Precision Public Health Approaches to Intestinal Parasitic Infections in Children under Five: A Policy Brief

The majority of the burden of childhood disease and delayed development worldwide is attributed to one of the most neglected diseases, intestinal parasitic infections (IPIs). Helminth and protozoan infections continue to disproportionately affect under 5-year-old children, especially in low and low-middle income countries. These infections contribute to childhood diarrhea, malnutrition, growth failure, anemia, poor cognitive development, and preventable death. Nearly a third of all under 5 children globally have IPIs; however, this estimate could actually be significantly underestimated given low diagnostic sensitivity. This policy brief provides a comprehensive review of existing evidence on the global burden and causes of IPIs among under-fives, and identifies a range of evidence-based policy actions for governments, international organizations and development partners. Three proposed interconnected policy priorities are targeted geographically specific mass drug administration (MDA) and surveillance in high burden hotspots; climate-smart and context specific Water and sanitation and hygiene (WASH) interventions; and enhanced diagnostic and surveillance capacity for improved burden estimation and targeting resources. Despite the need for it, implementation is severely hampered by insufficient funding, under-developed health systems, inadequate inter-sectoral coordination, continuing environmental transmission environments, and under-diagnosis arising from use of low-sensitivity diagnostics. The challenge posed by IPIs in children under five will necessitate a shift from broad-based control plans to more precision public health approaches. These will include the implementation of hotspot targeting, environmentally tailored WASH interventions and enhanced diagnostic surveillance.