学龄前儿童驱虫时不良吞咽事件和窒息的风险。
Risk of adverse swallowing events and choking during deworming for preschool-aged children.
机构信息
Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America.
Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America.
出版信息
PLoS Negl Trop Dis. 2018 Jun 22;12(6):e0006578. doi: 10.1371/journal.pntd.0006578. eCollection 2018 Jun.
BACKGROUND
In areas where the prevalence of soil-transmitted helminthiasis (STH) is >20%, the World Health Organization (WHO) recommends that deworming medication be given periodically to preschool-age children. To reduce risk of choking-related deaths in children <3 years old, WHO recommends that deworming tablets be crushed and given with water. Little is known about how widely this is practiced or its effectiveness.
METHODOLOGY AND PRINCIPAL FINDINGS
Albendazole distributions for STH were observed for children 1-4 years old in 65 sites in India and Haiti. Information was recorded on child demographics; child demeanor immediately before, as well as struggling or resistance during albendazole administration; tablet form (i.e., crushed or not); and adverse swallowing events (ASEs), including choking, spitting; coughing; gagging; vomiting; and expelling a crushed tablet in a "cloud" of powder. Of 1677 children observed, 248 (14.8%) had one or more ASEs. ASE risk was 3.6% with whole tablets, 25.4% with crushed tablets, and 34.6% when crushed tablets were mixed with water. In multivariate analysis, ASE risk was significantly associated with children 1 year (OR 2.7) or 2 years (OR 2.9) of age; male gender (OR 1.6); non-content child demeanor (fearful, fussy, or combative) before albendazole administration (OR 4.3); child struggling when given albendazole (OR 2.1); and giving water, either after the tablet or mixed with it (OR 5.8). Eighteen (1.1%) children choked, none fatally; 17 choking incidents occurred with crushed tablets. In a multivariate analysis that controlled for distribution site, the only significant risk factor for choking was non-content demeanor (OR 20.6).
CONCLUSIONS AND SIGNIFICANCE
Deworming-related choking deaths in young children are preventable. In our sample, risk of choking could have been reduced by 79.5% if deworming tablets were not given to young children who were fussy, fearful, or combative or who struggled to resist tablet administration, with only an 18.4% reduction in drug coverage.
背景
在土壤传播性蠕虫病（STH）流行率>20%的地区，世界卫生组织（WHO）建议定期向学龄前儿童提供驱虫药物。为了降低<3 岁儿童因噎死的风险，WHO 建议将驱虫药片压碎后用水送服。但对于这种做法的普及程度及其有效性，我们知之甚少。
方法和主要发现
在印度和海地的 65 个地点，观察了用于治疗 STH 的阿苯达唑在 1-4 岁儿童中的分发情况。记录了儿童人口统计学信息；儿童在服用阿苯达唑之前和期间的表现（即，是否紧张或抗拒）；药片的形式（即，是否压碎）；以及不良吞咽事件（ASE），包括窒息、吐口水；咳嗽；作呕；呕吐；以及将压碎的药片吐出成“云”状粉末。在观察到的 1677 名儿童中，有 248 名（14.8%）有一个或多个 ASE。整粒药片的 ASE 风险为 3.6%，压碎的药片为 25.4%，压碎的药片与水混合的为 34.6%。在多变量分析中，ASE 风险与 1 岁（OR 2.7）或 2 岁（OR 2.9）的儿童显著相关；男性（OR 1.6）；阿苯达唑给药前非平静的儿童行为（OR 4.3）；儿童在给予阿苯达唑时挣扎（OR 2.1）；以及给儿童水，无论是在给完药片后还是与药片混合给（OR 5.8）。有 18 名（1.1%）儿童窒息，无死亡；17 例窒息事件发生在压碎的药片。在控制分发地点的多变量分析中，唯一与窒息相关的显著风险因素是非平静的行为（OR 20.6）。
结论和意义
可以预防幼儿因驱虫相关的噎死。在我们的样本中，如果不给紧张、恐惧或好斗或反抗服药的幼儿服用驱虫药片，窒息的风险本可以降低 79.5%，而药物覆盖率仅降低 18.4%。
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