Risk of adverse swallowing events and choking during deworming for preschool-aged children

Abstract

BackgroundIn areas where the prevalence of soil-transmitted helminthiasis (STH) is >20%, the World Health Organization (WHO) recommends that deworming medication be given periodically to preschool-age children. To reduce risk of choking-related deaths in children <3 years old, WHO recommends that deworming tablets be crushed and given with water. Little is known about how widely this is practiced or its effectiveness.Methodology and principal findingsAlbendazole distributions for STH were observed for children 1–4 years old in 65 sites in India and Haiti. Information was recorded on child demographics; child demeanor immediately before, as well as struggling or resistance during albendazole administration; tablet form (i.e., crushed or not); and adverse swallowing events (ASEs), including choking, spitting; coughing; gagging; vomiting; and expelling a crushed tablet in a “cloud” of powder. Of 1677 children observed, 248 (14.8%) had one or more ASEs. ASE risk was 3.6% with whole tablets, 25.4% with crushed tablets, and 34.6% when crushed tablets were mixed with water. In multivariate analysis, ASE risk was significantly associated with children 1 year (OR 2.7) or 2 years (OR 2.9) of age; male gender (OR 1.6); non-content child demeanor (fearful, fussy, or combative) before albendazole administration (OR 4.3); child struggling when given albendazole (OR 2.1); and giving water, either after the tablet or mixed with it (OR 5.8). Eighteen (1.1%) children choked, none fatally; 17 choking incidents occurred with crushed tablets. In a multivariate analysis that controlled for distribution site, the only significant risk factor for choking was non-content demeanor (OR 20.6).Conclusions and significanceDeworming-related choking deaths in young children are preventable. In our sample, risk of choking could have been reduced by 79.5% if deworming tablets were not given to young children who were fussy, fearful, or combative or who struggled to resist tablet administration, with only an 18.4% reduction in drug coverage.

Treatment of Plexiform Neurofibromas with MEK Inhibitors: First Results with a New Therapeutic Option

“…This has previously been reported for different medical settings in which children had to swallow tablets or capsules and where choking could effectively be prevented by education and pill-swallowing interventions. 27 28 29 30 We, therefore, believe that if therapy is required MEK inhibitor tablets or capsules can safely be used even in small children as long as age-appropriate formulations are not in the market.…”

Improving anthelmintic treatment for schistosomiasis and soil-transmitted helminthiases through sharing and reuse of individual participant data

“…Side effects of praziquantel, particularly in heavily infected individuals, can be substantial 97 , 98 and may have a deleterious effect on participation with subsequent rounds of MDA 99 . Side effects of benzimidazoles are generally mild (but see 100 ), including in young children under 5 years old 101 , 102 but it will be necessary to assess side effect and tolerability profiles of new combination therapies that improve treatment of T. trichiura and hookworm infections 63 , 103 . A key component of any analysis of tolerability is the robust assessment of bias; studies actively collecting information on adverse events are likely rare and those based on passive surveillance, such as during MDA programmes, will be subject to reporting bias 104 .…”

Ethical dimensions of neglected tropical disease programming

“…19 Anecdotal reports suggest that one or more cases occur every year. 20 Evidence indicates that forcing young children to take deworming tablets is the primary risk factor for choking. 20 , 21 Thus these tragic choking-related deaths are preventable through improved safety training for community drug distributors (CDDs) and other measures such as age-appropriate drug formulation, but they have not yet been eliminated, despite increased attention from the WHO, 19 , 21 non-governmental organizations 22 , 23 and national NTD programmes.…”