Maternal postpartum deworming: a novel strategy to reduce infant and maternal morbidity in low-and-middle-income countries
Bibliographic record
Abstract
Background:The World Health Organization identifies women of reproductive age as a high risk group for soil-transmitted helminth infections because these infections cause blood loss, iron deficiency anemia, and nutritional impairment.Deworming is a central component of control efforts aimed at reducing the burden of disease in endemic areas.The postpartum period offers a unique opportunity to reach women periodically throughout their reproductive lifespans.To date, no study has investigated the effect of maternal postpartum deworming on infant or maternal health outcomes. Objectives:The objectives of this study were to determine the effectiveness of maternal postpartum deworming on the following infant and maternal health outcomes: 1) infant growth and morbidity; 2) maternal soil-transmitted helminth infection and intensity, anemia, and fatigue; and 3) breast milk quality indicators.Methods: A double-blind, randomized, placebo-controlled trial was carried out in Iquitos, Peru.Mother-infant pairs were enrolled into the trial following delivery at Hospital Iquitos "Cesar Garayar Garcia".Prior to hospital discharge women were randomized to receive either a singledose 400 mg albendazole tablet (i.e., deworming) or identical placebo, based on a pre-specified randomization schedule.Mother-infant pairs were visited in their homes at 1 and 6 months postpartum for outcome ascertainment.The primary outcome was mean infant weight gain between birth and 6 months of age.Continuous outcomes were compared between intervention groups using linear regression models and dichotomous outcomes were compared using logbinomial regression models.Analyses followed an intention-to-treat approach.Adjusted, complete-case, and per-protocol analyses were also performed. Results:Between February and August 2014, 1010 mother-infant pairs were enrolled into the trial.A total of 999 (98.9%) and 970 (96.0%) mother-infant pairs completed their 1 and 6-month study visits, respectively.Infant weight gain between birth and 6 months of age was similar between intervention groups (4.3 kg 0.04 vs. 4.4 kg 0.04), as were secondary growth indices.The single-dose deworming intervention also did not have a differential effect on the occurrence ii of hospitalizations, nor on the incidence of diarrhea, respiratory illness, fever, or ear infections in infants.Over the 6-month postpartum period, deworming significantly reduced the prevalence (RR: 0.5; 95% CI: 0.4, 0.6) and intensity of maternal helminth infections but had no demonstrable effect on maternal anemia (RR: 1.0; 95% CI: 0.9, 1.1) or fatigue score (mean difference: -0.4; 95% CI: -1.1, 0.3).Additionally, the mean concentration of vitamins and minerals in breast milk was similar between intervention groups.Conclusions: Overall, while single-dose deworming did reduce maternal helminth infections, no statistically significant benefit was detected on infant growth or morbidity outcomes in the first 6 months of life.Maternal postpartum deworming also had no effect on the prevalence of maternal anemia, fatigue, and breast milk composition.The benefits of deworming may be more apparent in areas of higher prevalence and intensity of soil-transmitted helminth infection, over longer periods of follow-up, and with repeated administration.This first trial on maternal postpartum deworming contributes essential empirical evidence to inform World Health Organization policy and guidelines towards eliminating soil-transmitted helminthiasis as a public health problem.personally.All this would not have been possible without the guidance and encouragement of my supervisor, Dr. Theresa Gyorkos.It is not every day that we encounter a mentor that invests so deeply in the success of their students and pushes them to be the best version of themselves.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".