A double-blind randomized controlled trial of antenatal mebendazole to reduce low birthweight in a hookworm-endemic area of Peru.
OBJECTIVE
To assess the effect on birthweight of antenatal mebendazole plus iron vs. placebo plus iron in a highly hookworm-endemic area.


METHODS
Double-blind, randomized controlled trial set in rural and peri-urban communities in the Peruvian Amazon region. A total of 1042 second trimester pregnant women between the ages of 18 and 44 years were recruited from April to November 2003, and followed to July 2004. Women were randomly assigned to receive either mebendazole (500 mg single dose) plus iron supplements (60 mg elemental iron daily) or placebo plus iron supplements. The primary outcome was mean infant birthweight and secondary measures included proportion of low birthweight babies and maternal anaemia.


RESULTS
The prevalence of hookworm infection was 47.5%. There were no differences between intervention groups in mean birthweight (3104 g vs. 3090 g, P = 0.629), proportion of low birthweight (<2500 g; 8.1%vs. 8.7%, P = 0.755) or maternal anaemia in the third trimester [33.0% (158/479) vs. 32.3% (152/471), P = 0.815]. However, the proportion of very low birthweight (<1500 g) was significantly lower in the mebendazole group [0% (0/479) vs. 1.5% (7/471), P = 0.007].


CONCLUSIONS
This trial provides additional evidence for the use of anthelmintics, over and above iron supplementation, within antenatal care programmes in hookworm-endemic areas. Benefits of de-worming may be higher in countries not having an antenatal iron supplementation programme or where intensity of hookworm infections is higher.
Larocque
Renée
R
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada.
Casapia
Martin
M
Gotuzzo
Eduardo
E
MacLean
J Dick
JD
Soto
Julio C
JC
Rahme
Elham
E
Gyorkos
Theresa W
TW
D000328:Adult; D000740:Anemia / Q000517:prevention & control; D000969:Antinematodal Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D019353:Endemic Diseases; D005260:Female; D006725:Hookworm Infections / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology; D008463:Mebendazole / Q000627:therapeutic use*; D010568:Peru / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000517:prevention & control; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000517:prevention & control*; D015995:Prevalence
D000969:Antinematodal Agents; D008463:Mebendazole