We used logistic regression with coarsened exact matching, fixed effects for survey and year, and person-level covariates. When autocomplete results are available use up and down arrows to review and enter to select. We used all available DHS surveys that included data on deworming exposure, health outcomes, and relevant covariates from endemic countries based on WHO classification (Appendix). Worms can cause anemia, stunting, lethargy and other problems that derail children's development. The enhanced donations of quality anthelminthic medicines by GSK, J&J and Merck KGaA provide a unique opportunity to achieve this. Department of Earth System Science, Stanford University, Stanford, CA, United States of America, 6 We also reported the marginal effects, which represent the change in the probability of the outcome among those exposed to deworming relative to those that were not. To better understand the relationship between deworming and health in pre-school age children, we performed an empirical analysis using data from the Demographic and Health Surveys (DHS) across 45 countries. government site. 8600 Rockville Pike In addition, it is estimated that from 40-70% of these children are enrolled at school. All data are available from the DHS database/USAID Institutional Data Access (http://dhsprogram.com/data/available-datasets.cfm). Note, region classification is based upon World Health Organization definition. Yes, deworming is a narrow intervention but it is almost a magic bullet, and most impactful.. We included pre-specified person-level covariates in the analysis to address potential confounding relations, including childs age and gender, mothers age (<30 years or older based on prior DHS analysis on health-seeking behavior [29]) and education (defined as no education, some primary school, and completion of primary school or higher education), wealth quintile (a composite measure for each persons household, relative based on country standard), place of residence (urban or rural, relative based on countrys definition), and binary variables indicating access to improved water, sanitation (based on toilet facility using the Joint Monitoring Programme definitions) [30], and healthcare-seeking behaviors using receipt of third dose of diphtheria-tetanus-pertussis vaccine as an indirect proxy (Appendix). mass drug administration, child health days) and unprogrammed sources [36, 37]. However, the impact of school-based deworming on transmission in the wider community remains unclear. I work for a research organization Deworming your pet will assist in the prevention of illnesses caused by these intestinal parasites. They are a major public health problem because the worms disrupt peoples ability to absorb nutrients, impeding the growth and physical development of millions of children. Among pre-school age children, we detected a robust and consistent association between deworming and reduced stunting, with additional evidence for reduced anemia in sub-Saharan Africa. Geneva: World Health Organization. Rollins School of Public Health, Emory University, Atlanta, GA, United States of America, 5 Meta-analysis, Cost-Effectiveness, and Statistical Power, Andrews JR, Bogoch II, Utzinger J. 0000001067 00000 n New Reasons Why School-Based Deworming is Smart Development Policy All children without other illness should be treated during a school deworming day. Deworming can prevent debilitating illness and keep children in school. But the treatment is simple and a phenomenal return on investment, says Michael Kremer, co-founder and President ofDeworm the World, that has achieved major success in tackling this sickness, which affects one person in four, globally, including over 400 million children. As a teacher, you can play an These findings were robust across the majority of alternative statistical models and mostly consistent in overall negative-exposure controls (Table A4, A5). Deworming for STHs is often targeted at school children because they are at greatest risk of morbidity and because it is remarkably cost-effective. [. I work for the GPE Secretariat (2014), The coverage and frequency of mass drug administration required to eliminate persistent transmission of soil-transmitted helminths, Lo NC, Bogoch II, Blackburn BG, Raso G, N'Goran EK, Coulibaly JT, et al. Deworm the World was founded after the 2004 study by Miguel and Kremer, and subsequently governments in Kenya and globally adopted ambitious anti-worm programs, dramatically . Andy Wright, Director of Disease Programs at GlaxoSmithKline, explained that GSK takes this role seriously, with current donations of some 400 million albendazole deworming tablets to theWorld Health Organizationeach year to support deworming. 0000004933 00000 n To replicate the program's success, three states in India have now embarked on piloting a similar approach to reach 35 million school children. Innovations for Poverty Action (IPA) is registered as a 501(c)(3) nonprofit organization. increased health knowledge) or recall bias, this would be more likely to bias our findings towards null unless the bias was unique and differential in the deworming group. (PDF) Deworming school children in Ethiopia: The importance of a comprehensive approach Deworming school children in Ethiopia: The importance of a comprehensive approach Authors: Zvi. Drawing upon data from more than 320,000 pre-school age children in 45 countries, this empirical analysis provides evidence for a global-level association between deworming and reduced stunting, with additional evidence for reduced anemia in sub-Saharan Africa for pre-school age children. Regular deworming contributes to good health and nutrition for children of school age, which in turn leads to increased enrolment and attendance, reduced class repetition, and increased educational attainment. vitamin A receipt, use of malaria net, and breastfeeding), and country-specific analyses (see Appendix). The site is secure. We tested for dose-response effects through stratification by STH disease burden and age and testing continuous interaction; we found increasing effect size at older ages for the relationship between deworming and reduced stunting but did not find any other consistent relations (Table A6-A7). To conceptualize the magnitude of these effect sizes, we estimated that expanding deworming to 100% coverage could be related to 694,100 (95%UI: 134,3001,298,700) averted cases of stunting and 850,600 (95%UI: 325,3001,326,000) averted cases of anemia in pre-school age children from study countries in sub-Saharan Africa that are not yet being dewormed due to low coverage (Figure A4; Table A9). 0000013741 00000 n Reasons why it is important to deworm your child - Zee News WHO has long promoted large-scale treatment for intestinal worms, but this is the first guideline approved by WHOs Guidelines Review Committee confirming that deworming improves the health and nutrient uptake of heavily infected children. Puppies and kittens are susceptible to intestinal parasites which can include roundworms, hookworms, tapeworms, and whipworms. This included a total of 66 DHS surveys, and excluded an additional 26 surveys for lack of data or endemicity for STH (see Appendix, Section 1). Schools are central to delivery of such treatment. This association should be conceptualized as the diluted population-level impact. This would . This strategy of regular deworming (also known as preventive chemotherapy) with albendazole or mebendazole has been the main STH control strategy recommended by the World Health Organization (WHO) for over a decade [5]. Another teacher with him managed to escape, but Mr . States/UTs are encouraged to involve private A table of excluded surveys is available in the Appendix. We measured a consistent relationship between deworming and reduced risk of anemia (1.8% lower absolute percentage) in sub-Saharan Africa, which corresponds with an estimated 850,600 anemic pre-school age children in our study countries that could benefit from deworming. healthy growth, cause poor nutrition and reduce their capacity to This association was robust and mostly consistent, meaning this relationship was not observed in the negative-exposure controls, relaxing concern for any residual confounding (Table 3, A4, A5). When matching with addition of covariate for receipt of vitamin A, use of malaria net, and breastfeeding, the main study finding remained broadly consistent; we did not find evidence for interaction between deworming and vitamin A. We defined relationship robustness in reference to these alternative statistical models. We used the DHS to examine the relationship between deworming exposure and health outcomes using cross-sectional data. (2008), Effects of deworming on malnourished preschool children in India: an open-labelled, cluster-randomized trial, Alderman H, Konde-Lule J, Sebuliba I, Bundy D, Hall A. Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, United States of America. The positive impact of deworming onboth health andeducational outcomesis routinely cited as an example of aid effectiveness, including byNicholas Kristof in therecent column Getting Smart on Aid, in the New York Times. Before Even with the significant gains of DepEd's on Deworming Program, H1NI; and EHCP- the Department recognized the merit of having a comprehensive approach to the promotion of hygiene and sanitation . Linking up deworming with education is the only sustainable way to expand coverage and reach the WHO target of covering at least 75% of all school age children in need. lymphatic filariasis) that would also be effective against STH infections, and this would bias our findings towards no association. Importantly, while a mothers recall of deworming may be imperfect, any recall bias is unlikely to be unique to the dewormed group so this would bias our overall study findings towards no association and would not be a threat to the validity of our findings. We discuss the . On World Humanitarian Day, we turn our focus to the Tigray region of northern Ethiopia, where children have endured devastating consequences of conflict and the upheaval caused by COVID-19. STH control programs therefore usually focus on delivering deworming medications to school-aged children. We tested region (sub-national) fixed effects to match children within region. In the complex world of education policy, some experts comment that school-based deworming may be the closest we have come to finding a "magic bullet." DtW is now a program of the nonprofit organization Evidence Action, which builds long-term partnerships and provides technical assistance to help governments launch, monitor, and sustain school-based deworming programs. In more simple terms, it is a medicated process to kill worms. (2006), Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm, Awasthi S, Peto R, Read S, Richards SM, Pande V, Bundy D, et al. Soil-transmitted helminth infections - World Health Organization (WHO) School-based deworming is a low-cost intervention that takes advantage of existing school infrastructure and trains teachers to administer deworming treatmentsafe tabletsto all primary school students on dedicated "deworming days," once or twice per school-year. Citation: Ali J, Polland A, Adlerstein D, Gziabher YG, Bentwich Z, et al. Why is Deworming Important? Public health deworming programmes for soiltransmitted helminths in Geneva: World Health Organization. Our programs are active in 30 countries in Africa, Asia . Center for Effective Global Action, University of California, Berkeley, Creative Commons Attribution 4.0 International License. This suggests the possibility that deworming may associated with weight gain in children who are already underweight, but that the association is diluted out when including all children. Web page addresses and email addresses turn into links automatically. From a measurement standpoint, this age group may enable more sensitive detection of health, educational, and economic benefits in response to deworming than the school-age population, which is more often studied. Over the past 10 years, treatment in this age group has scaled up across many low and middle-income countries [27]. Education for All - Fast Track Initiative, full event webcast and related presentations, How deworming promotes learning and health. Conclusions: These estimates suggest that, whilst school-based programmes have many important benefits, the proportion of infective stages targeted by school-based deworming may be limited, particularly where hookworm predominates. We defined being underweight as a weight-for-age two standard deviations below the WHO global reference standard, stunting as a height-for-age two standard deviations below the WHO global reference standard, and anemia as a hemoglobin below 11 g/dL [28]. Education is a Humanitarian Imperative for Children in Tigray, Ethiopia, JICA and GPE: A deepening partnership to address the learning crisis. number of worms in each child. PDF Conducting a school deworming day - World Health Organization We included data on 325,115 children in 45 STH-endemic countries from 66 DHS surveys. The international effort in favour of Education for All provides a unique opportunity to fully institutionalize such activities and free all children from worms.". In sub-Saharan Africa, in the matched analysis of 32 countries, we found that children who received deworming treatment were less likely to be stunted (1.1 percentage decline from mean of 36%; 95%CI [-2.1, -0.2%]; OR: 0.94; p = 0.01) and less likely to be anemic (1.8 percentage decline from mean of 58%; 95%CI [-2.8, -0.7%]; OR:0.91; p<0.001) (Table 3). Because the tablets are inexpensive relative to diagnosis, which requires analysis of a stool sample in a laboratory, the World Health Organization (WHO) recommends periodic mass school-based treatments in areas where more than 20 percent of children have worm infections. Children need these deworming medicines to grow healthier and learn better in school. They present an already-existing infrastructure, staffed with a sizable workforce that reaches even the most rural areas of most countries (where the burden of intestinal worms is generally highest). Deworming helps meet the Millennium Development Goals -----25 22. We chose to dichotomize health outcome variables in the main analysis to isolate the disease state and to account for possible confounding trends (e.g. 0000013763 00000 n Importantly, we did not have data on person-level STH infection status, although since mass deworming programs are also being implemented without knowledge of individual infection status, our goal was to quantify the population-level effectiveness of these real-world programs. 0000016834 00000 n Our finding that older children had an increased association for improved height supports this hypothesis that larger benefits may be observed in repeatedly treated children. Deworming in children Vikaspedia The Cochrane Collaboration (2015) and Campbell Collaboration (2017) systematic reviews and meta-analyses of randomized trials concluded deworming does not result in improved health outcomes, although they did find some benefit to treating those known to be infected [3, 4]. The Importance Of Deworming For Children . 0000001388 00000 n Treating school-age children for intestinal worms occurs in schools during deworming days. JS and DA were employed by Children Without Worms (Task Force for Global Health), which is an organization that promotes prevention and treatment of soil-transmitted helminthiasis. School-based deworming. Deworming in pre-school age children: A global empirical - PubMed not including additional children in the household) and found our findings to be broadly consistent. Primary Care and Population Health, Stanford University, Stanford, CA, United States of America, 7 I work for a government agency Parents dont have to be sold on this. In this study, we bring an independent dataset with over 320,000 pre-school age children across 45 STH-endemic countries to investigate the relationship between deworming and health outcomes of weight, height, and anemia. 0000005283 00000 n Bennett A, Eisele T, Keating J, Yukich J. Pre-school age children remain a key population for STH burden, because of their potential for long-term health and educational consequences, contribution to ongoing transmission, and need for treatment outside of traditional school-based deworming [5, 21]. Other large-scale deworming programs in India were implemented in Andhra Pradesh, Delhi, and Rajasthan. We examined the relationship between reported deworming and the pre-specified health outcomes of malnutrition (underweight, stunting) and anemia among pre-school age children (ages 14 years, selected based on WHO classification of this age group) in 45 low- and middle-income STH-endemic countries in Africa, the Americas, Asia, and Europe using cross-sectional data during the period 20052016. Globally, in the matched analysis, children who received deworming treatment were less likely to be stunted (1.2 percentage decline from mean of 36%; 95%CI [-1.9, -0.5%]; OR:0.92; p<0.001). Accessibility Negative-exposure controls that were associated with the health outcome raised concerns about selection bias that could not be eliminated with the observed data, even after matching; in these cases, the primary relationships were deemed inconsistent. Effects of deworming on child and maternal health: a - PubMed (2015), The Effect of Deworming on Growth in One-Year-Old Children Living in a Soil-Transmitted Helminth-Endemic Area of Peru: A Randomized Controlled Trial. There is debate over the effectiveness of deworming children against soil-transmitted helminthiasis (STH) to improve health outcomes, and current evidence may be limited in study design and generalizability. Dr Antonio Montresor / Soil-transmitted helminthiases. Coarsened exact matching models do not include covariates in regression model since they are pre-processed for balance. praziquantel for Schistosoma spp). We did not measure a robust or consistent relationship between deworming and being underweight in the overall analysis (0.7 percentage decline from mean of 29%; 95%CI [-1.7, 0.2%]; OR:0.94; p = 0.06), but did measure a robust and consistent relationship between deworming and higher weight in the sub-group of underweight children (0.02 standard deviation increase; 95%CI [0.01, 0.04]; p<0.01). In 2016, Indias school-based deworming program is aiming to reach 200 million children ages 1-19 in schools and preschools across all 29 states and seven union territories. The study results from our global empirical analysis provide evidence to support the deworming of pre-school age children. FOIA Age (years). [, Anderson R, Truscott J, Hollingsworth TD. Large-scale deworming programmes are facilitated by WHO, using medicines donated by pharmaceutical companies. Deworming is the process of expelling intestinal worms or parasitic worms from the body by administering an anthelmintic medicine/drug. Regular treatment contributes to good health and nutrition for children of school age, which in turn leads to increased enrolment and attendance, reduced class repetition and better educational attainment. 0000004143 00000 n Since pre-school age children (ages 14 years) are not typically reached through school-based deworming programs, they more commonly receive treatment through Child Health days [19], community-based deworming for lymphatic filariasis, or though the healthcare system. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Globally, more than 1 in 4 people are infected by intestinal worms. While our deworming treatment record is reported for the previous 6 months, these children appear more likely to have received deworming treatments repeatedly, as recommended by WHO. This study relied on published data and did not require human subject research approval. In short, worm infections limit boys and girls ability to concentrate, think, and learn. HHS Vulnerability Disclosure, Help 0000001140 00000 n Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America, 3 Similarly, while the main exposure variable for deworming of a child was proxy-reported by his or her mother and potentially subject to reporting bias (e.g. The longer-term implications for countries implementing nation-wide deworming programs could be significant asNew York Timescolumnist,Nicholas Kristof,recently wrote about Michael Kremers deworming work. School-based deworming is a low-cost program that takes advantage of existing school infrastructure and trains teachers to administer deworming treatmentsafe tabletsto all primary school students on dedicated deworming days, once per school-year. We also included year fixed effects that control for common time effects across all surveys. Deworming in Children and it's Importance - omilights.com In our study, we measured a modest reduced risk of stunting among pre-school age children with a 1.1% decline from 36% prevalencealthough this modest association corresponds with an estimated 694,100 cases of stunting in pre-school age children in our study countries from sub-Saharan Africa. We also performed an analysis for sub-Saharan Africa alone given the substantial STH burden and scale of ongoing deworming [25]. Making it happen in Cambodia -----28 . Demographic and Health Surveys (DHS) 20052016. (2017), The benefits of mass deworming on health outcomes: new evidence synthesis, the debate persists, Lo NC, Addiss DG, Hotez PJ, King CH, Stothard JR, Evans DS, et al. Deworming did not show consistent benefits for indicators of mortality, anemia, or growth in children younger than five or women of reproductive age. Over 96 million children received deworming treatment in the 2014-2015 school year. A recent systematic review and meta-analysis of school-based deworming programs found positive effects of deworming on weight [16], while other meta-analyses failed to detect a measurable effect, although these have often focused on older children [3, 4]. Open J Trop Med 3(1): 001-006. 0000003116 00000 n Primary model was a logistic multivariable regression with coarsened exact matching and country survey-level and year fixed effects. (2016), Assessment of global guidelines for preventive chemotherapy against schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study, Truscott JE, Hollingsworth TD, Brooker SJ, Anderson RM. In some cases, a finding was not consistent because the negative-exposure control was related to the health outcome (e.g. Because intestinal worms are most prevalent in poor countries where diagnosis is relatively costly, the WHO recommends periodic mass administration of anthelmintic drugs to groups of people in worm endemic areas. (2014), Global numbers of infection and disease burden of soil transmitted helminth infections in 2010, Awasthi S, Peto R, Pande VK, Fletcher RH, Read S, Bundy DA. Deworming to increase school attendance | The Abdul Latif Jameel In 2015, just 39% of the global population had access to safe sanitation, while 71% could access safe water. Deworming school children in low and middleincome countries. When adopting a new pet, one important item to have checked off your list is having them dewormed. How deworming promotes learning and health | Blog | Global Partnership What is De-Worming and Why It's Important? - GiDoc Implications of the Review. 0000017609 00000 n Sometimes the biggest problems in education, and health, have simple, inexpensive solutions that can best be delivered through effective partnerships involving all stakeholders. local pharmacy, healthcare facility), it is likely that reported deworming included both programmed (e.g. I work in journalism / media Among interventions that have been rigorously tested by randomized evaluations, school-based deworming is one of the most cost-effective means of increasing school attendance. We defined the study exposure using the mothers report of whether her children received drugs for intestinal parasites in the 6 months prior to the survey. Methods is not yet fully developed. Periodic deworming programmes with a single-tablet treatment can drastically reduce the suffering of those infected with parasitic intestinal worms and protect the 1.5 billion people currently estimated to be at risk. However, drug therapy alone is only a short-term measure of reducing worm infection and re-infection is frequent. 2. Michael Kremer has recently published a study of 75 schools in Kenya which testifies to the success of apilot programof deworming in schools there which used sophisticated mapping technology to pinpoint where deworming actions could be targeted to communities particularly affected. Notably, these meta-analyses have found that deworming may improve weight among those who are known to be infected but not at a population-level, which may be explained by a dilution effect [3]. You must have JavaScript enabled to use this form. The WHO estimates that over 880 million school-age children are in need of treatment for intestinal worms, which are transmitted through contact with water or soil contaminated with fecal matter.1 Worm infections can reduce the absorption of nutrients in the body, leading to anemia and malnutrition, and weaken the bodys immunological response to other infections such as malaria. sources in areas that lack adequate sanitation. Deworming is not the only solution, however. 0000003067 00000 n Therefore, repeated periodic deworming, which consistently reduces worm burden, is more likely to result in long-term health-related outcomes and may also include treatment with different drugs (e.g. Utilizing schools as networks for the delivery of basic school health services like deworming encourages countries to piggy-back onto systems already in place rather than use limited human and financial resources to create new, stand-alone methods for delivery.
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