Sightsavers’ Deworming Programs Wins Top Ranking By GiveWell

Year after year, Sightsavers continues to be placed on GiveWell’s “Top Charities” list. This is an elite “club” to be in as there are only nine charities in total that get this prestigious honor, although GiveWell also provides a “Standout Charities” list which is basically a list of noteworthy honorable mentions also doing great work. GiveWell bestows the honor of “Top Charity” on Sightsavers specifically for its expanding deworming programs.

Sightsavers’ deworming programs are mostly based on the distribution of medication for parasitic worms in the poorest most underserved regions of Africa. Sightsavers has been amping up its deworming programs over the last few years, in part by combining these programs with other programs they have in place to eradicate neglected tropical diseases (NTDs). However, they have also begun to move into new regions with their deworming programs, based on need, feasibility, and sometimes requests from the government in the regions. However, in order to do this, Sightsavers must have additional funding.

Sightsavers is developing methods to evaluate the effectiveness of their deworming programs. This information will be shared with GiveWell, investors, donors, and the public at large. Transparency is a key aspect of every charitable program Sightsavers administers and always has been since Sir John Wilson founded the organization 1950. Back then, the charity was called the British Empire Society for the Blind but it’s the same organization and they still with the highest motivation to help people all over the world and do so with complete transparency.

What Is the Ultimate Importance For This Recognition?

If you’re looking for research based philanthropy, look no further than GiveWell. Thousands of hours of in depth analysis goes into the vetting of every charity on their “Top Charities” list, including Sightsavers. They are basically asking how well spent is every dollar donated to these charities. They’re not just looking for a good “bang for your buck” on charitable giving, they’re looking to identify charities that offer the best bang for your charitable buck, the creme de la creme of charity effectiveness! It’s a rigorous probing process and Sightsavers has come out on top for several times.

Donors just don’t have time, nor the expertise, to fully vet every potential charity on their list or even on their short list. Therefore, they depend heavily on the recommendations by GiveWell to know where to send their contributions. Donors like to know that their money is being put to the best possible use. They like to give their donations to organizations where they know it will do the most good. This is true for larger donors like Good Ventures, a philanthropic foundation based in San Francisco, that has donated millions to Sightsavers, and smaller individual donors who contribute $10, $50, $100, or whatever they can afford as they give from their heart.

GiveWell’s evaluation process is very thorough. Coming from a background as hedge fund managers, they bring a great deal of expertise in evaluating complicated financial documents. However, their evaluation of the charities they recommend does not stop there. As part of the process to evaluate Sightsavers, for example, GiveWell actually traveled to Africa to visit with Sightsavers’ field workers in Ghana in 2016 and Guinea in 2017.

The trip to Ghana was very informative. They met with Sightsavers’ Country Director for both Nigeria and Ghana, Sightsavers’ Technical Director of Neglected Tropical Diseases, Sightsavers Program Epidemiologist for Neglected Tropical Diseases, other Sightsavers’ staff, and a representative from the Ghana Health Service (GHS). They were able to delve into how the staff and program directors implicated their programs, how they monitored their programs, what type of problems had come up and how they resolved them, how they had been monitoring the effectiveness, how they planned to monitor the effectiveness in the future, and exactly how much funding they needed and for what purposes.

If you think about a potential donor to Sightsavers, big or small, as an investor in their deworming programs, then the information collected above, and then used to make their recommendations, is critical. Without these kinds of in depth analysis, a donor has to just get a “feel” for where their money would be best spent and that’s after weeding through the marketing that most profit seeking non-profits provide.

In their visit to Guinea, GiveWell was able to get a first hand look at the deworming programs in that region that were funded by GiveWell directed funds the year before. It’s this intensive personal scrutiny, and of course Sightsavers’ enthusiastic invitation to be scrutinized, that makes GiveWell’s list of “Top Charities” such an invaluable tool in knowing where to send your charitable dollars. So, if you can’t make the trip to Ghana or Guinea, or time or expertise to evaluate financials, feasibility, and performance, you can still make an informed decision by reading GiveWell’s reports on Sightsavers.

GiveWell looks well beyond the marketing of a charity and evaluates its effectiveness on multiple levels. They are particularly proud of the fact that they foster charitable giving for smaller donors as well as larger donors. They believe this helps charities develop a more diverse base of support. This philosophy seems to mirror what Sightsavers does as they court all types of donors, large and small, public and private, non-profit and for profit. Everyone has something valuable to bring to the table and when your mission is to eradicate neglected tropical diseases from the entire countries and even the entire world, you need all the help you can get! If you live in the United States, Sightsavers’ donation page is here: https://donate.sightsavers.org/countries/us/appeals/itnusolsmd. If you live outside the U.S., go to their home page and click on the bright orange donate button in the upper right hand corner of the page.

What Neglected Tropical Diseases (NTDs) Does Sightsavers Treat With Deworming?

Sightsavers treats schistosomiasis, also called bilharzia is a serious parasitic flatworm infection that is estimated by the World Health Organization (WHO) to affect 206.4 million people worldwide, mostly in Sub-Saharan Africa but also in the Indo-Pacific region. Common symptoms include bloody urine, bloody stools, abdominal bloating and pain, and diarrhea. Women also suffer from vaginal legions and pain during sexual intercourse. Even milder versions of schistosomiasis can make life miserable and impair one’s ability to work and go to school.

Schistosomiasis is sometimes referred to as snail fever because freshwater snails are the carriers for the flatworms that cause the parasitic infection. This disease has increased since the 1950s as dams have been built and the natural predator for the snails that carry the disease, a freshwater shrimp, has diminished due to the construction of dams. So, habitat restoration may need to come into play, along with deworming programs, to eradicate schistosomiasis. Perhaps Sightsavers may try to pursue environmental partners to carry out this part of the mission.

People come into contact with the infectious stage of the flatworms when they drink tainted water, use tainted water during farming or fishing, bathe in tainted water, or swim and play in tainted water. Children are more susceptible because they spend more time in the water. Schistosomiasis can also stunt the growth of children and make it more difficult for them to learn due to impair cognitive abilities. In adults, it can cause infertility. Death due to schistosomiasis isn’t terribly common but it does occur due to liver failure, kidney failure, other organ failure, bladder cancer, or sepsis, a body wide inflammatory response to the infection.

Soil transmitted helminthiasis (STH) is another type of parasitic infection that is being targeted with deworming programs. 1.5 billion people worldwide are infected with helminth worms, according to the World Health Organization, making it the most abundant parasitic disease in the entire world. According to the Sightsaver’s website, there are actually three type of helminth worms and each attack different parts of the body:

1. Trichuriasis, also known as whipworm infection

2. Ascariasis, also known as roundworm infection

3. Hookworm infection

Trichuriasis and Ascariasis feed on what’s in the intestines. Hookworms feed on their human host’s blood by puncturing holes in the small intestine. Sub-Saharan Africans are the most heavily inflicted populations, often having all three types of helminth worms in their gastrointestinal system at once. The loads of these worms can also be heavy.

Common symptoms include anemia, severe anemia (with heavy infestations), malnutrition because the worms get the nutrition ingested before the body can absorb it, abdominal pain, diarrhea, abdominal infection, fever, lung disease, skin rash, skin infections, lung disease, fatigue, physical weakness, birth defects, impaired growth, and mental retardation. The “load,” i.e. the number of worms in the body, determines how bad the symptoms are with this disease. Death can occur if the worms block or twist the intestine, thereby blocking the passage of feces.

Helminth worms are associated with soils which are contaminated with feces so this disease is higher in areas where there is only primitive sanitation. Therefore, if Sightsavers can find partners who can help improve sanitary conditions for defecation, such as the installation of sanitary outhouses, and educate people about washing their hands after they defecate, this would complement nicely the efforts to eradicate soil transmitted helminthiasis.

Lymphatic filariasis (LF) is a parasitic nematode infection transmitted by mosquito bites. According to the World Health Organization, it affects around 36 million people worldwide. The adult phase of the worms settle into the lymphatic system which can affect the entire body since the lymphatic system, just like the circulatory system, runs throughout the body. The infection can also infiltrate the kidneys and other areas of the body.

Lymphatic filariasis can be very painful. In more severe cases, lymphatic filariasis causes lymphedema, a swelling of the lymph vessels and nodes, as well as a thickening of the skin. In stage 3 lymphedema, lymphatic filariasis sometimes causes enlargement of the limbs and genitals. When this occurs, the disease is often called elephantiasis because it can cause the individual to become severely disfigured. Mosquito control and using treated mosquito nets can help subdue this neglected tropical disease but both are more expensive than medication.

Onchocerciasis, more commonly known as river blindness, is a parasitic worm infection, caused by the bite of the Simulium black fly, which lives and breeds near fast flowing rivers in Africa. Of course, most villages are located near rivers. The bite releases a microscopic worm, closely related to the microscopic worm that causes lymphatic filariasis, into the bloodstream.

When the worms travel to the eye, they cause lesions on the cornea. If left untreated, this can lead to permanent blindness. Onchocerciasis also causes intense itching and a “lizard skin” appearance as the larvae migrate to just below the surface of the skin. Before intensive eradication efforts by Sightsavers and their partners, the adults in entire villages were blinded by onchocerciasis as it was very widespread. Today, thanks to Sightsavers, river blindness has been all but eradicated in many areas. The goal is to completely eradicated it by 2025.

According to GiveWell, Sightsavers spends between thirty and thirty-four percent of their funding for neglected tropical disease on schistosomiasis, Soil transmitted helminthiasis, lymphatic filariasis, and onchocerciasis. Most of these programs are integrated together for the purpose of keeping the cost lower and the logistics easier.

How Are Children, Adults, and Villages Dewormed?

In general, deworming programs involves the administration of medication that will kill existing worms and stave off re-infection. These efforts are referred to as “mass drug administrations” or MDAs. Praziquantel is used to treat schistosomiasis. Soil transmitted helminthiasis is treated with a class of broad-spectrum antibiotics called benzimidazoles, including albendazole and mebendazole. Lymphatic filariasis is treated with diethylcarbamazine or mebendazole, depending on whether or not river blindness co-exists in the same area. River blindness is treated by Mectizan or ivermectin. Even if these medications don’t kill all of the worms, just decreasing the load can improve the inflicted person’s symptoms a lot.

Medications are given in a particular area at certain times during the year, with the ultimate goal to eradicate the disease for good. Sightsavers reports that this has almost occurred for lymphatic filariasis (LF) and onchocerciasis (river blindess) in some areas, which is a remarkable statement when you really stop and think about it! Deworming programs may also involve an attempted eradication of the vectors of the disease, such as the biting black flies that transport the microorganism that causes onchocerciasis.

 

Most deworming efforts performed in Africa specifically target children in schools. This is even true for the deworming programs Sightsavers administers because it’s easy to get funding and approval for school deworming programs. The thinking is this has a much greater impact long term. However, the problem with this limited approach is that many children don’t go to school and many parents won’t give permission for their children to receive the deworming medication. In most cases, this is because they have seen adverse side effects, such as itching or swelling, to other medications administered in other programs. So, it takes some education and some added precautions such as making sure that children eat something beforehand so they take the medication on a full stomach.

Sightsavers prefers to do community based deworming programs. In these types of deworming programs, health officials are first trained on how to administer the medication and keep track of the data collected (name, age, sex, etc). They then teach community volunteers on what to do and these volunteers go from home to home across their entire village, usually over the course of about two weeks. Sightsavers has reported that it a source of pride for the community volunteers as they know they are doing something really important that will save lives and make the quality of life better. There is also more trust amount the villagers when one of their own is administering the medication.

Whenever possible, Sightsavers prefers to combine the administration of a new deworming program with other more established programs they have in an area. This greatly reduces the overhead costs for the deworming program and helps it get up and going faster and with less resistance. However, where this is not possible, and there is a dire need, Sightsavers has committed to starting deworming programs in new areas if they can get enough funding.

Important Research On Deworming Programs In Africa

Research has shown that the long term effect of the Sightsavers’ deworming programs in Kenya and Uganda was quite substantial, even extending beyond improved health benefits. A 2004 study in Kenya showed the impact of a Sightsavers’ mass deworming to be a twenty-five percent increase in school attendance by children. A large scale study showed that higher incomes were achieved by adults who had been dewormed in Uganda as children. Further, higher scores on cognitive tests were also achieved. These incredible results are very similar to the results that the Rockefeller Sanitary Commission achieved in 1909-1915 in the American southern states just by burying the feces in the outhouses deeper in the ground, and thereby, eliminating hookworm infections.

The impact of treatment for river blindness in Kaduna, Nigeria was accessed in 2008 after fifteen to seventeen years of treatment by Sightsavers. The rate of river blindness dropped from fifty-two percent to zero, after 3703 people were tested! Another impact study was done in fifteen villages of Uganda. The rate of river blindness had dropped to between 0.8 percent to 5.5 percent. Sightsavers must be very proud of these records and how many lives they have transformed.

Deworming Is a Big Big Bang For Each Buck

The estimated cost to deworm a child is less than a dollar, about $0.95 cents per child. Because Sightsavers is always working with partners, about $0.56 cents of that $0.95 cents is donated by government resources and by in-kind donations of pharmaceutical companies for the medications needed to treat these parasitic infections. This leaves about $0.39 cents that Sightsavers needs to fund themselves from monetary donations for the establishment and administration of the programs. So, for every two bucks you donate toward their deworming programs, this will cover the deworming of about five children. Given the tremendous impact this can have on these children’s lives, this is an amazing bargain! Kudos to Sightsavers!

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About the Author: BJ Hetherington

BJ is the lead editor of Meical Daily Times. Fluent in French and proficient in Spanish and Arabic, he focuses on diseases and conditions. BJ is a graduate of York University In Toronto. When BJ isn't busy writing his next piece, he can often be found running the streets of the GTA.

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