Round worm, hook worm, tape worm, thread worm and whipworms are some of the common helminthes affecting human. These are transmitted through feco-oral route in the areas of poor sanitation. Common manifestations of the diseases caused by these groups of parasites include: pain abdomen, anemia, vomiting and poor health. Apart from these, some unusual complications from infestation of these worms are also seen.

Round worm (Ascariasis): These may lodge in the common bile duct, pancreatic duct and liver apart from their natural habitat; small intestine. That may cause obstruction to the free flow of bile resulting in obstructive jaundice, pancreatitis and liver abscess respectively. That may affect the liver function and cause inflammation of bile channel called cholangitis. Ascaria larva during the course of its development passes through the respiratory tract to come over to the alimentary tract once again, which causes night hawking cough and sometimes lungs infection by secondary bacterial invasion. A lot of adult round worms living or dead after administration of drugs or as such may cause obstruction of the alimentary tract which may arouse an emergency situation. These may become irritated during surgery by anesthetics and come up, to be aspirated to the respiratory tract causing the dangerous collapse of lungs.

Hook worm larva enters the body through the bare skin of foot, to find its way to the blood or lymphatic to reach the alimentary tract via respiratory tract. At the site of entry may evoke inflammation and intense pruritus called “Ground itch”. The route of its migration can be seen as an inflamed streak over the skin called the “Larva migrans”, which evokes pruritus. Finally they lodge themselves in the upper part of small intestine to cause the classical symptoms of the ankylostomiasis.

Thread worm egg are laid near the anal canal, hatch there and larva may migrate to the vagina in female to cause pruritus there. It may ascend upwards to the fallopian tubes, and even to the peritoneum to cause an infection there. Sometimes these may enter the appendix to cause appendicitis. These find their way again to the alimentary tract being carried by the nail to the mouth during intake of food.

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Paradip in Orissa, India is a port town. In the early morning, when I and many like me go for a walk in the coastline road, invariably encounter people of nearby slum dwelling on encroached land, attending call of nature in the road side. They even do not hesitate seeing us. This was the scenario in my village some ten years back. Now almost each family has a toilet in their home, thanks to the initiative by non-government organizations and Govt. collaboration. I do not understand the philosophy behind allowing slums to develop at the first place, try to evict them later on and fail, following a long protracted legal battle. There is perhaps a lot of local politics involved in it.

Open air defecation has its own hazards to the community as a whole. This habit is responsible for transmission of a number disease by face-oral route. These may be dysentery, worm diseases, typhoid and many more.

The main headache of people in the developing countries is earning the livelihood. When there is paucity of food who will think of putting a toilet in place! Govt. aid for the purpose is many a times biased by caste, it does not take poor as one class and so there is discrimination in providing the aid. Many always press for categorizing poor as one class irrespective of their caste, creed and religion; but there is also nasty politics involved in it. So, if the economic condition of people improves, they will think of having a latrine in their home. Some people have the taboo of having a toilet near the living rooms and kitchen, which is thought as unholy. This belief is changing fast in the rural India and linked directly to increase in number of toilets in the community.

A little political will is required, at least in India to enable people to have a toilet in each family by the way of improving their economic condition and a little persuasion.

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