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Anthelmintic drugs for treating worms in children: effects on growth and cognitive performance
R Dickson1, S Awasthi, C Demellweek
1Research and Development Support Unit, School of Health Science, University of Liverpool, Liverpool, Merseyside, UK, L69 3BX. rdickson@liv.ac.uk
Insights
Anthelmintic drug treatment for helminth infections in children shows limited, inconsistent effects on weight gain. Evidence is insufficient to determine impacts on cognitive performance, questioning current public health investments.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Helminth (worm) infections are prevalent globally, impacting child health through poor nutrition, anemia, and impaired development.
- These infections pose a significant burden on child populations worldwide.
Purpose of the Study:
- To systematically review the effects of anthelmintic drug treatment on children's growth and cognitive performance.
- To evaluate the efficacy of deworming interventions in pediatric populations.
Main Methods:
- Conducted a comprehensive literature search across multiple databases (Cochrane, Medline, Embase) and contacted experts.
- Included randomized and quasi-randomized trials comparing anthelmintic drugs to placebo or no treatment in children with intestinal helminths.
- Assessed trial quality and extracted data independently, contacting authors for additional information.
Main Results:
- Thirty trials involving over 1500 children were analyzed, with potential bias noted.
- Anthelmintic treatment showed some positive but heterogeneous effects on weight, height, and skinfold thickness.
- Pooled estimates indicated modest weight gain (0.10-0.43 kg) depending on dosage and follow-up duration; cognitive performance results were inconclusive.
Conclusions:
- Limited, inconsistent evidence suggests small positive effects of routine anthelmintic treatment on child weight gain in endemic areas.
- Insufficient evidence exists to confirm improvements in cognitive performance.
- Current public health investments in deworming programs may not be supported by consistent, reliable evidence regarding growth and learning benefits.
Background:
Helminth (worm) infections are widespread and are thought to contribute to poor nutritional status, anaemia, and impaired growth and learning in children.
Objectives:
To summarise the effects of anthelmintic drug treatment in children in relation to their growth and cognitive performance.
Search Strategy:
We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and the reference lists of articles. We also contacted experts in the field.
Selection Criteria:
Randomised and quasi-randomised trials of drug treatment compared with placebo or no drug treatment for intestinal helminths in children.
Data Collection And Analysis:
Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for additional information.
Main Results:
Thirty trials involving more than 1500 children were included. There was potential for bias from inadequate concealment of allocation. Studies varied in relation to target groups, drugs administered and treatment regimens. Compared to placebo or no drug treatment, drug treatment for helminths was associated with some positive effects on change in weight, height and skinfold thickness. However there was significant heterogeneity between the results of the trials. There were some positive effects on mean weight change in the trials reporting this outcome; after a single dose (any anthelminth) the pooled estimate was 0.24 kg, (95% CI 0.15 to 0.32; fixed effects model assumed); and 0.38 kg (95% CI 0.00 to 0.77; random effects model assumed). Results from trials giving multiple doses showed mean weight change under one year of follow up of 0.10 kg (95% CI 0.04 to 0.17; fixed effects assumed); or 0.15 (95% CI 0.00 to 0.30; random effects assumed). At more than one year of follow up, mean weight change was 0.12 kg (95% CI -0.02 to 0.26; fixed effects assumed) and 0.43 (95% CI -0.61 to 1.47; random effects model assumed). Results from studies of cognitive performance were mixed and inconclusive.
Reviewer'S Conclusions:
There is some limited evidence that routine treatment of children in areas where helminths are common has small effects on weight gain, but this is not consistent between trials. There is insufficient evidence to know whether this intervention improves cognitive performance. Our interpretation of these results is that the current public health programme investments in this intervention, based on the expectation that there will be an improvement in growth and learning, are not based on consistent or reliable evidence.