Effect of Deworming on Indices of Health, Cognition, and Education among Schoolchildren in Rural China: A Cluster-Randomized Controlled Trial
Effect of Deworming on Indices of Health, Cognition, and Education among Schoolchildren in Rural China: A Cluster-Randomized Controlled Trial
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驱虫对中国农村学童健康、认知和教育指数的影响：整群随机对照试验
DOI：
10.4269/ajtmh.16-0354
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Zhu, Tingjun
中科院分区：
文献类型：
--
作者：
Liu, Chengfang;Lu, Louise;Zhu, Tingjun
土壤传播蠕虫（STH）感染全球超过10亿人。令人关注的是，学龄儿童慢性感染STH可能会对他们的发育造成不良影响，包括他们的健康，认知和教育。然而，最近的两项科克伦综述研究了驱虫药物对STH营养、血红蛋白和学校表现的影响，发现文献中的随机对照试验（RCT）提供的证据基础不足以得出可靠的结论。本研究使用集群随机对照试验，通过评估驱虫干预对中国农村学童营养、认知和学校表现的影响来补充现有证据。由当地卫生从业人员在基线感染率为41.9%的环境中实施的干预措施（95%置信区间[CI] = 39.8%，43.9%）和阳性检测学童粪便中每克599.5个鸡蛋的感染强度（95%CI = 473.2，725.8），包括分发400 mg剂量的阿苯达唑，同时进行有关STH感染、治疗和预防的教育培训。在研究过程中进行了两次干预-在2013年5月的基线和后来的2013年11月。我们发现，驱虫干预降低了感染率和感染强度，但这些感染率的下降并没有伴随着对营养，认知或学校表现的影响。我们的解释是，在我们的样本人群中，驱虫的影响被轻度感染强度减弱。需要来自未来随机对照试验的证据来评估驱虫对中度和重度蠕虫感染地区关键结局的影响。
Soil-transmitted helminths (STHs) infect over one billion people worldwide. There is concern that chronic infection with STHs among school-aged children may detrimentally affect their development, including their health, cognition, and education. However, two recent Cochrane reviews examining the impact of deworming drugs for STH on nutrition, hemoglobin, and school performance found that randomized controlled trials (RCTs) in the literature provide an insufficient evidence base to draw reliable conclusions. This study uses a cluster-RCT to add to existing evidence by assessing the impact of a deworming intervention on nutrition, cognition, and school performance among schoolchildren in rural China. The intervention, implemented by local health practitioners in a setting with a baseline infection prevalence of 41.9% (95% confidence interval [CI] = 39.8%, 43.9%) and infection intensity of 599.5 eggs per gram of feces among positive-tested schoolchildren (95% CI = 473.2, 725.8), consisted of distributing a 400-mg dose of albendazole accompanied with educational training about STH infection, treatment, and prevention. The intervention was conducted twice over the course of the study-at baseline in May 2013 and later in November 2013. We found that the deworming intervention reduced both infection prevalence and infection intensity, but these declines in infection were not accompanied by an impact on outcomes of nutrition, cognition, or school performance. Our interpretation is that the impact of deworming was attenuated by the light infection intensity in our sample population. Evidence from future RCTs is needed to assess the effect of deworming on key outcomes in areas with moderate and severe worm infections.