1 Deworming and adjuvant interventions for children in low and
middle income countries: systematic review and network
meta-analysis Vivian Welch, Chris Cameron, Shally Awasthi, Chisa
Cumberbatch, Robert Fletcher, Jessie McGowan, Shari Krishnaratne,
Salim Sohani, Peter Tugwell, George Wells Slide 2 2
Acknowledgements Canadian Institutes of Health Research Knowledge
Synthesis Slide 3 3 Geohelminths and schistosomiasis Ascaris
lumbricoides (roundworm) Schistosomiasis Trichuris Trichiura
(whipworm) Necator americanus and Ancylostoma duodenale (hookworm)
Slide 4 4 Infection Process Light Infection Symptoms Heavy
Infection Symptoms Approximate # of people infected Ascaris
lumbricoides swallows food or soil Often no symptoms Cough, fever,
discomfort passing worms 800 million Necator Americanus absorbed
through skin. diarrhea, cramps and weight loss that can lead to
anorexia. anaemia 500-600 million Ancylostama Duodenale contact of
skin with soil contaminated with larvae Light infection causes
abdominal pain, loss of appetite protein deficiency or
iron-deficiency anaemia 100 million Trichuris trichiura Ingestion
of eggs Often no symptoms iron-deficiency anaemia, Vitamin A loss.
500-600 million Schistosomia sis swimming or playing in infected
water. anaemia, stunting and reduced ability to learn 243 million
Slide 5 5 Slide 6 6 Slide 7 7 The greatest burden of STH occurs in
Sub-Saharan Africa (SSA). This map shows the predicted distribution
of STHs in SSA with Ascaris Lumbricoides. Source: Global Atlas of
Helminth Infections Slide 8 8 WHO Guidelines for Deworming, 2011
For soil-transmitted helminths, annual treatment in areas where
prevalence rate of soil-transmitted helminthiases is between 20%
and 50%, and, a bi-annual treatment in areas with prevalence rates
of over 50%. For schistosomiasis, annual treatment with
praziquantel in high risk communities (>50%), once every two
years in medium risk (>10% and 1000: 4 Study duration: 1 year: 7
# cluster RCTs: 7 out of 21 Slide 28 Evidence Network
Deworming-Weight gain (Kg) 21 RCTs 16 Treatments N=42,197 Slide 29
29 FE: Resdev=161 vs 51; DIC=60.65 RE: Resdev=52.7 vs 51; DIC=-35.9
0.19(0.01,0.37) 0.24(-0.43,0.92) 0.15(0.11,0.19) 0.28(-0.01,0.57)
0(-0.35,0.34) 0.09(-0.84,1.02) 0.06(-0.21,0.33) -0.07(-0.89,0.67)
0.09(-0.04,0.23) 0.12(-0.48,0.69) 0.02(-0.09,0.14)
-0.08(-0.62,0.45) 0.43(0.13,0.74) 0.38(-0.48,1.26) 1.42(1.06,1.79)
1.38(0.12,2.64) 0.93(0.71,1.16) 0.93(0.02,1.85) 0.03(-0.32,0.37)
0.02(-0.92,0.97) 0.22(-0.11,0.55) 0.22(-0.73,1.16) 0.35(-0.31,1.01)
0.35(-0.75,1.44) 0.2(-0.22,0.62) 0.2(-0.78,1.18) 1.2(0.92,1.48)
1.2(0.27,2.13) 1.4(1.09,1.7) 1.41(0.47,2.35) Pyrantel Pamoate
Albendazole Albendazole-high dose Albendazole+iron iron Mebendazole
vitamin A Albendazole + vitamin A Levamisole Piperazine
Metronizadole (anti giardia) Piperazine+metronizadole Albendazole +
Praziquantel Praziquantel (for schistosomiasis) Metrifonate (also
for schistosomiasis) Results vs. Placebo Weight gain in Kg Slide 30
30 Results vs. Placebo, RE Model Weight gain in Kg Pyrantel Pamoate
Albendazole Albendazole-high dose Albendazole+iron iron Mebendazole
vitamin A Albendazole + vitamin A Levamisole Piperazine
Metronizadole (anti giardia) Piperazine+metronizadole Albendazole +
Praziquantel Praziquantel (for schistosomiasis) Metrifonate (also
for schistosomiasis) 0.24(-0.43,0.92) 0.28(-0.01,0.57)
0.09(-0.84,1.02) -0.07(-0.89,0.67) 0.12(-0.48,0.69)
-0.08(-0.62,0.45) 0.38(-0.48,1.26) 1.38(0.12,2.64) 0.93(0.02,1.85)
0.02(-0.92,0.97) 0.22(-0.73,1.16) 0.35(-0.75,1.44) 0.2(-0.78,1.18)
1.2(0.27,2.13) 1.41(0.47,2.35) 0.20(-0.01,0.41), I2-na 0.31(0.10,
0.53), i2, 94% na 0.14 (-0.04, 0.32), I2=0% 0.10 (-0.07, 0.26),
i2=0% -0.07 (-0.41, 0.28), i2=87% 0.14 (-0.20, 0.49), i2=0% na 0.93
(0.71, 1.15), i2-na 0.03 (-0.32, 0.37), i2=na 0.22 (-0.11, 0.55),
i2=na 0.35 (0.02, 0.68), i2=na 0.20 (-0.21, 0.61), i2=na 1.2(0.92,
1.47), i2-=na 1.40 (1.09, 1.71), i2=na Deworming 0.29 (0.13, 0.45)
Overall I 2 =92% Slide 31 31 Next steps Hand searching reference
lists, impact evaluation databases, contacting authors Educational
outcomes Quasi-experimental studies Risk of bias Causal pathway
analysis Covariate analysis to explore heterogeneity and improve
consistency of model Slide 32 32 Questions?
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