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Albendazole Treatment Improves Work Capacity in Women Smallholder Farmers Infected with Hookworm: A Double-Blind Randomized Control Trial

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  • 1 InnovationCZ, San Francisco, California;
  • | 2 Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada;
  • | 3 Western New England University, North Hampton, Massachusetts;
  • | 4 Health Education Action Leadership Africa Hospital, Goma, Democratic Republic of Congo;
  • | 5 Kindu General Hospital, Kindu, Democratic Republic of Congo;
  • | 6 Akeso Associates, Seattle, Washington;
  • | 7 Yale Partnerships for Global Health, Yale School of Medicine, New Haven, Connecticut;
  • | 8 Yale School of Public Health, New Haven, Connecticut;
  • | 9 Programme National de Lutte contre l’Onchocercose, Ministry of Health, Kinshasa, Democratic Republic of Congo;
  • | 10 Georgetown University Medical School, Washington, District of Columbia;
  • | 11 United States Agency for International Development, Yaoundé, Cameroon
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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

Address correspondence to Margaret Salmon, InnovationCZ, 2751 23rd St, San Francisco, CA 94110. E-mail: margiesalmon@gmail.com

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.

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