School-based approach for parasitic disease control in Japan and Africa.

Japan has achieved significant improvements in the control and prevention of parasitic infections through a school-based approach since the 1930s. The use of chemical fertilizers in agriculture, safe water and food, and improved sanitation and hygiene also contributed to the near eradication of endemic parasites. However, parasite infections continued to affect children mostly in resource-limited countries. The African continent has one of the highest burdens of such infections. The application of school-based approaches has several advantages where the structure of health-care systems is not optimal. In Africa, soil-transmitted helminths and schistosomiasis are frequently targets for school-based public health intervention. Mass drug administration by teachers at school can reach targeted children effectively and safely. The limitations of this approach include missing unattended children and absentee of teachers. Initially, mass drug administration at school for parasitic infections was thought to improve health and even socioeconomic status of children in the community. However, more recently the socioeconomic impact has been questioned although the reduction of parasitic diseases is still apparent. Moreover, other basic public health measurements such as increased toilet use, assuring safe water access and avoiding the use of human excrement as an agricultural fertilizer, are equally important for control and prevention of parasitic diseases. Further global efforts should be continued to achieve equal health for every child in a sustainable way.