6 0 0 S W T h i r d S t r e e t , P o m p a n o , F L 3 3 0 6 0 U S A

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Helping the World’s Poorest Children Survive

Anti-Parasite Program for Children in the Central African Republic Education System

A Proposal Prepared for

NAME

Spring 2011

EXECUTIVE SUMMARY

The Central African Republic (CAR) is the 3rd poorest country in the world. Lack of clean water and poor sanitation means that more than 60% of school-aged children in CAR suffer from debilitating intestinal illness caused by parasites. These infections from parasitic worms produce chronic malaise, malnutrition, poor learning at school, and stunted growth. Parasites even contribute to 35,000 deaths each day of children around the world. Yet treatment is so simple and inexpensive only 2 cents per child.

Hope Education Foundation (HEF), in partnership with the Central African Republic’s Ministry of Education and Ministry of Health, and with cooperation of UN-World Health Organization (WHO), plans to help 1,000,000 children in CAR get rid of infections from parasites and live improved lives.

This two-year program begins with a pilot program to deworm 120,000 school age children in the CAR. The pilot will begin in September 2011 and finish in November 2011. Following the pilot, distribution of additional medicines and continued training in the spring of 2012 will extend the program into additional districts of CAR for up to 1,000,000 children per year. The program will be in effect for two years with HEF support, and then transition to the combined efforts of the CAR government, UN-WHO, and possibly other international non-governmental organizations.

The program has two dimensions: deworming drug intervention (Mebendazole) and hygiene education in public schools. Hope Education will provide the medicines, teacher training and hygiene curriculum. The Ministry of Health (MoH) will train teachers in the delivery of the medications and provide tests and screening for intestinal worms while the Ministry of Education (MoE) will provide logistics, scheduling and venues.

The pilot program will be conducted over three months in a limited area for 120,000 learners. There will be a control group of untreated learners in an unrelated area. Learners and teachers will complete a pre-program survey on their knowledge, attitudes and practices (KAP) regarding hygiene related to the risk of intestinal parasite infection. They will then receive the medicine and hygiene training. Afterward a post survey will review any changes in their knowledge, attitudes and practices. The MoH will also conduct testing of students in a random sample to determine the prevalence level of intestinal worms within the pilot populations before and after the program.

The pilot program will show the impact of hygiene training and allow the partners to evaluate their capacity for research, logistics, education and testing. From this pilot project the program will be rapidly expanded to reach the additional learners and teachers for distribution to 1,000,000 children.

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A major goal of this program is to produce research publishable in international journals, and to provide benefit to the greater global community involved in eradicating intestinal parasites from children in developing countries.

The program will also set the stage for the character education iMatter curriculum, created by HEF to empower children who live in countries with a high incidence of HIV & AIDS.

NEED STATEMENTTreating children, of any age, for worms is one of the simplest and most cost-effective interventions for improving children’s health. The evidence demonstrating how worm infections damage children’s health is unambiguous: worm infections are associated with a significant loss of micronutrients. Roundworms are the most prevalent parasite infection in children and cause significant vitamin A malabsorption, which can aggravate malnutrition and anemia rates and contribute to retarded growth. A child’s physical fitness and appetite are negatively affected and his or her cognitive performance at school is compromised. The constant and life-long immune activation due to worm infections reduces the body’s capacity to resist other infections. Preschool children are extremely vulnerable to the deficiencies induced by worm infections: they are in a period of intense physical and mental development and particularly need the vitamins and micronutrients that are lost through worm infections.1

UN-WHO conventional protocol is to automatically provide deworming medicine when prevalence of geo-helminthiasis (worms) rates are 20% or higher. Research was conducted in eight provinces of Central African Republic in 2008. A population base of 1,631,195 persons was surveyed using the KATO method and the prevalence was found to be 33%. The highest district rate was 67% and the lowest 6%. This represents a very significant prevalence of intestinal worms for school-age children in CAR.

The solution lies in providing deworming medications to children and helping them learn to avoid future infection. Mebendazole (the drug chosen for use in CAR) is chewable and normally fruit flavored, which means it is not difficult to persuade children to take it. The tablets can be crushed between two spoons and given with a glass of water for children that have difficulty in swallowing the tablets.

1 World Health Organization. How to Add Deworming to a Vitamin A Distribution. Publication, WHO/CDS/CPE/PVC/2004.11. Copyright World Health Organization 2004.

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Deworming drugs are safe, single dose, cost about 2 cents a dose, and are simple to administer.

PROJECT PURPOSE AND OBJECTIVESThe purpose of this project is to create and execute a pilot program to deworm 120,000 school-age children in the Central African Republic in conjunction with a hygiene education curriculum that focuses on the knowledge, attitudes and practices that can prevent and reduce worm infestation. This project will be scaled up to reach 1,000,000 children per year.

Objective 1Through drug intervention, reduce the incidence of soil-transmitted helminthes (worms) by 60% in 120,000 school-age children.

Objective 2Through a school-based curriculum, improve the knowledge and beliefs regarding soil-transmitted helminthes.

Objective 3Through a school-based curriculum, demonstrate increased intentions for changed hygiene behavior to reduce the risk of soil-transmitted helminthes.

OUTPUTS A minimum of 240 teachers trained in the proper dispensing of Mebendazole with

children. 120,000 doses of Mebendazole dispensed to school age children. Pre and post survey results documenting the difference in hygiene-related knowledge,

attitudes and practices regarding the risk of soil-transmitted helminthes from before and after the pilot program.

Pre and post program samples of children’s stool to document the difference in levels of worm infestation from before and after the pilot program.

Teacher training curriculum prepared for drug administration and for hygiene education curriculum.

Learner curriculum prepared for hygiene education. Hygiene education provided for 120,000 school-age children that receive deworming

medicine.

This pilot will set the foundation for reaching 1,000,000 children in CAR in the spring of 2012 and again in 2013.

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MONITORING AND EVALUATIONEach school will keep a report of the drug distribution and rosters of the hygiene education. The MoE will provide HEF with summaries of the drug distribution by school.

Upon completion of drug distribution and hygiene training, the HEF Program Manager will insure the completion of a follow-up survey of teachers and learners. HEF will collect data, provide for data processing and will complete a report on the survey results. A combined, final report will be produced through the cooperation of HEF, MoE and MoH.

SUSTAINABILITYHEF plans to transition full financial support and operations of this project to the cooperative efforts of the CAR Ministry of Education, Ministry of Health, and possibly other international partners after 2013.

MANAGEMENTOversight of this project is by Mr. Al York, Chief Operations Officer for Hope Education Foundation. In his 28 year relief and development career York has been a leader in cooperative efforts in emergency relief response, HIV and AIDS alliances, establishing multi-country consortia for development and in establishing sector-wide standards. Mr. York has lived and worked in Kenya and Rwanda and while in Africa had oversight for relief and development programs in eight East Africa and Central Africa countries. From 1995 to 2005 he served as the Director of International Operations for World Concern and as Executive Director of World Concern Development Organization. As such he managed a field operation of 800 local and international development workers in 22 countries.

Program development is by Mr. Kelly Miller, consultant to the Hope Education Foundation. Beginning in 1995, Miller held executive positions with World Concern and led international collaborative program and funding efforts for emergency response, working in over 30 developing countries for the agency. He originated World Concern’s deworming program in 2000 which has grown to a consortia of six international non-governmental organizations serving over 11 million children per year in developing countries.

Day-to-day management will be staffed by a Program Manager in CAR who is MPH educated and experienced in related development work.

http://hopeeducation.org/

ANTI-PARASITE PILOT PROGRAM BUDGET

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Total Pilot Study Program Budget: $124,250

Raised To-Date: $ 44,000

Funds Needed: $ 80,250

Budget includes:*MedicinesTraining and materials **DistributionResearchMonitoring & EvaluationPersonnel & TravelCommunications & AdministrationEquipment

* Mebendazole, for up to 1,000,000 single doses. Of this, 120,000 will be used in the pilot program and the remaining will be distributed in the first year follow-up program.

** This program is cooperative and has shared costs with the Central African Republic government (Ministry’s of Education and Health). Many distribution costs (warehousing, security, teacher and health care personnel) will be absorbed by the CAR government.

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