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Iron deficiency and helminth infections are two common conditions of children in developing countries. The consequences of helminth infection in young children are not well described, and the efficacy of low dose iron supplementation is not well documented in malaria-endemic settings. A 12-mo randomized, placebo controlled, double-blind trial of 10 mg daily iron and/or mebendazole (500 mg) every 3 mo was conducted in a community-based sample of 459 Zanzibari children age 6-71 mo with hemoglobin > 70 g/L at baseline. The trial was designed to examine treatment effects on growth, anemia and appetite in two age subgroups. Iron did not affect growth retardation, hemoglobin concentration or mild or moderate anemia (hemoglobin < 110 g/L or < 90 g/L, respectively), but iron significantly improved serum ferritin and erythrocyte protoporphyrin. Mebendazole significantly reduced wasting malnutrition. but only in children <30 mo old. The adjusted odds ratios (AORs) for mebendazole in this age group were 0.38 (95% CI: 0.16, 0.90) for weight-for-height less than -1 Z-score and 0.29 (0.09, 0.91) for small arm circumference. In children <24 mo old, mebendazole also reduced moderate anemia (AOR: 0.41, 0.18, 0.94). Both iron and mebendazole improved children's appetite, according to mothers' report. In this study, iron's effect on anemia was limited, likely constrained by infection, inflammation and perhaps other nutrient deficiencies. Mebendazole treatment caused unexpected and significant reductions in wasting malnutrition and anemia in very young children with light infections. We hypothesize that incident helminth infections may stimulate inflammatory immune responses in young children, with deleterious effects on protein metabolism and erythropoiesis. [ABSTRACT FROM AUTHOR]

Unlabelled: School health programmes have been identified as a cost-effective strategy to reduce morbidity due to soil-transmitted helminths in the school-age population, but the low rate of school enrollment in developing countries is a major factor limiting their success.Objective: The present study was conducted to identify reasons for non-enrollment and to evaluate differences in the occurrence of helminth infection between enrolled and non-enrolled children in Zanzibar, United Republic of Tanzania.Method: A questionnaire was submitted to 520 households to obtain information about enrollment and other socio-economic indicators. In addition, one school-age child was randomly selected in each household and investigated for soil-transmitted helminth infection.Results: Overall, 71% of school-age children were enrolled. Enrollment increased with age. Only 41% of children under 9 years of age were enrolled compared to 91% in children older than 12 years. Enrollment is delayed because of an insufficient number of schools. Among non-enrolled school-age children, the proportion of heavy intensity infections was twice that of enrolled school-age children.Conclusions: Most of the non-enrolled school-age children live together with enrolled siblings in the same household, thereby representing an important opportunity for effective outreach activities. The effectiveness of the school-based helminth control programme in reducing the intensity of infection was confirmed. The significant gains achieved by enrolled school-age children in this study must be viewed as an attainable goal for the important numbers of non-enrolled school-age children in endemic areas. Decision-makers must ensure that outreach activities are included in helminth control programmes targeted to school-age children. [ABSTRACT FROM AUTHOR]

A new modified quantitative Kato-Katz thick-smear technique for the detection of helminth eggs in faeces preserves hookworm eggs unaltered for a long time, while with the classic Kato-Katz technique, they disappear after approximately 2 h in tropical climates and thus slides must be read within hours after sample collection. For an independent comparison of these two laboratory techniques, faecal smears from 263 school children were examined in two surveys and prevalence, intensity of infection and costs of surveys calculated. There was no statistical difference between the methods in detecting prevalence and stratification of the sample in different classes of intensity. While there was no statistical difference for the arithmetic mean of the epg for T. trichiura and only a small difference for A. lumbricoides (P=0.04), we observed a highly significant difference for hookworm mean intensities of infections (P<0.001). From the public health viewpoint both methods provided similar results, but due to its simplicity and widespread use the classical Kato-Katz technique remains first choice for community investigation of soil-transmitted nematodes. However, the Nigrosin-Eosin approach has several advantages and can be a valuable alternative in certain circumstances. [ABSTRACT FROM AUTHOR]

School health programmes are the basis of the strategy defined by WHO to reduce morbidity due to soil-transmitted nematodes and schistosomes in school age populations in developing countries. However, low rates of school enrollment can be a major factor limiting their success. In the present study enrolled children were informed by teachers on the date of the next deworming campaign and were invited to pass along this information to parents, siblings and friends of school-age. On the day of the deworming campaign, teachers were instructed to administer anthelminthics to enrolled and not enrolled school-age children present at school. In the month following the treatment day, information about coverage was collected by questionnaire in 257 households in two regions of Unguja Island, Zanzibar. Over 89% of school age children resulted treated (98.9% of those enrolled plus 60% of those not enrolled). The additional cost of treating non-enrolled is limited to the cost of providing additional doses of anthelminthic drug in each school. Non-enrolled school age children can easily, successfully and inexpensively included in school based deworming campaign. Managers of control programmes are invited to test this method adapting it in their particular and cultural environment. [ABSTRACT FROM AUTHOR]