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Two findings that may revolutionize the implementation of oral iron supplementation programs worldwide have recently come to light. The first is that weekly administration of oral iron to anemic Chinese preschool children improved iron status as much as daily dosing, producing only negligible side effects. The relevance of this finding is being examined in studies of pregnant women, adolescent girls, and preschoolers in eight countries in the WHO (World Health Organization)–UNU (United Nations University)–UNICEF study of weekly iron supplements. Hopefully, this phenomenon will vastly increase the coverage, feasibility, and effectiveness of supplementation programs, particularly in the developing world. The second finding, that daily oral iron given to iron-sufficient Indonesian toddlers appeared to decrease weight gain compared with a placebo group, had not been apparent in three other small studies. If verified, screening for anemia could be required for all young children in predominantly anemic populations before iron supplements are given. However, it may not be an issue if weekly dosing is adopted.

Dyslexia is a common heterogeneous disorder with a significant genetic component. Multiple studies have replicated the evidence for linkage between variously defined phenotypes of dyslexia and chromosomal regions on 15q21 (DYX1) and 6p22.2 (DYX2). Based on association studies and the possibility for functional significance of several polymorphisms, candidate genes responsible for the observed linkage signal have been proposed-DYX1C1 for 15q21, and KIAA0319 and DCDC2 for 6p22.2. We investigated the evidence for contribution of these candidate genes to dyslexia in our sample of multigenerational families. Our previous quantitative linkage analyses in this dataset provided supportive evidence for linkage of dyslexia to the locus on chromosome 15, but not to the locus on chromosome 6. In the current study, we used probands from 191 families for a case control analysis, and proband-parent trios for family-based TDT analyses. The observation of weak evidence for transmission disequilibrium for one of the two studied polymorphisms in DYX1C1 suggests involvement of this gene in dyslexia in our dataset. We did not find evidence for the association of KIAA0319 or DCDC2 alleles to dyslexia in our sample. We observed a slight tendency for an intronic deletion in DCDC2 to be associated with worse performance on some quantitative measures of dyslexia in the probands in our sample, but not in their parents.

We previously published the discovery of a highly efficacious, functionally biased D2 dopamine receptor (D2R) agonist (MLS1547) that can selectively activate G protein signaling while blocking β-ar...

Objective Latino family caregivers of older people with memory problems are a rapidly growing group. However, their participation in intervention research is disproportionately low. The authors compared the participant retention rates of three different recruitment strategies in a sample of Latino and Caucasian family caregivers. Methods A total of 310 caregivers (195 Latino and 105 Caucasian) were screened for participation in one of two clinical intervention trials. Potential participants were recruited from one of three sources: 1) non-professional (e.g., health fairs); 2) professional (e.g., community agencies); and 3) advertisements. Reasons for non-participation were also obtained. Results Caucasians were significantly more likely to be successfully retained across all recruitment strategies (52% versus 31%, respectively). However, logistic regression revealed a recruitment strategy-by-ethnicity interaction: Latinos were highly similar in retention rates to Caucasians when recruited through professional referrals, and far less likely to participate with other strategies. Descriptive analyses also revealed ethnic differences for non-participation. Conclusion Partnership of Latino family caregivers with community agencies may result in the highest recruitment rates among this group. Latino cultural values likely play a role in the success of these partnerships in participant recruitment.

Persons born where tuberculosis (TB) is prevalent are at higher risk of contracting the disease. In Maryland, people born in countries where TB is prevalent comprised 43% of TB cases in 1998.1 In Anne Arundel County, Maryland, where only 3% of the population is foreign born,2 40% of active TB cases in 1998 were foreign born.3 The incidence rate for foreign-born county residents was 66 TB cases per 100 000 population (compared with a US rate of 6.8 per 100 000 for the general population and 28 per 100 000 for the foreign-born population).1 Among US-born county residents, incidence was only 3 TB cases per 100 000. In 1987, active pulmonary TB occurred in 2 foreign-born students in the Anne Arundel County public school system, and 35 school contacts (i.e., people who came into contact with TB cases at school) developed latent TB infection (LTBI). In 1989, the Anne Arundel County Department of Health, in collaboration with the county’s public school system, instituted a policy of targeted screening of all foreign-born students entering public schools, using the tuberculin skin test (TST) and the guidelines of the American Academy of Pediatrics, the Advisory Committee for Elimination of Tuberculosis of the Centers for Disease Control and Prevention (CDC), and the American Thoracic Society.4,5 The policy was revised in 1996 to include any untested foreign-born students. All those born outside the United States, including American citizens, are defined as foreign born. Such students must show TST documentation before enrolling in school. Students with a history of TB must show documentation of adequate therapy.4,5 In 1999, the county department of health evaluated the health and economic impact of targeted TB screening by retrospectively reviewing data on those that the department had screened from 1993 to 1998.

The D2 dopamine receptor (D2R) can activate a spectrum of signaling cascades primarily through G proteins and β-arrestin recruitment, making it an attractive target for the development of signaling...

Optimal use of anthelmintics in children is of major public health importance because the parasites involved probably infect over 2 billion persons, and most are especially common and debilitating in children. Well targeted drug delivery, particularly via community chemotherapy, can substantially decrease aggregate morbidity and mortality and also improve growth rates, physical fitness and activity, cognitive and school performance, and social well-being. The drugs discussed here include the benzimidazoles (albendazole, levamisole and mebendazole), pyrantel, praziquantel, oxamniquine, ivermectin, diethylcarbamazine and some traditional medicines. The parasitic infections discussed are hookworm, ascariasis, trichuriasis, strongyloidiasis, schistosomiasis and lymphatic filariasis; onchocerciasis and loiasis are also mentioned briefly. Dosage regimens and effectiveness, including combination treatment, are discussed. Mechanisms by which parasites may cause or aggravate malnutrition and retard development are shown, along with examples of nutritional and functional improvement at various ages due to antiparasitic treatment. Improvement in appetite is likely to be the single most important mechanism through which a variety of physiological improvements occur. We recommend community treatment of girls and women of childbearing age in areas with widespread hookworm and anaemia, because effective treatment can reduce the incidence of low birthweight, mortality in infancy and pregnancy, and stunted growth and morbidity in children and adults. Treatment of moderate-to-severe anaemia improves appetite, growth and cognitive and school performance in children, and also improves work and social capacity and productivity in children and adults. Since treatment for helminth infections may also decrease both the probability of contracting HIV infection and the rate of viral replication in those infected with both types of organisms, large-scale treatment and control of helminths and treatment of individual cases when diagnosed are now truly urgent.

To determine the relationships of dietary iron sources, other dietary factors, and lifestyle to iron status among premenopausal and recently postmenopausal Chinese women with widely varying regional dietary patterns.Cross-sectional. Subjects were interviewed, blood samples were drawn, and dietary intakes were measured by a 3-day dietary survey for subjects in the five survey counties.Rural China.About 80 randomly selected subjects per county among women aged 32 66 y.Blood hemoglobin, plasma ferritin, and plasma iron.Total iron intake was relatively high (15-29 mg/d) compared to developed counties. Heme iron intake was negligible in two of the study counties. Overall levels of iron deficiency anemia were relatively low in these generally iron-stressed women. There was no clear statistical relationship between iron intake and physiological iron status. Although several measures of dietary intake (heme iron, dietary calcium, animal protein) were correlated with several measures of iron status before adjusting for survey county, only dietary animal protein was significantly positively correlated with plasma ferritin after adjusting for the possibly confounding factor of the survey county (r= 0.15, P = 0.009). Intakes of potential inhibitors of iron absorption, such as tea, even in very high amounts, were not correlated to iron status. Plasma ferritin was positively correlated with plasma retinol (P = 0.024) and cholesterol (P = 0.007). Systemic inflammatory response, as indicated by high plasma C-reactive protein levels, was shown to be raised in a group of subjects with apparently contradictory high levels of ferritin and low levels of hemoglobin (P = 0.03).Iron nutriture in these areas of rural China seemed more related to physiological factors such as inflammatory response, menses, plasma vitamin A and cholesterol, than to dietary factors.

DBH is a candidate gene in Parkinson's disease (PD) and contains a putative functional polymorphism (-1021C-->T) that has been reported to modify PD susceptibility. We examined -1021C-->T in a sample of 1,244 PD patients and 1,186 unrelated control subjects. There was no significant difference in allele (p = 0.14) or genotype (p = 0.26) frequencies between the two groups. A similar result was obtained after pooling our data with those previously published. Furthermore, we found no evidence for an effect of genotype on age at onset among patients. Our findings argue against DBH -1021C-->T as a risk factor or age at onset modifier in PD.

False-positive Ascaris suum egg counts in pig faeces are frequently observed under both experimental and natural conditions. Data from 12 experiments with A. suum infections in pigs were summarized and showed that the percentage of false-positive faecal samples ranged from 4 to 36%. False-positive egg count values varied greatly between pigs and experiments (range 20-1060 eggs per gram faeces). Indoor experiments with pigs housed groupwise in pens generally produced more and higher false-positive egg counts, which may reflect differences in surface area and hence exposure to infective eggs, compared with pasture experiments. The positive predictive value (the number of pigs diagnosed positive by faecal sample that actually harboured worms) was low for indoor experiments (45%) compared with pasture experiments (89%). Differences in design for indoor experiments, such as floor type and use of bedding material, did not influence the positive predictive value (44-47%). A positive correlation was found (r = 0.56, P < 0.05) between faecal egg counts of true-positive and false-positive pigs that were penned together. The results of this survey strongly support previous suggestions that false-positive A. suum egg counts in pigs are the result of coprophagia in indoor experiments and coprophagia/geophagia in pasture experiments. False-positive A. suum egg counts in pig faeces may vary greatly in prevalence and magnitude, and depend in part on management/housing factors.

SUMMARYAppetite and growth were studied in primary schoolboys (6–10 years) infected with Ascaris lumbricoides (86%) and Trichuris trichiura (100%) who received a single dose of pyrantel pamoate (which has little or no effect on Trichuris trichiura ) or a placebo. Boys were examined, allocated at random by descending Ascaris egg count to pyrantel (PR, n = 36) or placebo (PL, n = 36) groups, treated, and re-examined 3 and 7 weeks later. The 2 groups did not differ significantly before treatment in helminth infections, appetite, or growth. Three and 7 weeks after treatment, the PR group exhibited significantly greater increases than did the PL group in weight (0·2 kg and 0·4 kg more, respectively) and percentage weight-for-age (0·6% and 1·7% points more, respectively). Appetite increased significantly in the PR group at 3 and 7 weeks (P < 0·0005 and P < 0·01, respectively) but not in the PL group. The prevalence and intensity of A. lumbricoides infection were greatly reduced in the PR group at 3 and 7 weeks (both P < 0·0001) but not in the PL group. We conclude that treatment with pyrantel pamoate may improve appetite and growth in schoolchildren in areas where A. lumbricoides infections and poor growth are highly prevalent.

SUMMARYThis article reviews studies that examine the negative effects of urinary and intestinal schistosomiasis on the following nutritional parameters in humans: urinary and faecal blood and iron loss, anaemia and haemoglobin levels, proteinuria, child growth and adult protein-energy status, physical fitness, physical activity, appetite and symptomatology. The conclusions reached are (1) that community-level treatment and control of schistosomiasis in areas where the infection, protein-energy malnutrition, and anaemia are common are to be encouraged and are likely to improve child growth, appetite, physical fitness and activity levels and to decrease anaemia and symptoms of the infection, and (2) that further studies are needed to determine how much and by what means decreases in and treatment of schistosomal infection may improve nutritional status, cognitive and school performance and attendance, and work capacity and productivity in communities with different amounts of parasitism and malnutrition.

We studied physical fitness, as determined by the Harvard Step Test (HST), and appetite, as measured by the consumption of a morning snack (maize meal porridge), in primary school boys infected with Schistosoma haematobium (100% baseline prevalence) and hookworm (94-100% prevalence) who received a single dose of metrifonate (MT, 10 mg/kg body weight) or praziquantel (PR, 40 mg/kg body weight), or a placebo (PL). Five weeks after treatment, HST scores and porridge intake increased significantly in the MT and PR groups, but the PL group did not change. At the second examination, the MT group showed a significant decrease in S. haematobium egg counts (mean = 180 vs. 14 eggs/10 ml adj, P less than 0.0002, 82% egg reduction in arithmetic means) as did the PR group (mean = 198 vs. 0.1 eggs/10 ml adj, P less than 0.0002, 99.9% reduction); the egg counts in the PL group did not change. The MT group also exhibited a significant decrease in hookworm egg counts (mean = 1,550 vs. 75 eggs per gram feces [epg], P less than 0.0005, 80% reduction). Treatment with either drug may allow improved physical fitness and appetite in areas where S. haematobium and protein-energy malnutrition are highly prevalent.

Latino family caregivers of older people with memory problems are a rapidly growing group. However, their participation in intervention research is disproportionately low. The authors compared the participant retention rates of three different recruitment strategies in a sample of Latino and Caucasian family caregivers.A total of 310 caregivers (195 Latino and 105 Caucasian) were screened for participation in one of two clinical intervention trials. Potential participants were recruited from one of three sources: 1) non-professional (e.g., health fairs); 2) professional (e.g., community agencies); and 3) advertisements. Reasons for non-participation were also obtained.Caucasians were significantly more likely to be successfully retained across all recruitment strategies (52% versus 31%, respectively). However, logistic regression revealed a recruitment strategy-by-ethnicity interaction: Latinos were highly similar in retention rates to Caucasians when recruited through professional referrals, and far less likely to participate with other strategies. Descriptive analyses also revealed ethnic differences for non-participation.Partnership of Latino family caregivers with community agencies may result in the highest recruitment rates among this group. Latino cultural values likely play a role in the success of these partnerships in participant recruitment.

An estimated 1049 million persons harbour T. trichiura, including 114 million preschool-age children and 233 million school-age children. The prevalence of T. trichiura is high and may reach 95% in children in many parts of the world where protein energy malnutrition and anaemias are also prevalent and access to medical care and educational opportunities is often limited. The Trichuris dysentery syndrome (TDS) associated with heavy T. trichiura, which includes chronic dysentery, rectal prolapse, anaemia, poor growth, and clubbing of the fingers constitutes an important public health problem, as do lighter but still heavy infections, even if not strictly TDS, especially in children. The profound growth stunting in TDS can be reversed by repeated treatment for the infection and, initially, oral iron. However findings from Jamaica strongly suggest that the significant developmental and cognitive deficits seen are unlikely to disappear without increasing the positive psychological stimulation in the child's environment. The severe stunting in TDS now appears likely to be a reaction at least in part to a chronic inflammatory response and concomitant decreases in plasma insulin-like growth factor-1 (IGF-1), increases in tumor necrosis factor-α (TNF-α) in the lamina propria of the colonic mucosa and peripheral blood (which likely decrease appetite and intake of all nutrients) and a decrease in collagen synthesis. Improvements in cognitive performance have been found after treatment for relatively heavy infections (without chronic dysentery) in school-going children; it is unclear precisely how much T. trichiura interferes with children's ability to access educational opportunities, but treatment of infections whenever possible is obviously sensible. The blood loss that can occur in T. trichiura infection is likely to contribute to anaemia, particularly if the child also harbours hookworm, malaria and/or has a low intake of dietary iron. Community control is important, particularly for the individuals within a population who harbour heavy worm burdens; this means children, with special attention to girls who will experience increased iron requirements and blood loss due to menstruation, pregnancies, and lactation. Mebendazole and albendazole, both of which are on the WHO Essential Drugs List, are very effective against T. trichiura; multiple doses are needed to attain complete parasitological cure in all cases. However the goal of control programmes in endemic areas is morbidity reduction, which follows when intensity of infection is significantly reduced.

The Global Burden of Disease caused by the 3 major intestinal nematodes is an estimated 22·1million disability-adjusted life-years (DALYs) lost for hookworm, 10·5million for Ascaris lumbricoides, 6·4million for Trichuris trichiura, and 39·0million for the three infections combined (as compared with malaria at 35·7million) (World Bank, 1993; Chan et al. 1994); these figures illustrate why some scarce health care resources must be used for their control. Strongyloides stercoralis is the fourth most important intestinal worm infection; its nutritional implications are discussed, and the fact that its geographic distribution needs further study is emphasized. Mechanisms underlying the malnutrition induced by intestinal helminths are described. Anorexia, which can decrease intake of all nutrients in tropical populations on marginal diets, is likely to be the most important in terms of magnitude and the probable major mechanism by which intestinal nematodes inhibit growth and development. We present a revised and expanded conceptual framework for how parasites cause/aggravate malnutrition and retard development in endemic areas. Specific negative effects that a wide variety of parasites may have on gastrointestinal physiology are presented. The synergism between Trichuris and Campylobacter, intestinal inflammation and growth failure, and new studies showing that hookworm inhibits growth and promotes anaemia in preschool (as well as school-age) children are presented. We conclude by presenting rationales and evidence to justify ensuring the widest possible coverage for preschool-age children and girls and women of childbearing age in intestinal parasite control programmes, in order to prevent morbidity and mortality in general and specifically to help decrease the vicious intergenerational cycle of growth failure (of low-birth-weight/intrauterine growth retardation and stunting) that entraps infants, children and girls and women of reproductive age in developing areas.

The purpose of this study was to assess the correlates and possible determinants of plasma vitamin A among middle-aged women in rural China. The vitamin A adequacy of the different diets at the five widely varying survey sites was also assessed. Patterns of correlations among dietary and biochemical measurements were strikingly different from previous studies in Western subjects. Plasma beta-carotene was uncorrelated with beta-carotene intake even after adjusting for potential confounders. In counties with low preformed vitamin A intake, plasma retinol correlated with plasma copper (P = 0.007), which in turn was correlated with dietary intake of copper (P = 0.007). In these counties plasma retinol was correlated with plasma beta-carotene (P = 0.001) and was increased 10% in women in the first 2 y of menopause (P = 0.028). Plasma retinol and C-reactive protein levels are inversely correlated (r = -0.15, P < 0.001), indicating that vitamin A status and inflammatory response may be related but the causal direction is unknown. Despite low intake of vitamin A (county averages of 13-78% of recommended daily allowance [RDA]), and particularly of preformed vitamin A, only 3% of these women had plasma retinol levels below 0.7 mumol/L, considered to indicate possible marginal deficiency. Plasma levels of retinol and beta-carotene were more influenced by intrinsic factors such as menopause, lipid status, retinol requirements, and possibly copper status and inflammation than by extrinsic factors such as diet and lifestyle.

Seize porcs temoins sains, places avec 16 porcs contamines par Trichuris suis, excretent des oeufs de T. suis dans leurs feces (de 20 a 4 960 oeufs par gramme de feces). Quand les porcs temoins ont ete places dans des er.clos propres, le nombre d'oeufs dans leurs feces est passe o zero en l'espace de cinq jours. Une correlation significative a ete trouvee entre le nombre d'oeufs presents chez les porcs contamines et chez les porcs temoins (r = 0,89, P < 0,001). Ces resultats confirment que le comptage faussement positif des oeufs dans Ic matiere fecale est peut-etre le resultat de la coprophagie comme suggere anterieurement.

Parametric tests were performed in a containment fixture simulating automotive side impact to determine the boundary conditions which simulate inertial properties of whole cadavers during impacts of the isolated human pelvis. The global motion of each specimen was captured with two KODAK EKTAPRO digital imagers calibrated to measure displacement of the pubic symphysis in the AP plane and lateral compression of the pelvis and pubic symphysis in the frontal plane. Motion analysis was completed with a KODAK EKTAPRO hi-spec motion analyzer. The measurements indicate that the pubic symphysis exhibits a stiff response during simulated automotive side impact at 4.5 m/s.

The aim of the study was to measure the impact of Schistosoma japonicum and Trichuris suis infections in young growing pigs fed low- or high-protein diets. Thirty-two pigs, 6–10 weeks old, were randomly allocated to 2 groups receiving either a high- or a low-protein diet. After 11 weeks half of the pigs from each group were infected with 1500 S. japonicum cercariae and 4000 T. suis eggs. The weight of the pigs was measured throughout the study, and blood and faecal samples were collected every second week from the time of infection. At the time of infection the low-protein pigs had significantly lower mean body weights, haemoglobin and albumin levels compared with the high-protein pigs, and this pattern continued throughout the study. The serum albumin concentration was further significantly reduced in the infected low-protein pigs compared to the non-infected low-protein pigs. Significantly more S. japonicum worms as well as faecal and tissue eggs were found in the low-protein pigs compared with the high-protein pigs. No differences between the 2 diet groups were observed in T. suis establishment rates or faecal egg excretion. We conclude that this low-protein diet increased the establishment rates of S. japonicum, favoured larger deposits of S. japonicum eggs in the liver and faecal egg excretion, reduced weight gains and caused anaemia and hypoalbuminaemia in young growing pigs as compared with a high-protein diet.

Experiments were conducted to study the possible influence of fasting on Ascaris suum and Oesophagostomum spp. In growing pigs. Forty young crossbred pigs naturally infected with A. suum and Oesophagostomum spp. were used. In one experiment 10 pigs were fasted and offered water ad libitum for 6 days, in another experiment for 10 days. Subsequently, these pigs, together with 10 non-fasted control pigs per experiment were slaughtered, and worm numbers, worm location, sex, developmental stage and female worm fecundity were determined. Pigs fasted for 10 but not for 6 days had decreased numbers of A. suum and Oesophagostomum spp. at slaughter vs controls, and worms were found in more distal locations in the gastrointestinal tract. Fasting for both 6 and 10 days significantly lowered the fecundity of both worm species.

This study examined the relationship between intestinal helminthiases and growth in urban slum schoolchildren. Children (n = 330) who received single doses of either pyrantel, albendazole, or placebo at baseline and again at 6 months were followed and examined fully at 0, 3, 6, and 12 months for helminth infections and anthropometry. Results of treatments indicated that all groups reduced their prevalence and intensity toward the period of the study. Reductions in intensity of both infections in the treatment groups were observed large in 3 and 12 months, whereas at 6 months reached mostly the initial level of infection. There was no significant difference in growth changes between the dewormed (once and twice) and the placebo groups. However, after controlling for some potential confounding factors, there was a significant relationship between reduction of A. lumbricoides infection and height gain at 3 and 12 months (both P0.05). In addition, there was a significant association between reduction in T. trichiura infection and increased midarm circumference at 3 and 12 months (P0.002 and P0.08, respectively). We conclude that treatment of helminth infections in school-age children may improve growth in areas where malnutrition and helminth infections are prevalent.

Growth, activity, appetite and intestinal helminth infections were compared for 55 Kenyan primary school children with hookworm (93% prevalence), T. trichiura (84% prevalence) and A. lumbricoides (29% prevalence) before and 9 wk after treatment with three 400-mg doses of albendazole (Zentel) or placebo. Fecal samples were examined for helminth eggs using a modified Kato technique. Activity was measured during free-play with motion recorders on the dominant thigh. Children rated their appetites on a 5-point scale. After baseline measurements, children were randomly allocated to the albendazole-treated (n = 28) and placebo (n = 27) groups, treated, and re-examined 9 wk later. At follow-up, egg counts were significantly lower than at baseline in the albendazole-treated group (P < or = 0.002), and gains in activity, reported appetite and most indices of growth were significantly greater for the albendazole-treated group than for the placebo group. We conclude that treatment of undernourished school children for intestinal helminth infections with albendazole may improve growth and appetite and increase spontaneous physical activity.

A randomized, double-blind, placebo-controlled iron supplementation trial was conducted in Kenya to examine the effect of iron supplements on appetite and growth in 87 primary school children. Sustained-release ferrous sulfate (150 mg) or placebo tablets were provided daily at school for 14 wk. Prior to tablet administration, baseline anthropometry, iron nutritional status (hemoglobin and serum ferritin), parasitic infections and clinical indicators of morbidity were measured. A baseline appetite test was conducted twice on each child by quantitatively measuring the ad libitum consumption of a midmorning snack. In addition, each child was asked for a subjective assessment of his or her appetite. Follow-up exams and appetite tests were identical to those at baseline. Findings indicated that provision of iron supplements resulted in improved growth and improved appetite (in terms of both energy intake of the snack and child report of appetite) as compared with children receiving the placebo. The increased energy intake from the snack was 10% of the daily estimated energy intake for children of this same age group living elsewhere in Kenya. Further research into the underlying physiological mechanisms may shed light on the relationship between iron nutritional status and appetite.

We studied growth in infected children given one dose (600 mg) or two doses of albendazole per school year. Children were examined and allocated at random within sex by descending hookworm egg count to one of three groups: placebo (n = 93), one dose (1x, n = 96) or two doses (2x, n = 95). Each child was treated and then re-examined and treated 3.6 and 8.2 mo later (Exams 2 and 3). The 1x and 2x groups gained significantly more by Exam 3 than the placebo group in weight (1.1 and 0.9 kg more, respectively), percent weight-for-age (3.3 and 2.7 percentage points more), percent weight-for-height (3.1 and 2.9 percentage points more), percent arm circumference-for-age (2.3 and 2.0 percentage points more) and triceps and subscapular skinfolds but did not differ significantly from each other. The placebo group showed significant decreases between exams (P < 0.0002) in percent weight-for-age and percent arm circumference-for-age and no change in percent weight-for-height, whereas the 1x and 2x groups exhibited significant increases (P < 0.005). At Exam 3, arithmetic mean egg reduction rates for the 1x and 2x groups were 84 and 95% for hookworm, 42 and 32% for Trichuris and 55 and 87% for Ascaris, respectively. We conclude that one or two doses of albendazole per year resulted in similar growth improvements, despite reinfection, in school-age children in an area where these helminths and poor growth are prevalent.

We studied physical fitness with the Harvard step test (HST), in primary schoolboys infected with hookworm (91% baseline prevalence), Trichuris trichiura (94%) and Ascaris lumbricoides (39-40%) who received a single 400 mg dose of albendazole or an identical placebo. Boys were examined, allocated at random to placebo or albendazole groups, treated, and re-examined 7 weeks later. The 2 groups did not differ significantly before treatment in age, anthropometry, haemoglobin levels, prevalence or intensity of the 3 helminth infections, or in initial HST fitness scores and heart rates. Seven weeks after treatment, the albendazole group (n = 18) exhibited significant improvements in fitness scores and heart rates at 1, 2, 3, and 4 min after the HST while in the placebo group (n = 15) these quantities had not changed significantly. After treatment, the albendazole group had significant decreases in the logarithmic egg counts for hookworm (80% reduction in arithmetic means) and A. lumbricoides (100% reduction); T. trichiura egg counts did not change significantly. The placebo group showed a borderline increase in the logarithms of hookworm egg counts and no significant change in T. trichiura and A. lumbricoides egg counts. Multiple regression analysis showed that the significant linear predictors of increase in HST score after treatment were decrease in resting heart rate after treatment, and decreases in hookworm egg counts and logarithms of A. lumbricoides egg counts after treatment. We conclude that single dose treatment with albendazole, despite continual exposure to reinfection, can allow improved physical fitness in schoolboys in areas where soil-transmitted helminths and protein-energy malnutrition are highly prevalent.