Bihar's pioneering school-based deworming programme: Lessons learned in deworming over 17 million Indian school-age children in one sustainable campaign.

Editor's introduction:

India is estimated to account for more than a quarter of all children requiring treatment for STH globally, and in 2009 the State Government of Bihar, in the eastern region of India, planned to initiate a state-wide, evidence-based deworming programme run out of state-schools and with technical support from Deworm the World (DtW).

Bihar is one of India’s poorest states, with 8.5% of India’s population and only 1.6% of its gross domestic product (GDP). The population of Bihar was estimated to be over 104 million in the 2011 census with approximately 28% between 6–14 years of age. Surveys conducted in 2010–2011 found a high prevalence of STH throughout Bihar state, and subsequent predictive mapping indicated that at least annual, and in some cases biannual, MDA treatment would be required.

This paper outlines the political environment, development, and implementation of all stages of this pioneering and sustainable large-scale deworming programme, which led to the treatment of over 17 million school-age children in Bihar state. In addition, the synergistic support provided by all partners ensured a rapid rollout of the programme, which went from conception to implementation to treatment in less than 12 months, and deworming was rolled out across the state over three months.