Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance

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Review status: Current question ‐ update pending: a search conducted in July 2011 has been passed to authors for assessment. ("Published notes" explains the review status categories). In areas where intestinal worm infections occur, the World Health Organization recommends treating all school children at regular intervals with deworming drugs to improve growth and school performance. The evidence base for this policy needs to be established for countries to commit resources to implement these programmes. To summarize the effects of deworming drugs used to treat soil‐transmitted intestinal worms (nematode geohelminths) on growth and school performance in children. In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, mRCT, and reference lists. Randomized and quasi‐randomized controlled trials (RCTs) comparing deworming drugs for geohelminth worms with placebo or no treatment in children aged 16 years or less, reporting on growth, nutritional status, school performance, or cognition tests. Two authors independently assessed the trials and evaluated methodological quality; one author extracted data, and another checked a sample. Continuous data were analysed using the mean difference (MD) with 95% confidence intervals (CI). The random‐effects model (RE model) was used in the presence of statistically significant heterogeneity. Thirty‐four RCTs, including six cluster‐RCTs, met the inclusion criteria. Four trials had adequate allocation concealment, and three cluster‐RCTs failed to take design effects into account in their analysis. Weight increased after one dose of a deworming drug (MD 0.34 kg, 95% CI 0.05 to 0.64, RE model; 2448 children, 9 trials); however, there was considerable heterogeneity between trials that was not explained by background intestinal worm infection or intensity. A meta‐analysis of multiple dose trials reporting on outcomes within a year of starting treatment showed no significant difference in weight gain (1714 children, 6 trials); however, one cluster‐RCT did show effects on weight at one year in a subgroup analysis. In the seven multiple dose trials with follow up beyond 12 months, only one showed a significant increase in weight. Six of seven trials reported clear data on cognitive tests and school performance: five reported no significant effects, and one showed some improvements in three out of 10 cognitive tests. Deworming drugs used in targeted community programmes may be effective in relation to weight gain in some circumstances but not in others. No effect on cognition or school performance has been demonstrated. 使用驅蟲藥物治療經土壤傳染之腸道寄生蟲對兒童生長發育及學校學習情況之影響 世界衛生組織建議在腸道寄生蟲感染盛行之區域之學齡兒童應在固定期間投予驅蟲藥物治療，以改善生長發育及學校學習情況。對於承諾投入資源來推行這項計畫的國家而言, 這項政策需要證據支持。 針對驅蟲藥物治療經土壤傳染之腸道寄生蟲(蠕蟲)，兒童生長發育及學校學習情況影響之歸納整理。 我們於2007年5月搜尋了Cochrane Infectious Diseases Group Specialized Register，CENTRAL(The Cochrane Library2007, Issue 2)，MEDLINE，EMBASE，LILACS，mRCT 等資料庫及其參考文獻。 選擇在小於16歲兒童進行之使用驅蟲藥物治療蠕蟲與使用安慰劑或不治療之隨機及半隨機對照試驗(randomized controlled trials ;RCTs)，這些研究需報告兒童生長，營養狀況，學習表現，及認知測驗。 兩位作者分別檢閱試驗與評估研究方法之品質;一位作者蒐集數據，另一位檢查樣本。本文使用加權平均差異(weighted mean difference ：WMD)及其95 ％的信賴區間(CI)分析連續性資料，各試驗間異質性的統計顯著性以隨機效應模型(randomeffects model：RE model)進行檢定。 本研究收集了34個符合納入標準之RCTS，其中包括6個群組型RCTs。有四個試驗or有適當的隱蔽分組，有三個群組型RCTs在分析結果時沒有考慮到設計的影響。給予一次驅蟲藥物後體重增加，(WMD 0.34kg， 95 ％CI為0.05至0.64 ，RE model; 2448位兒童， 9個臨床試驗);但臨床試驗間有相當大無法以腸道蠕蟲感染或強度之背景來解釋的異質性。1統合分析(metaanalysis)針對多種劑量服用驅蟲藥物一年內之結果並無顯著體重增加之影響(1714位兒童， 6個臨床試驗);不過，有一個群組型RCT的一個子群分析中針確實發現在一年中體重有顯著的增加。在7個追蹤超過12個月的多種劑量試驗中，只有一個有顯著增加體重。 在7個試驗中有6個試驗有明確的認知測驗及學校表現數據報告， 其中5個試驗指出並無顯著影響，僅一個試驗顯示在10項認知測驗中有3項會有某些改善。 在某些特定之社區方案中驅蟲藥物的使用在特定的情境下可能和體重之增加有關。現階段證據顯示驅蟲藥物的使用對兒童認知或學校的表現沒有影響。 本摘要由三軍總醫院吳宜穎翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 以驅蟲藥物治療兒童經土壤傳播的腸道蠕蟲疾病對生長和學校表現的影響。全世界大約四分之一的人口感染一個或多個土壤傳播的寄生蟲。主要經土壤傳播的蠕蟲感染有，蛔蟲，鉤蟲，犬鞭蟲。這類感染廣泛分佈於熱帶和亞熱帶地區，大多數的人感染一種以上的寄生蟲。這類感染較易發生於窮人，主因是衛生設施不足，過分擁擠，教育水平低，以及缺乏醫療保健資源。這些感染導致了營養不良和兒童發育不良，並且有些研究指出其與在校表現不佳有關。改善環境和衛生，可能會有幫助。此外，基本治療感染用藥策略如下：(1)針對診斷出感染的個體作治療，(選擇性治療); (2)針對高風險的團體治療(特定對象治療);及(3)針對整個社區的人治療，不論他是否有感染(普世治療)。特定對象治療是目前一般採用的方式。這篇文章主要檢討針對特定對象治療的臨床試驗中兒童生長和在校表現作評估。這34個臨床試驗中有單一或多劑量，但只有某些有評估在校表現。單一劑量即可使兒童的體重改善，但更多的劑量似乎沒有更進一步的效果。在7個有評估學校表現的臨床試驗中只有1個發現有進步，所以尚無法確定是否真的有好處。有兩項試驗探討藥物不良反應，但臨床試驗規模稍小。本議題需要進一步研究。