
According to Dr Patel, when it comes to diagnosis, it can be done by examining the patient, stools and other microscopic blood testing. Once a patient is diagnosed treatments are usually in the form of tablet, he said.
"Treatment regimes vary, again by parasite found, but can be anywhere from one tablet given once, to multiple doses over many weeks. Some parasites require secondary treatments after a few weeks of initial treatment. Some parasites also require close contacts to be given prophylactic treatment in anticipation of getting infected," he added.
According to Dr Patel there are no proven benefits to "purging" the body with laxatives and advises against it.
He noted however that the improvement of sewage and municipal facilties along with the overall reduction of "worms" in Trinidad and Tobago, he finds the practice of de-worming without diagnosis dangerous and financially unnecessary.
According to Dr Patel unless a true diagnosis of worms is made children everywhere can breathe sighs of relief and say goodbye to getting a "worm out."