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Mass deworming for improving health and cognition of children in endemic helminth areas: a systematic review and individual participant data network meta‐analysis

Welch, A. V. and Ghogomu, E. and Hossain, A. and Riddle, A. and Gaffey, M. and Arora, P. and Dewidar, O. and Salaam, R. and Cousens, S. and Black, R. E. and Hollingsworth, T. D. and Horton, S. and Tugwell, P. and Bundy, D. and Castro, M. and Eliott, A. and Friis, H. and Le, H. T. and Liu, C. and Rousham, E. K. and Rohner, F. and King, C. and Sartono, E. and Supali, T. and Steinmann, P. and Webb, E. and Wieringa, F. and Winnichagoon, P. and Yazdanbakhsh, M. and Bhutta, Z. and Wells , GA.. (2019) Mass deworming for improving health and cognition of children in endemic helminth areas: a systematic review and individual participant data network meta‐analysis. Systematic Reviews, 15 (4). e1058.

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Abstract

Background
Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide.
Objectives
To use individual participant data network meta‐analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers.
Search Methods
We developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews.
Selection Criteria
We included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection.
Data Collection and Analysis
We conducted NMA with individual participant data (IPD), using a frequentist approach for random‐effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest.
Results
We received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence).
Authors' Conclusions
This analysis reinforces the case against mass deworming at a population‐level, finding little effect on nutritional status or cognition. However, children with heavier intensity infections may benefit more. We urge the global community to adopt calls to make data available in open repositories to facilitate IPD analyses such as this, which aim to assess effects for the most vulnerable individuals.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Swiss Centre for International Health (SCIH) > Health Systems Support (Prytherch)
UniBasel Contributors:Steinmann, Peter
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:BioMed Central
e-ISSN:2046-4053
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:03 Mar 2020 14:11
Deposited On:03 Mar 2020 14:11

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