Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis

2017
Background Soil-transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by WHO, affect more than a third of the world's population, with varying intensity of infection. We aimed to evaluate the effects of mass deworming for soil-transmitted helminths (with or without deworming for schistosomiasis or co-interventions) on growth, educational achievement, cognition, school attendance, quality of life, and adverse effects in children in endemic helminth areas. Methods We searched 11 databases up to Jan 14, 2016, websites and trial registers, contacted authors, and reviewed reference lists. We included studies published in any language of children aged 6 months to 16 years, with mass deworming for soil-transmitted helminths or schistosomiasis (alone or in combination with other interventions) for 4 months or longer, that reported the primary outcomes of interest. We included randomised and quasi-randomised trials, controlled before-after studies, interrupted time series, and quasi-experimental studies. We screened in duplicate, then extracted data and appraised risk of bias in duplicate with a pre-tested form. We conducted random-effects meta-analysis and Bayesian network meta-analysis. Findings We included 52 studies of duration 5 years or less with 1 108 541 children, and four long-term studies 8-10 years after mass deworming programmes with more than 160 000 children. Overall risk of bias was moderate. Mass deworming for soil-transmitted helminths compared with controls led to little to no improvement in weight over a period of about 12 months (0.99 kg, 95% credible interval [CrI] -0.09 to 0.28; moderate certainty evidence) or height (0.07 cm, 95% CrI -0.10 to 0.24; moderate certainty evidence), little to no difference in proportion stunted (eight fewer per 1000 children, 95% CrI -48 to 32; high certainty evidence), cognition measured by short-term attention (-0.23 points on a 100 point scale, 95% CI -0.56 to 0.14; high certainty evidence), school attendance (1% higher, 95% CI -1 to 3; high certainty evidence), or mortality (one fewer per 1000 children, 95% CI -3 to 1; high certainty evidence). We found no data on quality of life and little evidence of adverse effects. Mass deworming for schistosomiasis might slightly increase weight (0.41 kg, 95% CrI -0.20 to 0.91) and has little to no effect on height (low certainty evidence) and cognition (moderate certainty evidence). Our analyses do not suggest indirect benefits for untreated children from being exposed to treated children in the community. We are uncertain about effects on long-term economic productivity (hours worked), cognition, literacy, and school enrolment owing to very low certainty evidence. Results were consistent across sensitivity and subgroup analyses by age, worm prevalence, baseline nutritional status, infection status, impact on worms, infection intensity, types of worms (ascaris, hookworm, or trichuris), risk of bias, cluster versus individual trials, compliance, and attrition. Interpretation Mass deworming for soil-transmitted helminths with or without deworming for schistosomiasis had little effect. For schistosomiasis, mass deworming might be effective for weight but is probably ineffective for height, cognition, and attendance. Future research should assess which subset of children do benefit from mass deworming, if any, using individual participant data meta-analysis. Funding Canadian Institutes of Health Research and WHO. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
LANCET GLOBAL HEALTH
卷号:5|期号:1
ISSN:2214-109X
来源机构
University of Ottawa; University of Ottawa; University of Ottawa; University of Ottawa; University of Ottawa; University of Ottawa Heart Institute; King George's Medical University; University of Toronto; Hospital for Sick Children (SickKids); University of Toronto; University of Toronto; Aga Khan University; University West Indies Mona Jamaica; Harvard University; Harvard Medical School; Harvard Pilgrim Health Care; University of London; London School of Hygiene & Tropical Medicine
资助信息
Canadian Institutes of Health Research and WHO.
被引频次(WOS)
74
出版日期
2017
WOS学科分类
Public, Environmental & Occupational Health
其他关键词
IMPACTS WORMS
资助机构
Canadian Institutes of Health Research WHO