Evidence Action

Evidence Action's Deworm the World Program distributes extremely low cost pills to school children in order to prevent and treat worm infections.  By administering mass treatments to every child during Deworming Days that happen one to two times a year, Deworm the World hopes to avoid suffering, increase cognition, improve nutrition and alleviate the toll on human capital and productivity taken by parasitic worm infections.

What’s the need?

  • It has been estimated that 868 million children are at risk of parasitic worm infections worldwide.
  • While often not fatal, parasitic infections cause easily preventable suffering for an immense number of people.  Infections can leave those affected anemic, malnourished, and developmentally impaired both mentally and physically.  Given that those who suffer from these infections are 1) in developing parts of the world and 2) mainly children, these infections pose a serious threat to affected region’s future health, education, and productivity.
  • Worm infections are disproportionately distributed: the majority of those infected come from developing countries and specifically their poor, taking a toll on human capital where the people can least afford it.

What they do (Program Details)

  • Parasitic worm infections are easily combated: through a single pill, worms can be take care of. Specifically, these pills have little or no side effects (including for those unaffected by worms), which has led Deworm the World to take a school-based, mass treatment approach in order to achieve maximum coverage. By operating through existing infrastructure, Deworm the World has teachers administer the medicine, supported by (often Governmental) health systems. According to surveys surveys conducted by Deworm the World, this approach is highly effective, cost-efficient and accepted by the communities in which it takes place.

  • They operate mainly in India (most cost effective here due to prevalence and then ease of administering pills), Kenya, Pakistan, Nigeria.

  • Delivery through the school system often occurs in a single annual or biannual “deworming day,” where every child is provided with a pill in order to ensure maximum coverage.

  • Each pill has been determined to be around $0.04 per physical pillThe total cost of treatment (including delivery and the time taken from the teachers and government workers who administer and maintain the program) ranges from $0.32 to $2.03, depending on the area.  The average cost per treatment (and thus cost per year) is $0.50.

Evidence of impact of intervention

  • Data from RCTs indicate that areas that are treated for worms have a 25% decrease in their students’ absenteeism, see a 9.5% increase in female students passing national primary school exit exams, a substantial positive impact on child weight where the World Health Organization recommends mass treatment, and cognitive gains equivalent to between 0.5 and 0.8 years of schooling for younger siblings of children who were treated.
  • Many of the downsides of worm infections are actually in long-term losses in productivity and education: studies have estimated that sub-Saharan African could save $52 billion by 2030 if they meet WHO’s control goals for the five most common neglected tropical diseases (of which worms are included in multiple forms).
  • Not accounting for externalities, studies have estimated that deworming is as much as 50 times as cost-effective as cash transfers.  GiveWell estimates that there is a 1-2% chance that deworming can be generalized as this effective across the world, with the other 99-98% representing a lower, but still high, cost-effectiveness.

Evidence of impact of charity

  • The most recent data, from 2015, estimates that in India (specifically where this data comes from), 9% of schools gave a higher dose of the pill, and 5% of schools gave a lower dose than recommended.
  • GiveWell is less confident that the Baird et al. 2012 study can be taken at face value and generalized across all regions.  According to the 2019 estimates, Deworm the World was determined to be roughly 12 times as cost-effective as cash transfers.
  • Deworm the World treats over 270 million children every year.
  • They support India’s National Deworming Day, which targets all children ages 1-19 at schools and preschools; in 2019 the program treated more than 255 million children.
  • With Deworm thee World’s help, Kenya’s National School-Based Deworming Program has consistently treated over 6 million children per year since 2012, dramatically reducing STH and schistosomiasis infection.
  • Since 2013, GiveWell has named the Deworm the World Initiative one of its top-rated charities.
  • In areas where Deworm the World operates, there have been significant decreases in the prevalence of worm infections.

Plans for 2020

  • Currently working on a 5 year plan to double their impact by 2024.
  • Recently created the Evidence Action Accelerator, which aims to aid the development of new programs and develop them to scales comparable to Evidence Action’s work with Deworm the World and Safe Dispensers of Water.
  • Currently working to leverage opportunities to accelerate treatment in high-need areas (Pakistan and Nigeria).
  • With partners, drive further progress towards achievement of the WHO target of STH treatment for 75% of at-risk children by 2020

Remaining uncertainties

  • Large boost in cost-effectiveness due to how leveraging is taken into account by GiveWell’s current cost-effectiveness analyses.
  • Due to the nature of mass treatment, the prevalence rates of worms can greatly change the cost effectiveness: in areas above WHO’s 20% prevalence baseline for mass treatment, the cost effectiveness steadily drops. Thus, identifying and treating areas where infections are endemic is a high priority.
  • Strong evidence showing long term benefits, but the causal factor has not yet been identified (i.e. why does removing worms result in long-term gains in productivity and improved life outcomes?).
  • Questions about whether the pills are actually delivered and then taken by the children: hired monitors from Deworm the World report that the children do indeed get the pills and subsequently ingest them.