Control of Ascaris infection by chemotherapy: which is the most cost-effective option?

Cost-effectiveness analysis is used to predict the optimal design of mass chemotherapy strategies in controlling Ascaris lumbricoides infection. The question of who to treat, how many to treat, and how often to treat are addressed using a population dynamic model of helminth transmission that assesses effectiveness in terms of disease reduction, combined with cost data from an actual control programme. Child-targeted treatment can be more cost-effective than population treatment in reducing the number of disease cases. The model also implies that, in the circumstances described here, enhancing coverage is a more cost-effective approach than increasing frequency of treatmen

Evaluation of efficacy of school-based anthelmintic treatments against anaemia in children in the United Republic of Tanzania

Objective: To determine the impact of deworming on anaemia as part of a large-scale school-based anthelmintic treatment programme in the Tanga Region of the United Republic of Tanzania. Methods: Both the reduction in the prevalence of anaemia and the cost per case prevented were taken into consideration. Cross-sectional studies involved parasitological examination and anaemia evaluation before and at 10 months and 15 months after schoolchildren were dewormed. Findings: Baseline studies indicated that the prevalence of anaemia (haemoglobin < 110 g/l) was high (54%) among schoolchildren, particularly those with high intensities of hookworm and schistosomiasis. Attributable fraction analysis suggested that hookworm and schistosomiasis were responsible for 6% and 15% of anaemia cases, respectively. Fifteen months after deworming with albendazole and praziquantel the prevalence of anaemia was reduced by a quarter and that of moderate-to-severe anaemia (haemoglobin <90 g/l) was reduced by nearly a half. The delivery of these anthelmintics through the school system was achieved at the relatively low cost of US$1 per treated child. The cost per anaemia case prevented by deworming schoolchildren was in the range US$ 6 - 8, depending on the haemoglobin threshold used. Conclusions: The results suggested that deworming programmes should be included in public health strategies for the control of anaemia in schoolchildren where there are high prevalences of hookworm and schistosomiasis

Effect on weight gain of routinely giving albendazole to preschool children during child health days in Uganda: cluster randomised controlled trial

Objective: To estimate the effectiveness of delivering an anthelmintic through a community child health programme on the weight gain of preschool children in Uganda. Design: Cluster randomised controlled trial. Setting: Eastern Uganda. Participants: 48 parishes participating in a new programme for child health: 24 offered children an additional service of anthelmintic treatment. The outcome is based on measurements from 27 995 children. Intervention: Treatment of children aged between 1 and 7 years with 400 mg albendazole added to standard services offered during child health days over a three year period. Main outcome measure Weight gain. Results: The provision of periodic anthelmintic treatment as a part of child health services in Uganda resulted in an increase in weight gain of about 10% (166 g per child per year, 95% confidence interval 16 to 316) above expected weight gain when treatments were given twice a year, and an increase of 5% when the treatment was given annually. Conclusion: Deworming of preschool children in Uganda as part of regularly scheduled health services seems practical and associated with increased weight gain

Health and cultural factors associated with enrolment in basic education: a study in rural Ghana

This inter-disciplinary study compares the health status of school-age children in Ghana, both enrolled and non-enrolled, and examines these results within a wider socio-economic and socio-cultural context including kinship and livelihood. Children matched for age and sex who were not enrolled in Primary School were significantly shorter and more stunted than enrolled children were, and 70% of all Primary school-age children were anaemic. Young children from farming communities were significantly more undernourished than children from fishing communities. Adolescent non-enrolled boys were more heavily infected with Schistosoma haematobium, and were more likely to be anaemic than enrolled adolescent boys. The data indicate how health and health related factors may influence and affect enrolment and how socio-economic indicators, livelihood, and kinship may also constrain enrolment and, in turn, affect child health. This study sheds light on the complex factors that may influence enrolment in education and provides novel data on the similarities and differences between the health of enrolled and non-enrolled children in rural Ghana

The effects of sex and age of responders on the reliability of self-diagnosed infection: a study of self-reported urinary schistosomiasis in Tanzanian school children

Self-reported schistosomiasis has been proven to be a reliable estimation of the prevalence of infection in school children. For the first time, this paper presents an investigation into the use of self-reported schistosomiasis to estimate the prevalence of urinary schistosomiasis, due to Schistosoma haematobium, in school children with particular emphasis on whether the age and sex of respondents influences the reliability of diagnosis. It is shown first, that the prevalence and intensity of infection vary with sex; infection in boys is always more prevalent and more intense than in girls of the same age and second, that age and sex influence the reliability of self-reported schistosomiasis as a diagnostic method. Age and sex are factors that should be considered when implementing control measures in endemic areas

Heavy schistosomiasis associated with poor short-term memory and slower reaction times in Tanzanian schoolchildren.

Cross-sectional studies of the relationship between helminth infection and cognitive function can be informative in ways that treatment studies cannot. However, interpretation of results of many previous studies has been complicated by the failure to control for many potentially confounding variables. We gave Tanzanian schoolchildren aged 9-14 a battery of 11 cognitive and three educational tests and assessed their level of helminth infection. We also took measurements of an extensive range of potentially confounding or mediating factors such as socioeconomic and educational factors, anthropometric and other biomedical measures. A total of 272 children were moderately or heavily infected with Schistosoma haematobium, hookworm or both helminth species and 117 were uninfected with either species. Multiple regression analyses, controlling for all confounding and mediating variables, revealed that children with a heavy S. haematobium infection had significantly lower scores than uninfected children on two tests of verbal short-term memory and two reaction time tasks. In one of these tests the effect was greatest for children with poor nutritional status. There was no association between infection and educational achievement, nor between moderate infection with either species of helminth and performance on the cognitive tests. We conclude that children with heavy worm burdens and poor nutritional status are most likely to suffer cognitive impairment, and the domains of verbal short- term memory and speed of information processing are those most likely to be affecte