Research School of Population Health, Australian National University, Canberra, ACT, Australia.
Research School of Population Health, Australian National University, Canberra, ACT, Australia.
Lancet. 2017 Jan 21;389(10066):287-297. doi: 10.1016/S0140-6736(16)32123-7. Epub 2016 Dec 13.
Soil-transmitted helminth infections are a major global health issue, causing substantial morbidity in the world's poorest populations. Regular delivery of anthelmintic drugs is the mainstay for global soil-transmitted helminth control. Deworming campaigns are often targeted to school-aged children, who are at high risk of soil-transmitted-helminth-associated morbidity. However, findings from modelling studies suggest that deworming campaigns should be expanded community-wide for effective control of soil-transmitted helminth transmission. We aimed to do a systematic review and meta-analysis to compare the effect of mass (community-wide) and targeted (children only) anthelmintic delivery strategies on soil-transmitted helminth prevalence in school-aged children.
In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Web of Science for articles published on or before Nov 5, 2015, reporting soil-transmitted helminth prevalence before and after distribution of albendazole or mebendazole, either targeted to children or delivered to the whole community. We excluded studies in which drug delivery was restricted to infected individuals or to a subset of the community or school, or if follow-up time was less than 3 months or greater than 18 months after drug delivery. We extracted data on study year, country, drug administration strategy, drug dose, number of deworming rounds, treatment coverage, diagnostic method, follow-up interval, and soil-transmitted helminth prevalence before and after treatment. We used inverse variance weighted generalised linear models, with prevalence reduction as the outcome variable, to examine the effect of mass versus targeted drug administration, as well as baseline prevalence, number of drug doses, and follow-up time. This study is registered with PROSPERO, number CRD42016026929.
Of 10 538 studies identified, 56 studies were eligible for the systematic review and 38 of these were included in meta-analysis. Results of the regression models showed that mass deworming led to a significantly greater reduction in prevalence in children than targeted deworming, for both hookworm (odds ratio 4·6, 95% CI 1·8-11·6; p=0·0020) and Ascaris lumbricoides (16·4, 2·1-125·8; p=0·0092), with no effect seen for Trichuris trichiura. There was significant heterogeneity across studies; for targeted studies I was 97% for A lumbricoides and hookworm, and 96% for T trichiura, and for mass studies, I was 89% for A lumbricoides, 49% for hookworm, and 66% for T trichiura.
The results of this meta-analysis suggest that expanding deworming programmes community-wide is likely to reduce the prevalence of soil-transmitted helminths in the high-risk group of school-aged children, which could lead to improved morbidity outcomes. These findings are in support of recent calls for re-evaluation of global soil-transmitted helminth control guidelines.
None.
土壤传播的蠕虫感染是一个主要的全球健康问题，在世界上最贫穷的人群中造成了大量的发病。定期提供驱虫药物是全球土壤传播的蠕虫控制的主要手段。驱虫运动通常针对学龄儿童，他们有很高的感染土壤传播的蠕虫相关发病的风险。然而，来自建模研究的结果表明，为了有效控制土壤传播的蠕虫传播，驱虫运动应该扩大到整个社区。我们旨在进行系统回顾和荟萃分析，比较大规模（社区范围）和有针对性（仅儿童）驱虫药物输送策略对学龄儿童土壤传播的蠕虫患病率的影响。
在这项系统回顾和荟萃分析中，我们搜索了 MEDLINE、Embase 和 Web of Science，以查找在 2015 年 11 月 5 日之前发表的文章，报告了在阿苯达唑或甲苯咪唑分发前后，土壤传播的蠕虫患病率，要么针对儿童，要么针对整个社区。我们排除了药物输送仅限于感染个体或社区或学校的一部分，或者随访时间少于 3 个月或大于 18 个月的研究。我们提取了关于研究年份、国家、药物管理策略、药物剂量、驱虫次数、治疗覆盖率、诊断方法、随访间隔以及治疗前后土壤传播的蠕虫患病率的数据。我们使用逆方差加权广义线性模型，以患病率降低为结果变量，来检查大规模与有针对性的药物管理、基线患病率、药物剂量和随访时间的效果。本研究已在 PROSPERO 注册，编号为 CRD42016026929。
在确定的 10538 项研究中，有 56 项研究符合系统综述的条件，其中 38 项研究被纳入荟萃分析。回归模型的结果表明，与有针对性的驱虫相比，大规模驱虫导致儿童患病率显著降低，钩虫（优势比 4.6，95%可信区间 1.8-11.6；p=0.0020）和蛔虫（16.4，2.1-125.8；p=0.0092），而对鞭虫没有影响。研究之间存在显著的异质性；对于有针对性的研究，A 蛔虫和钩虫的 I 为 97%，鞭虫为 96%，对于大规模研究，A 蛔虫为 89%，钩虫为 49%，鞭虫为 66%。
这项荟萃分析的结果表明，扩大社区范围的驱虫计划可能会降低学龄儿童这一高风险群体中土壤传播的蠕虫的患病率，从而改善发病结果。这些发现支持了最近对全球土壤传播的蠕虫控制指南进行重新评估的呼吁。
无。
