Effects of a Post-Deworming Health Hygiene Education Intervention on Absenteeism in School-Age Children of the Peruvian Amazon

Abstract

Soil-transmitted helminth (STH) infections are a leading cause of disability and disease burden in school-age children of worm-endemic regions. Their effect on school absenteeism, however, remains unclear. The World Health Organization currently recommends delivering mass deworming and health hygiene education through school-based programs, in an effort to control STH-related morbidity. In this cluster-RCT, the impact of a health hygiene education intervention on absenteeism was measured. From April to June 2010, all Grade 5 students at 18 schools in a worm-endemic region of the Peruvian Amazon were dewormed. Immediately following deworming, nine schools were randomly assigned to the intervention arm of the trial using a matched-pair design. The Grade 5 students attending intervention schools (N = 517) received four months of health hygiene education aimed at increasing knowledge of STH prevention. Grade 5 students from the other nine schools (N = 571) served as controls. Absenteeism was measured daily through teachers' attendance logs. After four months of follow-up, overall absenteeism rates at intervention and control schools were not statistically significantly different. However, post-trial non-randomized analyses have shown that students with moderate-to-heavy Ascaris infections and light hookworm infections four months after deworming had, respectively, missed 2.4% (95% CI: 0.1%, 4.7%) and 4.6% (95% CI: 1.9%, 7.4%) more schooldays during the follow-up period than their uninfected counterparts. These results provide empirical evidence of a direct effect of STH infections on absenteeism in school-age children.

Prevalence, intensity and associated risk factors of soil-transmitted helminth and schistosome infections in Kenya: Impact assessment after five rounds of mass drug administration in Kenya

“…However, a post-trial non-randomized study has previously shown that pupils with mostly moderate-to-heavy STH infections especially for A . lumbricoides were found to miss up to 2.4% of school days during follow-up periods compared to their uninfected counterparts [ 60 ]. Our study provides associational evidence of an effect of STH infections on school absenteeism among SAC.…”

“…Whereas this study reports significant association between STH infections and school absenteeism, most studies have acknowledged difficulty in exclusively quantifying the effect of STH infections on school absenteeism, mainly attenuated by the low levels of infection intensity in the sample population [57][58][59]. However, a post-trial non-randomized study has previously shown that pupils with mostly moderate-to-heavy STH infections especially for A. lumbricoides were found to miss up to 2.4% of school days during follow-up periods compared to their uninfected counterparts [60]. Our study provides associational evidence of an effect of STH infections on school absenteeism among SAC.…”

Soil transmitted helminthiasis in indigenous groups. A community cross sectional study in the Amazonian southern border region of Ecuador

“…The transmission rate of soil helminths remains high in regions such as the Amazonian southern border of Ecuador, in spite of the fact that in recent years member countries of the Pan American Health Organisation have celebrated regional conventions to address the intensification of control of these poverty related diseases. 30 …”

Diarrhea, Helminth Infection, Dehydration, and Malnutrition Associated with Water, Sanitation, and Hygiene Facilities and Poor Handwashing in Schools in Metro Manila, Philippines: A Cross-Sectional Study

“…30 Prevalence of STH infection in older children was 31.3% in a 2014 survey of 14-15 year-old secondary school students. 31 In 2018 the prevalence rates of school-age (6)(7)(8)(9)(10) years old) children's stunting, underweight, wasting/thinness (low weight-for-height), and overweight-for-height were: 24.5%, 25%, 7.6%, and 11.7%, respectively. 32 Over 29,000 annual deaths of children < 5 in the Philippines were attributed to undernutrition.…”