ANNEXURE- XVII

STRUCTURED TEACHING PROGRAMME ON

PREVENTION OF WORM INFESTATION

SUBMITTED BY
ABHISHEK KUMAR SHARMA
[Link] NURSING FINAL YEAR
[Link] OF NURSING
MBS HOSPITAL KOTA
{ RAJASTHAN }

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 STRUCTURED TEACHING PROGRAMME

 NAME OF TEACHER Abhishek kumar Sharma

 SUBJECT Child Health Nursing

 NAME OF TOPIC Prevention of worm infestation

 AUDIENCE Selected Mothers of under five Children selected community at Kota (Raj.)

 VENUE Nayapura Kota, Rajasthan

 METHOD OF TEACHIG Lecture Cum Discussion

 [Link] Charts, Black board

 DURATION 1 Hour

 DATE & TIME

 PLACE Kota

 PREVIOUS KNOWLEDGE OF THE LEARNER Basic knowledge regarding common infection mothers of under five children

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General objective :-
After the completion of structured teaching programme the mothers of under five children will be able to acquire depth knowledge on
Worm infestation.

Specific Objective:-
At the end of class the mothers will be able to:

 Understands the meaning of worm infestation

 Enlist the common types of worm infestation
 Enumerate the causes of worm infestation
 Elaborate the mode of transmission of worm infestation
 Describe the preventive measures of worm infestation
 list out the foods or spices prevents intestinal parasites

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S.N TIM SPECIFIC CONTENT TEACHING AV EVALUATION
O E OBJECTIVE LEARNING AIDS
ACTIVITY

Good morning all of

you .Myself
ABHISHEK
SHARMA [Link]
NURSING final
year student.
Today I will be teach
you about
Prevention of worm
infestation related to
children health &
nutrition in front of
you.

1. 2 Explain about WORM INFESTATION

Lecture cum Chart
min. the meaning of
worm "Worm infestation is one of the most discussion and
infestation common infections among children all over the world. Almost black
every alternate child, under the age of five, suffers from this board
ailment. But, it is more prevalent during monsoon season, it
being primarily a waterborne infection," said Dr Yashwant Rao
of Lala Lajpat Rai (LLR) hospital.

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2 5 Enlist out the Type of worm infestation :- Lecture cum Chart &
min. common types
of worm There were four types of parasitic worms- discussion black
round worm, thread worm, hook worm and taenia worm-- that board
infestation
cause infection. During the rainy season, round worm
infestation is common among young and old alike, and is
transmitted through contaminated food and water. Worms are
grayish white or pinkish white in color.
3 10
Enumerate the
min. Common causes :- Lecture cum Chart &
causes of
discussion black
worm Eating contaminated food, whether
board
infestation cooked or fresh. Infestation may occur when the food is
undercooked or even when properly cooked, the food is
handled by contaminated hands or utensils. Raw food.
Penetration of the skin of the feet.
4. 10
Elaborate the Mode of transmission: -
min. Lecture cum Chart &
mode of Intestinal parasites can be acquired in many discussion black
transmission of ways. Some parasites can live in the soil for extended periods. board
worm They may penetrate the body through the skin or if
infestation contaminated soil is ingested accidentally. Other parasites live
in animals, such as pigs and cows. People can become infested
with these by eating undercooked meat or drinking
unpasteurized milk The eggs of some intestinal parasites pass
through an infested person's gastrointestinal tract and into feces.
The parasite then can spread to other people through
unintentional contact with the feces. Depending on the type of

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 parasite, a person may become infested by touching his or her
mouth after contact with feces that contain the organism or a
contaminated area. Parasites can spread when a person eats
contaminated food or drinks water contaminated by feces.
Swimming in contaminated water also may result in infestation
by certain [Link] intestinal infestations often occur
in outbreaks, when several people have symptoms at the same
time. This is especially likely if many people come into contact
with the same supply of contaminated food or water.

5. Signs and symptoms:

5 Recognize the
Min. signs and stomach pain and watery diarrhea usually start Lecture cum Chart &
symptoms of 1 to 2 weeks after infection. About half the people who are discussion black
infected also lose weight. The illness lasts 2 to 6 weeks, or bord
worm
infestation longer in people who are sick with another disease. Tiredness,
Malaise, Nausea, vomiting, Weight loss, Irregular bowel
movement, diarrhea, Abdominal pain of [Link]
hookworm infestation, itchy rash on the feet In pinworm
infestation, itch around the anus.

Treatment and Management: Medication used to treat the

illnesses varies with the type of infection. Doctors may use
antibiotics or ant parasitic medicines. In most cases, patients
can remain at home and maintain a normal schedule. Children
must stay out of daycare until they have been treated adequately
and can no longer spread the infection. Albendazole and
mebendazole are much more effective.

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 Prevention of worm infestation:

Cook your food well Avoid unhygienic

places and areas with poor [Link] fruit and vegetables
thoroughly. Peel fruit just before eating it. Avoid raw salads not
prepared at home. Thoroughly wash your hands with soap and
clean water after using the toilet, and before preparing food or
eating. Wear shoes outdoors.

After playing or working or (handling) soil, do

not put your finger in the mouth without first washing your
hands. Have a stool examination if you have some Symptoms
mentioned previously. Consult your doctor if you suspect worm
infestation or there is abdominal pain or swelling.

TAPEWORM :-
6 20 Explain the
Min treatment and Tapeworm Infestation is the infection of the Lecture cum Chart &
management digestive tract by adult parasitic flatworms called cestodes or discussion black
of worm tapeworms. Adult tapeworms can measure up to 50 feet (15 m) board
infestation long and can survive as long as 20 years. Some tapeworms
attach themselves to the walls of the intestine, where they cause
irritation or mild inflammation, while others may pass through
to the stool and exit the body. Unlike other tapeworms, the
dwarf tapeworm can complete its entire life cycle — egg to
larva to adult tapeworm — in one host. This is the most
common tapeworm infection in the world and can be
transmitted between humans. Even while being treated for
certain tapeworm infections, reinfection can result from

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 ingesting tapeworm eggs shed by the adult worm into the stool,
as a result of insufficient personal hygiene.

Causes:

Tapeworm infection can be caused by eating raw or

undercooked meat from an animal or a fish that has the larval
form of the tapeworm cysts in its muscle tissue. Once ingested,
the larvae then develop into adult tapeworms in the intestines.

Mode of Transmission:

Tapeworm eggs are generally ingested through

food, water or soil contaminated with human or animal faeces.
Live tapeworm larvae are sometimes ingested by consuming
undercooked food. Once inside the digestive tract, a larva can
grow into a very large adult tapeworm. Additionally, many
tapeworm larvae cause symptoms in an intermediate host.

Signs and Symptoms:

Tapeworms in the intestine usually cause no symptoms, some

people experience upper abdominal discomfort, diarrhea, and
loss of appetite. Infection is generally recognized when the
infected person passes segments of proglottids in the stool
(looks like white worms), especially if a segment is
[Link], worms may cause obstruction of the intestine.
And very rarely, T. solium larvae can migrate to the brain
causing severe headaches, seizures and other neurological
problems. This condition is called neurocysticercosis. It can

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 take years of development before the patient has those
symptoms of the brain.

Treatment:

Tapeworms are treated with medications taken by mouth,

usually in a single dose. The drug of choice for tapeworm
infections is praziquantel. Niclosamide can also be used.

Preventive measures:

Good hygiene is the best defense against intestinal

parasites. This includes frequent and thorough hand washing,
especially after changing diapers, after going to the bathroom,
and before handling food. Doctors advise that travelers to
undeveloped countries drink and brush their teeth with bottled
water and avoid eating raw fruits and vegetables,food from
street vendors, and unpasteurized dairy products.

ROUNDWORMS:

Round worm or nematodes, are a group of invertebrates

with long, round bodies. They range in size from those that can
be seen by the naked eye to those several hundredths of an inch
long that can only be seen under a microscope. Roundworms
can be 1 millimeter to 1 meter long, and infestations are more
likely to occur in warmer climates than in colder locations. The
common cause of human parasitic infestations is worldwide.
The severity of illnesses caused by parasitic roundworms
ranges from mild to life threatening. School-age children are

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 particularly at risk for parasitic roundworm infections.

Types, causes and mode of transmission:

The six most common types of roundworms include pinworms,

ascaris, hookworms, whipworms, strongyloides and trichinella
spiralis. Roundworms vary in size, transmission and habitat.
Though most roundworm infections are not life threatening in
healthy people, many cause

uncomfortable and sometimes serious symptoms. Pinworm

eggs are found in the human colon and rectum. They are
transmitted when an infected host scratches the area and
touches other people, food, or objects. Ascaris roundworm is
transmitted mainly through feces and is thus prevalent in areas
with poor sanitation. Humans become infected from touching
infected dog or cat feces and then touching food or their
mouths. Hookworms, whipworms and strongyloides travel from
feces to moist soil. When a human walks over contaminated
soil barefoot, the worms attach to the feet and penetrate the
skin, making their way to the digestive tract. Humans become
infected with trichinosis after eating undercooked contaminated
pork products. The parasite thrives in the muscle fibers of the
intestines. Trichinosis is a roundworm infection that may occur
after a person ingests undercooked meat especially meats such
as walrus, bear and fox contaminated with the eggs from the
worm.

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 Signs and Symptoms:

Many individuals do not show symptoms.

Symptoms may vary, depending on the type of roundworm
causing the infection and the area of the body infected.
Symptoms of an ascariasis infection range from mild abdominal
pain to sharp abdominal pain, restlessness and vomiting. The
severity of symptoms depends on the number of worms in the
intestinal tract. Hookworm larvae migrate to the intestine,
symptoms of diarrhea, abdominal pain, colic, nausea and
cramps itchy rash where the worm entered the body. Mild
hookworm infections may not cause any symptoms, but severe
infections may cause abdominal pain,bloody stools, weight
loss, diarrhea and decreased appetite. A mild strongyloides
infection usually does not have symptoms. Moderate infections
can cause vomiting, diarrhea or constipation. A mild trichinosis
infection usually produces no symptoms or light stomachaches
and joint and/or muscle pain. Severe infections can cause
muscular rheumatism and symptoms that mirror food poisoning
include cramping and diarrhea. The individual may also
experience general discomfort throughout the body. Additional
symptoms that may appear after larvae begin to migrate out of
the intestines and enter the bloodstream or other tissues. These
possible symptoms include headaches, weakness, muscular
pain, fever, pink eye, facial or eye swelling and sensitivity to
light.

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 Prevention:

Roundworms can be easily prevented with proper hygiene.

Children should be taught to always wash their hands after
using the bathroom, or sharing toys with other children. A
trichinosis infection can be prevented by avoiding undercooked
pork products. People handling raw pork products should
always wash their hands after exposure. To avoid whipworm,
hookworm and strongyloides, proper shoes should be worn
over moist ground. The best solution is to try to prevent these
diseases rather than treat or cure them.

HOOKWORM

The hookworm is a parasitic nematode that lives in the small

intestine of its host, which may be a mammal such as a dog, cat,
or human. Two species of hookworms commonly infect
humans, Ancylostoma duodenale and Necator americanus. This
bend forms a definitive hook shape at the anterior end for
which hookworms are named. They possess well developed
mouths with two pairs of teeth. While males measure
approximately one centimeter by 0.5 millimeter, the females are
often longer and stouter. Hookworm is a leading cause of
maternal and child morbidity in the developing countries of the
tropics and subtropics. In susceptible children hookworms
cause intellectual, cognitive and growth retardation, intrauterine
growth retardation, prematurity and low birth weight among
newborns born to infected mothers. In developed countries,

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 hookworm infection is rarely fatal, but anemia can be
significant in a heavily infected individual.

Causes:

Hookworms initially gain access through the body via

the skin. As a result, a hookworm infestation may initially
present itself as a small rash, particularly one on the feet if the
parasite has been picked up by walking around bare foot.

Mode of transmission:

Hookworms are transmitted through soil

contamination rather than worm egg ingestion. The immature
form of the worm, the larva, burrows into the skin of the foot
and travels to the lungs. It migrates to the throat where it is
swallowed. Hookworms attach to the wall of the small intestine
where they mature and feed on blood from the intestinal wall.

Signs and Symptoms:

Heavy infestation may cause weight loss, protein

deficiency and iron-deficiency anemia. Larval invasion of the
skin might give rise to intense, local itching, usually on the foot
or lower leg, which can be followed by lesions that look like
insect bites, can blister ("ground itch"), and last for a week or
more Coughing, chest pain, wheezing, and fever will
sometimes be experienced by people who have been exposed to
very large numbers of larvae. Epigastric pains, indigestion,
nausea, vomiting, constipation, and diarrhea can occur early or

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 in later stages as well, although gastrointestinal symptoms tend
to improve with time.

Management:

The most common treatment for hookworm were

as follows: 72% for albendazole, 15% for mebendazole, and
31% for pyrantel pamoate. This substantiates prior claims that
albendazole is much more effective than mebendazole for
Hookworm infections. Albendazole is effective both in the
intestinal stage and during the stage the parasite is still
migrating under the skin. In case of anaemia, iron
supplementation can cause relief symptoms of iron deficiency
anemia.

Prevention:

Do not defecate in places other than latrines,

toilets etc. Do not use human excrement or raw sewage or
untreated 'night soil' as manure/fertilizer in agriculture. Do not
walk barefoot in known infected areas. Deworm pet dogs and
cats. Developing countries need to improve sanitation measures
to prevent infection.

THREADWORMS

Threadworms, also known as Enterobios

Vermicularis, are small worm parasites that infect the intestines
of humans. They are thin, white and look like pieces of thread.
The adult female worm is 8-13mm long and the adult male is 2-

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 5 mm long. They live for up to 6 weeks.

Mode of transmission:

The immature larval worms burrow through the skin, migrate to

the lungs and throat and are swallowed. Threadworms live in
the upper part of the small intestine. Threadworms are unusual
in that they can repeatedly infect the same person, a process
called autoinfection. Threadworm autoinfection can cause a
heavy infestation called a hyperinfection wherein the worms
migrate to organs outside the intestine including the liver, heart
and brain.

Signs and Symptoms:

The main symptom of worms is itching around the

anus and vagina (in girls), the itching is always at night leading
to a disturbed sleep for the child abdominal pain, nausea,
vomiting, diarrhea and weight loss sometimes the worms can be
seen in a child`s faeces. Hyperinfection can cause intestinal
blockage, bleeding, cough and shortness of breath.

Management:

The most common medications that are used to

treat threadworm infections are mebendazole and piperazine.
Treatment may not be suitable for everyone and you should
always follow the manufacturer’s instructions. Treatment alone
does not kill threadworm eggs - good hygiene is the only way
to prevent eggs from spreading and causing another infection.

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 Mebendazole works by preventing the threadworms from being
able to absorb glucose, which means that they will die within a
few days. Mebendazole is the preferred treatment for children
over two years old. As threadworm re-infections are very
common, a second dose of mebendazole may be prescribed to
be taken after two weeks. In rare cases,mebendazole can cause
abdominal pain or diarrhoea, particularly if the threadworm
infection is severe. Piperazine paralyses the threadworms until
they are passed naturally out of the bowel. It is combined with a
medication called senna, which has a laxative effect to expel
the worms more quickly. Piperazine and senna usually come in
a sachet of powder, which you mix with a small amount of milk
or water before drinking. Piperazine can be used to treat
children who are between the ages of three months and two
years old. As re-infection is very common, a second dose may
be taken after two weeks. Piperazine is not recommended if you
have epilepsy or problems with your liver or kidneys.
Mebendazole and piperazine are 90%-100% effective at killing
the threadworms, but they don't kill the eggs.

Prevention:

7. washing hands It is important to treat the whole house to

5 Describe the
prevent reinfection. Cleaning hands and under nails with a nail
Min preventive
brush. Discourage nail biting/finger sucking. Wash bed linen, if
measures of
possible wear clean pyjamas every night and avoid sharing Lecture cum
thread worm
towels and flannels Vacuum and damp dust bedrooms and discussion Chart &
bathrooms Wear close fitting knickers or pants at night under black
pyjamas, so that if urge to scratch persists there is a cloth board

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 barrier between anus and fingers, so hopefully eggs will not get
under nails. Wash anus as soon as you get up in the morning, to
wash off any lingering eggs laid the previous night. Avoid
shaking any material, like sheets, which may have eggs on.
Keep your fingernails short, wear cotton gloves at night if you
scratch. Make sure children don’t suck their thumb. Wash your
hands frequently and scrub under your fingernails, particularly
before eating or preparing food, after going to the toilet and
before and after changing a nappy. Bath or shower first thing in
the morning and clean your bottom to remove any eggs. Make
sure everyone has their own separate flannel, towel and
toothbrush. To prevent reinfection and to break the life cycle of
the worm, these measures should be adhered to for at least 6
weeks.

Foods or Spices Prevent Intestinal Parasites and Worms

Intestinal parasites and worms
8 3 List out foods spend at least a part of their life cycles in the
min or spices gastrointestinal tracts of host organisms. Intestinal parasites
Prevent common in the [Link] roundworms, tapeworms, Lecture cum
Intestinal hookworms and Giardia, a type of protozoa. Several foods and discussion Chart &
Parasites and spices contain antiparasitic properties that might prevent you black
Worms from becoming infested with intestinal parasites and worms. board

Garlic

Garlic, or Allium sativum, is a perennial bulb plant long valued

for its culinary and medicinal benefits. Folk healers have long

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 used garlic to treat intestinal infestations. According to the
University of Maryland Medical Center, or UMMC, animal and
test tube research indicates that raw garlic prevents and kills
intestinal parasites and worms, particularly roundworms.
Testing on human subjects still needs to be done. An article in
the "Trends in Parasitology" journal reports that garlic oil
inhibits infestations of Giardia and other protozoa parasites.
The UMMC suggests consuming 2 to 4 grams of fresh, raw
garlic to prevent intestinal parasites. Garlic sometimes interacts
with blood thinners and ant platelet drugs, so consult your
physician before using garlic if you take such medications.

Other Anti parasitic Spices

Consuming turmeric and ginger can also reduce your risks of

becoming infected by intestinal parasites and worms, according
to the UMMC. Turmeric, or Curcuma longa, contains
antioxidant properties and ant parasitic agents that kill
roundworms in lab studies. [Link] adds that thyme, or
Thymus vulgaris, might successfully treat intestinal hookworm
infestations. Although spices can naturally boost the health of
your gastrointestinal system and prevent parasites, always
check with your doctor before adding new spices to your diet.

Antioxidant-Rich Fruits and Vegetables

The UMMC suggests that you help prevent intestinal

parasites by eating foods rich in antioxidants, particularly fruits
and vegetables high in vitamin C. The Linus Pauling Institute

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 notes that citrus fruits, tomatoes, bell peppers, strawberries and
broccoli all contain high levels of vitamin C. Other antioxidant-
rich fruits include blueberries, figs, cherries, squash, carrots,
beets and spinach. Eating these foods improves the overall
health of your gastrointestinal system, which reduces your risks
of infestations.

Fiber-Rich Foods

Eating fiber-rich foods keeps your gastrointestinal system

healthy and promotes regular elimination, both of which help to
prevent intestinal parasites and worms. According to the Mayo
Clinic, fiber-rich foods include whole grains such as barley,
bran and oatmeal. Replace white rice and white bread with
brown rice and multigrain or rye bread. Legumes also contain
healthy levels of fiber, especially split peas, lentils and black
beans. Snack on pistachio nuts, pumpkin seeds, almonds and
sunflower seeds to get extra servings of fiber during your day.

Other Foods

The UMMC suggests avoiding any meats that come

from carnivorous animals, particularly pork, if you are trying to
prevent parasites. Eat fish, tofu and beans for your protein
servings instead. Yogurt and kefir both contain healthy
probiotics that promote intestinal health and prevent infections.
Because foods and spices might affect prescription drugs,
always tell your doctor about any changes in your diet.

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CONCLUSION :-

On completion of structured teaching programme the mothers of under five children will be able to
acquire depth knowledge on Worm infestation.

BIBLIOGRAPHY :-

1. Keshav swarnkar (2005), “COMMUNITYHEALTH NURSING ”, N.R Brother, Indols. Pg. 65-66

2. K. Parle (2007), “PREVENTIVE AND SOCIAL MEDICINE”, 19 th edition, Banarsidas Bhanot. Jabalpur. Pg. 473-475,527

3. S. Kamalam (2005), “COMMUNITY HEALTH NURSING PRACTICE”,. Pg. 451

ONLINE DATA BASE

1. [Link]
2. [Link]
3. [Link]
4. [Link]

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