Difference between revisions of "Deworming debunked"

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==Lack of evidence for benefits of deworming==
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==Lack of evidence for the claimed benefits of deworming==
  
There is growing evidence that helminth eradication does not produce most of the benefits that have previously been claimed for it.
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There is mounting evidence that helminth eradication does not produce most, if not all, of the benefits that have been claimed for it.
  
A careful reading of all the published evidence that passes the Cochrane organisation's quality test showed, in 2013, “quite strongly” that deworming alone has no effect on growth, cognitive ability, or school attendance.  
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A "worm wars" debate has been raging since the noughties. On one side, are the established global advocacy organizations which continue to raise funds to implement deworming programmes and distribute free deworming medicines to entire continents in pursuit of their goal, with development economists and parasitologists cheer-leading this approach. On the other side, is a substantial and growing body of research showing that not only does deworming not achieve the benefits claimed for it, but that it may even be detrimental to the health and wellbeing of those who are stripped of their helminths. 
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The latest systematic review carried out by the highly respected Cochrane Database, which included a total of over 50 trials with 84,336 participants, plus an additional trial with one million children, found no benefit for height, haemoglobin, cognition, school performance or mortality. And, while studies carried out more than 20 years ago had shown large effects on weight, this has not been seen in more recent, much larger studies.
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Based on the findings, the review authors suggest that philanthropists and governments should re-assess policies for mass treatment. 
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* 2019 Sept 11 [https://www.ncbi.nlm.nih.gov/pubmed/31508807 Public health deworming programmes for soil-transmitted helminths in children living in endemic areas]
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: {{Quote|indent}}Current evidence does not support large public health programmes of deworming in low- and middle-income settings, particularly in terms of wider, societal and educational benefit.{{Quote|/indent}}
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===Other recent studies===
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* 2019 Feb 6 [https://www.ncbi.nlm.nih.gov/pubmed/30727974 A comparative cross-sectional study of prevalence and intensity of soil-transmitted helminthic infection between healthy and severe acutely malnourished pre-school aged children in Kano, Northern Nigeria]
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: {{Quote|indent}}Our findings confirm the WHO recommendation that at low levels of prevalence and intensity, interventions to control soil-transmitted helminths are unnecessary.{{Quote|/indent}}
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* 2019 Jan 31 [https://www.ncbi.nlm.nih.gov/pubmed/30703096 The long run impact of early childhood deworming on numeracy and literacy: Evidence from Uganda]
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: {{Quote|indent}}Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion.{{Quote|/indent}}
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===Previous studies===
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In 2013, a careful reading of all the published evidence that passes the Cochrane organisation's quality test showed “quite strongly” that deworming alone has no effect on growth, cognitive ability, or school attendance.  
 
*[http://www.bmj.com/content/346/bmj.e8558 Deworming debunked]
 
*[http://www.bmj.com/content/346/bmj.e8558 Deworming debunked]
  
Cochrane reiterated their findings in 2015, stating that there is substantial evidence that mass deworming of all children in endemic areas does not improve average nutritional status, haemoglobin, cognition, school performance, or survival.  
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Cochrane reiterated their findings in 2015, stating that there is substantial evidence that mass deworming of all children in endemic areas does not improve average nutritional status, haemoglobin, cognition, school performance, or survival.  
  
 
*[https://www.ncbi.nlm.nih.gov/pubmed/26202783 Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance]
 
*[https://www.ncbi.nlm.nih.gov/pubmed/26202783 Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance]
  
And this conclusion was again confirmed by a study in 2016 which reported that mass deworming for soil-transmitted helminths compared with controls led to little to no improvement in weight or height over a period of about 12 months, little to no difference in proportion stunted, cognition measured by short-term attention, school attendance, or mortality. In fact, the researchers found little evidence of any adverse effects. <br/>
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This conclusion was again confirmed by a study in 2016 which reported that mass deworming for soil-transmitted helminths compared with controls led to little to no improvement in weight or height over a period of about 12 months, little to no difference in proportion stunted, cognition measured by short-term attention, school attendance, or mortality. In fact, the researchers found little evidence of any adverse effects.<br/>
 
*[https://www.ncbi.nlm.nih.gov/pubmed/27955788 Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis]
 
*[https://www.ncbi.nlm.nih.gov/pubmed/27955788 Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis]
  
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Where good, general antenatal care is provided, the deworming of pregnant women produces no benefits in respect of anaemia, birth weight, perinatal mortality, infant mortality or infant response to immunisation.
 <br/>
 
Where good, general antenatal care is provided, the deworming of pregnant women produces no benefits in respect of anaemia, birth weight, perinatal mortality, infant mortality or infant response to immunisation.
 <br/>
 
*[https://www.ncbi.nlm.nih.gov/pubmed/21810307 Treatment with anthelminthics during pregnancy: what gains and what risks for the mother and child?] <br/>
 
*[https://www.ncbi.nlm.nih.gov/pubmed/21810307 Treatment with anthelminthics during pregnancy: what gains and what risks for the mother and child?] <br/>
* [https://www.ncbi.nlm.nih.gov/pubmed/29143641 Effects of deworming on child and maternal health: a literature review and meta-analysis]<br>
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*[https://www.ncbi.nlm.nih.gov/pubmed/29143641 Effects of deworming on child and maternal health: a literature review and meta-analysis]<br>
 
*[https://www.ncbi.nlm.nih.gov/pubmed/20067426 Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial]
 
*[https://www.ncbi.nlm.nih.gov/pubmed/20067426 Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial]
 
*[https://www.ncbi.nlm.nih.gov/pubmed/28178298 The impact of prenatal exposure to parasitic infections and to anthelminthic treatment on antibody responses to routine immunisations given in infancy: Secondary analysis of a randomised controlled trial]
 
*[https://www.ncbi.nlm.nih.gov/pubmed/28178298 The impact of prenatal exposure to parasitic infections and to anthelminthic treatment on antibody responses to routine immunisations given in infancy: Secondary analysis of a randomised controlled trial]
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The stunted growth seen in children in some Third World communities may be due more to bacterial pathogens than helminths.  <br/>
 
The stunted growth seen in children in some Third World communities may be due more to bacterial pathogens than helminths.  <br/>
 
*[http://www.ncbi.nlm.nih.gov/pubmed/26111567 Stunting Persists despite Optimal Feeding: Are Toilets Part of the Solution?]
 
*[http://www.ncbi.nlm.nih.gov/pubmed/26111567 Stunting Persists despite Optimal Feeding: Are Toilets Part of the Solution?]
 
===More recent studies showing a lack of benefit from deworming===
 
 
* 2019 Feb 6 [https://www.ncbi.nlm.nih.gov/pubmed/30727974 A comparative cross-sectional study of prevalence and intensity of soil-transmitted helminthic infection between healthy and severe acutely malnourished pre-school aged children in Kano, Northern Nigeria]
 
: {{Quote|indent}}Our findings confirm the WHO recommendation that at low levels of prevalence and intensity, interventions to control soil-transmitted helminths are unnecessary.{{Quote|/indent}}
 
* 2019 Jan 31 [https://www.ncbi.nlm.nih.gov/pubmed/30703096 The long run impact of early childhood deworming on numeracy and literacy: Evidence from Uganda]
 
: {{Quote|indent}}Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion.{{Quote|/indent}}
 
  
 
==Evidence of the harmful effects of deworming==
 
==Evidence of the harmful effects of deworming==

Latest revision as of 15:17, 13 September 2019

Home>Effects of helminthic therapy>Deworming debunked

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Lack of evidence for the claimed benefits of deworming

There is mounting evidence that helminth eradication does not produce most, if not all, of the benefits that have been claimed for it.

A "worm wars" debate has been raging since the noughties. On one side, are the established global advocacy organizations which continue to raise funds to implement deworming programmes and distribute free deworming medicines to entire continents in pursuit of their goal, with development economists and parasitologists cheer-leading this approach. On the other side, is a substantial and growing body of research showing that not only does deworming not achieve the benefits claimed for it, but that it may even be detrimental to the health and wellbeing of those who are stripped of their helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths].

The latest systematic review carried out by the highly respected Cochrane Database, which included a total of over 50 trials with 84,336 participants, plus an additional trial with one million children, found no benefit for height, haemoglobin, cognition, school performance or mortality. And, while studies carried out more than 20 years ago had shown large effects on weight, this has not been seen in more recent, much larger studies.

Based on the findings, the review authors suggest that philanthropists and governments should re-assess policies for mass treatment.

Quotein.gif
Current evidence does not support large public health programmes of deworming in low- and middle-income settings, particularly in terms of wider, societal and educational benefit.

Other recent studies

Quotein.gif
Our findings confirm the WHO recommendation that at low levels of prevalence and intensity, interventions to control soil-transmitted helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] are unnecessary.
Quotein.gif
Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion.

Previous studies

In 2013, a careful reading of all the published evidence that passes the Cochrane organisation's quality test showed “quite strongly” that deworming alone has no effect on growth, cognitive ability, or school attendance.

Cochrane reiterated their findings in 2015, stating that there is substantial evidence that mass deworming of all children in endemic areas does not improve average nutritional status, haemoglobin, cognition, school performance, or survival.

This conclusion was again confirmed by a study in 2016 which reported that mass deworming for soil-transmitted helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] compared with controls led to little to no improvement in weight or height over a period of about 12 months, little to no difference in proportion stunted, cognition measured by short-term attention, school attendance, or mortality. In fact, the researchers found little evidence of any adverse effects.

In early 2017, researchers at the Liverpool School of Tropical Medicine reported substantial methodological problems with three widely cited studies relating to mass deworming in Africa. The original researchers had claimed that their results showed the long-term effectiveness of these mass deworming programs in developing countries, but this latest critical analysis concluded that the findings are unlikely to be as positive as previously reported.

There is a report on this research by Science Daily.

A 2018 meta-analysis found that, while mass deworming probably reduces the prevalence of soil-transmitted helminth infections, it may have little or no effect on anaemia and iron-deficiency in adolescent girls and non-pregnant women.

Where good, general antenatal care is provided, the deworming of pregnant women produces no benefits in respect of anaemia, birth weight, perinatal mortality, infant mortality or infant response to immunisation.


Reevaluation of an influential trial concluded that deworming children may not improve school attendance.

This study found no strong evidence for significant improvements in physical fitness and anthropometric indicators due to deworming over a 6-month follow-up period.

Declines in helminth infection as a result of deworming were not accompanied by an impact on outcomes of nutrition, cognition, or school performance.

No statistically significant difference in weight gain was seen in any of the deworming intervention groups compared to the control group.

The largest randomized trial ever performed in human history - involving two million children in India - looked at how helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] affect health in places where humans naturally have them. This study showed that not only did mass treatment with an effective deworming drug not increase body weight or survival, but that the helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] didn’t seem to be doing any harm, since getting rid of them didn’t improve health.

Deworming HIV-positive adults only produces small and short-term favourable effects on disease progression.

For many years experts have recommended treating large groups at risk of helminth infection - but is this mass approach worthwhile?

The stunted growth seen in children in some Third World communities may be due more to bacterial pathogens than helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths].

Evidence of the harmful effects of deworming

Apart from the lack of evidence for any appreciable benefit from deworming, there is growing evidence of a significant downside to this practice.

Deworming increases the prevalence of allergic sensitization.

Deworming may lead to the emergence of inflammatory and metabolic conditions in countries that are not prepared for these new epidemics.

Deworming significantly increases insulin resistance.

Removal of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] may also increase the risk from infectious agents such as malaria and influenza.

Children who are hosting helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] are less likely to develop malaria.

Hosting hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. concurrently with one species of malaria can reduce the malaria burden by almost 50 percent.

A systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health.

This trial shows the capacity of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] to suppress proinflammatory immune responses in humans, which could anticipate the future rise in inflammatory diseases when helminth infections are increasingly controlled.

Some treatments may increase problems with diseases they were meant to reduce.

Anthelminthic drugs may have an environmental impact.

This study is investigating both the beneficial and detrimental effects of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] and their eradication.

Further reading