In times of fiscal restraints in developed countries and private donor fatigue to contribute for massive Public Health initiatives in the developing world, many programs have come under intense scientific and political scrutiny. Mass deworming of people infected with soil-transmitted helminthiasis and schistosomiasis—affecting almost one billion people worldwide—has been implemented with drugs given to school-age children in national campaigns.
Mass deworming per se cannot eliminate helminthiasis if it is not coupled with complementary long-term strategies to improve people’s access to clean water, sanitation facilities, proper housing and labour opportunities. This holistic approach has been pushed by the “Global Health diplomacy.” Several national governments, private donors, aid agencies and big pharma companies signed the “London declaration” to commit to a sustained control and eradication of soil-transmitted helminthiasis in developing countries.
Vivian A. Welch et al. searched 11 databases up to January 2016, websites, trial registers and contacted experts to review reference lists together. They studied the results of massive deworming that involved more than one million children and follow-up of 160,000 children after those campaigns.
Mass deworming with albendazole twice per year compared to controls did not show any improvement in weight or height over a 12 months-period. There was little to no difference in weight-for-height, proportion stunted, performance on short-attention tasks, school attendance and mortality. Mass deworming for schistosomiasis improved children’s weight but not height.
Subgroup and sensitivity analyses are based on aggregate level data, which might conceal the differences in results at the individual level or interaction with other sociological factors like poor sanitation, housing and transport. Treating infected and non-infected children will dilute the resulting data. Even though studies that used proper screening and targeted treatment for helminthiasis showed benefits in the meta-analyses of results, the massive campaigns are more inexpensive and easier to logistically deploy worldwide. Is economics enough of a reason to treat both the infected and non-infected?
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