Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, United States of America.
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
PLoS Negl Trop Dis. 2018 May 31;12(5):e0006500. doi: 10.1371/journal.pntd.0006500. eCollection 2018 May.
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. However, programmatic deworming continues throughout low and middle-income countries.
We performed an empirical evaluation of the relationship between deworming in pre-school age children (ages 1-4 years) within the previous 6 months, as proxy-reported by the mother, and health outcomes of weight, height, and hemoglobin. We used nationally representative cross-sectional data from 45 countries using the Demographic and Health Surveys (DHS) during the period 2005-2016. We used logistic regression with coarsened exact matching, fixed effects for survey and year, and person-level covariates. We included data on 325,115 children in 45 STH-endemic countries from 66 DHS surveys. Globally in STH-endemic countries, children who received deworming treatment were less likely to be stunted (1.2 percentage point decline from mean of 36%; 95% CI [-1.9, -0.5%]; p<0.001), but we did not detect consistent associations between deworming and anemia or weight. In sub-Saharan Africa, we found that children who received deworming treatment were less likely to be stunted (1.1 percentage point decline from mean of 36%; 95% CI [-2.1, -0.2%]; p = 0.01) and less likely to have anemia (1.8 percentage point decline from mean of 58%; 95% CI [-2.8, -0.7%]; p<0.001), but we did not detect consistent associations between deworming and weight. These findings were robust across multiple statistical models, and we did not find consistently measurable associations with data from non-endemic settings.
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. We did not find a consistent relationship between deworming and improved weight. This global empirical analysis provides evidence to support the deworming of pre-school age children.
对于针对土壤传播性蠕虫病（STH）的儿童驱虫以改善健康结果的有效性存在争议，并且当前的证据可能在研究设计和普遍性方面受到限制。然而，在中低收入国家，驱虫计划仍在继续。
我们通过母亲报告的 6 个月内学前儿童（1-4 岁）的驱虫情况，对驱虫与体重、身高和血红蛋白健康结果之间的关系进行了实证评估。我们使用了 2005 年至 2016 年期间来自 45 个国家的具有代表性的横断面数据，这些数据来自人口与健康调查（DHS）。我们使用逻辑回归进行粗化精确匹配，对调查和年份进行固定效应，并对个人层面的协变量进行分析。我们包括了来自 45 个 STH 流行国家的 66 项 DHS 调查中 325,115 名儿童的数据。在 STH 流行国家中，全球范围内接受驱虫治疗的儿童身高较矮的可能性较小（从平均 36%下降 1.2 个百分点；95%CI[-1.9，-0.5%]；p<0.001），但我们没有发现驱虫与贫血或体重之间存在一致的关联。在撒哈拉以南非洲，我们发现接受驱虫治疗的儿童身高较矮的可能性较小（从平均 36%下降 1.1 个百分点；95%CI[-2.1，-0.2%]；p=0.01）和贫血的可能性较小（从平均 58%下降 1.8 个百分点；95%CI[-2.8，-0.7%]；p<0.001），但我们没有发现驱虫与体重之间存在一致的关联。这些发现在多种统计模型中都具有稳健性，并且我们没有发现来自非流行地区的数据存在一致的可衡量关联。
在学前儿童中，我们发现驱虫与减少发育迟缓之间存在稳健且一致的关联，在撒哈拉以南非洲地区，还存在驱虫与减少贫血之间的关联。我们没有发现驱虫与体重增加之间的一致关系。这项全球实证分析为支持对学前儿童进行驱虫提供了证据。
