Meta-analysis and public policy: Reconciling the evidence on deworming.

The WHO recommends mass drug administration (MDA) for intestinal worm infections in areas with over 20% infection prevalence. Recent Cochrane meta-analyses endorse treatment of infected individuals but recommend against MDA. We conducted a theory-agnostic random-effects meta-analysis of the effect of multiple-dose MDA and a cost-effectiveness analysis. We estimate significant effects of MDA on child weight (0.15 kg, 95% CI: 0.07, 0.24; P < 0.001), mid-upper arm circumference (0.20 cm, 95% CI: 0.03, 0.37; P = 0.02), and height (0.09 cm, 95% CI: 0.01, 0.16; P = 0.02) when prevalence is over 20% but not on Hb (0.06 g/dL, 95% CI: -0.01, 0.14; P = 0.1). These results suggest that MDA is a cost-effective intervention, particularly in the settings where it is recommended by the WHO.

Twenty-year economic impacts of deworming.

Estimating the impact of child health investments on adult living standards entails multiple methodological challenges, including the lack of experimental variation in health status, an inability to track individuals over time, and accurately measuring living standards and productivity in low-income settings. This study exploits a randomized school health intervention that provided deworming treatment to Kenyan children, and uses longitudinal data to estimate impacts on economic outcomes up to 20 y later. The effective respondent tracking rate was 84%. Individuals who received two to three additional years of childhood deworming experienced a 14% gain in consumption expenditures and 13% increase in hourly earnings. There are also shifts in sectors of residence and employment: treatment group individuals are 9% more likely to live in urban areas, and experience a 9% increase in nonagricultural work hours. Most effects are concentrated among males and older individuals. The observed consumption and earnings benefits, together with deworming's low cost when distributed at scale, imply that a conservative estimate of its annualized social internal rate of return is 37%, a high return by any standard.

Feasibility of delivering vitamin A supplementation (VAS) and deworming through routine community health services in Siaya County, Kenya: A cross-sectional study.

Vitamin A deficiency and soil-transmitted helminth infection are serious public health problems in Kenya. The coverage of vitamin A supplementation and deworming medication (VASD) provided through mass campaigns is generally high, yet with a cost that is not sustainable, while coverage offered through routine health services is low. Alternative strategies are needed that achieve the recommended coverage of >80% of children twice annually and can be managed by health systems with limited resources. We undertook a study from September to December 2021 to compare the feasibility and coverage of VASD locally delivered by community health volunteers (CHV) ("intervention arm") to that achieved by the bi-annual Malezi Bora campaign event ("control arm"). This comparative cross-sectional study was conducted in sub-counties of Siaya County using both qualitative and quantitative methods. VASD were offered through the CHS in Alego Usonga and through Malezi Bora in Bondo Sub-County. Coverage was assessed by a post-event coverage survey among caregivers of children aged 6-59 months (n = 307 intervention; n = 318 control). Key informant interviews were conducted with n = 43 personnel across both modalities, and 10 focus group discussions were conducted with caregivers of children aged 6-59 months to explore knowledge, attitudes and perceptions of the two strategies. VAS coverage by CHV was 90.6% [95% CI: 87.3-93.9] compared to 70.4% [95% CI: 65.4-75.4] through the Malezi Bora, while deworming coverage was 73.9% [95% CI: 69.0-78.7] and 54.7% [95% CI: 49.2-60.2], respectively. With sufficient training and oversight, CHV can achieve superior coverage to campaigns.

Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age: a study from Sub-Saharan Africa.

BACKGROUND: In sub-Saharan Africa, infant anemia, stunting and low birth weight remains major public health problems. It is unclear whether prenatal iron supplementation and/or deworming can reduce the risk of infant stunting, anemia and low birth weight. The aim of this study was to investigate the relationship between iron supplementation and/or deworming and stunting, anemia, and low birth weight in infants under two years of age in sub-Saharan Africa. METHODS: Our studies examined pooled data from Demographic and Health Surveys (DHS) in twenty-three African countries collected between 2014 and 2020. childhood anemia and stunting in infants under the age of two were the primary outcomes. Iron supplementation and deworming during prenatal visits were the main exposure variables. A multivariate logistic regression model was used to investigate these relationships. RESULTS: The prevalence of stunting was 29.9%, severe stunting was 10.6%, childhood anemia was 74.3%, childhood severe anemia was 3.2%, and low birth weight was 16.4%, respectively. The use of prenatal iron supplementation alone was associated with a significant reduction of childhood anemia [aOR (95% CI) = 0.9 (0.8-1.0)]. Prenatal deworming alone was associated with a significantly reduced risk of stunting [aOR (95% CI) = 0.7 (0.8-1.0)], childhood anemia [aOR (95% CI) = 0.7 (0.8-0.9)], and low birth weight [aOR (95% CI) = 0.7 (0.8-1.0)]. Prenatal iron supplementation plus deworming or iron supplementation (with or without deworming) were not associated with childhood anemia, infant stunting and low birth weight. CONCLUSIONS: In Sub-Saharan Africa, prenatal deworming alone has the potential to improve infants' outcomes. Childhood anemia was improved with prenatal iron supplementation alone. Our recent findings indicate the necessity for prospective studies on the association between prenatal iron supplementation plus deworming and childhood anemia, stunting and low birth weight.

Resistance to single dose albendazole and reinfection with intestinal helminths among children ages 2 to 11 years from the Peruvian Amazon region: a study protocol.

BACKGROUND: Deworming programs aimed at reducing morbidity and mortality from geohelminth infections are common in many countries where these infections are endemic, but data demonstrating increasing levels of resistance to albendazole and mebendazole are causes for concern. Studies to evaluate the clinical efficacy of deworming programs are critical to maintain high infection control goals. METHODS: We propose to assess the clinical efficacy of Peruvian national guidelines for deworming programs in a prospective observational study conducted in the Amazon River basin area near Iquitos, Peru. Major outcomes to be evaluated include (1) albendazole resistance of intestinal helminths (trichuriasis, ascariasis, hookworm), and (2) frequency of reinfection with intestinal helminths 4 months after treatment with albendazole. Children ages 2-11 years from the Belén District of Iquitos will be identified based on a community census. Following parental informed consent, demographic data, weight, and height will be recorded and a stool specimen for parasitological exam by direct observation and Kato-Katz concentration method, and helminthic egg counts will be collected prior to administration of albendazole, following Peruvian national guidelines. Follow-up stool specimens examined in the same manner will be collected at 20 days, 90 days, and 100 days following initial administration of albendazole, and based on parasites found repeat treatment will be administered in accordance with national guidelines. Real-time multiplex qPCR will be performed on helminth positive samples collected prior to initial deworming and on helminth-positive specimens detected on day 15-20. A total sample size of 380 participants was calculated based on total population in the target group and prevalence estimates of helminth infections and clinical resistance based on recent data. DISCUSSION: Data from observational clinical efficacy studies are important to guide geohelminth infection control programs. Trial registration https://www.researchregistry.com/ . Identification number: researchregistry7736; Registered retrospectively March 13, 2022; https://www.researchregistry.com/browse-the-registry#home/registrationdetails/622e024cf06132001e3327bf/.

Factors associated with the use of deworming drugs during pregnancy in Tanzania; an analysis from the 2015-16 Tanzanian HIV and malaria indicators survey.

BACKGROUND: The use of deworming drugs is one of the important antenatal strategies in preventing anaemia in pregnancy. Little is known about the factors associated with the use of deworming drugs, which accounts for the aim of this study. METHOD: The study used data from the 2015-16 Tanzania HIV Demographic and Health Survey and Malaria Indicators Survey (2015-16 TDHS-MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple logistic regression analyses were used. RESULTS: The majority of interviewed women 3864(60.1%) took deworming drugs. In a weighed multiple logistic regression, women residing in urban areas reported greater use of deworming drugs than women residing in rural areas [AOR = 1.73, p = 0.01, 95% CI (1.26-2.38)]. In the four areas of residence, compared to women residing in mainland rural areas, women residing in mainland urban areas and Pemba islands reported greater use of deworming drugs [mainland urban (AOR = 2.56 p < 0.001,95% CI(1.78-3.75), and Pemba Island (AOR = 1.18, p < 0.001, 95% CI(1.17-1.20)]. However, women residing in Zanzibar Island (Unguja) were less likely to use deworming drugs compared to women in mainland rural women (AOR = 0.5, p < 0.001, 95% CI (0.45-0.55). Similarly, compared to women under 20 years of age, women between 20 to 34 years reported significantly greater use of deworming drugs [20 to 34 years (AOR = 1.30, p = 0.03, 95% CI(1.02-1.65). Likewise, greater use of deworming drugs was reported in women with a higher level of education compared to no education [higher education level (AOR = 3.25, p = 0.01,95% CI(1.94-7.92)], rich women compared to poor [rich (AOR = 1.43, p = 0.003, 95% CI (1.13-1.80)] and in women who initiated antenatal care on their first trimester of pregnancy compared to those who initiated later [AOR = 1.37, p < 0.001, 95% CI (1.17-1.61)]. CONCLUSION: Women who were more likely to use the deworming drugs were those residing in urban compared to rural areas, aged between 20 and 34 years, those with a higher level of formal education, wealthier, and women who book the antenatal clinic (ANC) within their first trimester of pregnancy. Considering the outcomes of anaemia in pregnancy, a well-directed effort is needed to improve the use of deworming drugs.

Community and individual level determinants and spatial distribution of deworming among preschool age children in Ethiopia: spatial and multi-level analysis.

BACKGROUND: Soil-transmitted helminths caused millions of morbidity of preschool age children in sub-Saharan Africa with low socio-economic status and lack of clean water and sanitation. In Ethiopia, nearly half of children are affected by intestinal parasites. Despite this prevalence, deworming medication utilization among preschool age children is low. Hence, this study aimed to assess the community and individual level determinants and spatial distributions of deworming among preschool age children in Ethiopia. METHODS: Crossectional collected 2016 Ethiopian Demographic and Health Survey datasets with a total weighted 8146 children 12-59 months old were used for this study. The data were cleaned, extracted, and analyzed using STAT Version 16 software and exported to MS excel for spatial analysis. In addition, ArcGIS and SaTScan software were used to detect the geographic distribution of deworming utilization among preschool age children. RESULTS: The magnitude of deworming among preschool age children in Ethiopia was 13.32% (95% CI: 12.60, 14.08) and ranges from the lowest 3.34% (95% CI: 1.01, 10.45) Afar region to the highest 28.66% (95% CI:24.95, 32.69) Tigray region. In multilevel multivariable logistics regression analysis; variables such as secondary and above women education [AOR = 1.89; 95%CI; 1.32, 2.73], women who have occupation [AOR = 1.47; 95%CI; 1.23, 1.76], child with 12-23 months old [AOR = 2.00; 95%CI; 1.62, 2.46], having ANC visit [AOR = 1.68; 95%CI; 1.35, 2.08], households that have media exposure [AOR = 1.50; 95%CI; 1.22, 1.85] were significantly associated with deworming among preschool age children. Afar, Eastern Amhara, Dire Dewa, Harari, Somalia, and Eastern SNNPE regions were cold spot regions with Global Moran's I value 0.268 (p < 0.0001) for deworming of preschool age children. CONCLUSIONS: The prevalence of deworming among preschool age children in Ethiopia is relatively low. Individual-level factors such as; maternal education and occupation, having ANC visit, child age, household media exposure, and community-level variables such as; community media usage had a significant association with deworming among preschool age children in Ethiopia. These findings highlight that, the Ministry of Health (MOH) Ethiopia should prepare a regular campaign for deworming programs for preschool age children. Mass media promotion of deworming should be strengthened. The Ministry of Education should work to strengthen women's education, household and community media exposure. Prior attention should be given to low deworming regions such as Afar, Somalia, Diredewa, and Harari regions.

Spatial variation and associated factors of deworming among children aged 24 to 59 months in Ethiopia: spatial and multilevel logistic analysis.

BACKGROUND: Intestinal parasitic infection is one of the neglected tropical diseases (NTD) which is mainly concentrated in developing countries. Gastrointestinal parasitic infections are diseases of poverty, which mainly affects children living in tropical and subtropical regions like Ethiopia. Deworming to children aged 24-59 months of age is one of the strategic initiatives to halt the global burden of intestinal parasitosis among under-five children. The information generated at local levels like hotspot areas (clusters with a high proportion of poor deworming uptake) that were identified in this study could help decision-makers to develop location-based interventional strategies. OBJECTIVE: This study was aimed to assess the spatial variation and factors associated with poor deworming uptake among children aged 24-59 months in Ethiopia using evidence from the 2016 Ethiopian Demographic Health Survey (EDHS). METHODS: To explore, create, visualize and edit the spatial information of poor uptake of deworming medication, ArcGIS version 10.8 software was used. The spatial pattern of poor deworming uptake was determined using global spatial autocorrelation. Purely spatial scan statistic was used to identify statistically significant hotspot areas using SaTScan™ version 9.7 software. Multilevel logistic regression analysis was fitted to identify factors associated with poor deworming uptake in Ethiopia. Variables with a p-value< 0.2 in the bivariable regression were considered for multivariable regression analysis. Adjusted odds ratio with a 95% confidence interval (CI) and p-value < 0.05 were used to declare the statistical significance of each factor. RESULTS: The spatial pattern of poor deworming uptake in Ethiopia was non-random, i.e. clustered. The most likely cluster was found concentrated in most parts of Somali and East Oromia. Variables like being born from an uneducated mother ((Adjusted Odds Ratio (AOR) = 1.65; 95% CI: 1.16-2.36)), being born from an unemployed mother (AOR = 1. 1.43; 95% CI: 1.19-1.74), being delivered at home (AOR = 1.60 95% CI: 1.27, 2.02), diarrhea in the last 2 weeks (AOR = 0.68, 95%CI: 0.51, 0.90), and region of residency were the significant variables associated with poor deworming medication uptake among children aged to 24 to 59 months in Ethiopia. CONCLUSION: The spatial pattern of poor deworming uptake was non-random in Ethiopia. Variables like educational status, employment, distance, place of delivery, diarrhea and region of living were found associated with poor deworming uptake. Tailoring interventional programs based on identified clusters is recommended to minimize this unfavorable deworming uptake.

Household caregivers' knowledge and control of helminthiasis in preschool children in a rural community of Enugu state, Nigeria.

Helminthiasis causes iron deficiency anemia, pica, growth, and mental retardation in children. Deworming exercises are being included as part of various interventional programs to reduce the disease burden. However, the success or failure of such activities in terms of household caregivers' knowledge and practice of deworming is not usually adequately evaluated, thus this study. This was a cross-sectional descriptive study carried out in the rural community of Enugu State, Nigeria. Pretested semi-structured interviewer-administered questionnaire was used. Inferential statistics, χ2 test, and t-test were also used in the analysis for categorical and continuous variables, respectively. A total of 294 preschool children and 250 caregivers were studied. Among the caregivers, 212 (71.9%) had good knowledge and 149 (50.5%) had good practice of deworming. There was a statistically significant association between the age of respondents and knowledge score (χ2 = 6.471, p = 0.039) and between the educational level of respondents and practice score (χ2 = 30.632, p < 0.001). Most respondents in the rural community had a good knowledge of worm infestation and only half had good practice of deworming. Also, there was a significant difference between the age of respondents and knowledge of helminthiasis and between the educational level of respondents and deworming activities of respondents.

Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania.

BACKGROUND: Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania. METHODS: We conducted a cluster randomised trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders. RESULTS: At the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28-2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.74-1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59-2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73-1.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study. CONCLUSIONS: The intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children's handwashing behaviour. TRIAL REGISTRATION: The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number ( ISRCTN45013173) .

Association of iron supplementation and deworming with early childhood development: analysis of Demographic and Health Surveys in ten low- and middle-income countries.

PURPOSE: We assessed the associations of iron supplementation and deworming separately or combined with improved early childhood development (ECD) status. METHODS: Cross-sectional data were analyzed for 29,729 children aged 36-59 months surveyed using the Demographic and Health Surveys in ten low- and middle-income countries, where iron supplementation and deworming are recommended by the World Health Organization. In each country, we estimated linear regression models for the effects of iron supplementation and deworming individually or combined on the Early Childhood Development Index (ECDI) z score, and whether this association differed between various ECD domains and the sex and residence of the child. Estimates were pooled using random-effects meta-analyses. RESULTS: Compared with receiving neither of the two interventions, iron supplementation plus deworming was associated with an increased ECDI z score (ß = 0.13, 95% confidence interval (CI) 0.03-0.22, p = 0.009), particularly in rural residences. However, iron supplementation and deworming, individually, were not associated with the ECDI z score. Iron supplementation plus deworming was associated with higher odds of on-track development in literacy-numeracy (OR = 1.57, 95% CI 1.24-2.01, p < 0.001) and learning domains (OR = 1.27, 95% CI 1.09-1.48, p = 0.003), but not with development in the social-emotional and physical domains. CONCLUSION: Iron supplementation plus deworming, particularly for populations who are more susceptible to iron deficiency and intestinal worm infections, could be an important intervention for improving ECD. These findings may inform the argument for the necessity of implementing iron supplementation and deworming for preschool-age children.

Perception and attitudinal factors contributing to periodic deworming of preschool children in an urban slum, Nigeria.

BACKGROUND: Over 20 million preschool-age children (PSAC) in Nigeria require periodic chemotherapy (PC) for soil-transmitted helminth (STH) infections. Persistently low coverage for this age group threatens the World Health Organization (WHO) 2030 target for eliminating STH infections. Current strategies for targeting PSAC have been largely ineffective. Hence, PSAC are mostly dewormed by their parents/caregivers. However, little is known of the perception and attitude of parents/caregivers of PSAC to deworming in this setting. METHODS: A mixed methods design, combining a community-based interviewer-administered questionnaire-survey (n = 433) and focus group discussions (FGD) (n = 43) was used to assess the perceptions and attitudes of mothers to periodic deworming of preschool children aged 2-5 years in Abakpa-Nike, Enugu, Nigeria. RESULTS: Coverage of periodic deworming in PSAC is 42% (95% CI: 37.3-46.8%). There is significant difference in the specific knowledge of transmission of STH (AOR = 0.62, 95% CI: 0.48-0.81, p = 0.000), complication of STH infections (AOR = 0.77, 95% CI: 0.61-0.98, p = 0.034), accurate knowledge of deworming frequency (AOR = 0.41, 95% CI: 0.18-0.90, p = 0.026), and knowledge of PC drug, mebendazole (AOR = 0.28, 95% CI: 0.09-0.90, p = 0.031), and pyrantel (AOR = 8.03, 95% CI: 2.22-29.03, p = 0.001) between mothers who periodically deworm their PSAC and those who do not. There is no significant difference in specific knowledge of the symptoms of STH infections (AOR = 0.76, 95% CI: 0.57-1.02, p = 0.069) and PC drug, Albendazole (AOR = 1.00, 95% CI: 0.46-2.11, p = 0.972). FGD revealed misconceptions that are rooted in stark ignorance of the disease. Overall attitude to deworming is positive and favourable. CONCLUSIONS: Poor coverage of periodic deworming for STH infections in PSAC in this setting are primarily driven by poor specific knowledge of the risks and burden of the infection. Focused health education on the burden and transmission of STH infections could complement existing strategies to improve periodic deworming of PSAC in this setting.

Routine vitamin A supplementation and other high impact interventions in Sierra Leone.

In 2017, transition to routine vitamin A supplementation (VAS) commenced as an integrated reproductive and child health service including vaccinations, Albendazole for deworming, complementary feeding demonstrations, 'quality' family planning counselling and provision of modern contraceptives. After 10 months, a lot quality assurance sampling survey evaluated coverage of these interventions. Each of three districts was divided into five supervision areas (lots), and 19 villages were randomly selected in each lot proportional to population size. Households were randomly selected, and a questionnaire was administered to a caregiver of a child 6-11, 12-23 and 24-59 months in each village. Overall, caregivers of 855 children were interviewed, and 19 questionnaires were completed for each age group (6-11, 12-23 and 24-59 months) in each of the five lots in each district. All lots in one district passed the threshold of 80% for VAS and 75% coverage for Albendazole, and two lots failed for either VAS/Albendazole in the other two districts. Overall, weighted VAS coverage for children 6-59 months was 86.9%, and weighted Albendazole coverage for children 12-59 months was 80.9%. Most caregivers (77.2%) knew that complementary feeding should be introduced at 6 months, 44.9% were providing three or more (of six) food groups, 84.9% were aware of family planning and 37.5% were using a modern contraceptive. Integration of reproductive and child health services appears to be a suitable platform for routine VAS and Albendazole whilst improving complementary feeding practices and access to family planning.

Prevalence and factors associated with intestinal parasitic infection among under-five children in and around Haro Dumal Town, Bale Zone, Ethiopia.

BACKGROUND: Intestinal parasitic infection is diversified illness and diseases caused millions morbidity among under-five children lives in developing countries particularly vulnerable rural communities. Deworming coverage in such community is low. The aim of this study was to determine the prevalence and associated risk factors of intestinal parasitic infections (IPIs) among under-five children live in and around Haro Dumal Town. METHODS: Community-based cross-sectional study was conducted in 561 randomly selected under-five children from June to August, 2018. The stool samples were collected and examined by basic parasitological techniques. Data related to socio-demographic and risk factors were collected using a self administered questionnaire. Statistical data analysis was done using SPSS version 21 and the bivariate and multivariate logistic regression used to compute the association between variables. P-value of < 0.05 was statistical significance. THE RESULTS: Of the 561 total under-five children, 216 (38.5%) were found to be infected with intestinal parasites. E.histolytica/dispar (15.3%) was the most prevalent parasite, followed by hook worm (14.4%) and T.trichuria (13.9%). Regarding risk factors, geo-phage [(AOR = 4.7; 95%CI: 2.0-10.4), P < 0.001], tungiasis [(AOR = 3.1; 95%CI: 1.1-6.6), P < 0.001], eating raw vegetable [(AOR = 1.3; 95%CI: 1.4-3.3), P < 0.001] were significantly associated with intestinal parasitic infections. CONCLUSION: Intestinal parasitic infections (IPIs) were found to be highly prevalent in the study area. Hence, improving sanitation, controlling ecto-parasite such as tungiasis, provision of safe water and successful mass-deworming are important.

Community deworming alleviates geohelminth-induced immune hyporesponsiveness.

In cross-sectional studies, chronic helminth infections have been associated with immunological hyporesponsiveness that can affect responses to unrelated antigens. To study the immunological effects of deworming, we conducted a cluster-randomized, double-blind, placebo-controlled trial in Indonesia and assigned 954 households to receive albendazole or placebo once every 3 mo for 2 y. Helminth-specific and nonspecific whole-blood cytokine responses were assessed in 1,059 subjects of all ages, whereas phenotyping of regulatory molecules was undertaken in 121 school-aged children. All measurements were performed before and at 9 and 21 mo after initiation of treatment. Anthelmintic treatment resulted in significant increases in proinflammatory cytokine responses to Plasmodium falciparum-infected red blood cells (PfRBCs) and mitogen, with the largest effect on TNF responses to PfRBCs at 9 mo-estimate [95% confidence interval], 0.37 [0.21-0.53], P value over time (Ptime) < 0.0001. Although the frequency of regulatory T cells did not change after treatment, there was a significant decline in the expression of the inhibitory molecule cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) on CD4+ T cells of albendazole-treated individuals, -0.060 [-0.107 to -0.013] and -0.057 [-0.105 to -0.008] at 9 and 21 mo, respectively; Ptime = 0.017. This trial shows the capacity of helminths to up-regulate inhibitory molecules and to suppress proinflammatory immune responses in humans. This could help to explain the inferior immunological responses to vaccines and lower prevalence of inflammatory diseases in low- compared with high-income countries.

Identification and molecular characterization of Echinococcus canadensis G6/7 in dogs from Corsica, France.

Recent surveys at slaughterhouses confirmed the presence of three different species of Echinococcus granulosus sensu lato in France: E. granulosus sensu stricto, E. ortleppi, and E. canadensis G6/7. The latter species was only identified on the French Mediterranean island of Corsica, with a high prevalence in pigs and wild boar. In order to investigate the life cycle of E. canadensis in this region, dog feces were collected in 31 municipalities, mainly from individual kennels. The analysis of fecal samples from 259 dogs by multiplex real-time PCR shows no infection by E. granulosus sensu stricto, but three dogs were infected by E. canadensis G6/7. Genetic analyses of mitochondrial genes (cox1, nad1, nad3, atp6) revealed in two dogs a haplotype previously identified in pigs. The third dog was infected by a new haplotype differing only from the two others from dogs by two mutations in the nad3 gene. This latter haplotype is genetically closer to those identified in pigs rather than those from wild boars. Analysis of questionnaires completed by the owners revealed that the sampled dog population was almost exclusively composed of hunting dogs that had been infrequently dewormed. Most of the owners (78%) leave carcasses of hunter-harvested wild boar in close proximity to their dogs. Nevertheless, genetic results seem to indicate that the three dogs were infected due to their consumption of a pig's infected viscera following home slaughtering. This study confirms the role of dogs as definitive hosts of E. canadensis G6/7 in Corsica. Further molecular studies, notably in human cases, are needed to assess the zoonotic impact of E. canadensis G6/7 in this region.

Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia.

Background: Emerging evidence suggests that helminth infections are associated with lower insulin resistance (IR). Current deworming programs might remove this helminth-associated protective effect. Therefore, we evaluated the anthelmintic treatment effect on changes in IR. Methods: We conducted a double-blind, household-cluster-randomized, placebo-controlled clinical trial on Flores island, Indonesia, an area endemic for soil-transmitted helminths (STHs). All subjects received 4 rounds of albendazole or matching placebo with 3-month intervals, for 3 consecutive days. The primary outcome was the change in homeostatic model assessment of IR in those aged >16 years. An intention-to-treat analysis was performed involving all subjects and ad hoc in the helminth-infected subjects. Results: We examined 797 (in 329 households) and 872 (in 353 households) subjects, who were assigned randomly into the albendazole and placebo arms, respectively. Albendazole was associated with a significant reduction in STH prevalence, total immunoglobulin E (IgE), and eosinophil count. Whereas albendazole had no effect on IR (estimated treatment effect, 0.006 [95% confidence interval, -.010 to .021]; P = .48) at the community level, it was associated with a significant increase in IR (estimated treatment effect, 0.031 [95% confidence interval, .004 to .059]; P = .04) (P value for interaction = .01) among helminth-infected subjects as detected by microscopy. Pathway analysis suggested that this might in part be due to an increased body mass index or a reduced eosinophil count. Conclusions: Anthelmintic treatment reduces STH prevalence, total IgE, and eosinophil count but has no effect on IR at the community level. In helminth-infected subjects, treatment significantly increases IR, highlighting the need for metabolic health monitoring with ongoing deworming programs. Clinical Trials Registration: ISRCTN 75636394.

Comparison of administrative and survey data for estimating vitamin A supplementation and deworming coverage of children under five years of age in Sub-Saharan Africa.

OBJECTIVE: To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries. METHODS: Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6- to 11-month and 12- to 59-month age group. RESULTS: For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean ± SD differences in coverage between administrative and survey data were 12.2% ± 22.5% for the door-to-door delivery strategy and 25.9% ± 24.7% for the fixed-site model (P = 0.06). For deworming, mean ± SD differences in coverage between data sources were 28.1% ± 43.5% and 33.1% ± 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6- to 11-month age group and 45 of 48 (94%) comparisons for the 12- to 59-month age group. CONCLUSION: Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods.

Lessons from implementing mass drug administration for soil transmitted helminths among pre-school aged children during school based deworming program at the Kenyan coast.

BACKGROUND: The 2012 London declaration which committed to "sustaining, expanding and extending drug access programmes to ensure the necessary supply of drugs and other interventions to help control soil-transmitted helminths (STH) by 2020" has seen many countries in Africa roll out mass drug administration (MDA) especially among school age children. In Kenya, however, during the National school-based deworming exercise, pre-school aged children (PSAC) have to access treatment at primary schools as the pre-school teachers are not trained to carry out deworming. With studies being conducted on the effectiveness of MDAs, the experiences of key education stakeholders which could improve the programme by giving best practices, and challenges experienced have not been documented. METHODS: This was a cross-sectional qualitative study using Focus group discussions (FGDs) and Key informant interviews (KIIs). It was conducted in 4 sub-counties with high STH prevalence at the Kenyan coast (Matuga, Malindi, Lunga Lunga and Msambweni) to understand best practices for implementing MDA among PSAC.FGDs categorized by gender were conducted among local community members, whereas KIIs involved pre-school teachers, primary school teachers, community health extension workers (CHEWs) and opinion leaders. Participants were purposefully selected with the saturation model determining the number of interviews and focus groups. Voice data collected was transcribed verbatim then coded and analyzed using ATLAS.Ti version 6. RESULTS: Majority of the primary school teachers and CHEWs reported that they were satisfied with the method of mobilization used and the training tools. This was however not echoed by the pre-school teachers, parents and chiefs who complained of being left out of the process. Best practices mentioned included timely drug delivery, support from pre-school teachers, and management of side effects. Overcrowding during the drug administration day, complexity of the forms (for instance the 'S form') and long distance between schools were mentioned as challenges. CONCLUSION: There is need to utilize better sensitization methods to include the local administration as well as the parents for better uptake of the drugs. Extending deworming training to pre-school teachers will enhance the national deworming programme.

'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR.

BACKGROUND: The Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR. METHODS: The study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression. RESULTS: A total of 1847 children (mean age = 6.7 years, range 6.0-8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination - 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools. CONCLUSIONS: The study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children. The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).