The impact of anthelmintic treatment intervention on malaria infection and anaemia in school and preschool children in Magu district, Tanzania: an open label randomised intervention trial

Abstract

BackgroundSome studies have suggested that helminth infections increase the risk of malaria infection and are associated with increased number of malaria attacks and anaemia. Thus interventions to control helminth infections may have an impact on incidence of clinical malaria and anaemia. The current study assessed the impact of two anthelmintic treatment approaches on malaria infection and on anaemia in school and pre-school children in Magu district, Tanzania.MethodsA total of 765 children were enrolled into a prospective randomized anthelmintic intervention trial following a baseline study of 1546 children. Enrolled children were randomized to receive either repeated treatment with praziquantel and albendazole four times a year (intervention group, 394 children) or single dose treatment with praziquantel and albendazole once a year (control group, 371 children). Follow up examinations were conducted at 12 and 24 months after baseline to assess the impact of the intervention. Stool and urine samples were collected and examined for schistosome and soil transmitted helminth infections. Blood samples were also collected and examined for malaria parasites and haemoglobin concentrations. Monitoring of clinical malaria attacks was performed at each school during the two years of the intervention.ResultsOut of 1546 children screened for P. falciparum, S. mansoni, S. haematobium, hookworm and T. Trichiura at baseline, 1079 (69.8%) were infected with at least one of the four parasites. There was no significant difference in malaria infection (prevalence, parasite density and frequency of malaria attacks) and in the prevalence of anaemia between the repeated and single dose anthelmintic treatment groups at 12 and 24 months follow up (p > 0.05). However, overall, there was significant improvement in mean haemoglobin concentrations (p < 0.001) from baseline levels of 122.0g/L and 123.0g/L to 136.0g/L and 136.8g/L for the repeated and single dose treatment groups, respectively, at 24 months follow-up which resulted in significant reduction in prevalence of anaemia.ConclusionsThese results suggest that repeated anthelmintic treatment did not have an impact on malaria infection compared to single dose treatment. However, both treatment approaches had overall impact in terms of improvements of haemoglobin levels and hence reductions in prevalence of anaemia.

Soil-transmitted helminth infections

“…163 Finally, data suggest that deworming may have beneficial effects on co-infections such as HIV, 164,165 and further research is needed to determine the impact of anthelmintic treatment on malaria. 166,167 OUTSTANDING RESEARCH One of the principal bottlenecks for adequate individual diagnosis and management, as well as public health control of STH, has been insufficient investment in research and development of diagnostic tools and treatment options. This is especially true for Strongyloides, which has been called the most neglected of NTDs.…”

High Malaria Prevalence among Schoolchildren on Kome Island, Tanzania

“…Tanzania is located at the mid-eastern part of sub-Saharan Africa south to Kenya and Uganda and north to Mozambique. In Tanzania, malaria prevalence was reported to be variable according to geographical regions and ecosystem [ 3 - 6 ]. In a national survey performed in 2011-2012 in Tanzania, high malaria prevalence was reported in regions adjacent to Lake Victoria (Geita; 20.7% and Mara; 14.4%) and Lake Tanganyika (Kigoma; 9.9%) [ 3 ].…”

“…In Kilosa district, central Tanzania, the malaria prevalence of schoolchildren was as low as 4.5% [ 4 ]. However, around the lakeside areas of Lake Victoria malaria prevalence has been reported to be quite high [ 5 , 6 ]. For example, in another side of Lake Victoria, Magu district, north-western Tanzania, a high malaria prevalence of 29.8% [ 5 ] to 44.9% [ 6 ] was reported among school and pre-schoolchildren.…”

“…However, around the lakeside areas of Lake Victoria malaria prevalence has been reported to be quite high [ 5 , 6 ]. For example, in another side of Lake Victoria, Magu district, north-western Tanzania, a high malaria prevalence of 29.8% [ 5 ] to 44.9% [ 6 ] was reported among school and pre-schoolchildren. Our study demonstrated a high prevalence of P. falciparum malaria, with a few mixed-infection cases with P. vivax , among schoolchildren on Kome Island, within Victoria Lake regions of Tanzania.…”

Organomegaly in Mali before and after praziquantel treatment. A possible association with Schistosoma haematobium

“…An opposing study found more serious hepato-splenomegaly in chronic malaria exposed augmented by concomitant S. mansoni infection and demonstrated pro-inflammatory mechanisms behind the additive effect [35] . Nevertheless, the recovery from organomegaly after PZQ in the current study cannot be explained by concomitant malaria-infection, as Plasmodium falciparum is refractive to PZQ treatment [36] . Distinguishing between organomegaly caused by malaria and schistosomiasis is a problem due to the geographic and seasonal overlap of the two diseases [37] .…”