Healthy Children, Healthy Futures:
INMED’s Public-Private Partnership Initiative Improves the Health and Lives of Brazil’s Children

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(Joyce Capelli or Linda Pfeiffer of INMED, will be available for interviews in São Paulo on April 16, 17 and 18. Please call Nils Hoffman or Liliana Hisas to schedule time. Thad Jackson or Suzanne Wilcox of INMED will be available for interviews in Washington, DC, April 16, 17 and 18. Call Marshall Hoffman to schedule time.)

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More than 350,000 children across Brazil have been freed from debilitating and sometimes life-threatening intestinal parasites by an innovative public-private program led by INMED and its partners, stressing treatment and critical health education. In the next five years INMED plans to reach at least 2 million of the most at-risk children in communities identified by Brazilian health authorities throughout Brazil.

Intestinal parasites infect 2 billion people worldwide — and children suffer the most. Intestinal parasites have long constituted the single largest health problem among school-age children in Brazil, infecting up to 90 percent of children in rural areas, and between 40 and 45 percent in cities, according to the World Health Organization. Parasites can stunt children’s physical and mental development by robbing their bodies of micronutrients, especially vitamin A and iron. Children with parasites are also more vulnerable to disease, anemia, malnutrition, blindness and even death.

In 1988, INMED, a U.S.-based international health and development organization, headquartered in Sterling, Virginia, developed the Healthy Children, Healthy Futures program, based on a combined strategy using children as positive agents of change. The program is aimed at not only ridding the children of parasites with medicine but also educating children, their families and entire communities on how to prevent re-infections of parasites by improving hygiene, sanitation, and nutrition behaviors. INMED and its partners accomplish all this for a cost of less than US$5 per year per child — an essential investment for the future.

Children Quickly Act Like Children Again

After biomedical screening, children between the ages of 5 and 14 are given the drug mebendazole in a school setting. Mebendazole, produced and marketed under the brand name Pantelmin by Janssen-Cilag in Brazil, kills the parasites in two or three days. The results of the treatment are dramatic: children who were once listless, bloated and malnourished quickly become vibrant, energetic and eager to learn. The immediate improvements in the childrens’ energy level, vitality, and well being win support for the program from parents and teachers.

Since parasites are transmitted in soil and water contaminated with fecal matter, re-infection can occur easily in communities with poor sanitation infrastructure. Thus, INMED found that it is only possible to interrupt the cycle of parasite transmission if the entire community becomes involved in healthy hygiene and sanitation.

Children are taught basic lessons, like washing their hands, wearing shoes, avoiding contact with fecal matter, washing fruits and vegetables, purifying water, and building corrals for animals. They also learn about good nutrition and safe food preparation.

“The teaching methods are unusual, but they need to be in order to prevent re-infection,” says Linda Pfeiffer, Ph.D., president of INMED. “We use songs, theatre, skits and even parades to teach our lessons. The entire community becomes involved through outreach activities such as science fairs, cooking contests and parent days.” A recent addition to INMED’s teaching methods is Dr. Med, a puppet that thoroughly engages the children in dialogue about their health behaviors. Dr. Med attends classroom education activities and special events, bringing along a delightful sense of humor and a wealth of information tailored for children.

“Children are great teachers for the rest of the family and the whole community,” says Dr. Joyce Capelli, Executive Director of INMED Brazil. “Once they go through our program, they will begin to ask their mothers why they aren’t washing their hands before preparing supper. They’ll recite program poems and songs containing health messages at home. They teach their younger siblings through example. Through the influence of the children, we estimate that about one million family members and neighbors are also adopting healthier behaviors and changing their lives.”

“This community trust and support allow INMED to introduce targeted hygiene, sanitation, and nutrition messages as part of the school curriculum,” Dr. Pfeiffer says. “Drawing on their new-found energy and enthusiasm, the children are able to learn and apply the health messages in their lives and enthusiastically take these messages to their families and communities.”

The program boasts a wide range of public- and private-sector partners including local universities that provide personnel and lab support for biomedical exams; federal, state, and local government offices in both the health and education sectors; and national and international corporations that provide both monetary support and donations of medicines, vitamin A and iron. Corporate support comes from sectors as diverse as telecommunications, pharmaceuticals, energy, and food technology. Janssen-Cilag and its parent company, Johnson & Johnson, are core partners with INMED in Brazil, providing deworming medicines and core support and joining with INMED in welcoming a broad range of other corporate, government, foundation, community and individual partners in this effort for the children of Brazil.

The project has brought far-reaching benefits to the participating children and their families:

  • Biomedical examinations confirm that parasitic infection rates fell by more than half in São Paulo, Brazil’s most populous city, from 44 percent to 20 percent. In Rio de Janeiro, infection rates were reduced from 41 percent to 28 percent in the participating communities. In rural areas where infection rates for children reach 80 to 90 percent, infections have been reduced to 25 percent.
  • Significant reductions in anemia have been achieved through the program’s treatment activities. Sixty-three percent of children identified as anemic have at least a one-point improvement in blood hemoglobin levels after receiving iron supplements.
  • Communities have joined forces to improve their health. More than 70 percent of families in program communities are active in outreach activities such as science fairs, theater performances, and workshops. This participation translates into community action projects where children, families and neighbors work together to make significant improvements in local sanitation infrastructure, such as building latrines, handwashing stations and animal corrals.
  • Students are engaging in proactive efforts to make positive changes in their communities such as petitioning for increased garbage pickup, making environmental surveys of their neighborhoods, and distributing fresh vegetables grown in school gardens. Through these activities, students are learning important lessons in citizenship.
  • After witnessing and participating in successful treatment and education activities, local governments, school systems and health departments have pledged their active and continued support to the project. For example, schools in São Paulo agreed to formally incorporate the project’s education component into their official school curriculum. In addition, the Rio health department dedicated a day to the treatment component of the project.
  • The local capacity of teachers and health clinics to identify and treat health problems has been enhanced greatly through program activities, including training. More than 10,000 teachers, cafeteria workers, and health department staff have been trained through the program and cooperation between education and health personnel has been stimulated.
  • Many of Brazil’s premier academic, civic and nonprofit institutions have committed their support to the Healthy Children, Healthy Futures project, including the São Paulo and Rio state departments of Health and Education, São Paulo State University Institute of the Child, Rio de Janeiro State University Biochemistry and Pharmacy College and Nursing College, Faculdade Carioca, Centro de Defesa da Cidadania de Jacaré e Manguínhos, Centro Comunitário Brazil Cabo Verde, Fundação Leão XII, and Fundação Oswaldo Cruz. The first Lady of Brazil has also been very supportive.

Although Healthy Children, Healthy Futures was developed internationally, each of the community-based projects is designed and adapted within the local context. All of the program staff members are Brazilian, and other contributing partners and supporters are deeply rooted domestically.

INMED operates similar programs in Mexico and the Dominican Republic. They have taught the Healthy Children, Healthy Futures strategy (sometimes called Children as Agents of Change) in Burkina Faso, Chile, Ecuador, Bolivia, Guatemala, Honduras, The Philippines and India. In addition to Healthy Children, Healthy Futures, INMED also is the parent organization for the MotherNet program and The Millennium Alliance for Social Investment.

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