Resourceful Young Children

Resourceful Young Children
Learning Brief

The Angus Gillis Charitable Trust

Tackling the challenge of intestinal worms: A rural ECD perspective

Category: Resourceful Young Children | Comprehensive ECD package | 8 November, 2012 - 15:05


The Angus Gillis Foundation works in deep rural communities and, in line with our overall asset-based community-driven approach, our Early Childhood Development (ECD) programme supports self-help groups to establish and run safe, stimulating and quality ECD sites where children can play, learn and develop. These ‘Safe Parks’, form a focal point for an integrated approach to community development which aims to reach individuals, families and communities. By focusing on family health, hygiene and nutrition our Positive Health training programme seeks to address fundamental health challenges through emphasising the interconnectedness of individual, family, community and environmental health and the importance of taking responsibility for one’s own health and the health of those around you. 

The challenge of intestinal worms

Intestinal worms and particularly their impact on child health and development represent one such issue that we have begun to tackle proactively through our ECD programme. Worms are a major health issue throughout the country but particularly in rural areas where lack of adequate sanitation and the large number of free roaming livestock and domestic animals exacerbate the problem. According to Fincham and Dhansay (2006), “Worm infection is imposing an unnecessary burden on many South African children and on the overall cost of health care.” Intestinal worms produce a wide range of symptoms including diarrhoea and abdominal pain as well as general malaise and weakness. They aggravate malnutrition, anaemia and stunting levels and retard both physical and cognitive development (WHO website). 

The Department of Health has attempted to address the issue by introducing six monthly de-worming at primary schools, however, this is hampered by the challenges of obtaining parental consent. Neither is this approach entirely effective as it does not address the whole family and their living environment. A child who has been treated at school will quickly become re-infected in a home environment where worms are a problem. Our experience of working with a number of rural sites has taught us that it is vital to address prevention hand-in-hand with treatment and medication. The treatment of intestinal worms is relatively straightforward; however, addressing the environmental and behavioural factors which aggravate the problem is not. 

Addressing the challenge 

By drawing on external expertise, we have developed and integrated information on intestinal worms and de-worming into our existing training programme. Through this programme, our Positive Health Coordinator and locally-based Positive Health Champions train our self-help group members, trainee ECD Practitioners and clinic staff. The information and knowledge is then further disseminated by clinic staff and group members (most of whom are mothers or grandmothers of children attending Safe Parks), thereby reaching families and the wider community beyond our ECD sites. Crucially, the specific learning on intestinal worms goes hand-in-hand with workshops on healthy eating, food preparation, household hygiene, the importance of hand-washing and environmental health. The sessions connect with one another to show how all of these issues are interrelated and how they impact on one another. 


Rural community members had little or no information about intestinal worms before our intervention and were shocked when confronted with the facts (and particularly with real specimen worms!). Once equipped with the knowledge there is a desire to take proactive steps to tackle the problem. For example, one women’s group took their newfound understanding and did a presentation to their community committee. They have now been asked to come back and present to the whole community. The group are not only determined to remove a pigsty which is located dangerously close to their ECD site, but have decided to launch a campaign to rid the whole of community of free-roaming pigs. 

Our major challenge in terms of working with community-run ECD sites in rural areas remains lack of access to adequate toilet facilities and their proper usage during toilet routine as part of the daily programme. This can be difficult to address because of the lack of plumbing and sometimes reluctance by donors to fund the construction of toilets. 

The reality of the rural village also remains a challenge with livestock kept at close quarters with humans, the abundance of free roaming animals, lack of routine de-worming of domestic animals and proliferation of litter. These issues are not easily resolved, as they are rooted in poverty, a lack of adequate services, and entrenched culture and habits. We have, however, found that addressing these issues from the perspective of the risks to healthy childhood development can create a more receptive context for learning. 

Implications for other organisations, policy and practice 

The lessons we have learnt in trying to address the challenge of intestinal worms emphasise the importance of taking an integrated approach to ECD and making clear the interconnectedness of individual, family, community and environmental health. 

It is clear that alongside treatment programmes, information on intestinal worms should be part of the school curriculum from ECD level. Knowledge can be passed directly to teachers and parents as well as to children through games, songs and routine activities. Instilling this kind of knowledge and discipline from an early age will allow us to break the cycle of behaviour that exacerbates this and so many basic health problems. 

In addition, this learning underscores the importance of adequate toilets and the control of free roaming livestock and domestic animals. 

Going forward 

As an organisation, the implications are clear: We have already seen the positive impact of raising awareness and educating about intestinal worms, (at child, teacher, family and community level), and we will continue to strengthen this aspect of our training programme and to make sure that this health focus is fully integrated in our ECD programme. 

We will put greater emphasis on toilet facilities and safe outdoor play areas at all of our Safe Park sites. The provision of resources and external assistance must be carefully balanced with a genuine partnership approach which allows the development process to unfold at a community’s own pace, and does not ‘parachute’ in resources which interfere with the power dynamic and can be counter-productive in developing an empowered, ‘self-help’ attitude. Our role has never been to simply build and equip fully compliant ECD sites in rural communities. However, we will continue to support community groups in accessing the resources necessary to achieve this and to play a guiding role in advocating for the importance healthy, hygienic spaces and practices. 


Fincham. J. and Dhansay. A. (2006), Worm’s in SA’s children, MRC Policy Brief, available at 

World Health Organisation (WHO), Intestinal Worms, available at


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