Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta‐analysis

BackgroundSoil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide.ObjectivesTo use individual participant data network meta‐analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers.Search MethodsWe developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews.Selection CriteriaWe included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection.Data Collection and AnalysisWe conducted NMA with individual participant data (IPD), using a frequentist approach for random‐effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest.ResultsWe received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence).Authors' ConclusionsThis analysis reinforces the case against mass deworming at a population‐level, finding little effect on nutritional status or cognition. However, children with heavier intensity infections may benefit more. We urge the global community to adopt calls to make data available in open repositories to facilitate IPD analyses such as this, which aim to assess effects for the most vulnerable individuals.</div

Effect of Parental Migration on the Academic Performance of Left Behind Children in North Western China

<p>China’s rapid urbanisation has induced large numbers of rural residents to migrate from their homes in the countryside to urban areas in search of higher wages. As a consequence, it is estimated that more than 60 million children in rural China are left behind and live with relatives, typically their paternal grandparents. These children are called Left Behind Children (LBCs). There are concerns about the potential negative effects of parental migration on the academic performance of the LBCs that could be due to the absence of parental care. However, it might also be that when a child’s parents work away from home, their remittances can increase the household’s income and provide more resources and that this can lead to better academic performance. Hence, the net impact of out-migration on the academic performance of LBCs is unclear. This paper examines changes in academic performance before and after the parents of students out-migrate. We draw on a panel dataset collected by the authors of more than 13,000 students at 130 rural primary schools in ethnic minority areas of rural China. Using difference-in-differences and propensity score matching approaches, our results indicate that parental migration has significant, positive impacts on the academic performance of LBCs (which we measure using standardised English test scores). Heterogeneous analysis using our data demonstrates that the positive impact on LBCs is greater for poorer performing students.</p

Frequency of household interview responses.

<p>*We were informed during Interview #6 of 23 that deworming of pigs was a universal practice in the village. Thus, we began explicitly asking this question in every subsequent household interview, totaling 18 responses.</p><p>Frequency of household interview responses.</p

Map of the study area and location of the six villages in Danzhai, Guizhou, China.

<p>Map of the study area and location of the six villages in Danzhai, Guizhou, China.</p

Heterogeneous impact of daily text messages: Rural Shaanxi Province, 2013.

<p>Heterogeneous impact of daily text messages: Rural Shaanxi Province, 2013.</p

Using daily text messages to improve adherence to infant micronutrient powder (MNP) packets in rural western China: A cluster-randomized controlled trial

<div><p>Objective</p><p>To evaluate the effectiveness of daily text messages as a means to improve caregivers’ adherence to infant micronutrient powder (MNP) in rural Shaanxi Province of China.</p><p>Methodology</p><p>638 infants aged 6–11 months in 234 villages were involved in a cluster-randomized controlled trial (RCT). All caregivers were given free infant MNP packets at baseline in April 2013 and the follow-up survey was in July 2013. We randomly assigned 318 infants in 117 villages to treatment group (receiving daily text message) and 320 infants in the other 117 villages as control group.</p><p>Results</p><p>On average, daily text messages increased the number of MNP packets fed (marginal effect = 4.63; 95% confidence interval (CI) = 0.16, 9.10). The text message is more likely to increase the consumption of MNP packets if the primary caregiver was the mother (marginal effect = 12.19; 95% CI = 0.69, 23.68). Receiving the text message appears to significantly increase the likelihood of full adherence when the primary caregiver can either check (odds ratio = 2.93; 95% CI = 1.34, 6.40) or knows how to send (odds ratio = 3.26; 95% CI = 1.53, 6.97) text messages.</p><p>Conclusion</p><p>Daily text messages improved the consumption of infant MNP packets. However, the impact was not large enough to increase the probability of caregivers being fully adherent to the feeding instruction, which is to feed 5–7 packets per week as recommended. In addition, when the mother is the caregiver and when the caregiver can check or knows how to send text messages there is greater adherence by the primary caregivers.</p><p>Trial registration</p><p><a href="http://www.isrctn.com/ISRCTN44149146" target="_blank">http://www.isrctn.com/ISRCTN44149146</a></p></div

Baseline characteristics of sample infants, caregivers, household social economic status, and primary caregivers’ text message practice by trial groups: Rural Shaanxi Province, China, 2013.

<p>Baseline characteristics of sample infants, caregivers, household social economic status, and primary caregivers’ text message practice by trial groups: Rural Shaanxi Province, China, 2013.</p

Intent-to-treat analysis of the impact of daily text messages on caregiver feeding adherence: Rural Shaanxi Province, 2013.

<p>Intent-to-treat analysis of the impact of daily text messages on caregiver feeding adherence: Rural Shaanxi Province, 2013.</p

Trial of text message campaign on the adherence of rural caregivers in feeding infants with free MNP packets, comprising the control group and the text group (April 2013-July 2013): Rural Shaanxi Province, China.

<p>Trial of text message campaign on the adherence of rural caregivers in feeding infants with free MNP packets, comprising the control group and the text group (April 2013-July 2013): Rural Shaanxi Province, China.</p

Heterogeneous impact of daily text messages: Rural Shaanxi Province, 2013.

<p>Heterogeneous impact of daily text messages: Rural Shaanxi Province, 2013.</p