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
Highlights
An estimated 800 million persons in tropical and sub-tropical countries are at risk of infection by one of three main human Schistosoma parasites–S. mansoni, S. haematobium, and S. japonicum [1]
Schistosoma infection or non-dewormed status was associated with educational loss and cognitive deficits
Schistosoma infection or non-dewormed status was associated with deficits in learning and memory domains of psychometrically tested cognitive function
Summary
An estimated 800 million persons in tropical and sub-tropical countries are at risk of infection by one of three main human Schistosoma parasites–S. mansoni, S. haematobium, and S. japonicum [1]. As many as 240 million adults and children are actively infected [2,3,4] resulting in as much as 3.3 million disability-adjusted life years (DALYs) lost per annum due to overt and subclinical morbidities of Schistosoma infection [4, 5]. Sub-Saharan Africa is most affected; children from endemic areas are often infected by two years of age and many remain chronically infected throughout their school-age years [6,7,8]. Schistosoma-infected pre-school children are not routinely treated in such settings, and they constitute a potentially high risk group for accumulation of morbidity [9]. By 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
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