Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta‐analysis

20 Nov 2019
Vivian A. Welch Elizabeth Ghogomu Alomgir Hossain Alison Riddle Michelle Gaffey Paul Arora Omar Dewidar Rehana Salam Simon Cousens Robert Black T. Déirdre Hollingsworth Sue Horton Peter Tugwell Donald Bundy Mary Christine Castro Alison Elliott Henrik Friis Huong T. Le Chengfang Liu Emily K. Rousham Fabian Rohner Charles King Erliyani Sartono Taniawati Supali Peter Steinmann Emily Webb Franck Wieringa Pattanee Winnichagoon Maria Yazdanbakhsh Zulfiqar A. Bhutta George Wells

Background

Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide.

Objectives

To use individual participant data network meta‐analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers.

Search Methods

We developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews.

Selection Criteria

We included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection.

Data Collection and Analysis

We conducted NMA with individual participant data (IPD), using a frequentist approach for random‐effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest.

Results

We received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence).