Cognitive deficits and educational loss in children with schistosome infection—A systematic review and meta-analysis

Abstract

BackgroundBy means of meta-analysis of information from all relevant epidemiologic studies, we examined the hypothesis that Schistosoma infection in school-aged children (SAC) is associated with educational loss and cognitive deficits.Methodology/Principal findingsThis review was prospectively registered in the PROSPERO database (CRD42016040052). Medline, Biosis, and Web of Science were searched for studies published before August 2016 that evaluated associations between Schistosoma infection and cognitive or educational outcomes. Cognitive function was defined in four domains—learning, memory, reaction time, and innate intelligence. Educational outcome measures were defined as attendance and scholastic achievement. Risk of bias (ROB) was evaluated using the Newcastle-Ottawa quality assessment scale. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated to compare cognitive and educational measures for Schistosoma infected /not dewormed vs. uninfected/dewormed children. Sensitivity analyses by study design, ROB, and sequential exclusion of individual studies were implemented. Thirty studies from 14 countries, including 38,992 SAC between 5–19 years old, were identified. Compared to uninfected children and children dewormed with praziquantel, the presence of Schistosoma infection and/or non-dewormed status was associated with deficits in school attendance (SMD = -0.36, 95%CI: -0.60, -0.12), scholastic achievement (SMD = -0.58, 95%CI: -0.96, -0.20), learning (SMD = -0.39, 95%CI: -0.70, -0.09) and memory (SMD = -0.28, 95%CI: -0.52, -0.04) tests. By contrast, Schistosoma-infected/non-dewormed and uninfected/dewormed children were similar with respect to performance in tests of reaction time (SMD = -0.06, 95%CI: -0.42, 0.30) and intelligence (SMD = -0.25, 95%CI: -0.57, 0.06). Schistosoma infection-associated deficits in educational measures were robust among observational studies, but not among interventional studies. The significance of infection-associated deficits in scholastic achievement was sensitive to ROB. Schistosoma infection-related deficits in learning and memory tests were invariant by ROB and study design.Conclusion/SignificanceSchistosoma infection/non-treatment was significantly associated with educational, learning, and memory deficits in SAC. Early treatment of children in Schistosoma-endemic regions could potentially mitigate these deficits.Trial registrationClinicalTrials.gov CRD42016040052

Positive impact of preventative chemotherapy during a national helminth control program: Perception and KAP

“…Both the pupils and the school authorities perceived that school attendance had improved as a result of the helminth treatment program and the teachers further perceived that the school performance of their pupils had also improved since the implementation of the national control program. This is consistent with findings from a recent systematic review using data predominantly from Africa, which reported that compared to uninfected or children treated with praziquantel, the presence of Schistosoma infection was associated with deficits in school attendance as well as school performance in school aged children [24].…”

Underestimation of the global burden of schistosomiasis

“…These urogenital manifestations often do not resolve after clearance of infection. 4 Other serious clinical manifestations of intestinal schistosomiasis were also not incorporated, such as chronic blood loss and the cognitive impairment and diminished academic performance that are now clearly linked with schistosomiasis, 5 which further exacerbate the repercussions of poverty.…”

Environmental Predictors of Schistosomiasis Persistent Hotspots following Mass Treatment with Praziquantel

“…Repeated childhood infections contribute significantly to anemia, undernutrition, and impaired physical and cognitive development. [2][3][4][5] Schistosomiasis control programs can include improving access to clean water and sanitation, 6 reducing populations of snail hosts, 7 and implementing campaigns of mass drug administration (MDA) with praziquantel (PZQ) for preventive chemotherapy, with MDA being the most widely used strategy. 1 In areas of active transmission, the WHO recommends that school-aged children receive MDA with PZQ at different intervals depending on the prevalence of infection in that population, with MDA for adults also recommended under certain conditions.…”