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Cited by 35Parasites and Host InteractionsChild Nutrition and Water AccessPoverty, Education, and Child Welfare

Deworming and adjuvant interventions for improving the developmental health and well-being of children in low- and middle-income countries: A systematic review and network meta-analysis

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Welch, Vivian A., Ghogomu, Elizabeth, Hossain, Alomgir, Awasthi, Shally, Bhutta, Zulfi, Cumberbatch, Chisa, Fletcher, Robert, McGowan, Jessie +7 more·2016·Campbell Systematic Reviews: Better Evidence for a Better World
DOI 10.4073/csr.2016.7
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Abstract

This review evaluates the effects of mass deworming for soil-transmitted helminths on growth, educational achievement, cognition, school attendance, quality of life and adverse effects in children in endemic helminth areas. Mass deworming for soil-transmitted helminths probably has little to no effect on weight, height, school attendance, cognition measured by short-term attention, or mortality. There are no data on short-term quality of life and little evidence of adverse effects. Mass deworming for schistosomiasis alone may slightly increase weight but probably has little to no effect on height and cognition. The evidence does not support indirect benefits for untreated children from being exposed to treated children. One moderate quality long term study showed an increase in economic productivity (hours worked) and increase in educational enrollment 10 years later of mass deworming and hygiene promotion. But, it is uncertain whether these effects are due to the deworming or the combined hygiene intervention. Findings are consistent for various groups of the population by age, gender, worm prevalence, baseline nutritional status, compliance, impact on worms, infection intensity, types of worms, risk of bias, and study characteristics. Deworming for children who screened positive for schistosomiasis or soil-transmitted helminths results in larger gains in weight but no difference in effect on height, cognition or school attendance. Also, one low to moderate quality study showed long-term benefit on school enrolment of sanitation improvement combined with screening and treating people for hookworm infection. Abstract Background Soil-transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by the World Health Organization (WHO), affect more than a third of the world's population, with varying intensity of infection. There is debate about the effectiveness and cost-effectiveness of mass deworming of children as a strategy to improve child health in endemic areas. Objectives The objective of this review was 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 inendemic helminth areas. We also aimed to assess possible effect modifiers using pre-planned subgroup analysis of age, sex, prevalence of worms and baseline nutritional status. Search strategy Our librarian scientist designed a search strategy that was reviewed by the Campbell Collaboration librarian for the following 11 electronic databases: MEDLINE, CINAHL, LILACS, EMBASE, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts, up to May 13, 2015. We also searched websites and clinical trial registers, other systematic reviews, and contacted authors and experts in the field. Study selection criteria We included studies if they included children aged six months to 16 years, carried out mass deworming for soil-transmitted helminths (alone or in combination with other drugs or child health interventions), reported one of our primary outcomes of growth, school attendance, school performance, cognitive processing or development, well-being, or adverse events, and included a comparator to a control or active comparator. We included randomized trials, quasi-randomized trials, controlled before after studies, interrupted time series and quasi-experimental studies that used statistical methods of analysis to match participants with non-participants, or statistical methods to account for confounding and sample selection bias. Data collection and analysis We screened titles and abstracts in duplicate, as well as the full texts of those considered eligible at level 1. We used a pre-tested data extraction form to collect details on participants, interventions, outcomes, study methods and setting, and extracted data in duplicate. We conducted random effects pairwise meta-analysis for all primary outcomes. If heterogeneity was acceptable (I 2 <75%), we conducted random effects, Bayesian network meta-analysis to compare different drugs and combinations of interventions, using WinBugs. We assessed risk of bias with the Cochrane risk of bias tool or the Campbell International Development review group tool, as appropriate. We assessed GRADE certainty of evidence for each outcome using the GRADE Working Group methods. Results We analysed 65 studies with a duration from four months to five years (median 12 months) with 1,092,120 children and five long-term studies eight to 10 years after mass deworming programmes with >90,000 children. These studies were conducted in 23 low and middle income countries (L&MICs), in areas where prevalence of worms ranged from 0.5 per cent to 99 per cent infected. Most of

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Authors
Welch, V. A., Ghogomu, E., Hossain, A., Awasthi, S., Bhutta, Z., Cumberbatch, C., Fletcher, R., McGowan, J., Krishnaratne, S., Kristjansson, E., Sohani, S., Suresh, S., Tugwell, P., White, H., & Wells, G.
Corresponding author
Welch, Vivian A.
ORCID
Venue
Campbell Systematic Reviews: Better Evidence for a Better World
Publisher
SAGE Publications
Published
2016-08
Volume
12
Issue
1
ISSN
1891-1803 (ISSN-L)
DOI
10.4073/csr.2016.7
OpenAlex
W4238469332
Cited by
35
References
177
Citations by year
2026: 3 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 5 · 2018: 7 · 2016: 3 · 2015: 1
FWCI
0.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Campbell Systematic Reviews (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Canadian Institutes of Health Research Knowledge Synthesis
  • World Health Organization
Topics
  • Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Social Sciences › Safety Research › Poverty, Education, and Child Welfare
Keywords
mass deworming, soil-transmitted helminths, schistosomiasis, child growth, school attendance, academic performance, cognitive development, quality of life, neglected tropical diseases, hygiene promotion, sanitation, hookworm, economic productivity, child mortality, low- and middle-income countries, effect modifiers, subgroup analysis, cost-effectiveness

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