Mass deworming for children: no wormhole

Anand Viswanathan


Children in developing countries are generally considered to be at a high risk of malnourishment. Many have worms growing in their intestines. Stunted growth, impaired mental development, poor school performance leading to reduced success at jobs later in life were some of the effects attributed to the worms. One miracle cure that was supposed to improve all these outcomes was mass administration of a short course of deworming medications to all school-going children, irrespective of whether they had the worms or not. Well, this was believed to be effective, until recently.

iStock_Indian_Children_000057472796_Medium

Do we have recent cumulative scientific evidence about this?

Updated Cochrane Systematic Review “Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance”, published in July 2015 http://bitly.com/1JgBbaY

What was the question asked?

Large scale public health mass-deworming programs: do they cause improvements in health and school-related outcomes in children?

Which population was represented in the studies?

Children living in low to high endemic areas in Asia (India, Bangla Desh, Indonasia, Vietnam, Malaysia, China, Kenya, Philippines), Africa (Cameroon, Sierra Leone, South Africa, Botswana, Uganda, Ethiopia, Benin, Zaire, Nigeria, Tanzania), Carribean nations Haiti and Jamaica, and the Central American country Guatemala.

What were the findings?

Deworming public health programmes have little or no effect on average weight gain, haemoglobin, height, cognitive ability, school performance, and mortality of children, even in high endemic areas

What did the authors conclude?

Current evidence does not support large public health programmes of deworming in developing countries.

What does this mean? Should we continue with mass-deworming programs?

Public health initiatives targeted at deworming large number of children are being supported by the WHO, as well as by many national governments and NGOs across the world. In light of the findings of this latest scientific evidence, it might be time for these institutions to have a relook at their strategies. Funds and resources utilized in deworming programs could instead be used for interventions that are proven to be effective. More importantly, the ball would be back in the states’ court to take concrete steps to address the more tangible deficiencies in terms of nutrition, hygiene and school infrastructure for children.

Reference:

Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance. In: Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2015 [cited 2015 Jul 23]. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000371.pub6/abstract

 

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Anand Viswanathan, a rehabilitation physician, currently works in a research position at Cochrane South Asia, Christian Medical College, Vellore- India. He is a firm believer in ‘shared decision making’  and ‘patient-centered clinical research’  being key to achieving optimal population healthcare. He could be reached at @anandtmc 

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