Background
Methods
Ethics statement
Study design and sample size calculation
Study area and subjects
Field and laboratory procedures
Physical fitness testing
Cognitive function testing
Statistical analysis
Results
Compliance and study samples
Results from attrition analysis
Baseline situation
Characteristic | Total (n = 257) | Females (n = 134) | Males (n = 123) |
---|---|---|---|
Age (years) | |||
Mean (range) | 10.6 (5–14) | 10.6 (5–14) | 10.7 (7–14) |
Age group 5–9, no. of children (%) | 65 (25.3) | 37 (27.6) | 28 (22.8) |
Age group 10–14, no. of children (%) | 192 (74.7) | 97 (72.4) | 95 (77.2) |
School grade | |||
4 | 48 (18.7) | 26 (19.4) | 22 (17.9) |
5 | 115 (44.8) | 63 (47.0) | 52 (42.3) |
6 | 94 (36.6) | 45 (33.6) | 49 (39.8) |
Infection with P. falciparum
| |||
No. of children infected (%) | 234 (91.1) | 119 (88.8) | 115 (93.5) |
Parasitaemia, mean no. of parasites/μl of blood(log-transformed) | 1,254 (6.2) | 1,085 (6.2) | 1,429 (6.2) |
Infection with P. malariae
| |||
No. of children infected (%) | 21 (8.2) | 14 (10.5) | 7 (5.7) |
Parasitaemia, mean no. of parasites/μl (log-transformed) | 1,037 (6.5) | 972 (6.6) | 1,167 (6.3) |
Infection with S. mansoni
| |||
No. of children infected (%)** |
91
(35.4)
|
25
(18.7)
|
66
(53.7)
|
Infection intensity, no. of children infected (%) | |||
Light (1–99 EPG) | 49 (53.9) | 15 (60.0) | 34 (51.5) |
Moderate (100–399 EPG) | 33 (36.3) | 9 (36.0) | 24 (36.4) |
Heavy (≥ 400 EPG) | 9 (9.9) | 1 (4.0) | 8 (12.1) |
Infection with soil-transmitted helminths#
| |||
Hookworm, no. of children infected (%)** |
25
(9.7)
|
2
(1.5)
|
23
(18.7)
|
T. trichiura, no. of children infected (%) | 2 (0.8) | 1 (0.8) | 1 (0.8) |
A. lumbricoides, no. of children infected (%) | 1 (0.4) | 1 (0.8) | 0 (0.0) |
Infection with pathogenic intestinal protozoa | |||
G. intestinalis, no. of children infected (%) | 38 (14.8) | 16 (11.9) | 22 (17.9) |
E. histolytica/E. dispar, no. of children infected (%) | 11 (4.3) | 5 (3.7) | 6 (4.9) |
Major co-infections | |||
Plasmodium spp. + helminth, no. of children co-infected (%)** |
97
(37.7)
|
27
(20.2)
|
70
(56.9)
|
Plasmodium spp. + pathogenic intestinal protozoa, no. of children co-infected (%) | 44 (17.1) | 19 (14.2) | 25 (20.3) |
P. falciparum + S. mansoni, no. of children co-infected (%)** |
86
(33.5)
|
23
(17.2)
|
63
(51.2)
|
Haemoglobin levels and anaemia | |||
Hb, mean (SD), g/l* |
120.2
(13.6)
|
122.3
(13.0)
|
118.0
(13.9)
|
Anaemia, no. of children (%) | 89 (34.6) | 40 (29.9) | 49 (39.8) |
Malnutrition | |||
Any form of malnutrition (Z ≤ −2), no. of children (%) | 84 (32.7) | 45 (33.6) | 39 (31.7) |
Stunting H/A, no. of children (%) | |||
Moderate to severe (Z-score ≤ −2) | 35 (13.6) | 20 (14.9) | 15 (12.2) |
Wasting BMI/A, no. of children (%) | |||
Moderate to severe (Z-score ≤ −2) | 59 (23.0) | 30 (22.4) | 29 (23.6) |
Underweight W/A§, no. of children (%) | |||
Moderate to severe (Z-score ≤ −2)* |
9
(13.9)
|
8
(21.6)
|
1
(3.6)
|
Logistic models (binary outcomes) | Association | Adjusted OR (95% CI) |
---|---|---|
Clinical status
§
| ||
Anaemia | Age group (10–14 years) | 0.50 (0.27, 0.92) |
Any form of malnutrition | 1.83 (1.04, 3.21) | |
Stunting (HAZ-scores < −2) | Age (years) | 2.34 (1.71, 3.20) |
Wasting (BMIZ-scores < −2) | Any severity of stunting | 2.28 (1.18, 4.40) |
Any form of malnutrition (WAZ|HAZ|BMIZ-scores < −2) | Age (years) | 1.21 (1.02, 1.44) |
Anaemia | 1.96 (1.10, 3.47) | |
Cognition
†
| ||
Low digit span test performance (LSF ≤ 4) | Grade (6) | 0.42 (0.20, 0.90) |
Negative binomial model
(count outcome)
|
Association
|
Adjusted IRR
(95%
CI)
|
Plasmodium parasitaemia§
| Haemoglobin level (g/l) | 0.98 (0.97, 0.99) |
Linear/
tobit models
(continous outcomes)
|
Association
|
Adjusted mean difference
(95%
CI)
|
Physical fitness
§
| ||
VO2 max (ml kg−1 min−1) | Age (years) | −0.97 (−1.25, −0.70) |
Sex (female) | −2.72 (−3.70, −1.74) | |
S. mansoni intensity (light) | 1.24 (0.05, 2.43) | |
Hand grip strength (kg) | Age (years) | 1.41 (1.01, 1.80) |
Anaemia | −1.99 (−3.30, −0.68) | |
Stunting (Z-score < −2) | −4.79 (−6.70, −2.89) | |
Standing broad jump (cm) | Age (years) | 3.45 (2.06, 4.84) |
Sex (female) | −9.95 (−14.46, −5.44) | |
Wasting (Z-score < −2) | −9.82 (−14.86, −4.78) | |
S. mansoni
| 6.62 (1.81, 11.43) | |
Cognition
†
| ||
Code transmission test (score range: 0-20) | Grade (6) | 2.73 (0.93, 4.55) |
Sex (female) | −1.49 (−2.76, −0.23) | |
Wealth tertile (least poor) | 1.85 (0.44, 3.27) |
Effect of deworming on parasitic infections, clinical status, physical fitness and cognition
Parameter | Baseline, mean | Follow-up, mean | Mean change (95% CI) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Helminth infection | N | All | Females | Males | All | Females | Males | All | Females | Males | |
Weight (kg)§
| Not infected | 141 | 31.7 | 32.4 | 30.4 | 33.0 | 33.9 | 31.4 | 1.4 (1.0, 1.8) | 1.6 (1.0, 2.1) | 1.0 (0.3, 1.7) |
S. mansoni (+) | 44 | 31.8 | 33.0 | 31.2 | 33.4 | 34.9 | 32.6 | 1.6 (0.9, 2.2) | 2.0 (1.0, 3.0) | 1.4 (0.5, 2.3) | |
S. mansoni (++/+++) | 34 | 33.1 | 35.5 | 32.5 | 35.2 | 39.1 | 34.2 | 2.1 (1.3, 2.8) | 3.6 (1.2, 6.1)* | 1.7 (1.0, 2.4) | |
Haemoglobin (g/l) | Not infected | 130 | 121.4 | 123.7 | 116.8 | 120.9 | 121.3 | 120.1 | −0.5 (−3.0, 2.1) | −2.3 (−5.4, 0.7) | 3.4 (−1.2, 7.9) |
Helminth#
| 89 | 119.0 | 119.7 | 118.8 | 118.6 | 122.1 | 117.3 | −0.4 (−3.7, 2.8) | 2.4 (−2.4, 7.2) | −1.5 (−5.6, 2.6) | |
Plasmodium parasitaemia (log (parasites/μl of blood + 1)) | Not infected | 129 | 5.5 | 5.4 | 5.7 | 4.0 | 3.9 | 4.2 | −1.5 (−2.1, −0.9)Δ
| −1.4 (−2.6, −0.3)Δ
| −1.5 (−2.3, −0.7)Δ
|
Helminth#
| 88 | 5.9 | 5.9 | 5.9 | 4.4 | 4.6 | 4.3 | −1.5 (−2.3, −0.8)Δ
| −1.6 (−2.4, −0.8)Δ
| −1.3 (−3.1, 0.5) | |
VO2 max (ml kg−1 min−1) | Not infected | 141 | 48.8 | 47.7 | 50.9 | 48.7 | 46.9 | 52.0 | −0.1 (−0.8, −0.6) | −0.8 (−1.7, 0.1) | 1.2 (0.0, 2.3)†
|
S. mansoni (+) | 44 | 50.3 | 48.1 | 51.3 | 49.4 | 48.0 | 50.0 | −0.9 (−2.1, 0.3) | −0.1 (−1.8, 1.6) | −1.3 (−2.9, 0.4)* | |
S. mansoni (++/+++) | 34 | 49.4 | 47.1 | 50.0 | 51.1 | 45.5 | 52.5 | 1.7 (0.2, 3.2)†* | −1.6 (−4.9, 1.7) | 2.5 (0.9, 4.1)†
| |
Standing broad jump (cm) | Not infected | 141 | 130 | 128 | 135 | 143 | 141 | 146 | 13 (10, 15)†
| 13 (10, 17)†
| 12 (8, 15)†
|
S. mansoni (+) | 44 | 140 | 133 | 144 | 151 | 140 | 157 | 11 (7, 15)†
| 7 (−0, 14) | 13 (7, 18)†
| |
S. mansoni (++/+++) | 34 | 146 | 134 | 149 | 158 | 148 | 161 | 12 (6, 19)†
| 13 (−2, 29) | 12 (5, 19)†
| |
Hand grip strength (kg) | Not infected | 130 | 16.8 | 16.7 | 16.8 | 17.9 | 17.6 | 18.5 | 1.1 (0.4, 1.8)†
| 0.8 (−0.0, 1.7) | 1.7 (0.3, 3.0)†
|
Helminth#
| 89 | 17.7 | 17.1 | 18.0 | 18.8 | 17.9 | 19.1 | 1.0 (0.4, 2.0)†
| 0.8 (−1.0, 2.7) | 1.1 (−0.1, 2.3) | |
Digit span test (score range: 2–8)§
| Not infected | 130 | 4.5 | 4.5 | 4.4 | 5.2 | 5.1 | 5.4 | 0.8 (0.6, 0.9) | 0.7 (0.5, 0.9) | 0.9 (0.6, 1.3) |
Helminth#
| 89 | 4.4 | 4.4 | 4.5 | 5.2 | 5.3 | 5.1 | 0.8 (0.5, 1.0) | 1.0 (0.5, 1.4) | 0.7 (0.3, 1.0) | |
Code transmission test (score range: 0–20) | Not infected | 81 | 16.2 | 16.0 | 16.7 | 16.2 | 16.4 | 15.6 | −0.1 (−0.8, 0.7) | 0.4 (−0.5, 1.2) | −1.1 (−2.6, 0.4) |
Helminth#
| 65 | 15.2 | 12.5 | 16.1 | 15.7 | 15.1 | 15.9 | 0.5 (−0.4, 1.3) | 2.6 (0.7, 4.5)†* | −0.2 (−1.1, 0.7) |
Model by outcome | Predictor | Change |
---|---|---|
Logistic models
(binary outcomes)
|
OR
(95%
CI)
| |
Cognition
†
| ||
Change in low performance in digit span test | Time | 0.27 (0.16, 0.46)* |
Negative binomial model
(count data)
|
Predictor
|
IRR
(95%
CI)
|
Plasmodium parasitaemia | Time | 0.84 (0.55, 1.29) |
S. mansoni
| 6.37 (1.94, 20.88) | |
Hookworm | 0.19 (0.05, 0.79) | |
Anaemia status (no longer anaemic) | 0.18 (0.07, 0.51) | |
Linear models
(continuous outcomes)
|
Predictor
|
Coefficient
(95%
CI)
|
Clinical status
§
| ||
Change in Hb level (g/l) | Time | 0.76 (−2.91, 4.43) |
Plasmodium parasitaemia (1,000+) | 5.16 (0.87, 9.44) | |
Change in H/A Z-score (stunting) | Time | −0.19 (−0.32, −0.06)* |
Age group (10–14 years) | 0.14 (0.02, 0.26) | |
Change in BMI/A Z-score (wasting) | Time | 0.30 (−0.01, 0.60) |
Weight gain (kg) | Time | 0.88 (0.31, 1.45)* |
Sex (female) | 0.73 (0.07, 1.39) | |
S. mansoni intensity (++/+++) | 1.06 (0.19, 1.92) | |
Physical fitness
§
| ||
Change in VO2 max (ml kg−1 min−1) | Time | 1.01 (−0.31, 2.33) |
Sex (female) | −1.40 (−2.56, −0.24) | |
S. mansoni intensity (+) | −1.58 (−2.99, −0.16) | |
Stunting severity (↑) | −2.65 (−4.52, −0.79) | |
Change in hand grip strength (kg) | Time | 1.45 (0.71, 2.18)* |
Anaemia status (new anaemia case) | −1.59 (−3.05, −0.13) | |
Change in standing broad jump (cm) | Time | 13.84 (10.67, 17.01)* |
Anaemia status (constantly anaemic) | −5.71 (−11.42, −0.00) | |
Tobit model
(censored count data)
|
Predictor
|
Coefficient
(95%
CI)
|
Cognition
†
| ||
Change in code transmission score | Time | −0.87 (−2.25, 0.50) |
Sex (female) | 2.07 (0.73, 3.41) | |
Helminth infection intensity (+) | 2.02 (0.52, 3.52) |