Impact of Annual Albendazole versus Four-Monthly Test-and-Treat Approach of Intestinal Parasites on Children Growth-A Longitudinal Four-Arm Randomized Parallel Trial during Two Years of a Community Follow-Up in Bengo, Angola.

Carolina Gasparinho,Luzia Gonçalves,Aguinaldo Kanjungo,Félix Zage,Isabel Clemente,Filomeno Fortes,Ana Santos-Reis,José Carlos Sousa-Figueiredo,Miguel Brito

doi:10.3390/pathogens10030309

Abstract

Malnutrition and intestinal parasites continue to have serious impacts on growth and cognitive development of children in Angola. A longitudinal four-arm randomized parallel trial was conducted to investigate if deworming with a single annual dose of albendazole (annual-ALB) or a four-monthly test-and-treat (4TT) intestinal parasites approach at individual or household levels improve nutritional outcomes of pre-school children in Bengo province. Children with intestinal parasites (n = 121) were randomly assigned (1:1:1:1) to arm A1: annual-ALB*individual level; A2: annual-ALB*household level; A3: 4TT*individual; and A4: 4TT*household level. At baseline, 4, 8, 12, 16, 20, and 24 months of follow-up, growth was assessed by height, weight, height-for-age, weight-for-height, weight-for-age, and mid-upper arm circumference. Intention-to-treat analysis was done using non-parametric approach, mixed effect models, and generalized estimating equations (GEE). Initially, 57% and 26% of the children were infected by Giardia lamblia and Ascaris lumbricoides, respectively. This study did not show that a 4TT intestinal parasites approach results on better growth outcomes of children (height, weight, HAZ, WAZ, WHZ and MUACZ) when compared with annual ALB, with exception of height and WHZ using GEE model at 5% level. Positive temporal effects on most nutrition outcomes were observed. Implementing a longitudinal study in a poor setting is challenging and larger sample sizes and ‘pure and clean’ data are difficult to obtain. Nevertheless, learned lessons from this intensive study may contribute to future scientific research and to tailor multidisciplinary approaches to minimize malnutrition and infections in resource-poor countries.

Highlights

Undernutrition is a major public health concern in developing countries contributing45% of all child deaths worldwide and to high levels of morbidity [1]
Children were deemed eligible according to inclusion criteria: age between 20–36 months at the recruitment; residence in the Health and Demographic Surveillance System (HDSS) area; and no history of antibiotic or antiparasitic drug
Between December 2013 and December 2014, 692 children were assessed for eligibility, of which 121 were included and randomly assigned to one of the four arms for two years of community follow-up completed in January 2017

Summary

Introduction

Undernutrition is a major public health concern in developing countries contributing45% of all child deaths worldwide and to high levels of morbidity [1]. Chronic undernutrition, is an indicator of linear growth retardation with a negative impact on child health and educational performance and, in a broader perspective, on economic development and poverty of nations [1,2]. A recent study revealed that many low- and middle-income countries (LMICs) remain far from the World Health Organization Global Nutrition Targets to reduce stunting and wasting by 2025. Malnutrition can result from exposure to poor nutrition, reduced access to healthcare services, inadequate water and sanitation, and recurrent infections [1]. Intestinal parasitic infections are a common public health problem in tropical regions, especially in developing regions where defecation habits, poor hygiene, and living conditions can increase the risk of infection [6]. Other preventive strategies include access to improved water, sanitation, and hygiene conditions

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