Deworming Women of Reproductive Age During Adolescence and Pregnancy: What is the Impact on Morbidity From Soil-transmitted Helminths Infection?

Abstract

Background: Soil-transmitted helminths (STHs) are a major cause of poor health in low- and middle-income countries. In particular, hookworm is known to cause anaemia in children and women of reproductive age (WRA). One goal of the World Health Organization’s (WHO) 2030 roadmap for neglected tropical diseases is to reduce STH-related morbidity in WRA. As a minimal intervention the WHO recommends deworming adolescent girls annually during human papilloma virus vaccination programmes and women of reproductive age (WRA) during pregnancy and lactation. These routine interventions are low cost can be implemented even from the most basic health services in endemic countries. In this study we use a cohort model to investigate the potential impact on STH-related morbidity in WRA.Results: We find that annual deworming of adolescent girls reduces morbidity in a similar way treatment programmes for pre-school-age and school-age children (pSAC and SAC). Treatment of WRA during pregnancy and lactation on its own has a small but significant effect on morbidity although it does not achieve the morbidity target (<2% moderate-to-high intensity infections) in this age group. However, depending on the age-intensity profile of infection, which may vary geographically, and assumptions on the density-dependence of egg production by fertilised female worms, continued school-based treatment may be able to reduce the force of infection acting on WRA, both through an indirect effect on the overall population based force of infection and via reducing the burden of infection as children age and move into the WRA age classes. As a result, morbidity in WRA may be eliminated.Conclusion: While deworming during pregnancy and lactation does not achieve the morbidity target in WRA and its efficacy may vary by setting, it is still expected to be beneficial for maternity and child health. Monitoring of any WRA-based intervention is recommended to evaluate its effectiveness.