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.

COVID-19 and the gendered impacts on adolescent wellbeing: Evidence from a cross-sectional study of locally adapted measures in Ethiopia, Jordan, and Palestine.

Background: The COVID-19 pandemic and associated policy responses have interrupted services, increased financial stress, and driven social isolation, with acute impacts for adolescents. This study explores relationships between gender, COVID-19 vulnerability, social protection, and adolescent wellbeing in three diverse contexts: Ethiopia, Jordan, and Palestine. Methods: This study presents findings from a quantitative phone survey with adolescents in Ethiopia, Jordan, and Palestine (n = 5752) on household-level vulnerability to COVID-19-related shocks, household-level social protection (cash transfers or food aid), and locally adapted outcome measures designed to capture the gendered impacts of COVID-19 (collected between November 22, 2020 and February 25, 2021). We examine the relationship between each outcome and household-level COVID-19 vulnerability and social protection (and their interaction) using multivariate regressions, adjusting for adolescent and household characteristics. Findings: For all adolescents, increased vulnerability to COVID-19-related shocks is associated with worse outcomes for resilient coping and time spent on domestic tasks and care work. Across samples, girls spent over two additional hours on domestic and care work compared to boys. Girls in more vulnerable households experienced greater gendered constraints on behaviour. We find no association between receipt of social protection and adolescent wellbeing, and find that it only moderates the effect of COVID-19 vulnerability for less vulnerable households. Disability status, being out of school, and experiencing child marriage are also associated with adverse outcomes. Interpretation: Our study highlights that the pandemic has exacerbated underlying gender inequalities across adolescents in three very different settings, and that existing social safety nets are not adequate to fully address these impacts, particularly for the most vulnerable. Funding: This work was supported by UK aid through a grant from the Foreign, Commonwealth & Development Office to the Gender and Adolescence: Global Evidence (GAGE) longitudinal research study; the EMERGE project (Bill & Melinda Gates Foundation grants: OPP1163682 and INV018007; PI Anita Raj) and the World Health Organization (WHO) Regional Office for the Eastern Mediterranean.

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.