My first encounter with an intestinal worm was not pleasant. A female client approached me and requested some advice. I took her to the confidential area, where she opened up what looked like a baby's plastic pants. She held it up to my face and asked me what is the best treatment I have for this.

I was face to face with the thing which she said she had found in her baby's diaper while changing him a few minutes earlier. The thing was wormy, white, about 10 inches long, and it was moving.

Intestinal worms are parasites which invade and reside in our intestines. Some can grow to nine metres (30 feet) long. Children are susceptible and are often infected with more than one kind of worm. Roundworms, pinworms, threadworms, tapeworms (pork and beef), hookworms and whipworms are common.

Infected soil and water

Intestinal worms (helminths) are fairly common in tropical countries like Jamaica. These worms are different from fruit worms (larvae of insects) found in mangoes, cherries, apples and other fruits. However, we can acquire intestinal worms from contaminated fruits and other foods which have not been properly washed.

We become infected with intestinal worms via direct contact with soil contaminated with faeces from an infected person or animal. The faeces contain eggs of the adult worms. Fruits and vegetables are sometimes contaminated with worm eggs of roundworm and whipworm which we consume when these foods are not properly washed. Consuming contaminated water is another source.

Barefoot can make contact with soil infected with hookworm eggs. The larvae then worm their way through the skin and enter our blood and lungs. From there they enter the throat and we swallow them into our intestines where they feed and reproduce themselves. Eating raw or undercooked fish and meat, especially pork and beef, can give us tapeworms that live in these animals. Handling food without properly washing hands after toilet use is another possible source of food contamination with worm eggs. Worms may also be sexually transmitted, and worminfestation is now also classified as a sexually transmitted infection.

The itching anus usually comes as a result of having threadworm which travels to the area at night to lay eggs. Coughing, diarrhoea, fatigue, abdominal pain and loss of appetite are common symptoms of infection with the other worms. Worm infestation may lead to serious complications like bowel obstruction, malnutrition and loss of blood from the intestines leading to iron deficiency and anaemia.

Take worm medicines

Treatment with anthelmintics (worm medicines) is very simple except if the worms have lodged into muscles or internal organs causing treatment to be prolonged. For threadworm or pinworm infestation, all persons sharing the same house should be treated together. Treatment kill or paralyse the worms which then pass out of the body in faeces. Laxatives serve to hasten the expulsion of dead worms and are unnecessary.

Each anthelmintic is specific to the worm being treated and the medical doctor should identify the nature of the infection before selecting appropriate treatment. Truth be told however, most anthelmintics are available without a prescription and so choosing one which kills many types of worms is the common practice here. In severe infections, a second course of treatment may be necessary.

Prevention

Albendazole (Zentel) and levamisole (Levam) have a very impressive scope of activity and kill most types of worms. A single dose of either, is given after a meal, full stop. Threadworm treatment may involve repeated doses over three days. Mebendazole (Vermox) or its combination with quinfamide (Amoebriz) are sound and popular choices too. There are several home remedies including consuming coconut, pomegranate root, garlic, pumpkin or papaya seeds.

Worm infestation may be prevented by improving food hygiene, maintaining clean drinking water, cooking fish and meat thoroughly, defaecating in a latrine instead of in the soil, washing hands thoroughly with soap after defaecating or gardening, wearing slippers and shoes outdoors, and not wearing outdoor shoes indoors.

Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.