Treatment of Trichuris trichiura Infections Improves Growth, Spelling ...

TRICHURIASIS, GROWTH AND SCHOOL PERFORMANCE 1881
Trichuris intensity < 7000 epg Trichuris intensity > 7000 epg
kg/ms kg/m*
16.5
16.5
16.0
15.5
15.0
14.5
(n-165)
(n-175)
*•Placebo
•*• Treated
Baseline Post test Baseline Post test
16.0
15.5
15.0
14.5
r
(n-21)
(n-31)
•x- Placebo
•*Treated
FIGURE 3 Treatment-by-infection intensity interaction in body mass index. Values are means ±SEM. Among the children
with a low infection intensity, i.e., 7000 epg) who received treatment or a placebo.
There was no significant treatment-by-stunting inter
action in body mass index.
When the children's height-for-age was examined,
there was no significant main treatment effect or
treatment interactions with intensity or stunting.
Post-hoc analyses. Fifteen children in the placebo
group were no longer infected with T. trichiura when
their stools were reexamined, and 10 children in the
treatment group had infection intensities >1200 epg.
To be certain that this did not affect the results, the
analyses to determine the effects of treatment on the
various outcome variables were repeated excluding
these 25 children. The findings were unchanged.
DISCUSSION
The present study was a double-blind, randomized
treatment trial with 80% power to detect differences
in school achievement in children treated for T.
trichiura infections. The children were treated with
two doses of albendazole every 3 mo, which is con
siderably more than that recommended by WHO
(1992). In addition, malaria and schistosomiasis do
not occur in Jamaica and the prevalence of hookworm
infections is low. Ascaris is the only other helminth
of importance (Rawlins et al. 1991) and this was
controlled in the analysis. Protozoan infections such
as Giardia are also uncommon in Jamaican school
children (Rawlins et al. 1991). Therefore the present
study was likely to have been a valid assessment of
the effects of 6 mo of treatment for T. trichiura
infections. There was no overall benefit in the
measured outcomes, although certain subgroups of
children did show benefits. The observed treatment
interactions with intensity of infection and stunting
were not taken into account in the initial design of
the study, in that the groups were not stratified by
infection intensity or by nutritional status before
random assignment to treatment. Therefore, the
findings need to be replicated in further studies.
However, the observed interactions were particularly
interesting.
The children with a heavier infection who were
treated were more likely to improve in spelling com
pared with those who received a placebo, whereas
there was no difference in children with a lighter
infection. Conversely, children with a lighter in
fection had a higher body mass index after treatment,
whereas those with heavier infections did not. This
latter finding is difficult to explain, but suggests a
different mechanism from that affecting spelling. The
mechanism whereby these infections may have af
fected spelling is not clear, but heavy Trichuris infec
tions cause iron deficiency anemia and growth
retardation, both of which are associated with poor
cognition (Simeon and Grantham-McGregor 1990). A
study, concurrent with the present one, was con
ducted to determine whether Trichuris infection was
associated with iron deficiency anemia. The results
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