The neat rows of shoes look pretty, but many pupils at Phum Chreh school prefer to play bare-foot in the yard. This increases their risk of being infected with intestinal parasites, which can cause anaemia and malnutrition and stunt their growth. These 12 year old students all have worms.

Phum Chreh school on the outskirts of Phnom Penh is a school like many others. The

sing-song chant of children learning their lessons drifts out from the neat white

buildings. Between classes the dusty yard is a happy chaos of barefooted ball games

and aspiring apsaras.

Like many children in Cambodia, the pupils of Phum Chreh are tiny. Twelve-year-olds

look eight; eight-year-olds look five. It is a poor area, but funded by the Order

of Don Bosco the 300 students frequently receive a meal at school.

They are not small simply due to a poor diet. These kids have worms.

A study conducted in January this year reported that nearly 90 percent of Phum Chreh

pupils are infected with intestinal parasites. Over a quarter of them have an "extremely

high" number of parasites, including hookworm, roundworm and giardia.

The intestinal parasites cause anemia, malnutrition and great discomfort. Infected

children have sleeping difficulties and find it nearly impossible to concentrate.

Dr Robert Wakuluk, a researcher working in collaboration with Charles Lerman from

the American Red Cross, described the results of the study as "alarming".

"These kids cannot grow, they cannot develop properly, they are stunted. Their

school performance will also be much lower because they can't concentrate. Sometimes

they can't eat and they are itchy and can't sleep," Dr Wakuluk said.

The most prevalent infections are soil-transmitted helminth (STH), a group of parasites

that live in the human intestine. STH are picked up through the skin by walking barefoot

in ground where someone else has defecated.

"Given that humans are the only reservoir, theoretically, this should be the

easiest [health problem] to eliminate", Dr Wakuluk said. But in areas like Phum

Chreh, where children are often shoeless and sanitation is not always adequate, contamination

levels are high.

But the children of Phum Chreh are not alone in hosting these unwanted parasites.

The WHO estimates that more than one billion people worldwide are "chronically

infected" with STH. In Cambodia, a nationwide survey between 1997 and 2000 revealed

that the worms were "highly prevalent" in school-age children and in some

provinces up to 85 percent of children were infected.

But for the parasites of Phum Chreh, their time is almost up.

In December 2002, the National Malaria Centre, together with the WHO, began a nationwide

de-worming project that promises every primary school-age child (aged 6 to 14) regular

de-worming medication.

Effective treatment simply requires one Mebendazole tablet every six months. The

program also provides an education kit for schools and training for health centers.

So far, the project is on schedule. Program manager Muth Sinuon said 2.8 million

children - 78 percent of the age group - have been treated already.

The challenge will be to ensure medication continues to reach the schools. Project

organizers have worked with the immunization and vitamin A delivery programs to administer

the medication and training to the provinces, and Dr Sinuon is hoping to collaborate

with regional NGOs to ensure the distribution of Mebendazole in the future.

Dr Sinuon said the Ministry of Health (MoH) has indicated its commitment to the project

and has agreed to fully fund the project, thus far supported by the Japanese Embassy,

WHO, UNICEF, as well as the MoH.

WHO technical advisor Dr Reiko Tsuyuoka said the project should not prove a great

burden on the national budget. "This project is very, very cheap. Once teachers

get the skills we only need an additional budget for monitoring the program and to

buy the drugs," she said. Mebendazole tablets cost about 3 cents each.

"We are investing in the next generation so we should consider this a priority,"

Dr Tsuyuoka pointed out.

A government task force to control such infections was established last year, and

will meet on April 28 to hear a progress report on the de-worming program and plan

work for the future.

Dr Tsuyuoka said the next challenge is to reduce reinfection rates. Improving sanitation

is an important step in reducing infection, she said. "We shouldn't continue

Mebendazole forever. If there is sanitation and clean water supply, the chance of

infection is less."

For the children of Phum Chreh, many of whom drink from the village pond, improved

sanitation and water supply are essential for combating the giardia and other infections

reported by Dr Wakuluk.

But as Dr Wakuluk pointed out, the vital first steps have been taken. "These

children have to go to school, they have to study, they have to grow... The most

important thing is to give the kids the medication as soon as possible."

National Malaria Center's Dr Sinuon said the children of Phum Chreh are due to get

their Mebendazole next week.

The doctors are promising swift improvements. "The results of the de-worming

program is very easy to see. You can see the impact almost immediately. Right now,

they think slowly. They should definitely do better at school straight away,"

Dr Tsuyuoka said.

And while they may never be professional basketball players, they can still catch

up, and with regular de-worming they will definitely be tall enough to be footballers

or apsaras.