Abstract
BackgroundMalaria and helminth infections are thought to negatively affect children’s nutritional status and to impair their physical and cognitive development. Yet, the current evidence-base is weak. The purpose of this study was to determine the effect of deworming against soil-transmitted helminthiasis and schistosomiasis on children’s physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic setting of Côte d’Ivoire.MethodsWe designed an intervention study with a 5-month follow-up among schoolchildren aged 5–14 years from Niablé, eastern Côte d’Ivoire. In late 2012, a baseline cross-sectional survey was conducted. Finger-prick blood, stool and urine samples were subjected to standardised, quality-controlled techniques for the diagnosis of Plasmodium spp., Schistosoma spp., soil-transmitted helminths and intestinal protozoa infections. Haemoglobin level was determined and anthropometric measurements were taken for appraisal of anaemia and nutritional status. Children underwent memory (digit span) and attention (code transmission) cognitive testing, and their physical fitness and strength were determined (20 m shuttle run, standing broad jump and grip strength test). All children were treated with albendazole (against soil-transmitted helminthiasis) and praziquantel (against schistosomiasis) after the baseline cross-sectional survey and again 2 months later. Five months after the initial deworming, the same battery of clinical, cognitive and physical fitness tests was performed on the same children.ResultsLower scores in strength tests were significantly associated with children with harbouring nutritional deficiencies. Surprisingly, boys infected with Schistosoma mansoni achieved longer jumping distances than their non-infected counterparts. Light-intensity infection with S. mansoni was associated with slightly better aerobic capacity. Deworming showed no effect on haemoglobin levels and anaemia, but children with moderate- to heavy-intensity Schistosoma infection at baseline gained weight more pronouncedly than non-infected children. Interestingly, children with soil-transmitted helminth or Schistosoma infection at baseline performed significantly better in the sustained attention test than their non-infected counterparts at the 5-month follow-up.ConclusionsThis study revealed conflicting results regarding clinical parameters and cognitive behaviour of children after two rounds of deworming. We speculate that potential beneficial effects of deworming are likely to be undermined in areas where malaria is co-endemic and nutritional deficiencies are widespread.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-411) contains supplementary material, which is available to authorized users.
Highlights
Malaria and helminth infections are thought to negatively affect children’s nutritional status and to impair their physical and cognitive development
The main reason why children were excluded from sample 2 is that they missed at least one of the follow-up assessments. 213 children from sample 2 provided stool samples at the end of the study for treatment efficacy evaluation against helminth infections, whilst 217 provided finger-prick blood samples at follow-up and were considered for analysis of changes of Plasmodium parasitaemia
Children not understanding the code transmission test were kept in the two samples, but only 146 children with valid results at baseline and the 5-month follow-up were considered for evaluation of dynamics in test scores
Summary
Malaria and helminth infections are thought to negatively affect children’s nutritional status and to impair their physical and cognitive development. In 2010, malaria and the neglected tropical diseases (NTDs), of which helminth infections are of particular importance in terms of number of infections and global burden [7,8], accounted for an estimated 6.4 million disability-adjusted life years (DALYs) among the school-aged population in subSaharan Africa, representing 16.5% of the total DALYs [9] These burden estimates result from a complex construct to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors. Efforts have been made for improving the assessment of the ‘true’ burden of disease by incorporating different sequelae to capture direct consequences of disease (e.g. anaemia due to hookworm infection) [10] These sequelae mainly describe clinical conditions and do not sufficiently take into account subtle morbidities [11,12]
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