Deworming program for women of reproductive age implemented through national iron folate supplementation program reduces prevalence of anemia: evidence from a community trial in rural Bangladesh

Background: Anemia causes debilitating outcomes for women and children, and can be of multifactorial etiology, soil transmitted helminth (STH) infection being one of them. The Bangladeshi government does not have any regular deworming program for women of reproductive age (WRAs), who constitute an important portion of the population. Hence, we conducted this study to generate evidence on the effect of regular deworming on STH infection status and anemia status of WRAs in rural Bangladesh. Methods: This was a quasi-experimental study conducted in rural Bangladesh using existing healthcare delivery platform (Community Clinics) for mass deworming of WRAs. Catchment areas of two community clinics constituted the intervention arm, where the WRAs received two cycles of deworming four months apart on top of government recommended iron-folate supplementation (IFA), and catchment areas of two different community clinics were considered as the control arm where the study population received IFA but no deworming medication. Baseline and endline surveys were conducted on randomly selected participants to measure prevalence of anemia and STH infection using HemoCue 201+ and Kato-Katz respectively. Results: The study area contained 4791 women aged 15-49 years. Among them, 2441 lived in the intervention area and 2350 lived in the control area. Compliance to deworming medication and IFA was 82% (2001 out of 2441) and 79% (1938 out of 2441) for the two cycles, respectively. In the baseline survey there was no significant difference in prevalence of anemia between the intervention and control arms (63.7% vs 65.7%; p=0.522). However, the endline survey yielded significant difference in anemia prevalence between the arms (47.5% vs 65.7%, p<0.001) rendering a 14% reduction in anemia due the intervention (p=0.004). Similarly, our intervention was shown to reduce STH infection by 16% (p<0.001) Conclusions: Our study clearly showed that regular deworming of WRA benefits their anemia and STH infection status.

Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study

INTRODUCTION

In rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care.

METHODS AND ANALYSIS

This prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies.

ETHICS AND DISSEMINATION

The study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings.

TRIAL REGISTRATION NUMBER

NCT04285021.