Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials

doi:10.1136/bmj.39150.510475.AE

BMJ, doi: 10.1136/bmj.39150.510475.AE, (Published 13 April 2007)

RESEARCH

Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials

Anjana Gulani ¹, Jitender Nagpal ¹, Clive Osmond ², H P S Sachdev ¹^*

¹ Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi 110016, India
² Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD

^* Correspondence to: hpssachdev{at}gmail.com.

Objective To evaluate the effect of routine administration ofintestinal anthelmintic drugs on haemoglobin.

Design Systematicreview of randomised controlled trials.

Data sources Electronicdatabases and hand search of reviews, bibliographies of books,and abstracts and proceedings of international conferences.

Studyselection Included studies were randomised or quasi-randomisedcontrolled trials using an intestinal anthelmintic agent inthe intervention group, in which haemoglobin was evaluated asan outcome measure. Trials in which treatment for schistosoma(praziquantel) was given exclusively to the intervention groupwere excluded.

Results The search identified 14 eligible randomisedcontrolled trials. Data were available for 7829 subjects, ofwhom 4107 received an anthelmintic drug and 3722 received placebo.The pooled weighted mean difference (random effect model) ofthe change in haemoglobin was 1.71 (95% confidence interval0.70 to 2.73) g/l (P<0.001; test for heterogeneity: CochranQ=51.17, P<0.001; I²=61% (37% to 76%)). With the World HealthOrganization's recommended haemoglobin cut-offs of 120 g/l inadults and 110 g/l in children, the average estimated reductionin prevalence of anaemia ranged from 1.1% to 12.4% in adultsand from 4.4% to 21.0% in children. The estimated reductionsin the prevalence of anaemia increased with lower haemoglobincut-offs used to define anaemia.

Conclusions Routine administrationof intestinal anthelmintic agents results in a marginal increasein haemoglobin (1.71 g/l), which could translate on a publichealth scale into a small (5% to 10%) reduction in the prevalenceof anaemia in populations with a relatively high prevalenceof intestinal helminthiasis.

(Accepted 28 February 2007)

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