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

Surgical Success judged by two criteria IOP≤16, not on ocular hypotensive treatment and ≤21mmHg at different follow up intervals.

<p>Surgical Success judged by two criteria IOP≤16, not on ocular hypotensive treatment and ≤21mmHg at different follow up intervals.</p

Survival analysis of IOP control in combined trabeculectomy and cataract surgery.

<p>Failure is mean IOP>21mmHg with or without medical treatment.</p

Flow diagram of recruitment and follow-up.

<p>Flow diagram of recruitment and follow-up.</p

Cluster level summaries of the indicators for contacts, quality and lifesaving interventions across the continuum of care in 2012 and 2015 amongst women with a live birth in the 12 months preceding survey.

<p>Cluster level summaries of the indicators for contacts, quality and lifesaving interventions across the continuum of care in 2012 and 2015 amongst women with a live birth in the 12 months preceding survey.</p

Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia

<div><p>Background</p><p>Survival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts.</p><p>Methods and findings</p><p>Regression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator ‘focused ANC behaviours’ was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator ‘focused ANC behaviours’. At delivery, in multiple regression the quality indicator ‘availability of uterotonic supplies amongst birth attendants’ was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period.</p><p>Conclusions</p><p>Increases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality.</p></div

Results from the multiple regression of change in coverage of critical interventions during pregnancy on change in indicators of contacts and quality.

<p>Results from the multiple regression of change in coverage of critical interventions during pregnancy on change in indicators of contacts and quality.</p

Baseline Personal, Ophthalmic and Surgical factors in the two treatment arms.

<p>Baseline Personal, Ophthalmic and Surgical factors in the two treatment arms.</p

Studies comparing trabeculectomy surgery alone with combined phacoemulsification and trabeculectomy surgery.

<p>Studies comparing trabeculectomy surgery alone with combined phacoemulsification and trabeculectomy surgery.</p

Size of the surveys accessed in this analysis.

<p>Size of the surveys accessed in this analysis.</p