Micronutrient supplementation and deworming in children with geohelminth infections.

Selvi Rajagopal,Donald A P Bundy,Peter J Hotez

doi:10.1371/journal.pntd.0002920

Abstract

Soil-transmitted helminth (also known as ‘‘geohelminth’’) infections are among the most common chronic infections worldwide. The World Health Organization (WHO) estimates that almost 900 million children require treatment (also known as deworming) for geohelminth infection, while the 2010 Global Burden of Disease Study estimates that more than 5.2 million Disability-Adjusted Life Years (DALYs) are attributable to geohelminth infection. In 2001, the World Health Assembly resolved to treat 75 percentage of children at risk for morbidity from these geohelminths by 2010. However, WHO reported that by 2010 only approximately one-third of all children at risk had achieved access to mass drug administration (MDA). Treating the remaining two-thirds by 2020 is the target of the 2012 London Declaration for Neglected Tropical Diseases. More than a thousand million deworming treatments have been delivered for the three common (and coendemic) geohelminths. The evidence presented here suggests that adding micronutrient supplementation may provide additional benefits, but the case is far from clear. With vitamin A, there are demonstrable additive effects in some settings, but in others there is no clear benefit or no clear difference from supplementation alone. With iron supplementation, in contrast, there does not appear to be a significant added benefit over deworming alone. It would not appear practical to integrate deworming with iron supplementation since the latter requires an extended regime of daily or weekly supplementation over several weeks. Such an approach is adopted as part of clinical case management and is appropriate to the setting of antenatal care or the management of severe anemia. Thus, in populations in which hookworm is a significant hazard and MDA for deworming is offered, it would be useful to ensure that those responsible for case management in the community were aware of the particular synergies with iron supplementation, especially for pregnant women.

Highlights

Soil-transmitted helminth infections are among the most common chronic infections worldwide
We explore the relative benefits of vitamin A supplementation for children with ascariasis infection and iron supplementation for children with trichuriasis and hookworm infections, with and without deworming, and consider whether there are circumstances in which deworming programs should be complemented by micronutrient programs
In communities in which vitamin A deficiency coexists with geohelminth infection, deworming alone and in combination with vitamin A supplementation has been explored as a means to correct or reduce deficiency in infected children

Summary

Introduction

Soil-transmitted helminth ( known as ‘‘geohelminth’’) infections are among the most common chronic infections worldwide. The World Health Organization (WHO) estimates that almost 900 million children require treatment ( known as deworming) for geohelminth infection, while the 2010 Global Burden of Disease Study estimates that more than 5.2 million disability-adjusted life years (DALYs) are attributable to geohelminth infection [1,2]. In 2001, the World Health Assembly resolved to treat 75% of children at risk for morbidity from these geohelminths by 2010. The 2012 London Declaration and the global aspirations for universal deworming arise partly from studies conducted over the last two decades demonstrating the severe morbidity and poor cognitive, intellectual, and physical child development in populations with endemic geohelminth infections, and the resulting economic losses [4,5]. We explore the relative benefits of vitamin A supplementation for children with ascariasis infection and iron supplementation for children with trichuriasis and hookworm infections, with and without deworming, and consider whether there are circumstances in which deworming programs should be complemented by micronutrient programs

Vitamin A

Findings

Conclusions