title: Evaluation of the Integrated Management of Childhood Illness guidelines for treatment of intestinal helminth infections among sick children aged 2-4 years in western Kenya.
abstract: Anthelmintic treatment of sick preschool-age children at health facilities is a potentially effective strategy for intestinal helminth control in this age-group. We conducted a study from July 1998 to February 1999 in western Kenya to determine whether the Integrated Management of Childhood Illness (IMCI) guidelines' clinical assessment can be used to identify helminth-infected children, and to evaluate the nutritional benefit of treating sick children without pallor with an anthelmintic (mebendazole is already part of IMCI treatment for sick children aged 2-4 years with palmar pallor in areas where hookworm and Trichuris trichiura infections are endemic). Sick children aged 2-4 years seen at 3 rural health facilities were clinically evaluated and tested for haemoglobin concentration, malaria parasites, and intestinal helminths. Children without pallor were randomly assigned to receive a single dose of 500 mg of mebendazole or a placebo and re-examined 6 months later. Among the 574 children enrolled, 11% had one or more intestinal helminths. Most infections were of light intensity. Selected clinical signs and symptoms available from the IMCI assessment, including palmar pallor and low weight-for-age, were not associated with helminth infection. Six months after enrollment, no differences in growth of children without pallor were observed between the mebendazole (n = 166) and placebo (n = 181) groups. However, there was a significantly greater mean increase in weight, height, and weight-for-age Z score among the helminth-infected children in the mebendazole group (n = 22) as compared with helminth-infected children in the placebo group (n = 20). We conclude that even lightly infected preschool-age children without palmar pallor benefit from anthelmintic treatment; however, in this study setting of low helminth prevalence and intensity, helminth-infected children could not be identified using the IMCI guidelines. Cost-effectiveness studies are needed to help define helminth prevalence thresholds for routine anthelmintic treatment of sick preschool-age children seen at first-level health facilities.
authors.affiliation: International Child Survival and Emerging Infections Program Support Activity, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mail Stop F-22, 4770 Buford Hwy, Atlanta, Georgia 30341, USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Garg
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Lee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
authors.forename: C N
authors.initials: CN
authors.lastname: Wamae
authors.forename: Usha
authors.initials: U
authors.lastname: Ramakrishnan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Deming
mesh_terms: D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use*; D001196:Ascariasis / Q000188:drug therapy* / Q000453:epidemiology; D017164:Ascaris lumbricoides; D001827:Body Height; D001835:Body Weight; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology; D005243:Feces / Q000469:parasitology; D005334:Fever / Q000209:etiology; D006725:Hookworm Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008463:Mebendazole / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D014257:Trichuriasis / Q000188:drug therapy* / Q000453:epidemiology; D014258:Trichuris
chemical_list: D000969:Antinematodal Agents; D008463:Mebendazole