Hookworm disease: Puerto Rico's secret killer.

Drs. Bailey Ashford and Pedro Gutiérrez, with the economic aid of the United States and Puerto Rican governments, were able to implement a program to reduce the incidence of hookworm infestations in Puerto Rico during the turn of the century. The program was conducted in three phases. The first phase consisted of evaluating the prevalence of infestations among the population. The second phase was concerned with treating patients and reducing further infestations. The last phase of the program was the implementation of prevention programs whose goals were to educate the population on the mechanisms of contaminations and to help implement improvements in the waste disposal systems so as to reduce the exposure to contaminated soil. The programs greatly improved the level of health of many Puerto Ricans. The incidence of hookworm infestations was reduced from 90% to 15% among members of the population. The program obtained world-wide recognition and serves as a model for similar programs.