BMJ 2000;320:1697-1701 ( 24 June )

Papers

Effects of treatment for intestinal helminth infection on growth and cognitive performance in children: systematic review of randomised trials

Rumona Dickson, lecturer, ^a Shally Awasthi, associate professor of paediatrics, ^b Paula Williamson, lecturer, ^c Colin Demellweek, lecturer, ^d Paul Garner, senior lecturer. ^a

^a International Health Division, Liverpool School of Tropical Medicine, Liverpool L3 5QA, ^b Department of Paediatrics and Epidemiology, King George Medical College, Lucknow, India, ^c Department of Mathematical Sciences, University of Liverpool, Liverpool L69 3BX, ^d Department of Clinical Psychology, University of Liverpool

Correspondence to: R Dickson rdickson{at}liv.ac.uk

Objective: To summarise the effects of anthelmintic drug treatment on growth and cognitive performance in children.
Data sources: Electronic databases: Cochrane Infectious Diseases Group controlled trial register, Cochrane controlled trials register, Embase, and Medline. Citations of all identified trials. Contact with the World Health Organization and field researchers.
Review methods: Systematic review of randomised controlled trials in children aged 1-16 that compared anthelmintic treatment with placebo or no treatment. Assessment of validity and data abstraction conducted independently by two reviewers.
Main outcome measures: Growth and cognitive performance.
Results: Thirty randomised controlled trials in more than 15 000 children were identified. Effects on mean weight were unremarkable, and heterogeneity was evident in the results. There were some positive effects on mean weight change in the trials reporting this outcome: after a single dose (any anthelmintic) the pooled estimates were 0.24 kg (95% confidence interval 0.15 kg to 0.32 kg; fixed effects model assumed) and 0.38 kg (0.01 kg to 0.77 kg; random effects model assumed). Results from trials of multiple doses showed mean weight change in up to one year of follow up of 0.10 kg (0.04 kg to 0.17 kg; fixed effects) or 0.15 kg (0.00 to 0.30; random effects). At more than one year of follow up, mean weight change was 0.12 kg (0.02 kg to 0.26 kg; fixed effects) and 0.43 (0.61 to 1.47; random effects). Results from studies of cognitive performance were inconclusive.
Conclusions: There is some limited evidence that routine treatment of children in areas where helminths are common has effects on weight gain, but this is not consistent between trials. There is insufficient evidence as to whether this intervention improves cognitive performance.

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Ned Hoke
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