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- W2230642508 abstract "Your Dec 4 Editorial1The Lancet Thinking beyond deworming.Lancet. 2004; 364: 1993-1994Summary Full Text Full Text PDF PubMed Scopus (45) Google Scholar may be overly optimistic about the benefits of deworming children without giving other remedial reatment as well. If treating worm infections reduces malnutrition and anaemia as you say, it is useful to think how this will occur. Stopping blood losses due to hook-worms and schistosomiasis is important, but if the haemoglobin concentration is to recover, anaemic children will need iron and other nutrients. A randomised, placebo-controlled trial of vitamin A and iron given to Tanzanian school children after they had been dewormed reported an average increase in haemoglobin concentration in 3 months of 22·1 g/L in children given both micronutrients compared with only 3·6 g/L in the control group.2Mwanri L Worsley A Ryan P Masika J Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania.J Nutr. 2000; 130: 2691-2696PubMed Scopus (92) Google Scholar Worms exist in places where under-nutrition is common and where stunting and underweight persist throughout the school-age years and may even get worse.3PCD (Partnership for Child Development) The anthropometric status of schoolchildren in five countries in the Partnership for Child Development.Proc Nutr Soc. 1998; 57: 149-158Crossref PubMed Google Scholar If an effect of worms is to reduce appetite,4Stoltzfus RJ Chway HM Montresor A et al.Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children.J Nutr. 2004; 134: 348-356PubMed Google Scholar malnourished children will need extra micronutrient-rich food to fuel their catch-up growth after anthelmintic treatment. Deworming alone could, in theory, increase hunger. The failure of studies of deworming alone to measure improved growth and weight gain may partly be due to this point, although here may be other epidemiological factors involved as well.5Hall A Intestinal parasitic worms and the growth of children.Trans R Soc Trop Med Hyg. 1993; 82: 241-242Summary Full Text PDF Scopus (34) Google Scholar If micronutrient supplements or extra food are not available then deworming alone may not have much of an effect, or it will be very slow, and this may lead to a loss of enthusiasm among the governments who will, in the end, have to pay for anthelmintic treatments. This point is even more crucial if worms have an effect on children's educational achievement. If intellectual development is impaired because of worm infections and is reversible, how will any educational deficit be corrected after treatment without remedial education to make up for the teaching children have lost while they were sick or unable to concentrate? Deworming should be an essential part of child health programmes, but to be fully effective it needs to be given with remedial nutrition or education to treat he underlying deficits as well. The thinking beyond deworming needs to go further than buying drugs and delivering them through infectious disease control programmes. I declare that I have no conflict of interest." @default.
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- W2230642508 date "2005-02-01" @default.
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- W2230642508 title "Beyond deworming" @default.
- W2230642508 doi "https://doi.org/10.1016/s0140-6736(05)17977-x" @default.
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