Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance

Abstract

About a quarter of the world's population is infected with one or more soil-transmitted worms. The main soil-transmitted worms are roundworms, hookworms, and whipworms. Infections are widely distributed in tropical and subtropical areas, with most infected people having more than one type of worm. The burden of disease falls disproportionately on the poor, where there is inadequate sanitation, overcrowding, low levels of education, and lack of access to health care. These infections cause malnutrition and poor growth for children, and some studies have suggested an association with poor performance at school. Improved sanitation and hygiene are likely to be helpful. There are also three basic strategies for using drugs to treat these infections: (1) individual treatment based on a diagnosis of infection (selective treatment); (2) groups at increased risk are treated (targeted treatment); and (3) treating whole communities whether people have the infection or not (universal treatment). The targeted treatment is the one generally used. This review of trials looked at targeted treatment with a range of deworming drugs for children, particularly focusing on growth and school performance. Thirty-four trials were identified. These trials either looked at single or multiple doses, but only some assessed school performance. After just one dose children's weight improved, and more doses did not seem to improve this further. Only one of the seven trials that assessed school performance found any positive effect, so it seems unlikely that there is a benefit here. Two trials looked at adverse events, but the trials were small. Further research is needed