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Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: A systematic review and meta-analysis.

Abstract Evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published between 1992 and 2016.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos neglected tropical diseases
Publication Year Start




PMID- 29329288
OWN - NLM
STAT- In-Process
LR  - 20180114
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 12
IP  - 1
DP  - 2018 Jan
TI  - Soil-transmitted helminth infection, loss of education and cognitive impairment
      in school-aged children: A systematic review and meta-analysis.
PG  - e0005523
LID - 10.1371/journal.pntd.0005523 [doi]
AB  - BACKGROUND: Evidence of an adverse influence of soil transmitted helminth (STH)
      infections on cognitive function and educational loss is equivocal. Prior
      meta-analyses have focused on randomized controlled trials only and have not
      sufficiently explored the potential for disparate influence of STH infection by
      cognitive domain. We re-examine the hypothesis that STH infection is associated
      with cognitive deficit and educational loss using data from all primary
      epidemiologic studies published between 1992 and 2016. METHODS: Medline, Biosis
      and Web of Science were searched for original studies published in the English
      language. Cognitive function was defined in four domains (learning, memory,
      reaction time and innate intelligence) and educational loss in two domains
      (attendance and scholastic achievement). Pooled effect across studies were
      calculated as standardized mean differences (SMD) to compare cognitive and
      educational measures for STH infected/non-dewormed children versus STH uninfected
      /dewormed children using Review Manager 5.3. Sub-group analyses were implemented 
      by study design, risk of bias (ROB) and co-prevalence of Schistosoma species
      infection. Influential studies were excluded in sensitivity analysis to examine
      stability of pooled estimates. FINDINGS: We included 36 studies of 12,920
      children. STH infected/non-dewormed children had small to moderate deficits in
      three domains-learning, memory and intelligence (SMD: -0.44 to -0.27,
      P<0.01-0.03) compared to STH-uninfected/dewormed children. There were no
      differences by infection/treatment status for reaction time, school attendance
      and scholastic achievement (SMD: -0.26 to -0.16, P = 0.06-0.19). Heterogeneity of
      the pooled effects in all six domains was high (P<0.01; I2 = 66-99%). Application
      of outlier treatment reduced heterogeneity in learning domain (P = 0.12; I2 =
      33%) and strengthened STH-related associations in all domains but intelligence
      (SMD: -0.20, P = 0.09). Results varied by study design and ROB. Among
      experimental intervention studies, there was no association between STH treatment
      and educational loss/performance in tests of memory, reaction time and innate
      intelligence (SMD: -0.27 to 0.17, P = 0.18-0.69). Infection-related deficits in
      learning persisted within design/ROB levels (SMD: -0.37 to -52, P<0.01) except
      for pre-vs post intervention design (n = 3 studies, SMD = -0.43, P = 0.47).
      Deficits in memory, reaction time and innate intelligence persisted within
      observational studies (SMD: -0.23 to -0.38, all P<0.01) and high ROB strata
      (SMD:-0.37 to -0.83, P = 0.07 to <0.01). Further, in Schistosoma infection
      co-prevalent settings, associations were generally stronger and statistically
      robust for STH-related deficits in learning, memory and reaction time
      tests(SMD:-0.36 to -0.55, P = 0.003-0.02). STH-related deficits in school
      attendance and scholastic achievement was noted in low (SMD:-0.57, P = 0.05) and 
      high ROB strata respectively. INTERPRETATION: We provide evidence of superior
      performance in five of six educational and cognitive domains assessed for STH
      uninfected/dewormed versus STH infected/not-dewormed school-aged children from
      helminth endemic regions. Cautious interpretation is warranted due to high ROB in
      some of the primary literature and high between study variability in most
      domains. Notwithstanding, this synthesis provides empirical support for a
      cognitive and educational benefit of deworming. The benefit of deworming will be 
      enhanced by strategically employing, integrated interventions. Thus,
      multi-pronged inter-sectoral strategies that holistically address the
      environmental and structural roots of child cognitive impairment and educational 
      loss in the developing world may be needed to fully realize the benefit of mass
      deworming programs.
FAU - Pabalan, Noel
AU  - Pabalan N
AD  - Center for Research and Development, Angeles University Foundation, Angeles City,
      Philippines.
FAU - Singian, Eloisa
AU  - Singian E
AD  - Department of Medical Technology, College of Allied Medical Professions, Angeles 
      University Foundation, Angeles, Philippines.
FAU - Tabangay, Lani
AU  - Tabangay L
AD  - Department of Biological Sciences, Angeles University Foundation, Angeles City,
      Philippines.
FAU - Jarjanazi, Hamdi
AU  - Jarjanazi H
AD  - Environmental Monitoring and Reporting Branch, Biomonitoring Unit, Ontario
      Ministry of the Environment and Climate Change, Toronto, Ontario, Canada.
FAU - Boivin, Michael J
AU  - Boivin MJ
AD  - Department of Psychiatry, College of Osteopathic Medicine, Michigan State
      University, East Lansing, Michigan, United States of America.
FAU - Ezeamama, Amara E
AU  - Ezeamama AE
AUID- ORCID: 0000-0003-2164-8802
AD  - Department of Psychiatry, College of Osteopathic Medicine, Michigan State
      University, East Lansing, Michigan, United States of America.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180112
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
EDAT- 2018/01/13 06:00
MHDA- 2018/01/13 06:00
CRDT- 2018/01/13 06:00
PHST- 2016/09/06 00:00 [received]
PHST- 2017/10/01 00:00 [accepted]
PHST- 2018/01/13 06:00 [entrez]
PHST- 2018/01/13 06:00 [pubmed]
PHST- 2018/01/13 06:00 [medline]
AID - 10.1371/journal.pntd.0005523 [doi]
AID - PNTD-D-16-01619 [pii]
PST - epublish
SO  - PLoS Negl Trop Dis. 2018 Jan 12;12(1):e0005523. doi:
      10.1371/journal.pntd.0005523. eCollection 2018 Jan.