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RESEARCH: Harold Alderman, Joseph Konde-Lule, Isaac Sebuliba, Donald Bundy, and Andrew Hall Effect on weight gain of routinely giving albendazole to preschool children during child health days in Uganda: cluster randomised controlled trial BMJ 2006; 333: 122 [Abstract] [Full text]

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Worms; Are They Good Guys or Bad Guys?

Rafeeq Muhammed   (18 July 2006)

No significant difference in weight gain after correction for cluster design

David C Taylor-Robinson, Paul Garner, LSTM   (16 July 2008)

Worms; Are They Good Guys or Bad Guys? 18 July 2006
Rafeeq Muhammed, Specialist Registrar Paediatrics University Hospital of North Durham, Durham DH1 5TW Send response to journal: Re: Worms; Are They Good Guys or Bad Guys?	It was interesting to read the study by Alderman et al on deworming the malnourished children and demonstrating its effects on weight gain (1). It is quite amusing to note that when developing world is combating malnutrition by treating worm infestation, developed countries are looking at the worms with more respect and planning to use them as treatment in many conditions. Weinstock et al suggest that helminths induce regulatory T cell activity and these effects may have protected individuals from many of the emerging immune-mediated illnesses like IBD, multiple sclerosis, type I diabetes, and asthma (2). Trichuris suis ova therapy was found to be useful in the treatment of both ulcerative colitis and crohn’s disease (3,4). This contrasting approach towards worms in different parts of world points to the gap of knowledge about nature's influence on immunity and the need for extensive research on the impact of helminthic infection and immune regulation. Competing interests to declare: none References. 1.Harold Alderman, Joseph Konde-Lule, Isaac Sebuliba, Donald Bundy, and Andrew Hall. Effect on weight gain of routinely giving albendazole to preschool children during child health days in Uganda: cluster randomised controlled trial BMJ 2006 333: 122 2. Weinstock JV, Summers RW, Elliott DE. Role of helminths in regulating mucosal inflammation. Springer Semin Immunopathol. 2005 Jun;27(2):249-71. 3. Summers RW, Elliott DE, Urban JF Jr, Thompson RA, Weinstock JV. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Gastroenterology. 2005 Apr;128(4):825-32. 4. Summers RW, Elliott DE, Urban JF Jr, Thompson R, Weinstock JV Trichuris suis therapy in Crohn's disease. Gut. 2005 Jan;54(1):77, 96 Competing interests: None declared
No significant difference in weight gain after correction for cluster design 16 July 2008
David C Taylor-Robinson, Clinical Lecturer in Public Health Division of Public Health, University of Liverpool, L69 3GB, Paul Garner, LSTM Send response to journal: Re: No significant difference in weight gain after correction for cluster design	To the editor In a trial featured on the cover of the BMJ Alderman et al report on weight gain in 27,995 children who were cluster randomized in 48 parishes to either albendazole for treatment of soil-transmitted helminths or nothing (1). We have recently published a Cochrane review of the effects on growth and school performance of deworming for soil-transmitted helminths in children and included this study (2). The paper reported a weight gain of 2.413 kg in the 25 treatment parishes and 2.259 kg in the control parishes at an unspecified follow-up point. The 154 g difference was reported as statistically significant in the paper. We contacted the authors as the paper did not make it clear if the design effects had been taken into account in this result. The authors wrote that the result was unadjusted, and kindly provided us with adjusted data: these results showed no significant difference detected for the primary outcome of weight gain between intervention and control groups (difference 154 g; 95% CI -19.7 to 330 g). We think it is important that the correction outlined above - which is now published (2) - is linked to the published version of this trial. 1. Alderman H, Konde-Lule J, Sebuliba I, Bundy D, Hall A. Effect on weight gain of routinely giving albendazole to preschool children during child health days in Uganda: cluster randomised controlled trial. BMJ 2006;333(7559):122. 2. Taylor-Robinson DC, Jones AP, Garner P. Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000371. DOI: 10.1002/14651858.CD000371.pub3. Competing interests: None declared