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Cognitive deficits and educational loss in children with schistosome infection-A systematic review and meta-analysis
Open accessAbstract
BACKGROUND: By means of meta-analysis of information from all relevant epidemiologic studies, we examined the hypothesis that Schistosoma infection in school-aged children (SAC) is associated with educational loss and cognitive deficits. METHODOLOGY/PRINCIPAL FINDINGS: This review was prospectively registered in the PROSPERO database (CRD42016040052). Medline, Biosis, and Web of Science were searched for studies published before August 2016 that evaluated associations between Schistosoma infection and cognitive or educational outcomes. Cognitive function was defined in four domains-learning, memory, reaction time, and innate intelligence. Educational outcome measures were defined as attendance and scholastic achievement. Risk of bias (ROB) was evaluated using the Newcastle-Ottawa quality assessment scale. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated to compare cognitive and educational measures for Schistosoma infected /not dewormed vs. uninfected/dewormed children. Sensitivity analyses by study design, ROB, and sequential exclusion of individual studies were implemented. Thirty studies from 14 countries, including 38,992 SAC between 5-19 years old, were identified. Compared to uninfected children and children dewormed with praziquantel, the presence of Schistosoma infection and/or non-dewormed status was associated with deficits in school attendance (SMD = -0.36, 95%CI: -0.60, -0.12), scholastic achievement (SMD = -0.58, 95%CI: -0.96, -0.20), learning (SMD = -0.39, 95%CI: -0.70, -0.09) and memory (SMD = -0.28, 95%CI: -0.52, -0.04) tests. By contrast, Schistosoma-infected/non-dewormed and uninfected/dewormed children were similar with respect to performance in tests of reaction time (SMD = -0.06, 95%CI: -0.42, 0.30) and intelligence (SMD = -0.25, 95%CI: -0.57, 0.06). Schistosoma infection-associated deficits in educational measures were robust among observational studies, but not among interventional studies. The significance of infection-associated deficits in scholastic achievement was sensitive to ROB. Schistosoma infection-related deficits in learning and memory tests were invariant by ROB and study design. CONCLUSION/SIGNIFICANCE: Schistosoma infection/non-treatment was significantly associated with educational, learning, and memory deficits in SAC. Early treatment of children in Schistosoma-endemic regions could potentially mitigate these deficits. TRIAL REGISTRATION: ClinicalTrials.gov CRD42016040052.
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“Whilst the detrimental effects of helminth infections (both STH [4] and schistosomes [7]) have been previously reported”
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“while meta-analysis has indicated that schistosome infections were significantly associated with educational, learning, and memory deficits in school-aged children [7].”
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Metadata
- Authors
- Ezeamama, A. E., Bustinduy, A. L., Nkwata, A. K., Martinez, L., Pabalan, N., Boivin, M. J., & King, C. H.
- Affiliations
- University of Georgia (US)
- London School of Hygiene & Tropical Medicine (GB)
- Angeles University Foundation (PH)
- Michigan State University (US)
- Case Western Reserve University (US)
- Corresponding author
- Ezeamama, Amara E.
- ORCID
- Venue
- PLoS neglected tropical diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-01-12
- Volume
- 12
- Issue
- 1
- Pages
- e0005524
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC5766129
- OpenAlex
- W2783986784
- Cited by
- 149
- References
- 77
- Citations by year
- 2026: 19 · 2025: 13 · 2024: 15 · 2023: 16 · 2022: 20 · 2021: 27 · 2020: 15 · 2019: 15 · 2018: 7
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE).
- Topics
- Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Mollusks and Parasites Studies
- Keywords
- schistosomiasis, cognitive impairment, educational losses, school attendance, academic performance, praziquantel, anthelmintic treatment, school-aged children, learning, memory, reaction time, intelligence, intellectual disability, neuropsychological outcomes, neglected tropical diseases, neuroschistosomiasis, risk of bias
- MeSH terms
- Memory and Learning Tests, Adolescent, Animals, Anthelmintics, Child, Child, Preschool, Cognition, Humans, Intelligence, Learning Disabilities, Memory, Memory Disorders, Praziquantel, Reaction Time, Schistosoma, Schistosomiasis, Cognitive Dysfunction
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