Abstract
Soil-transmitted helminth (STH) infections are a leading cause of disability and disease burden in school-age children of worm-endemic regions. Their effect on school absenteeism, however, remains unclear. The World Health Organization currently recommends delivering mass deworming and health hygiene education through school-based programs, in an effort to control STH-related morbidity. In this cluster-RCT, the impact of a health hygiene education intervention on absenteeism was measured. From April to June 2010, all Grade 5 students at 18 schools in a worm-endemic region of the Peruvian Amazon were dewormed. Immediately following deworming, nine schools were randomly assigned to the intervention arm of the trial using a matched-pair design. The Grade 5 students attending intervention schools (N = 517) received four months of health hygiene education aimed at increasing knowledge of STH prevention. Grade 5 students from the other nine schools (N = 571) served as controls. Absenteeism was measured daily through teachers' attendance logs. After four months of follow-up, overall absenteeism rates at intervention and control schools were not statistically significantly different. However, post-trial non-randomized analyses have shown that students with moderate-to-heavy Ascaris infections and light hookworm infections four months after deworming had, respectively, missed 2.4% (95% CI: 0.1%, 4.7%) and 4.6% (95% CI: 1.9%, 7.4%) more schooldays during the follow-up period than their uninfected counterparts. These results provide empirical evidence of a direct effect of STH infections on absenteeism in school-age children.
Highlights
Soil-transmitted helminth (STH) infections are the world’s most important cluster of neglected tropical diseases and cause significant morbidity in school-age children [1]
Using a post-trial non-randomized analysis, the authors found that, while this health education intervention had no effect on overall absenteeism rates, Grade 5 students who had been re-infected during the four months following treatment had higher absenteeism rates than students who were uninfected after four months. These results contribute to a better understanding of the negative impact of STH infections on child health, showing that STH infections do increase the risk of absenteeism. These results show that health education interventions, while powerful tools in the fight against STH infections, likely need to be implemented over longer periods of time to impact overall absenteeism rates
The 18 participating schools were open for a total of 85,107 student-days between the date of deworming and the date of follow-up stool specimen collection for the 1,088 Grade 5 students included in the final sample
Summary
Soil-transmitted helminth (STH) infections are the world’s most important cluster of neglected tropical diseases and cause significant morbidity in school-age children (i.e. children aged between 5 and 14 years) [1]. A randomized controlled trial in Kenya found that a deworming intervention reduced absenteeism by at least 7 percentage points – a reduction of 25% of the baseline absenteeism rate – in school-age children [6]. This trial had a large sample size and strong methodology, and is often cited as evidence that STH infections have an important effect on absenteeism in school-age children [3,7]. Summarizing these results is difficult, as study quality was variable and results were discordant
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