The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial.
A randomized controlled trial in KwaZulu-Natal (South Africa) of 428 primary-school pupils (stratified into 6 groups by age, sex and intervention) measured the effect of different anthelmintic treatments and iron supplementation regimens provided twice at 6-monthly intervals for 1 year (1996/97). Half the pupils received iron supplementation (ferrous fumarate 200 mg weekly for 10 weeks). Pupils received 2 anthelmintic regimens, either (i) albendazole 400 mg plus praziquantel 40 mg/kg or (ii) albendazole 400 mg on 3 consecutive days plus praziquantel 40 mg/kg or (iii) placebo. Baseline prevalences of Ascaris 55.9%, Trichuris 83.6%, hookworm spp. 59.4%, were reduced after 12 months for single-dose albendazole treatment to Ascaris 17.4% (P < 0.005), Trichuris 61.5% (NS), hookworm spp. 0% (P < 0.005), and for triple-dose albendazole treatment to Ascaris 14.8% (P < 0.005), Trichuris 25.0% (P < 0.01), hookworm 0% (P < 0.005). Schistosoma haematobium 43.4% was reduced among treated groups to 8.3% (P < 0.005). There were no significant changes in the anthropometry of the different treatment groups at either 6 or 12 months post treatment. Twelve months after treatment there was a significant increase in haemoglobin levels (P = 0.02) among pupils receiving triple-dose albendazole, praziquantel and ferrous fumarate; pupils receiving no anthelmintic treatment showed a significant decrease as did pupils who received triple-dose albendazole and praziquantel but no iron. Regular 6-monthly anthelmintic treatment significantly reduced the prevalence of Ascaris, hookworm spp. and S. haematobium infections (P < 0.05). Triple-dose treatment for Trichuris was significantly more effective than a single dose of albendazole 400 mg (P = 0.002). In areas with schistosomiasis, hookworm infection and high prevalence of Trichuris infection, combination treatment with praziquantel, triple-dose albendazole, plus iron supplementation, is likely to improve pupils' health and haemoglobin levels.
Taylor
M
M
Departments of Community Health and Haematology, Faculty of Medicine, University of Natal, Private Bag 7, Congella 4013, South Africa. taylor@med.und.ac.za
Jinabhai
C C
CC
Couper
I
I
Kleinschmidt
I
I
Jogessar
V B
VB
D000293:Adolescent; D015766:Albendazole / Q000008:administration & dosage; D000740:Anemia / Q000097:blood / Q000517:prevention & control; D000871:Anthelmintics / Q000008:administration & dosage*; D001196:Ascariasis / Q000097:blood / Q000188:drug therapy; D001827:Body Height; D002648:Child; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006373:Helminthiasis / Q000097:blood / Q000188:drug therapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D011223:Praziquantel / Q000008:administration & dosage; D012044:Regression Analysis; D012307:Risk Factors; D012553:Schistosomiasis haematobia / Q000097:blood / Q000188:drug therapy; D014257:Trichuriasis / Q000097:blood / Q000188:drug therapy
D000871:Anthelmintics; D004338:Drug Combinations; D006454:Hemoglobins; D011223:Praziquantel; D007501:Iron; D015766:Albendazole