Status: Funded - Open
A cross-cultural evaluation of the benefits of long-running deworming programs in children
Serene Joseph, PhD
BACKGROUND: Soil-transmitted helminth (STH) infection is one of the most important neglected tropical diseases, affecting over 1.5 billion people worldwide. The World Health Organization (WHO) recommends large-scale delivery of anthelminthic drugs (i.e. deworming) to target STH-related morbidity, particularly in children.
GAP: Several landmark studies have demonstrated the benefits of deworming in improving growth, reducing anemia and improving school outcomes in children. However, recent systematic reviews have found mixed results and concluded that deworming may not be warranted. This latter evidence has been based on randomized controlled trials which have been limited by ethical and logistical constraints, such as a short time frame to detect long-term deworming impacts and effect dilution through the inclusion of a study population of infected and uninfected children.
HYPOTHESIS: The study hypothesis is that long-running deworming programs in STH-endemic areas have resulted in independent improvements in child health, nutrition and educational outcomes over time.
METHODS: This study will compare changes in key outcomes before and after implementation of large-scale deworming programs. Data will be available from STH-endemic countries that routinely collect information on child health indicators. Outcomes include underweight, stunting, anemia and school indicators. The causal effect of deworming will be examined using difference-in-differences regression, which takes into account observed and unobserved secular changes over time. Sources of data include Demographic and Health Surveys, Multiple Indicator Cluster Surveys and the Preventive Chemotherapy and Transmission Control databank.
IMPACT: Innovative methodologies are urgently needed to provide more accurate evidence of the long-term benefits of deworming. The findings will be immediately available to government ministries, NGOs and other important policy-makers and stakeholders in the over 100 STH-endemic countries worldwide.
Dr. Serene A. Joseph is also supported by a postdoctoral fellowship from the Canadian Institutes of Health Research.
World Health Organization