Situation: A public health nurse works with the barangay nutrition scholars (BNS) and barangay health workers (BHWs) of an upland barangay on its nutrition program, including the yearly Operation Timbang Plus (OPT Plus). During the Garantisadong Pambata week, an 18-month-old girl who has never been dewormed is brought to the Barangay Health Station (BHS). She is well. Which dose of albendazole should the nurse give?

Program deworming starts at 1 year of age and is repeated every 6 months. Albendazole is given as a single dose of 400 mg, except for children 12 to 23 months, who receive 200 mg. At 18 months, this girl receives 200 mg.

Clinical context
This item sits within community health nursing and the nursing process applied to a national deworming program. The child is 18 months old, clinically well, and has never received deworming. The task is to select the correct single dose of albendazole for program-based deworming.

Why age changes the dose
Program deworming for soil-transmitted helminths begins at 1 year of age and is repeated every 6 months. The standard dose for older children and adults is 400 mg as a single dose. However, children 12 to 23 months receive a reduced dose of 200 mg as a single dose. An 18-month-old falls within this younger age band, so the correct dose is 200 mg.

Albendazole is given as a single dose, not as a multi-day course, for routine program deworming. The 400 mg daily for 3 days option is used for specific clinical syndromes such as heavy infections or certain tissue parasites, not for mass drug administration in a well child.

Why a single dose works for public health deworming
Albendazole acts by binding to parasite beta-tubulin, inhibiting microtubule polymerization. This disrupts glucose uptake and leads to parasite immobilization and death. For Ascaris lumbricoides, hookworm, and Trichuris trichiura, a single oral dose is sufficient to reduce worm burden in most children. The goal of mass drug administration is not to cure every individual infection but to lower community-level transmission and morbidity.

Key point! The dose is based on age band, not weight, in the national program. A 12- to 23-month-old child receives 200 mg, while a child 24 months and older receives 400 mg.

Re-infection and the need for repeat dosing
A single dose does not prevent re-infection. Studies of school-age children in Ethiopia show that although albendazole has good efficacy against Ascaris lumbricoides, re-infection occurs over time because eggs remain in soil and environmental contamination continues ^[1]. This is why program deworming is repeated every 6 months rather than given once. The nurse should document that this child will need another dose at 24 months of age.

Program coverage and transmission interruption
Mass drug administration works best when coverage is high and repeated. The DeWorm3 trial evaluated whether community-wide albendazole MDA could interrupt transmission of soil-transmitted helminths ^[4]. High coverage reduces the overall environmental egg burden, which benefits even untreated individuals. However, interruption is difficult in areas with ongoing fecal contamination and poor sanitation. The nurse’s role includes not only giving the correct dose but also reinforcing hygiene measures such as handwashing, use of latrines, and wearing footwear.

Watch out! A child who is 12 to 23 months old and has never been dewormed still receives the age-appropriate single dose. There is no loading dose or double dose for the first deworming.

Comparing the options

Option	Interpretation	Appropriateness for an 18-month-old
100 mg single dose	Below the recommended pediatric dose	Incorrect; underdosing reduces efficacy
200 mg single dose	Correct dose for 12–23 months	Correct
400 mg single dose	Standard dose for 24 months and older	Incorrect for this age band
400 mg daily for 3 days	Used for specific clinical syndromes, not routine program deworming	Incorrect for a well child in mass drug administration

Nursing application
Before giving albendazole, the nurse confirms the child’s age and that the child is well. The tablet can be crushed or chewed for young children. The nurse records the dose and schedules the next deworming in 6 months. If the child has acute diarrhea, high fever, or severe malnutrition with complications, deworming may be deferred according to program guidelines. The nurse also educates the caregiver that deworming does not provide lasting immunity, so repeat doses and environmental hygiene remain essential.

For an 18-month-old child in the national deworming program, the correct albendazole dose is 200 mg as a single dose. This age-specific reduction reflects both safety and adequate efficacy in the 12- to 23-month age band, while the 400 mg dose applies from 24 months onward.

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