Evaluating Deworming Campaigns in the Dominican Republic
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Children’s Hospital of Philadelphia (CHOP)’s Niños Primeros en Salud (NPS) Program in Consuelo, Dominican Republic (DR) follows World Health Organization (WHO) guidelines for the care of children under 5. Therefore, NPS conducts bi-annual deworming campaigns, providing a single dose of albendazole to all enrolled children between the ages of 2 and 5. Albendazole protects against parasitic worms, primarily soil-transmitted helminths (STH), which are endemic in the DR. Children infected with parasitic worms are at risk for anemia, poor growth, and compromised neurocognitive development.
STH, which are transmitted through contact with infected human fecal matter, are the most common neglected tropical disease. Their neglect is exacerbated by the fact that STH more commonly affect poor communities with limited-to-non-existent water and sanitation infrastructure.
Each year, the NPS program achieves more than 90% albendazole coverage; however, many children still present with gastrointestinal issues and iron-deficiency anemia. This led NPS’ Lead Pediatrician, Dr. Ingrid Japa*, under the mentorship of Dr. Elizabeth Lowenthal, to conduct a study to evaluate the effectiveness of the program’s deworming campaigns, given growing concerns about the emergence of anti-helminthic drug resistance.
Over six months, from January to June 2019, the study enrolled 63 preschool-age children. Participants received a single dose (400 mg) of albendazole, and then stool samples were collected at (i) enrollment, (ii) between 2 to 4 weeks and (iii) between 12 to 16 weeks post-enrollment. Samples were collected using sterile containers, and then laboratory staff prepared slides with stool samples mixed with Lugol solution, which were examined for adult parasites, larvae, and amoeba and giardia cysts using a light microscope. Caregivers were interviewed about their child’s health status and surveyed about household hygiene practices.
Most families reported using bottled drinking water, and more than 60% had access to a flush toilet. At enrollment, 89% of children had a parasite-positive stool, with Ascaris lumbricoides, Entamoeba histolytica, and Giardia intestinalis being the most common organisms identified. In children, anorexia was the most common symptom, but 2-4 weeks post-treatment, caregivers reported fewer STH symptoms in their children (i.e., less anorexia, abdominal pain, and abdominal distension). Interestingly, there was no decrease in laboratory-confirmed Ascaris lumbricoides infections following albendazole treatment, and no participants were parasite-free for the duration of the study.
While the study design did not allow for quantification of STH burden in each participant, these data suggest that children likely had reduced (but not eradicated) STH burden after treatment. Therefore, further investigation is needed to improve STH prevention, treatment, and eradication in endemic areas like the DR.
More Information
Full article: Effectiveness of Deworming with Single-Dose Albendazole for Preschool-Aged Children in the Dominican Republic
*In memory of our colleague and friend, Dr. Ingrid Japa, NPS Lead Pediatrician, who passed away in January 2023.
Contributed by: Mazvita Rankin, MPH
