China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China.
Freeman Spogli Institute, Stanford University, Stanford, California.
Am J Trop Med Hyg. 2017 Jun;96(6):1478-1489. doi: 10.4269/ajtmh.16-0354.
AbstractSoil-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.
全世界有超过 10 亿人感染土源性线虫。人们担心，学龄儿童感染土源性线虫可能会对他们的发育造成不利影响，包括健康、认知和教育。然而，最近两项 Cochrane 综述研究了驱虫药物治疗土源性线虫对营养、血红蛋白和学业成绩的影响，发现文献中的随机对照试验（RCT）提供的证据基础不足，无法得出可靠的结论。本研究使用一项群组随机对照试验，通过评估驱虫干预对中国农村学龄儿童营养、认知和学业成绩的影响，为现有证据增添新内容。该干预措施由当地卫生工作者在基线感染率为 41.9%（95%置信区间 [CI] = 39.8%，43.9%）和感染强度为 599.5 个每克粪便虫卵（95%CI = 473.2，725.8）的背景下实施，包括发放 400 毫克剂量的阿苯达唑，并进行土源性线虫感染、治疗和预防方面的教育培训。该干预措施在研究过程中进行了两次，分别在 2013 年 5 月基线时和同年 11 月进行。我们发现，驱虫干预降低了感染率和感染强度，但这些感染的下降并没有对营养、认知或学业成绩产生影响。我们的解释是，在我们的样本人群中，轻度感染强度削弱了驱虫的影响。需要来自未来 RCT 的证据来评估中度和重度蠕虫感染地区驱虫对关键结果的影响。
