Introduction
    The West African Centre of International Parasite Control (WACIPAC) was established on 1 January 2004 as a project of the Japan International Cooperation Agency (JICA), an independent administrative corporation, in the Noguchi Memorial Institute for Medical Research of the University of Ghana. Thus there are now three centres working in concert on international parasite control, the two other ones being the Asian Centre of International Parasite Control (ACIPAC), set up in 2000 in the Faculty of Tropical Medicine of Mahidol University, Thailand, and the East and Southern African Centre of International Parasite Control (ESACIPAC) established in 2001 in the Kenya Medical Research Institute. Since there might be some scepticism as to the question " why parasite control now" in view of the current status of parasite epidemics in Japan, this article will explain the background that led to the establishment of these three centres and introduce their objectives with emphasis on the activities carried out so far by ACIPAC.
    Actually, if one reviews the situation regarding the spread of parasitic diseases worldwide in 1947, it may be recognized that the current situation of parasitic infections in the world remains practically the same as the time when it was called "This Wormy World" by Norman Stoll, a famous American parasitologist. For instance, 200 million to 450 million people are infected by malaria every year, and as many as one to three million people reportedly die of this disease (Breman, 2001). Approximately 200 million persons are estimated to be infected with schistosomiasis that is endemic in 74 countries, although its mortality became lower than decades ago. Besides, there are still countries with areas where 50 to 70% of the population is affected by soil-transmitted helminthiases (STH) such as ascariasis, ancylostomiasis, trichuriasis, etc. As described below, there exist such regions also in countries called "partner country" by ACIPAC (Brooker et al., 2003).
    In view of this context, it was decided at the Summit of Industrialized Countries held in Denver in 1997 and in Birmingham in 1998 that the eight advanced countries should support the WHO and strengthen further the international cooperation in order to promote the control of malaria and of other parasitic diseases, following a proposal formulated by Mr. Ryutaro Hashimoto, the then Prime Minister of Japan. Japan announced her policy at the Tokyo International Conference on African Development (TICADII) in the fall of 1998, which proposed to establish research and training centers, two in Africa and one in Asia, in line with these objectives. Following this policy, ACIPAC was established on March 23, 2000 in the Faculty of Tropical Medicine of Mahidol University as a JICA technical cooperation project under an agreement reached between Japan and Thailand.
    Thus ACIPAC became the first centre under the "Hashimoto Initiative for Global Parasite Control". ACIPAC is actively involved with a focus in particular on human resources development programmes for the promotion of parasite control in the countries around the Mekong River Basin whose base is located in Thailand, while taking also into perspective the South-South cooperation between Asia and Africa, together with the two above-mentioned African centres. Incidentally the Japanese Government announced the "Okinawa Infectious Diseases Initiative" at the Okinawa Summit held in August 2000 and declared it would make a contribution to the tune of three billion dollars in total during five years from 2001 in order to promote the control of malaria plus parasites and other infectious diseases including HIV/AIDS, tuberculosis and polio. This decision gave more strength to the Hashimoto Initiative and it is exerting a strong impact upon international organizations such as the WHO as a Global Parasite Control Initiative launched by Japan.

Why "human resources development"?
    Many parasitic infectious diseases are endemic in tropical developing countries.However, they have been ignored as a science for a long time from the standpoint of modern medicine (Kawakita, 1977). Investments for research into this field and funds for the control of these diseases have constantly been put on the back burner, and these chronic shortages have led to insufficient human resources. This in turn has resulted in delayed control measures, creating a repeated vicious circle. These infectious diseases including malaria are called "Great Neglected Diseases". However we may say that this expression symbolizes both the gravity of the problems related to the combat against these infectious diseases and the seriousness of the fact that the biological characteristics of the pathogens proper are a redoubtable opponent for humanity.
    Anyhow it is worth mentioning that the necessity of a "global approach" to bringing down not only new infections but also those known since long ago that have not been eradicated by man has finally been pointed out in the mid-1990s by the world political leaders and not by researchers in life sciences. In fact, an "Initiative on Emerging and Reemerging Infectious Diseases" has been taken up as the first item on the agenda as a new area of cooperation between Japan and the US during the talks at the highest level held between Prime Minister of Japan Mr. Hashimoto and President Clinton in Tokyo in April 1996. (Japan-US Common Agenda, http://www.mofa.go.jp/mofaj/kaidan/kiroku).
    This probably became a trigger for the launch of the abovementioned Hashimoto Initiative and Okinawa Infectious Diseases Initiative in Japan. At the same time on a worldwide basis programs such as the WHO's Roll Back Malaria, Multilateral Initiative on Malaria launched by the US NIH, etc. were initiated. Furthermore a Global Fund aimed at strengthening measures at the national level on HIV/AIDS, tuberculosis and malaria was introduced in the year 2000.
    Thus funds for research and implementation of control measures are now available to a certain extent also in the area of "neglected" infectious diseases, a field that had been so far put on the back burner. For instance, although subventions have been earmarked for large-scale scientific research projects on cancer and immunology since a long time in Japan, it was a landmark that in 1996 a high-priority research called "Molecular Basis of Malaria Control", the first large-scale study in the domains of parasitology and tropical medicine, was kicked off under the support from the Ministry of Education, Science, Sports and Culture. Fundamental research on malaria involving numerous fields including these areas as well as molecular biology, immunology, pharmacology and medical entomology and enrolling a vast number of research scientists and groups was carried out for four years under the research grant with numerous publications in the international journals. Thus a new science on malaria was disseminated to the whole world from Japan.
    If we look at the current situation in developing countries, however, we may face the reality that in many countries human resources are in extremely short supply for an adequate operation of any available Global Fund and for the implementation of measures to combat infectious diseases at the grass-root level. Besides the fundamental policies and strategies regarding infectious disease control at the national level have not been clearly defined. The control programs mapped out by various international organizations and NGOs have been incorporated separately into a vertically-divided administrative system. The limited number of staff has been further divided, and this often creates obstacles to the implementation of organized programs. Although there exists an extremely small number of high-calibre researchers and research institutions, the base of research is limited, and in many cases the results of research do not eventually reach people at the grass-root level.
    Therefore "human resource development", though simple this may seem, involves problems, such as what kind of people should be trained or what parasite control policies should be assumed for the staff training, in order to implement parasite control measures at the grass-root level in the countries of the Great Mekong Sub-region, notably Cambodia, Laos, Myanmar and Vietnam, which are ACIPAC's partner countries. In addition, each country should proactively work out adequate control systems, while coordinating the ongoing assistance programs put in place by various organizations and NGOs and acting in concert with the related organizations.
    Actually after the 2nd World War there was a period during which Japan was also called "paradise of parasites", and the current situation in developing countries is similar to Japan at that time. Japan has acquired experience in that the parasite control measures targeted at schoolchildren have been quite effective for the dissemination of various public health programmes to the community, and she has successfully eradicated parasitic diseases which the whole world is aiming to frantically eliminate, such as malaria, schistosomiasis, filariasis, etc. Learning from Japan's experience, ACIPAC has decided to organize a training course for programme managers geared to the implementation of parasite control measures focused on school health. Taking into consideration the situation of malaria epidemics in this region, ACIPAC has decided to actively work on malaria prevention through health education oriented to schoolchildren despite the fact that Japan has practically no such experience. Thus, training curriculum drafts were originally prepared by committee members from related institutions in Thailand (Mahidol University, Department of Communicable Disease Control of the Ministry of Health, Office of Basic Education Commission of the Ministry of Education), and curricula were further developed by including recommendation by the partner countries through discussion in an international workshop. Training started in September 2001 with these curricula and lasted twelve weeks. Over the last four years, in addition to the trainees from Thailand and the neighboring countries, seven trainees in total from Kenya and Ghana and four trainees from East Timor at the request of UNICEF and with the support of the local JICA were enrolled, and therefore a total of 111 participants received ACIPAC training.

Why school health-based malaria and STH control?
    The mortality due to malaria concentrates in sub-Saharan Africa. The majority of the victims are children under five years of age. So far the approach to children in their later childhood is considered as secondary, although anemia and the influence on their learning performances due to infections have been pointed out. However it is not likely that mosquitoes transmitting malaria do avoid sucking the blood of schoolchildren. There are actually children who in spite of being infected with malaria have mild symptoms but attend school. These children harbor the malaria parasite of the afebrile stage (i.e. gametocytes). This suggests that they themselves contribute to a new source of transmission. So strengthening control measures aimed at these school-aged children should be effective also for the prevention of malaria for the whole community.
    As far as intestinal parasitic infections are concerned, even in a semi-advanced country like Thailand, about 20 to 30% of schoolchildren are afflicted with STH (primarily ancylostomiasis) in the southern region (Anantaphuruti et al., 2002). Besides 60% of schoolchildren in the mountainous region of the northern provinces are infected with some kinds of intestinal parasitic helminthes (Waikagul et al., 2002). The morbidity is 70% for ascariasis and 86% for ancylostomiasis in case of Cambodia for instance, one of the neighboring countries of Thailand. A similar situation regarding STH infections is observed all over the world including Asia and Africa. This clearly demonstrates the immeasurable impact of STH not only on the health of the schoolchildren, but also on their intellectual learning, such influence being shown by a remarkable decline in their learning capacity and in their faculty to memorize. The WHO finally launched a policy at the 2001 World Health Assembly according to which at least 75% of the school-aged children should receive anthelmintics regularly and be protected against the damages caused by schistosomiasis and STH. Indeed infectious diseases such as malaria that are directly linked to death have been the focus of attention from the standpoint of epidemic prevention. The serious impact of health chronic damages caused by STH on the physical and intellectual development of children and on pregnant women has now been recognized.
    Therefore the development of various health education programmes including education on the prevention of malaria and other infectious diseases combining visible and easy-to-understand control measures on intestinal parasites is in full consistency with the global strategy on parasitic control pursued by international organizations such as the WHO, UNICEF, World Bank, etc. Furthermore, although education is not a tool with a direct immediate efficacy such as diagnosis and treatment, its effect is not transient and it can be expected to long lasting. It is possible to make up for the shortage in manpower in the health sector by mobilizing schoolteachers, while it is also possible to develop cooperative relations between different ministries and sectors, such as the Ministry of Health, the Ministry of Education, etc., and to eliminate the negative effects of the vertically-divided administrative system.
    Furthermore what ACIPAC is advocating is not providing a mere health-care service to schoolchildren (administration of anthelmintics, meal supply, vitamin supplements, etc.). The children should also be perceived as our health partners. The messages conveyed through teachers can be relayed to the children and then to their siblings and friends in a friendly and easy to understand form, through the wisdom and the language of the schoolchildren. They are capable of developing information and education communication tools by themselves. Such materials prepared by hand may have a greater impact on the parents than those printed and distributed in large volumes by authorities. It will also be possible to work jointly with teachers in order to identify breeding sites of the mosquitoes transmitting malaria and to develop activities having an positive impact on the improvement of the environmental sanitation of communities. Moreover as regards malaria, correct information on protection against this ailment should also lead to an adequate care of their siblings of under five who may be exposed to the threat of death.
    Thus if we desire that children become our "colleagues", we should rethink the education on health care and hygiene and switch from one-sided teacher-to-child education to participatory education so as to motivate the children to think and learn by themselves. Actually within the frame of ACIPAC model activities, the Office of Basic Education Commission of the Ministry of Education in Thailand has prepared new friendly textbooks for children and manuals for teachers reflecting the views of the latter for the prevention of malaria and intestinal parasitic infections. In particular malaria in Thailand has become a problem in the areas of the borders with Myanmar and Cambodia. ACIPAC former trainees on the border with Myanmar have prepared new textbooks written in the languages of ethnic minorities.
    As regard the significance of school health-based malaria prevention among malaria control measures, it will be necessary on the one hand to survey the actual situation of malaria infection in school-aged children and its impact, and on the other hand to carry out detailed operational research on the specific results of this approach in various regions and communities of the Great Mekong Sub-region.
    ACIPAC has trained people in the implementation of school health-based control measures on malaria and parasites. In order to put to profit their training in Bangkok, after returning to their countries, the trainees were requested to launch small-scale pilot projects on parasite control measures based on school health in each country with funds provided by JICA for the implementation of region-wide cooperation. These pilot projects constitute a follow-up of the trainees, and at the same time, they are expected to provide opportunities to gain practice and experience in many areas, such as further human resources development including training of laboratory test technicians, teachers and health care workers, dissemination of prevention services into communities through children's activities, cooperation between different sectors (health care, education) and coordination with international organizations.
    The most important fact before all of these advantages is that the entity responsible for implementing parasite control in each country should be clearly established through this approach. Indeed JICA, WHO, NGOs and other organizations are all no more than simple supporters, and the entity responsible is definitely the country itself. The residents of the community for whom the projects are planned should be recognized as the owner of the project. There should be discussion on what policy and strategy in each country should be proactively decided for parasite control and on the efficient utilization of the support groups within the frame of its strategy. So far a National Task Force has been set up in Laos and Cambodia, and a National Policy and Guidelines on school health-based parasite control have been announced with the collaboration of the WHO and UNICEF in these countries. Similar developments are expected for Vietnam in the years to come.

Summary
    Parasitic infections still remain as serious public health issues in most of developing countries in the Great Mekong Sub-region due to lack of human resources as well as of infrastructure capabilities. Based on the Japanese experiences in successful control of major parasitic infections, school health-based malaria and STH control has been introduced in the ACIPAC international training course for programme managers, since its approach is recognized as a cost-effective and visible entry point for health promotion programmes and eventually for community development. Through model activities to improve health education with participatory ways friendly to schoolchildren in Thailand and small scale pilot projects performed by ACIPAC ex-trainees in partner countries, promotion of health in a total sense is going to be accepted as an important concept over vertical health services in schools such as deworming, vitamin or food supply programmes, etc. Therefore coordination of development partners and sectors related to health and education is an important factor in promoting capabilities in respective countries. In this regard the Japanese Global Parasite Control Initiative has been playing a key role in coordination among partners at regional and respective country levels in collaboration with WHO and other UN organizations. The ACIPAC, together with ESACIPAC and WACIPAC, is expected to continue to be a human resources development centre and a hub of networking of global parasite control by encouraging the South-South cooperation.