The effect of different anthelmintic treatment regimens combined with ironsupplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial

A randomized controlled trial in KwaZulu-Natal (South Africa) of 428 primar y-school pupils (stratified into 6 groups by age, sex and intervention) mea sured the effect of different anthelmintic treatments and iron supplementat ion regimens provided twice at 6-monthly intervals for 1 year (1996/97). Ha lf the pupils received iron supplementation (ferrous fumarate 200 mg weekly for 10 weeks). Pupils received 2 anthelmintic regimens, either (i) albenda zole 400 mg plus praziquantel 40 mg/kg or (ii) albendazole 400 mg on 3 cons ecutive days plus praziquantel 40 mg/kg or (iii) placebo. Baseline prevalen ces of Ascaris 55.9%, Trichuris 83.6%, hookworm spp. 59.4%, were reduced af ter 12 months for single-dose albendazole treatment to Ascaris 17.4% (P <0. 005), Trichuris 61.5% (NS), hookworm spp. 0% (P <0.005), and for triple-dos e albendazole treatment to Ascaris 14.8% (P <0.005), Trichuris 25 0% (P <0. 01), hookworm 0% (P <0.005). Schistosoma haematobium 43.4% was reduced amon g treated groups to 8.3% (P <0.005). There were no significant changes in t he anthropometry of the different treatment groups at either 6 or 12 months post treatment. Twelve months after treatment there was a significant incr ease in haemoglobin levels (P = 0.02) among pupils receiving triple-dose al bendazole, praziquantel and ferrous fumarate; pupils receiving no anthelmin tic treatment showed a significant decrease as did pupils who received trip le-dose albendazole and praziquantel but no iron. Regular B-monthly anthelm intic treatment significantly reduced the prevalence of Ascaris, hookworm s pp, and S. haematobium infections (P <0.05). Triple-dose treatment for Tric huris was significantly more effective than a single dose of albendazole 40 0 mg (P = 0.002). In areas with schistosomiasis, hookworm infection and hig h prevalence of Trichuris infection, combination treatment with praziquante l, triple-dose albendazole, plus iron supplementation, is likely to improve pupils' health and haemoglobin levels.