The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial

Abstract

A randomized controlled trial in KwaZulu-Natal (South Africa) of 428 primary-school pupils (stratified into 6 groups by age, sex and intervention) measured the effect of different anthelmintic treatments and iron supplementation regimens provided twice at 6-monthly intervals for 1 year (1996/97). Half the pupils received iron supplementation (ferrous fumarate 200 mg weekly for 10 weeks). Pupils received 2 anthelmintic regimens, either (i) albendazole 400 mg plus praziquantel 40 mg/kg or (ii) albendazole 400 mg on 3 consecutive days plus praziquantel 40 mg/kg or (iii) placebo. Baseline prevalences of Ascaris 55.9%, Trichuris 83.6%, hookworm spp. 59.4%, were reduced after 12 months for single-dose albendazole treatment to Ascaris 17.4% (P < 0.005), Trichuris 61.5% (NS), hookworm spp. 0% (P < 0.005), and for triple-dose albendazole treatment to Ascaris 14.8% (P < 0.005), Trichuris 25.0% (P < 0.01), hookworm 0% (P < 0.005). Schistosoma haematobium 43.4% was reduced among treated groups to 8.3% (P < 0.005). There were no significant changes in the anthropometry of the different treatment groups at either 6 or 12 months post treatment. Twelve months after treatment there was a significant increase in haemoglobin levels (P = 0.02) among pupils receiving triple-dose albendazole, praziquantel and ferrous fumarate; pupils receiving no anthelmintic treatment showed a significant decrease as did pupils who received triple-dose albendazole and praziquantel but no iron. Regular 6-monthly anthelmintic treatment significantly reduced the prevalence of Ascaris, hookworm spp. and S. haematobium infections (P < 0.05). Triple-dose treatment for Trichuris was significantly more effective than a single dose of albendazole 400 mg (P = 0.002). In areas with schistosomiasis, hookworm infection and high prevalence of Trichuris infection, combination treatment with praziquantel, triple-dose albendazole, plus iron supplementation, is likely to improve pupils' health and haemoglobin levels.

Soil transmitted helminth infections and schistosomiasis in school age children in sub-Saharan Africa: Efficacy of chemotherapeutic intervention since World Health Assembly Resolution 2001

“…In fact, some of the studies reviewed in this report which investigated the efficacy of albendazole, mebendazole and levamisole showed a parasitological cure rates lower that 30% particularly with T. trichiura infection Taylor et al, 2001;Albonico et al, 2003;Saathoff et al, 2004b;Kihara et al, 2007;Kabatereine et al, 2007;Olsen et al, 2009;Appleton et al, 2009). Although there is limited evidence from the studies reviewed of a possible emergence of drug resistance, this may not be completely overruled.…”

“…Furthermore, the findings of this review indicated that benzimidazoles exhibited considerable cure rates and egg reduction rates particularly against A. lumbricoides and hookworms (Guyatt et al, 2001;Jinabhai et al, 2001;Saathoff et al, 2004b;Adugna et al, 2007;Kihara et al, 2007;) and aside from reducing the load of worms, benzimidazole treatment has been shown to improve the nutritional status and cognitive development of children infected with A. lumbricoides, T. trichiura, and hookworms and reduces hookworm associated anaemia in children (Albonico et al, 1996;Stoltzfus et al, 1998). On the other hand studies reviewed indicated that a single oral dose of 40 mg of praziquantel per kg of body weight was safe, showed no or only a few but transient side effects, but resulted in high parasitological cure and egg reduction rates against both S. mansoni and S. haematobium (Berhe et al, 1999;Taylor et al, 2001;Guyatt et al, 2001;Degu et al, 2002;Saathoff et al, 2004a;Midzi et al, 2008).…”

“…Although there is limited evidence from the studies reviewed of a possible emergence of drug resistance, this may not be completely overruled. A number of previous studies have indicated that there are no drugs available that are highly effective against T. trichiura infection as single dose treatments, but other studies show that two or three repeated doses of albendazole on consecutive days are more effective than a single dose (Horton 2000;Taylor et al, 2001;Jinabhai et al, 2001). To repeat the dose on 2 or 3 days would however increase cost, and might reduce compliance and complicate management (Adams et al, 2004).…”

Multiple micronutrient fortification of salt

“…Deworming was done to ensure that there are no worms to compete for the micronutrients and that the intestinal tract was clear for bioabsorption of the micronutrients as in other studies (Taylor et al, 2001;Olsen et al, 2003).…”

review of the control of schistosomiasis in South Africa

“…2,36,37 The increasing number of children attending school in KwaZulu-Natal provided a good opportunity for a cost-effective programme. 39 …”