Leribe – To address the severe impact of parasitic worm infections on children's health, nutrition, and education, the Ministry of Health in Lesotho, in collaboration with the World Health Organization (WHO), has initiated steps to re-establish its Mass Drug Administration (MDA) program for Soil-Transmitted Helminths (STH) through the annual administration of albendazole tablets to target both preschool-aged children (1–5 years) and school-aged children (6–15 years). To prepare for the implementation of this critical intervention, a three-and-a-half-day multi-sectoral workshop was held in Leribe District, focusing on the development and validation of a comprehensive operational manual to guide future MDA implementation.

WHO reports that over 1.5 billion people globally are infected with soil-transmitted helminths (STH), making it one of the most widespread infections. This parasitic disease is particularly prevalent in low-income and tropical regions. The AFRO region faces the highest burden, with more than 800 million people at risk. Around 290 million school-age children in this region require preventive chemotherapy. All Saharan African countries are endemic for STH, underscoring the critical need for comprehensive health interventions. 

Lesotho conducted its initial national STH mapping survey in 2015, which revealed an overall prevalence of 47.6%, with significant district level variations, some reaching as high as 99%. This led to the launch of an MDA program in 2017, which, however, ceased operations after 2019 due to various challenges, including the COVID-19 pandemic, leaving at-risk populations vulnerable once more. Population at risk in Lesotho is around 550,000. 

STH infections are classified by the WHO as Neglected Tropical Diseases (NTDs), characterized by their prevalence in populations with limited access to adequate sanitation and healthcare facilities. These parasitic infections contribute to adverse health outcomes, particularly among children, impacting their nutrition, growth, and educational performance.

A multi-sectoral approach is key to effectively and sustainably controlling and eventually eliminating STH infections in Lesotho and other high-burden areas. It involves not just the health sector (like mass drug administration), but also other sectors that address the main causes of transmission, such as poor sanitation, unsafe water, and poor hygiene.

Dr. Dhruv Pandey, the Technical Expert on Tropical and Vector-Borne Diseases, WHO Multicounty Assignment Team for the Southern Africa Hub countries, emphasized that the discontinuation of MDA since 2019 could have a detrimental impact on both public health and socioeconomic development in Lesotho. He stressed the need for renewed political and intersectoral commitment, stating:

"It is essential for the Ministry of Health to prioritize the resumption of MDA by initially integrating it within existing health programmes, such as immunization and HPV campaigns. STH is not merely a health issue; it is a social issue, influenced by multiple social determinants and should be addressed through coordinated action.”

Ntsoaki Mamoeketsi Mokete, National Integrated Disease Surveillance and Response (IDSR) Focal Person at the Ministry of Health, highlighted the significance of the newly developed operational manual. "Developing the operational manual is an important step towards controlling and eliminating neglected tropical diseases in Lesotho," Mokete said. She outlined future plans, including five years of continuous MDA followed by an impact assessment survey to determine the status of STHs in the country.

“Our next steps will be to continue with the MDA for five years, which will be followed by the impact assessment survey to determine the distribution of schistosomiasis and soil-transmitted helminths (STHs) among the general population. This will enable us to implement effective deworming strategies for the elimination of STH as a public health problem in the Kingdom of Lesotho.

 In addition, we will focus on advocacy for the revitalization of school health programmes, developing NTD clinical guidelines, integrating NTDs into the IDSR strategy, and developing a coherent and well-coordinated approach in collaboration with the Ministry of Education and other related organizations."

The Ministry of Education and Training (MoET) also affirmed its commitment to the program. Mpheng Molapo, Coordinator of the Learner Care and Welfare Support Unit at MoET, underlined the direct benefits for students. "The Ministry of Education strongly supports the implementation of the (MDA) for (STH) as a key public health intervention with direct impact on learner well-being, educational performance, and school attendance," Molapo stated.

Dr. Pabolo Nonyane, District Veterinary Officer and National Focal Point for the Ministry of Agriculture, Food Security and Nutrition, underscored the importance of the MDA to the agricultural sector. She stated:

"This initiative is vital for achieving sustainable food and nutrition security, particularly within our high-risk agricultural communities. Farmers and herd boys are uniquely vulnerable due to their exposure to contaminated soil. By using this operational manual to protect their health, we preserve the human capital essential for our agricultural future. This effort truly reflects the 'One Health' principle, ensuring that our work on STH contributes not only to public health but also directly to Sustainable Development Goal 2: Zero Hunger."

"The development of Standard Operating Procedures (SOPs) for the MDA campaign against Soil-Transmitted Helminths is essential," stated Matebele Setefane, UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) Focal Person, Ministry of Natural Resources. "This manual provides a structured, standardized approach that ensures clarity of roles and alignment with broader health and Water, Sanitation and Hygiene (WASH) goals. Given that STH infections are strongly linked to inadequate sanitation and poor hygiene, integrating WASH elements into the MDA operational SOPs helps address not just treatment but also prevention."

Setefane further emphasized the collaborative nature of the initiative: "The success of the MDA campaign depends not only on drug distribution but also on addressing the environmental drivers of STH transmission. Our ministry is committed to supporting the campaign through WASH integration, by collaborating with the Ministry of Health to ensure safe water access, functional sanitation facilities, and hygiene promotion are prioritized in targeted communities and schools."

The workshop convened a multidisciplinary team, including representatives from the Ministries of Education, Nutrition, Water, Sanitation and Hygiene (WASH), and Environment. This collaborative approach aims to ensure the operational manual is pragmatic and implementable across all levels of engagement, marking a critical step towards establishing a sustainable, multisectoral intervention for STH control and eventual elimination as a public health problem in Lesotho. 

WHO, working with other partners, has been instrumental in operationalizing the implementation of MDA in many countries, providing support at every stage of the process. This includes ensuring the sustainability of high-quality MDA, facilitating annual reporting, and conducting a comprehensive impact assessment after five years of optimal coverage.