Authors:
, , , , , , , , , , , , , , , , , and
- INTRODUCTION
- METHODS
- Democratic Republic of Congo study site.
- Study participants and randomization.
- Exclusion criteria.
- Outcome measures.
- Study design.
- Demographic questionnaire.
- Outcome measure: YMCA step test protocol.
- Work capacity metric.
- Ethics and ethical considerations.
- Study power.
- Statistical analysis.
- Data dissemination.
- RESULTS
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Kabatereine NB, Brooker S, Koukounari A, Kazibwe F, Tukahebwa EM, Fleming FM, Zhang Y, Webster JP, Stothard JR, Fenwick A, 2007. Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren. Bull World Health Organ 85: 91–99.
-
2.
Olsen A, Magnussen P, Ouma JH, Andreassen J, Friis H, 1998. The contribution of hookworm and other parasitic infections to haemoglobin and iron status among children and adults in western Kenya. Trans R Soc Trop Med Hyg 92: 643–649.
-
3.
Rimoin AW, Hotez PJ, 2013. NTDs in the heart of darkness: the Democratic Republic of Congo’s unknown burden of neglected tropical diseases. PLoS Negl Trop Dis 7: e2118.
-
4.
De Silva NR, Brooker S, Hotez PJ, Montresor A, Engels D, Savioli L, 2003. Soil-transmitted helminth infections: updating the global picture. Trends Parasitol 19: 547–551.
-
5.
Ruxin J, Negin J, 2012. Removing the neglect from neglected tropical diseases: the Rwandan experience 2008–2010. Glob Public Health 7: 812–822.
-
6.
Hotez PJ, Kamath A, 2009. Neglected tropical diseases in sub-saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis 3: e412.
-
7.
Gilman RH, 1982. Hookworm disease: host-pathogen biology. Rev Infect Dis 4: 824–829.
-
8.
Gilles HM, Williams EW, Ball PA, 1964. Hookworm infection and anaemia. An epidemiological, clinical, and laboratory study. Q J Med 33: 1–24.
-
9.
Awasthi S, Bundy DA, Savioli L, 2003. Helminthic infections. BMJ 327: 431–433.
-
10.
Brooker S, Hotez PJ, Bundy DA, 2008. Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis 2: e291.
-
11.
Belachew T, Legesse Y, 2006. Risk factors for anemia among pregnant women attending antenatal clinic at Jimma University Hospital, southwest Ethiopia. Ethiop Med J 44: 211–220.
-
12.
Zhu YI, Haas JD, 1997. Iron depletion without anemia and physical performance in young women. Am J Clin Nutr 66: 334–341.
-
13.
Gardner GW, Edgerton VR, Senewiratne B, Barnard RJ, Ohira Y, 1977. Physical work capacity and metabolic stress in subjects with iron deficiency anemia. Am J Clin Nutr 30: 910–917.
-
14.
Hinton PS, Giordano C, Brownlie T, Haas JD, 2000. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol 88: 1103–1111.
-
15.
Bailey RL, West KP Jr., Black RE, 2015. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab 66 (Suppl. 2): 22–33.
-
16.
Guyatt H, 2000. Do intestinal nematodes affect productivity in adulthood? Parasitol Today 16: 153–158.
-
17.
Basta SS, Karyadi D, Scrimshaw NS, 1979. Iron deficiency anemia and the productivity of adult males in Indonesia. Am J Clin Nutr 32: 916–925.
-
18.
Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA, 2013. Control of iron deficiency anemia in low-and middle-income countries. Blood 121: 2607–2617.
-
19.
Hotez PJ, Fenwick A, Savioli L, Molyneux DH, 2009. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 373: 1570–1575.
-
20.
Smith JL, Brooker S, 2010. Impact of hookworm infection and deworming on anaemia in non‐pregnant populations: a systematic review. Trop Med Int Health 15: 776–795.
-
21.
Wolgemuth JC, Latham MC, Hall A, Chesher A, Crompton DW, 1982. Worker productivity and the nutritional status of Kenyan road construction laborers. Am J Clin Nutr 36: 68–78.
-
22.
Gilgen DD, Mascie‐Taylor CG, Rosetta LL, 2001. Intestinal helminth infections, anaemia and labour productivity of female tea pluckers in Bangladesh. Trop Med Int Health 6: 449–457.
-
23.
Brabin BJ, Hakimi M, Pelletier D, 2001. An analysis of anemia and pregnancy-related maternal mortality. J Nutr 131: 604S–615S.
-
24.
Karagiannis-Voules DA et al. 2015. Spatial and temporal distribution of soil-transmitted helminth infection in sub-Saharan Africa: a systematic review and geostatistical meta-analysis. Lancet Infect Dis 15: 74–84.
-
25.
Katz N, Chaves A, Pellegrino J, 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop São Paulo 14: 397–400.
-
26.
Anon, 2017. Iron Deficiency Anaemia: Assessment, Prevention and Control. A Guide for Programme Managers. Available at: http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en/index.html. Accessed January 15, 2015.
-
27.
Humphries D et al. 2011. Epidemiology of hookworm infection in Kintampo North Municipality, Ghana: patterns of malaria coinfection, anemia, and albendazole treatment failure. Am J Trop Med Hyg 84: 792–800.
-
28.
McArdle WD, Katch FI, Pechar GS, Jacobson L, Ruck S, 1972. Reliability and interrelationships between maximal oxygen intake, physical work capacity and step-test scores in college women. Med Sci Sports 4: 182–186.
-
29.
Hiilloskorpi HK, Pasanen ME, Fogelholm MG, Laukkanen RM, Mänttäri AT, 2003. Use of heart rate to predict energy expenditure from low to high activity levels. Int J Sports Med 24: 332–336.
-
30.
Montgomery PG, Green DJ, Etxebarria N, Pyne DB, Saunders PU, Minahan CL, 2009. Validation of heart rate monitor-based predictions of oxygen uptake and energy expenditure. J Strength Cond Res 23: 1489–1495.
-
31.
Anon, 2017. The Heart Rate Debate. Available at: https://www.acsm.org/public-information/articles/2012/01/13/the-heart-rate-debate. Accessed January 21, 2016.
-
32.
Smith JL, Brooker S, 2010. Impact of hookworm infection and deworming on anaemia in non‐pregnant populations: a systematic review. Trop Med Int Health 15: 776–795.
-
33.
Keiser J, Utzinger J, 2008. Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA 299: 1937–1948.
-
34.
Vercruysse J et al. 2011. Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic. PLoS Negl Trop Dis 5: e948.
-
35.
Hall A, Hewitt G, Tuffrey V, De Silva N, 2008. A review and meta‐analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr 4: 118–236.
-
36.
Cherian S, Forbes DA, Cook AG, Sanfilippo FM, Kemna EH, Swinkels DW, Burgner DP, 2008. An insight into the relationships between hepcidin, anemia, infections and inflammatory cytokines in pediatric refugees: a cross-sectional study. PLoS One 3: e4030.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 764 | 574 | 154 |
| Full Text Views | 661 | 8 | 0 |
| PDF Downloads | 188 | 10 | 0 |
Albendazole Treatment Improves Work Capacity in Women Smallholder Farmers Infected with Hookworm: A Double-Blind Randomized Control Trial
Margaret Salmon
Margaret Salmon
InnovationCZ, San Francisco, California;
Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada;
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Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada;
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Christian Salmon
Christian Salmon
Western New England University, North Hampton, Massachusetts;
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Maurice Masoda
Maurice Masoda
Health Education Action Leadership Africa Hospital, Goma, Democratic Republic of Congo;
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Jean-Maurice Salumu
Jean-Maurice Salumu
Kindu General Hospital, Kindu, Democratic Republic of Congo;
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Carmine Bozzi
Carmine Bozzi
Akeso Associates, Seattle, Washington;
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Phil Nieburg
Phil Nieburg
Akeso Associates, Seattle, Washington;
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Lisa M. Harrison
Lisa M. Harrison
Yale Partnerships for Global Health, Yale School of Medicine, New Haven, Connecticut;
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Debbie Humphries
Debbie Humphries
Yale School of Public Health, New Haven, Connecticut;
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Naomi Abaca Uvon
Naomi Abaca Uvon
Programme National de Lutte contre l’Onchocercose, Ministry of Health, Kinshasa, Democratic Republic of Congo;
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Sarah K. Wendel
Sarah K. Wendel
Georgetown University Medical School, Washington, District of Columbia;
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Clint Trout
Clint Trout
United States Agency for International Development, Yaoundé, Cameroon
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Michael Cappello
Michael Cappello
Yale Partnerships for Global Health, Yale School of Medicine, New Haven, Connecticut;
Yale School of Public Health, New Haven, Connecticut;
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Yale School of Public Health, New Haven, Connecticut;
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An estimated 4.7 billion people live in regions exposed to soil-transmitted helminths, intestinal parasites that have significant impacts on the health of women smallholder farmers. The goal of this trial was to determine whether treatment with albendazole impacts the work capacity of these farmers. This is a prospective double-blind, randomized effectiveness trial. Participants (N = 250) were randomly selected from safe motherhood groups in the Democratic Republic of Congo. Prevalence/intensity of hookworm infection, hemoglobin, and demographics was obtained. At study (Time = 0), participants were randomized into treatment (albendazole 400 mg) and placebo (similar placebo tablet) groups. A step test was administered as a proxy metric for work capacity. Work capacity was defined as ∆heart rate before and after 3 minutes of step testing, in beats per minute. At study (time = 7 months), the step test was repeated and work capacity remeasured. The ∆work capacity (time = 0 minus time = 7 months) was the primary outcome. Investigators/field assistants were blinded to who was enrolled in groups, hookworm status, and step test results. Regression showed highly significant interactive effects of hookworm status and treatment group relative to ∆work capacity after controlling for resting pulse rate and age (P < 0.002). Estimated marginal means for work capacity (WC) for each of four groups (hookworm positive plus placebo, hookworm positive plus treatment, hookworm negative plus placebo, and hookworm negative plus treatment) showed women who were hookworm positive and received treatment decreased heart rate by 9.744 (95% confidence interval [CI]: 6.42, 13.07) beats per minute (increased WC), whereas women who were hookworm positive and received placebo saw a nonsignificant decrease of 0.034 (95% CI: −3.16, 3.84) beats per minute. Treatment with albendazole was associated with improved aerobic work capacity posttreatment. Given modest costs of drug distributions, risk benefits of periodic deworming warrants further study in larger controlled trials.
Author Notes
Authors’ addresses: Margaret Salmon, InnovationCZ, San Francisco, California and Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada, E-mail: margiesalmon@gmail.com. Christian Salmon, Western New England University, North Hampton, MA, E-mail: christian.salmon@wne.edu. Maurice Masoda, HEAL Africa Hospital, Goma, Democratic Republic of Congo, E-mail: mauricemas@yahoo.fr. Jean-Maurice Salumu, Kindu General Hospital, Kindu, Democratic Republic of Congo, E-mail: salumudr@gmail.com. Carmine Bozzi and Phil Nieburg, Akeso Associates, Seattle, WA, E-mails: carmine.bozzi@akesoassociates.com and pin610@embarqmail.com. Lisa M. Harrison and Michael Cappello, Yale Partnerships for Global Health, Yale School of Medicine, New Haven, CT, E-mails: lisa.harrison@yale.edu and michael.cappello@yale.edu. Debbie Humphries, Yale School of Public Health, New Haven, CT, E-mail: debbie.Humphries@yale.edu. Naomi Abaca Uvon, Programme National de Lutte contre l’Onchocercose, Ministry of Health, Kinshasa, Democratic Republic of Congo, E-mail: naopitchouna@gmail.com. Sarah K. Wendel, Georgetown University Medical School, Washington, DC, E-mail: skjwendel@gmail.com. Clint Trout, USAID, Yaoundé, Cameroon, E-mail: clintworldwide@yahoo.com.
- INTRODUCTION
- METHODS
- Democratic Republic of Congo study site.
- Study participants and randomization.
- Exclusion criteria.
- Outcome measures.
- Study design.
- Demographic questionnaire.
- Outcome measure: YMCA step test protocol.
- Work capacity metric.
- Ethics and ethical considerations.
- Study power.
- Statistical analysis.
- Data dissemination.
- RESULTS
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Kabatereine NB, Brooker S, Koukounari A, Kazibwe F, Tukahebwa EM, Fleming FM, Zhang Y, Webster JP, Stothard JR, Fenwick A, 2007. Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren. Bull World Health Organ 85: 91–99.
-
2.
Olsen A, Magnussen P, Ouma JH, Andreassen J, Friis H, 1998. The contribution of hookworm and other parasitic infections to haemoglobin and iron status among children and adults in western Kenya. Trans R Soc Trop Med Hyg 92: 643–649.
-
3.
Rimoin AW, Hotez PJ, 2013. NTDs in the heart of darkness: the Democratic Republic of Congo’s unknown burden of neglected tropical diseases. PLoS Negl Trop Dis 7: e2118.
-
4.
De Silva NR, Brooker S, Hotez PJ, Montresor A, Engels D, Savioli L, 2003. Soil-transmitted helminth infections: updating the global picture. Trends Parasitol 19: 547–551.
-
5.
Ruxin J, Negin J, 2012. Removing the neglect from neglected tropical diseases: the Rwandan experience 2008–2010. Glob Public Health 7: 812–822.
-
6.
Hotez PJ, Kamath A, 2009. Neglected tropical diseases in sub-saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis 3: e412.
-
7.
Gilman RH, 1982. Hookworm disease: host-pathogen biology. Rev Infect Dis 4: 824–829.
-
8.
Gilles HM, Williams EW, Ball PA, 1964. Hookworm infection and anaemia. An epidemiological, clinical, and laboratory study. Q J Med 33: 1–24.
-
9.
Awasthi S, Bundy DA, Savioli L, 2003. Helminthic infections. BMJ 327: 431–433.
-
10.
Brooker S, Hotez PJ, Bundy DA, 2008. Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis 2: e291.
-
11.
Belachew T, Legesse Y, 2006. Risk factors for anemia among pregnant women attending antenatal clinic at Jimma University Hospital, southwest Ethiopia. Ethiop Med J 44: 211–220.
-
12.
Zhu YI, Haas JD, 1997. Iron depletion without anemia and physical performance in young women. Am J Clin Nutr 66: 334–341.
-
13.
Gardner GW, Edgerton VR, Senewiratne B, Barnard RJ, Ohira Y, 1977. Physical work capacity and metabolic stress in subjects with iron deficiency anemia. Am J Clin Nutr 30: 910–917.
-
14.
Hinton PS, Giordano C, Brownlie T, Haas JD, 2000. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol 88: 1103–1111.
-
15.
Bailey RL, West KP Jr., Black RE, 2015. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab 66 (Suppl. 2): 22–33.
-
16.
Guyatt H, 2000. Do intestinal nematodes affect productivity in adulthood? Parasitol Today 16: 153–158.
-
17.
Basta SS, Karyadi D, Scrimshaw NS, 1979. Iron deficiency anemia and the productivity of adult males in Indonesia. Am J Clin Nutr 32: 916–925.
-
18.
Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA, 2013. Control of iron deficiency anemia in low-and middle-income countries. Blood 121: 2607–2617.
-
19.
Hotez PJ, Fenwick A, Savioli L, Molyneux DH, 2009. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 373: 1570–1575.
-
20.
Smith JL, Brooker S, 2010. Impact of hookworm infection and deworming on anaemia in non‐pregnant populations: a systematic review. Trop Med Int Health 15: 776–795.
-
21.
Wolgemuth JC, Latham MC, Hall A, Chesher A, Crompton DW, 1982. Worker productivity and the nutritional status of Kenyan road construction laborers. Am J Clin Nutr 36: 68–78.
-
22.
Gilgen DD, Mascie‐Taylor CG, Rosetta LL, 2001. Intestinal helminth infections, anaemia and labour productivity of female tea pluckers in Bangladesh. Trop Med Int Health 6: 449–457.
-
23.
Brabin BJ, Hakimi M, Pelletier D, 2001. An analysis of anemia and pregnancy-related maternal mortality. J Nutr 131: 604S–615S.
-
24.
Karagiannis-Voules DA et al. 2015. Spatial and temporal distribution of soil-transmitted helminth infection in sub-Saharan Africa: a systematic review and geostatistical meta-analysis. Lancet Infect Dis 15: 74–84.
-
25.
Katz N, Chaves A, Pellegrino J, 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop São Paulo 14: 397–400.
-
26.
Anon, 2017. Iron Deficiency Anaemia: Assessment, Prevention and Control. A Guide for Programme Managers. Available at: http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en/index.html. Accessed January 15, 2015.
-
27.
Humphries D et al. 2011. Epidemiology of hookworm infection in Kintampo North Municipality, Ghana: patterns of malaria coinfection, anemia, and albendazole treatment failure. Am J Trop Med Hyg 84: 792–800.
-
28.
McArdle WD, Katch FI, Pechar GS, Jacobson L, Ruck S, 1972. Reliability and interrelationships between maximal oxygen intake, physical work capacity and step-test scores in college women. Med Sci Sports 4: 182–186.
-
29.
Hiilloskorpi HK, Pasanen ME, Fogelholm MG, Laukkanen RM, Mänttäri AT, 2003. Use of heart rate to predict energy expenditure from low to high activity levels. Int J Sports Med 24: 332–336.
-
30.
Montgomery PG, Green DJ, Etxebarria N, Pyne DB, Saunders PU, Minahan CL, 2009. Validation of heart rate monitor-based predictions of oxygen uptake and energy expenditure. J Strength Cond Res 23: 1489–1495.
-
31.
Anon, 2017. The Heart Rate Debate. Available at: https://www.acsm.org/public-information/articles/2012/01/13/the-heart-rate-debate. Accessed January 21, 2016.
-
32.
Smith JL, Brooker S, 2010. Impact of hookworm infection and deworming on anaemia in non‐pregnant populations: a systematic review. Trop Med Int Health 15: 776–795.
-
33.
Keiser J, Utzinger J, 2008. Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA 299: 1937–1948.
-
34.
Vercruysse J et al. 2011. Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic. PLoS Negl Trop Dis 5: e948.
-
35.
Hall A, Hewitt G, Tuffrey V, De Silva N, 2008. A review and meta‐analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr 4: 118–236.
-
36.
Cherian S, Forbes DA, Cook AG, Sanfilippo FM, Kemna EH, Swinkels DW, Burgner DP, 2008. An insight into the relationships between hepcidin, anemia, infections and inflammatory cytokines in pediatric refugees: a cross-sectional study. PLoS One 3: e4030.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 764 | 574 | 154 |
| Full Text Views | 661 | 8 | 0 |
| PDF Downloads | 188 | 10 | 0 |