ABSTRACT

Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup effects across age, sex, nutritional status or infection intensity for each type of STH. These analyses showed that children with moderate or heavy intensity infections, deworming for STH may increase weight gain (very low certainty). The added value of this review is an exploration of effects on growth and cognition in children with moderate to heavy infections as well as replicating prior systematic review results of small effects at the population level. Policy implications are that complementary public health strategies need to be assessed and considered to achieve growth and cognition benefits for children in helminth endemic areas.

摘要

肠道寄生虫影响着全球数百万儿童。我们的目的是使用个体参与者数据（IPD）评估潜在效果调节剂对儿童驱虫对营养和认知结果的影响。我们检索了截至 2018 年 3 月 27 日的多个数据库、灰色文献和其他来源。我们纳入了与安慰剂或其他营养干预措施相比的驱虫随机和准随机试验以及基线感染数据。我们使用 IPD 的随机效应网络荟萃分析，并按照预先指定的协议评估整体质量。我们从 19 次 STH 驱虫试验中获得了 IPD。总体偏倚风险较低。对于每种类型的 STH，在年龄、性别、营养状况或感染强度方面没有统计学上显着的亚组效应。这些分析表明，对于中度或重度感染的儿童，驱虫可能会增加体重（确定性非常低）。该综述的附加价值在于探索了中度至重度感染对儿童生长和认知的影响，并复制了先前在人群水平上的小影响的系统评价结果。政策含义是，需要评估和考虑补充性公共卫生战略，以实现蠕虫流行地区儿童的成长和认知益处。