Centro de Investigação em Saúde de Angola (CISA), Rua Direita de Caxito, Caxito, Angola.
Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal.
Nutrients. 2022 May 24;14(11):2185. doi: 10.3390/nu14112185.
Undernutrition, anemia, and intestinal parasitic infections are public health problems in Angola, especially in pre-school children. We analyzed binary data from a longitudinal four-arm randomized parallel trial conducted in Bengo Province, northern Angola, over the course of two years, with seven follow-up assessments to explore the effects of four interventions (deworming and a test-and-treat approach for intestinal parasites, at both the individual and household levels) on wasting and stunting, and to understand their indirect benefits for anemia, malaria, diarrhea, and vomiting. A total of 121 children with intestinal parasitic infections received baseline treatment, and were allocated to the four arms (1:1:1:1). Using continuous outcome variables of height-for-age (HAZ) and weight-for-height (WHZ) statistical approaches did not reveal a clear benefit of any particular arm (Pathogens 2021, 10, 309). Next, HAZ and WHZ were transformed into binary variables of stunting and wasting, respectively, considering their mild-to-severe (Z-score < −1) and moderate-to-severe degrees (Z-score < −2). Original clinical data (on anemia, diarrhea, vomiting, and malaria) were also analyzed. From a binary longitudinal analysis with different dependence structures, using the R package bild, fitted models revealed the potential benefit of a test-and-treat approach at the individual level for wasting compared with annual albendazole at the individual level, especially considering mild-to-severe forms (ORadj = 0.27; p = 0.007). All arms showed similar effects on stunting, compared with annual albendazole, at a 5% significance level. Time and age at baseline presented favorable effects in the percentage of stunting using both severity degrees. Results showed a decreased chance of having anemia and diarrhea over time, although with no significant differences between arms. Data from longitudinal studies are essential to study the direct and indirect effects of interventions, such as deworming, and to explore additional approaches aiming at better understanding the temporal structure of nutrition and health outcomes in children.
营养不良、贫血和肠道寄生虫感染是安哥拉的公共卫生问题，尤其是在学龄前儿童中。我们分析了在安哥拉北部本戈省进行的一项为期两年的纵向四臂随机平行试验的二项数据，该试验进行了七次随访评估，以探讨四项干预措施（个体和家庭层面的驱虫和检测与治疗肠道寄生虫）对消瘦和发育迟缓的影响，并了解它们对贫血、疟疾、腹泻和呕吐的间接益处。共有 121 名患有肠道寄生虫感染的儿童接受了基线治疗，并被分配到四个组（1:1:1:1）。使用身高别年龄（HAZ）和体重别身高（WHZ）的连续结局变量进行统计分析，并没有发现任何特定组别的明显益处（Pathogens 2021, 10, 309）。接下来，分别将 HAZ 和 WHZ 转换为发育迟缓的二进制变量和消瘦的二进制变量，分别考虑其轻度至重度（Z 分数<−1）和中度至重度（Z 分数<−2）。还分析了原始临床数据（关于贫血、腹泻、呕吐和疟疾）。使用 bild R 包进行不同依赖结构的二项纵向分析，拟合模型显示，与个体层面每年服用阿苯达唑相比，个体层面的检测和治疗方法对消瘦有潜在益处，尤其是考虑到轻度至重度形式（ORadj=0.27；p=0.007）。与每年服用阿苯达唑相比，所有组在 5%的显著性水平上对发育迟缓的影响相似。在考虑严重程度时，基线时的时间和年龄对发育迟缓的百分比有有利影响。结果表明，随着时间的推移，贫血和腹泻的发生几率降低，尽管各组之间没有显著差异。纵向研究的数据对于研究驱虫等干预措施的直接和间接影响以及探索其他方法以更好地了解儿童营养和健康结果的时间结构至关重要。
