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Effects of Deworming on Malnourished Preschool Children in India: An Open-Labelled, Cluster-Randomized Trial

Awasthi S, Peto R, Pande VK, Fletcher RH, Read S, Bundy DA - PLoS Negl Trop Dis (2008)

Bottom Line: Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children.In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain.As, however, we do not know the control parasite burden, these results are difficult to generalize.

Affiliation: Department of Paediatrics, King George's Medical University, Lucknow, India. sawasthi@sancharnet.in

ABSTRACT

Background: More than a third of the world's children are infected with intestinal nematodes. Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children.

Methodology: We studied the effects on the heights and weights of 3,935 children, initially 1 to 5 years of age, of five rounds of anthelmintic treatment (400 mg albendazole) administered every 6 months over 2 years. The children lived in 50 areas, each defined by precise government boundaries as urban slums, in Lucknow, North India. All children were offered vitamin A every 6 months, and children in 25 randomly assigned slum areas also received 6-monthly albendazole. Treatments were delivered by the State Integrated Child Development Scheme (ICDS), and height and weight were monitored at baseline and every 6 months for 24 months (trial registration number NCT00396500). p Value calculations are based only on the 50 area-specific mean values, as randomization was by area.

Findings: The ICDS infrastructure proved able to deliver the interventions. 95% (3,712/3,912) of those alive at the end of the study had received all five interventions and had been measured during all four follow-up surveys, and 99% (3,855/3,912) were measured at the last of these surveys. At this final follow up, the albendazole-treated arm exhibited a similar height gain but a 35 (SE 5) % greater weight gain, equivalent to an extra 1 (SE 0.15) kg over 2 years (99% CI 0.6-1.4 kg, p = 10(-11)).

Conclusions: In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain. The ICDS system could provide a sustainable, inexpensive approach to the delivery of anthelmintics or micronutrient supplements to such populations. As, however, we do not know the control parasite burden, these results are difficult to generalize.

Trial registration: ClinicalTrials.gov NCT00396500.

CONSORT Flow Chart
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pntd-0000223-g001: CONSORT Flow Chart

Mentions: A total of 3935 children, aged 1 to 5 years at entry, 1967 from 25 anganwadi centers allocated “usual care” and 1968 from 25 anganwadi centers allocated “usual care plus albendazole” were enrolled in the study from April to August, 1994 and followed up until December, 1996 (Figure 1). Relative to WHO reference standards, the point prevalence at baseline of underweight was 49% (1924 children), stunting 63% (2471), and wasting 18% (699). The children were all from families with incomes below the national poverty level, and 51% were girls. The children were treated and surveyed 5 times (at 0, 6, 12, 18 and 24 months) and anthropometric data were collected on all 5 occasions from 95% (3712/3912) of the surviving children in each arm of the study. At 24 months, 99% (3855/3912) of the surviving children were measured. There were 23 deaths in 2 years, of which 13 were in the usual care arm and 10 were in the arm receiving usual care plus albendazole.

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Effects of Deworming on Malnourished Preschool Children in India: An Open-Labelled, Cluster-Randomized Trial

Awasthi S, Peto R, Pande VK, Fletcher RH, Read S, Bundy DA - PLoS Negl Trop Dis (2008)

CONSORT Flow Chart
© Copyright Policy
pntd-0000223-g001: CONSORT Flow Chart
Mentions: A total of 3935 children, aged 1 to 5 years at entry, 1967 from 25 anganwadi centers allocated “usual care” and 1968 from 25 anganwadi centers allocated “usual care plus albendazole” were enrolled in the study from April to August, 1994 and followed up until December, 1996 (Figure 1). Relative to WHO reference standards, the point prevalence at baseline of underweight was 49% (1924 children), stunting 63% (2471), and wasting 18% (699). The children were all from families with incomes below the national poverty level, and 51% were girls. The children were treated and surveyed 5 times (at 0, 6, 12, 18 and 24 months) and anthropometric data were collected on all 5 occasions from 95% (3712/3912) of the surviving children in each arm of the study. At 24 months, 99% (3855/3912) of the surviving children were measured. There were 23 deaths in 2 years, of which 13 were in the usual care arm and 10 were in the arm receiving usual care plus albendazole.

Bottom Line: Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children.In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain.As, however, we do not know the control parasite burden, these results are difficult to generalize.

Affiliation: Department of Paediatrics, King George's Medical University, Lucknow, India. sawasthi@sancharnet.in

ABSTRACT

Background: More than a third of the world's children are infected with intestinal nematodes. Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children.

Methodology: We studied the effects on the heights and weights of 3,935 children, initially 1 to 5 years of age, of five rounds of anthelmintic treatment (400 mg albendazole) administered every 6 months over 2 years. The children lived in 50 areas, each defined by precise government boundaries as urban slums, in Lucknow, North India. All children were offered vitamin A every 6 months, and children in 25 randomly assigned slum areas also received 6-monthly albendazole. Treatments were delivered by the State Integrated Child Development Scheme (ICDS), and height and weight were monitored at baseline and every 6 months for 24 months (trial registration number NCT00396500). p Value calculations are based only on the 50 area-specific mean values, as randomization was by area.

Findings: The ICDS infrastructure proved able to deliver the interventions. 95% (3,712/3,912) of those alive at the end of the study had received all five interventions and had been measured during all four follow-up surveys, and 99% (3,855/3,912) were measured at the last of these surveys. At this final follow up, the albendazole-treated arm exhibited a similar height gain but a 35 (SE 5) % greater weight gain, equivalent to an extra 1 (SE 0.15) kg over 2 years (99% CI 0.6-1.4 kg, p = 10(-11)).

Conclusions: In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain. The ICDS system could provide a sustainable, inexpensive approach to the delivery of anthelmintics or micronutrient supplements to such populations. As, however, we do not know the control parasite burden, these results are difficult to generalize.

Trial registration: ClinicalTrials.gov NCT00396500.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2291568&rFormat=json&query=null&req=5