Raj E, Calvo-Urbano B, Heffernan C, Halder J, Webster J P
Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.
London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK.
Parasit Vectors. 2022 Apr 20;15(1):135. doi: 10.1186/s13071-022-05235-5.
Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high-at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children.
Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0-1 year old, preschool-age children 1-5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201).
Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting.
Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting-notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups.
尽管在过去20年里公共卫生领域付出了巨大努力，但全球儿童发育迟缓（身体和/或认知方面）水平仍高得令人无法接受——2020年5岁以下儿童中发育迟缓率达22%。发育迟缓的病因复杂，很大程度上仍不清楚。蠕虫可导致严重的死亡率和发病率，常被认为是发育迟缓的主要致病因素，但其在儿童发育迟缓中的实际作用仍不明确。我们的目的是系统评价现有证据，以支持或反驳蠕虫导致儿童身体发育迟缓这一假说。
纳入标准如下：感染（和/或接触）蠕虫（土源性蠕虫、血吸虫或食源性吸虫），以儿童、孕妇或哺乳期妇女作为研究对象（儿童包括0至1岁婴儿、1至5岁学龄前儿童及5岁以上学龄儿童），驱虫治疗干预，报告发育迟缓相关变量（如身高、年龄别身高Z评分、出生体重），报告蠕虫感染与发育迟缓的关系，任何地理位置，任何日期，仅为同行评审文献。排除标准为：非原始研究、研究方案、无新数据的研究、非英文论文及动物（非人类）蠕虫研究。于2021年5月28日检索了七个数据库。对纳入研究进行偏倚风险评估，对随机对照试验亚组荟萃分析（学龄前儿童和孕妇）中纳入的研究采用GRADE方法。本系统评价已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42021256201）。
80项研究纳入分析。未发现支持蠕虫导致儿童身体发育迟缓这一假说的显著总体证据，尽管存在一些与消瘦的关联。
虽然对现有文献的分析未能支持蠕虫感染与儿童发育迟缓之间存在直接关联，但研究之间存在显著异质性，且许多研究的随访期可能过短，无法检测到对生长的影响。最明显的是缺乏来自关键人群的数据，而在这些人群中可能预测蠕虫感染与发育迟缓的关联最大——特别是婴儿、学龄前儿童以及孕妇或哺乳期妇女。因此，本综述强调迫切需要在这些潜在最脆弱人群中开展进一步有针对性的实证研究。
