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Published on: August 22, 2012
Effects of deworming on malnourished preschool children in India: an open-labelled, cluster-randomized trial
Shally Awasthi1, Richard Peto, Vinod K Pande
1Department of Paediatrics, King George's Medical University, Lucknow, India. sawasthi@sancharnet.in
Insights
Deworming preschool children in urban slums with albendazole significantly increased weight gain over two years. This study highlights the effectiveness of the Integrated Child Development Scheme for delivering health interventions to vulnerable populations.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Intestinal nematode infections affect over a third of the world's children.
- Current deworming strategies primarily target school-aged children, with limited data on preschool-aged populations.
- This study addresses the gap in understanding the impact of deworming on young children in urban slum settings.
Purpose of the Study:
- To evaluate the effects of mass anthelmintic treatment on the growth of preschool children in urban slums.
- To assess the feasibility of using the Integrated Child Development Scheme (ICDS) for delivering health interventions.
Main Methods:
- A randomized controlled trial involving 3,935 children aged 1-5 years in Lucknow, North India.
- Five rounds of 6-monthly albendazole treatment (400 mg) were administered over two years to children in 25 randomly selected slum areas.
- Height and weight were monitored every six months; all children received vitamin A supplementation.
Main Results:
- The Integrated Child Development Scheme successfully delivered the interventions, with high adherence rates (95% received all five treatments).
- Albendazole-treated children showed similar height gain but a significant 35% greater weight gain compared to the control group.
- The average weight gain difference was 1 kg over two years, with a 99% confidence interval of 0.6-1.4 kg (p = 10(-11)).
Conclusions:
- Mass deworming with albendazole in malnourished, preschool-aged children in urban slums leads to substantial weight gain.
- The ICDS system offers a sustainable and cost-effective platform for delivering anthelmintics and micronutrient supplements to underserved populations.
- Generalizability of findings is limited due to unknown baseline parasite burden in the control group.
Background:
More than a third of the world's children are infected with intestinal nematodes. Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children.
Methodology:
We studied the effects on the heights and weights of 3,935 children, initially 1 to 5 years of age, of five rounds of anthelmintic treatment (400 mg albendazole) administered every 6 months over 2 years. The children lived in 50 areas, each defined by precise government boundaries as urban slums, in Lucknow, North India. All children were offered vitamin A every 6 months, and children in 25 randomly assigned slum areas also received 6-monthly albendazole. Treatments were delivered by the State Integrated Child Development Scheme (ICDS), and height and weight were monitored at baseline and every 6 months for 24 months (trial registration number NCT00396500). p Value calculations are based only on the 50 area-specific mean values, as randomization was by area.
Findings:
The ICDS infrastructure proved able to deliver the interventions. 95% (3,712/3,912) of those alive at the end of the study had received all five interventions and had been measured during all four follow-up surveys, and 99% (3,855/3,912) were measured at the last of these surveys. At this final follow up, the albendazole-treated arm exhibited a similar height gain but a 35 (SE 5) % greater weight gain, equivalent to an extra 1 (SE 0.15) kg over 2 years (99% CI 0.6-1.4 kg, p = 10(-11)).
Conclusions:
In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain. The ICDS system could provide a sustainable, inexpensive approach to the delivery of anthelmintics or micronutrient supplements to such populations. As, however, we do not know the control parasite burden, these results are difficult to generalize.
Trial Registration:
ClinicalTrials.gov NCT00396500.
