Effects of Deworming on Malnourished Preschool Children in India: An Open-Labelled, Cluster-Randomized Trial

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Abstract
More than a third of the world's children are infected with intestinal nematodes. Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children. We studied the effects on the heights and weights of 3,935 children, initially 1 to 5 years of age, of five rounds of anthelmintic treatment (400 mg albendazole) administered every 6 months over 2 years. The children lived in 50 areas, each defined by precise government boundaries as urban slums, in Lucknow, North India. All children were offered vitamin A every 6 months, and children in 25 randomly assigned slum areas also received 6-monthly albendazole. Treatments were delivered by the State Integrated Child Development Scheme (ICDS), and height and weight were monitored at baseline and every 6 months for 24 months (trial registration number NCT00396500). p Value calculations are based only on the 50 area-specific mean values, as randomization was by area. The ICDS infrastructure proved able to deliver the interventions. 95% (3,712/3,912) of those alive at the end of the study had received all five interventions and had been measured during all four follow-up surveys, and 99% (3,855/3,912) were measured at the last of these surveys. At this final follow up, the albendazole-treated arm exhibited a similar height gain but a 35 (SE 5) % greater weight gain, equivalent to an extra 1 (SE 0.15) kg over 2 years (99% CI 0.6–1.4 kg, p = 10−11). In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1–5 years results in substantial weight gain. The ICDS system could provide a sustainable, inexpensive approach to the delivery of anthelmintics or micronutrient supplements to such populations. As, however, we do not know the control parasite burden, these results are difficult to generalize. ClinicalTrials.gov NCT00396500 About one-third of children in poor communities globally are infected with intestinal worms. Treatment is effective and safe, and involves taking a pill once or twice a year. Most deworming programs are aimed at children of school age because most infections occur in this age group and schoolchildren are easy to reach and treat in schools. But preschool children are also infected and, in North India, the State Integrated Child Development Scheme (ICDS) provides a system of preschools and teachers that could potentially deliver treatment to younger children. To see whether deworming would be feasible and beneficial for preschool children, we studied its effects on the growth of 4,000 children initially aged 1 to 5 years in the urban slums of Lucknow, North India. Over a 2-year period, the ICDS successfully provided regular 6-monthly treatment to 95% of the children targeted, and the treated children gained about an extra kilogram in weight when compared to untreated children in neighbouring slums. These results show that the preschool program in India could provide regular deworming simply and cheaply, and suggest that poor and malnourished preschool children with a heavy worm load could show a substantial gain in weight as a result.

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