Abstract
BackgroundDespite the existence of a population-based control program using single dose albendazole or mebendazole as a preventive chemotherapy, hookworm transmission remains high. It causes a negative impact on the growth and school performance of children. In connection to this preventive chemotherapy, different studies produced conflicting results. This study aimed at evaluating the efficacy of single (500 mg) versus multiple doses (100 mg twice a day during three consecutive days) of mebendazole against hookworm infections among school-aged children.MethodsThis randomized open-label clinical trial took place among school-aged children (6–14 years old) in Burie and Debre Elias towns, Northwest Ethiopia. Using simple randomization, eligible hookworm-positive children were allocated (1:1) to either a single or multiple dose treatment arms. Stool samples were collected and processed using McMaster method at baseline and follow-up period (14–21 days after treatment). Only laboratory technicians were blinded. The cure and egg reduction rates were the primary and secondary therapeutic outcome measures against hookworm infections, respectively. An independent t-test was used to compare group means, and logistic regression was used to calculate odds ratio (OR). P-value < 0.05 at 95% CI was considered statistically significant.ResultOne hundred eight children, 54 in each treatment arm had completed baseline data and received allocated treatment. One hundred three children had completed follow-up data records and included for the final efficacy analysis. Cure rate against hookworm was significantly higher in the multiple dose (96.1%) than in the single dose (30.8%) with OR = 55.125; 95% CI: 11.92–254.9; P < 0.001. The egg reduction rate in the multiple dose treatment arm (99.5%) was also significantly higher than in the single dose arm (68.9%) with difference t (101) =5.38; 95% CI 230.95–505.36; P < 0.001.ConclusionThe single dose regimen of mebendazole for the treatment of hookworm infections showed poor cure and egg reduction rates, while the multiple doses revealed satisfactory. Although multiple dose regimen administration is a bit more complex than the single dose, we strongly encourage replacing it with multiple dose regimen during deworming programs in hookworm endemic areas.Trial registrationThis trial is retrospectively registered in www.pactr.org, number PACTR201911466695052 on November 26, 2019.
Highlights
Despite the existence of a population-based control program using single dose albendazole or mebendazole as a preventive chemotherapy, hookworm transmission remains high
Eleven hookworm infected children were excluded because they were absent from school on the clinical and physical examination day
Two participants in the single dose and one child in the multiple dose arms were absent from school and two children in the multiple dose arm were unable to provide sufficient stool samples
Summary
Despite the existence of a population-based control program using single dose albendazole or mebendazole as a preventive chemotherapy, hookworm transmission remains high. It causes a negative impact on the growth and school performance of children. In 2017, the global burden of hookworm infections was estimated at 845,000 disable-adjusted life years (DALYs) [2] This parasite is mainly associated with hypo-albuminemia, iron deficiency anemia, and malnutrition, which cause more subtle chronic health problems like physical and intellectual growth retardation in children, and adverse pregnancy outcomes [3, 4]. Over 267 million preschool-aged children and over 568 million school-aged children live in areas where the parasite is intensively transmitted and are in need of treatment and preventive interventions [7]
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