Primary prevention
Ascaris eggs are hardy, being able to survive high and low temperatures, desiccation, and chemical disinfectants. Therefore, proper agriculture practices and improved sanitation and hygienic practices are key to the primary prevention of ascariasis. Studies suggest that implementation of educational efforts aimed at increasing knowledge of soil-transmitted helminth infections is associated with reduced levels of reinfection in school-age children.[20][21] Furthermore, because of strong links with poverty and poor sanitation, alleviation of poverty and economic development should also result in decreased prevalence of the infection.[22]
Secondary prevention
Studies demonstrating the negative effects of ascariasis and other intestinal helminths on childhood growth, nutrition, and development have increased attention on the global problem of intestinal parasites. In 1989, the United Nations Subcommittee on Nutrition and the World Health Organization (WHO) recommended regular deworming programs in areas with widespread ascariasis and malnutrition.[28] In 1993, the World Development Report cited parasites as a major cause of disability adjusted life years (DALYs) lost in children aged 5 to 14 years. Subsequently, the WHO recommended that anthelmintic drugs be used in programs designed to reduce morbidity of intestinal helminth infections. In 2016, the WHO achieved estimated global coverage rates of 50% in preschool-aged children, and 69% in school-aged children for soil-transmitted helminths. In addition, 66% of implementation units reached the effective coverage rate of 75%.[64] The WHO has also published a roadmap for control of neglected tropical diseases, including ascariasis, by 2030.[65]
The WHO recommends that preventive chemotherapy (deworming) using single-dose albendazole or mebendazole (if available) is given on an annual or biannual (if baseline prevalence is >50%) basis in the following patient groups:[51]
Young children (aged 12-23 months), preschool-aged children (24-59 months), and school-aged children living in areas where the baseline prevalence of any soil-transmitted helminth infection is ≥20% in this patient group
Nonpregnant adolescent girls (aged 10-19 years) and nonpregnant women of reproductive age (15-49 years) living in areas where the baseline prevalence of any soil-transmitted helminth infection is ≥20% in this patient group
Pregnant women after the first trimester in areas where both the baseline prevalence of hookworm and Trichuris trichiura infection is ≥20% in pregnant women, and anemia is a severe public health problem with a prevalence of ≥40% in pregnant women.
The benefits of deworming have been called into question. Meta-analyses conducted by the Cochrane Group found low certainty evidence that treatment in the second trimester may reduce maternal anemia by 15%, but did not to identify evidence that community-based mass drug administration of anthelmintics is associated with consistent improvements in nutritional status, blood hemoglobin levels, school performance, or birth outcomes when administered during the 2nd or 3rd trimester of pregnancy, suggesting that current recommendations and global policy may need to be revised.[66][67]
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One 5-year study of 1 million children, ages 6-72 months at the time of enrollment in India, found no benefit from the administration of twice-yearly albendazole on either weight, hemoglobin level, or survival.[68] Because re-infection occurs rapidly following deworming, it remains to be seen whether MDA has the potential to provide sustainable reductions in the health burden of ascariasis and other geohelminth infections.[69][70] Further work has focused on the impact of water, sanitation, and hygiene (WASH) on infection rates with Ascaris and other soil-transmitted helminths. One meta-analysis showed that access to clean water and specific practices (e.g., hand washing) are significantly associated with lower risk of infection. This suggests that integrated strategies combining targeted deworming with behavioral change and access to clean water might lead to more effective control of ascariasis in endemic areas.[71]
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