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4. Surviving and Thriving: Early Intervention for Neonatal Survivors with Developmental Disability in Uganda

Author

Tann, Cally J., Kohli-Lynch, Maya, Nalugya, Ruth, Sadoo, Samantha, Martin, Karen, Lassman, Rachel, Nanyunja, Carol, Musoke, Margaret, Sewagaba, Margaret, Nampijja, Margaret, Seeley, Janet, and Webb, Emily L.

Abstract

Global attention on early child development, inclusive of those with disability, has the potential to translate into improved action for the millions of children with developmental disability living in low- and middle-income countries. Nurturing care is crucial for all children, arguably even more so for children with developmental disability. A high proportion of survivors of neonatal conditions such as prematurity and neonatal encephalopathy are affected by early child developmental disability. The first thousand days of life is a critical period for neuroplasticity and an important window of opportunity for interventions, which maximize developmental potential and other outcomes. Since 2010, our group has been examining predictors, outcomes, and experiences of neonatal encephalopathy in Uganda. The need for an early child intervention program to maximize participation and improve the quality of life for children and families became apparent. In response, the "ABAaNA early intervention program," (now re-branding as 'Baby Ubuntu') a group participatory early intervention program for young children with developmental disability and their families, was developed and piloted. Piloting has provided early evidence of feasibility, acceptability, and impact and a feasibility trial is underway. Future research aims to develop programmatic capacity across diverse settings and evaluate its impact at scale.

Published
2021
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5. Evaluating the effectiveness of the Kidogo model in empowering women and strengthening their capacities to engage in paid labor opportunities through the provision of quality childcare: a study protocol for an exploratory study in Nakuru County, Kenya

Author

Okelo, Kenneth, Nampijja, Margaret, Ilboudo, Patrick, Muendo, Ruth, Oloo, Linda, Muyingo, Sylvia, Mwaniki, Elizabeth, Langat, Nelson, Onyango, Silas, Sipalla, Florence, and Kitsao-Wekulo, Patricia

Published
2022
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8. The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda : Results From the LaVIISWA Cluster-randomized Trial

Author

LaVIISWA Trial Team, Sanya, Richard E., Nkurunungi, Gyaviira, Spaans, Remy Hoek, Nampijja, Margaret, O’Hara, Geraldine, Kizindo, Robert, Oduru, Gloria, Nakawungu, Prossy Kabuubi, Niwagaba, Emmanuel, Abayo, Elson, Kabagenyi, Joyce, Zziwa, Christopher, Tumusiime, Josephine, Nakazibwe, Esther, Kaweesa, James, Kakooza, Fred Muwonge, Akello, Mirriam, Lubyayi, Lawrence, Verweij, Jaco, Nash, Stephen, van Ree, Ronald, Mpairwe, Harriet, Tukahebwa, Edridah, Webb, Emily L., and Elliott, Alison M.

Published
2019

10. Nurturing care practices for children with developmental disabilities in sub-Saharan Africa: A scoping review protocol.

Author

Onyango, Silas, Nampijja, Margaret, Otwate, Paul, Langat, Nelson, Oloo, Linda, Okelo, Kenneth, and Kitsao-Wekulo, Patricia

Subjects
*CHILDREN with developmental disabilities, *CHILD care, *MIDDLE-income countries, *PUBLIC health, *RESEARCH questions
Abstract

Background: The majority of children with neurodevelopmental disorders (NDDs) reside in low- and middle-income countries (LMICs). NDDs are a public health concern in countries in sub-Saharan Africa (SSA). Nurturing care has been recommended as a pathway for addressing the developmental needs and unlocking the full potential of children, including those with NDDs. However, little information exists on the strategies to support children with NDDs using the Nurturing Care Framework in many countries in SSA. This review aims to synthesize information on nurturing care practices for children with NDDs in SSA. The review will also determine gaps in the provision of nurturing care for children with NDDs. Further, the review will highlight the drivers of care as well as the experiences of the caregivers. Methods: The review will be implemented in six steps: specification of the research question, identification of relevant studies, selection of studies to be included, extracting, mapping, and charting the data, collating, summarizing, and reporting the results, and stakeholder consultation. We propose a database search followed by a manual search for the literature synthesis. We will search the following electronic databases: PubMed, ScienceDirect, Scopus, Open Grey and African Journals Online (AJOL). All studies published after May 2018 to May 2023 that include relevant terms will be identified and included. The research team will develop a data extraction form for use in capturing relevant information from each of the included studies. A patterning chart that will summarize and analyze the key findings of each article will be created. Discussion: We anticipate that the study will provide evidence on the existing nurturing care practices and unearth gaps in the provision of nurturing care for children with NDDs. Key determinants of care and the experiences of the parents/caregivers of children will also be identified. The study will provide key recommendations on interventions to improve the quality of care for children with NDDs. Through this study, awareness of the unmet nurturing care needs of these children will be increased. The evidence generated may assist policymakers and stakeholders in addressing the needs of children with NDDs. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Feasibility and acceptability of integrating an early childhood development intervention into the health-facility setting in Siaya County: findings of a qualitative study

Author

Onyango, Silas, primary, Kitsao-Wekulo, Patricia, additional, Okelo, Kenneth, additional, Nampijja, Margaret, additional, Oyugi, Beatrice, additional, Obongo, Christopher, additional, Omedo, Dickens, additional, Sen, Debjeet, additional, and Kimani-Murage, Elizabeth, additional

Published
2023
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12. Examining cognitive functions of Ugandan infants and children in relation to worm infections and anthelminthic treatment, social stimulation and the organization of executive function

Author

Nampijja, Margaret

Subjects
614.5
Abstract

BACKGROUND: A big proportion of populations in sub-Saharan Africa still battle with poverty and intense exposure to infections including chronic worm infections. Studies of cognitive effects of worms have not been consistent regarding which functions are affected and whether deworming is beneficial. However, executive functions could be particularly susceptible to impairment. The home environment is reported to affect child development. However, its unique contribution in Ugandan children exposed to various factors has not been estimated. This PhD research therefore aimed to [I] examine effects of maternal and childhood worm infections and their treatment on executive function and other developmental outcomes in infancy and preschool-age children; and [2] investigate the independent effects of the home environment on child mental performance, taking into account the confounding effects of other socio-demographic exposures. In the same sample, [3] relationships between executive functions were examined in order to understand how they may be disrupted by worms and other adverse factors. METHODS: This research was conducted within the ongoing Entebbe Mother and Baby Study (EMABS) in which 2500 pregnant women were randomised to receiving a single dose of albendazole or placebo and praziquantel or placebo in a 2x2 design. 983 infants born to these women were assessed at age 15 months on executive function, and other abilities to measure the effect of maternal worm infections and their treatment on these functions. The infants were then randomised to quarterly doses of albendazole or placebo from age 15 months and were assessed again at age five years (N=870) on measures of executive function, general ability and motor function to examine effects of childhood worm infections and their treatment on performance on these functions. Relevant health and socio-demographic date were collected and used in the analyses. 200 children were assessed on an extended battery of executive function measures and their scores were used to explore the structure and relationships between executive functions . Home environments of 163 children were examined using an adapted version of the Home Observation for Measurement of the Environment (HOME). RESULTS: Maternal Mansonella perstans and Strongyloides stercoralis infection were negatively associated with infants' performance on the A not B task (a measure of executive function) and language respectively but anthelminthic treatment did not show significant effects overall. In childhood, worms were negatively associated with performance on measures of working memory (Verbal Fluency, Counting Span, and Running Memory), attention (Picture Search), and general ability (Block Design). However, treatment with quarterly albendazole did not have significant effects on performance on measures of cognitive functioning. The home environment contributed to cognitive performance above and beyond the effect of other factors. Low-to-moderate inter-construct correlations were observed among executive functions and three components were extracted from the four domains. Planning was most related to inhibition with working memory also contributing to the best fit model. CONCLUSION: Both infant and childhood developmental outcomes suggest that executive functions may particularly be susceptible to impairment by worm infections but treatment may not reverse the effects. Furthermore, the results show that the home environment affects the child independently of SES, parental education and other global measures. Correlations and factor loadings indicate unity among the executive functions, particularly between planning and a combination of inhibition and working memory,

Published
2012

15. Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums

Author

Nampijja, Margaret, primary, Langat, Nelson, additional, Oloo, Linda, additional, Okelo, Kenneth, additional, Muendo, Ruth, additional, Kiyeng, Martin, additional, Amboka, Patrick, additional, Abboah-Offei, Mary, additional, Ray, Anna, additional, Kitsao-Wekulo, Patricia, additional, Kimani-Murage, Elizabeth W., additional, and Elsey, Helen, additional

Published
2023
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16. The feasibility, acceptability, cost and benefits of a “communities of practice” model for improving the quality of childcare centres: a mixed-methods study in the informal settlements in Nairobi

Author

Nampijja, Margaret, primary, Langat, Nelson, additional, Oloo, Linda, additional, Amboka, Patrick, additional, Okelo, Kenneth, additional, Muendo, Ruth, additional, Habib, Sabrina, additional, Kiyeng, Martin, additional, Ray, Anna, additional, Abboah-Offei, Mary, additional, Kitsao-Wekulo, Patricia, additional, Kimani-Murage, Elizabeth, additional, Li, Jinshuo, additional, and Elsey, Helen, additional

Published
2023
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18. Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya

Author

Oloo, Linda, primary, Elsey, Helen, additional, Abboah-Offei, Mary, additional, Kiyeng, Martin, additional, Amboka, Patrick, additional, Okelo, Kenneth, additional, Kitsao-Wekulo, Patricia, additional, Kimani-Murage, Elizabeth, additional, Langa't, Nelson, additional, and Nampijja, Margaret, additional

Published
2023
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24. Neurodevelopment and Recovery From Wasting

Author

Babikako, Harriet M., primary, Bourdon, Celine, additional, Mbale, Emmie, additional, Aber, Peace, additional, Birabwa, Annet, additional, Chimoyo, Josephine, additional, Voskuijl, Wieger, additional, Kazi, Zaubina, additional, Massara, Paraskevi, additional, Mukisa, John, additional, Mupere, Ezekiel, additional, Nampijja, Margaret, additional, Saleem, Ali Faisal, additional, Uebelhoer, Luke S., additional, Bandsma, Robert, additional, Walson, Judd L., additional, Berkley, James A., additional, Lancioni, Christina, additional, Gladstone, Melissa, additional, and van den Heuvel, Meta, additional

Published
2022
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25. Improving early childhood development in the context of the nurturing care framework in Kenya: A policy review and qualitative exploration of emerging issues with policy makers

Author

Abboah-Offei, Mary, primary, Amboka, Patrick, additional, Nampijja, Margaret, additional, Owino, George Evans, additional, Okelo, Kenneth, additional, Kitsao-Wekulo, Patricia, additional, Chumo, Ivy, additional, Muendo, Ruth, additional, Oloo, Linda, additional, Wanjau, Maryann, additional, Mwaniki, Elizabeth, additional, Mutisya, Maurice, additional, Haycraft, Emma, additional, Hughes, Robert, additional, Griffiths, Paula, additional, and Elsey, Helen, additional

Published
2022
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26. Early care and support for young children with developmental disabilities and their caregivers in Uganda: The Baby Ubuntu feasibility trial

Author

Nanyunja, Carol, primary, Sadoo, Samantha, additional, Kohli-Lynch, Maya, additional, Nalugya, Ruth, additional, Nyonyintono, James, additional, Muhumuza, Anita, additional, Katumba, Kenneth R., additional, Trautner, Emily, additional, Magnusson, Brooke, additional, Kabugo, Daniel, additional, Cowan, Frances M., additional, Zuurmond, Maria, additional, Morgan, Catherine, additional, Lester, Deborah, additional, Seeley, Janet, additional, Webb, Emily L., additional, Otai, Christine, additional, Greco, Giulia, additional, Nampijja, Margaret, additional, and Tann, Cally J., additional

Published
2022
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28. Surviving and Thriving

Author

Tann, Cally J., Kohli-Lynch, Maya, Nalugya, Ruth, Sadoo, Samantha, Martin, Karen, Lassman, Rachel, Nanyunja, Carol, Musoke, Margaret, Sewagaba, Margaret, Nampijja, Margaret, Seeley, Janet, and Webb, Emily L.

Subjects
cerebral palsy, early intervention, neurodevelopment, neonatal encephalopathy, developmental disability, Uganda, Original Articles
Abstract

Global attention on early child development, inclusive of those with disability, has the potential to translate into improved action for the millions of children with developmental disability living in low- and middle-income countries. Nurturing care is crucial for all children, arguably even more so for children with developmental disability. A high proportion of survivors of neonatal conditions such as prematurity and neonatal encephalopathy are affected by early child developmental disability. The first thousand days of life is a critical period for neuroplasticity and an important window of opportunity for interventions, which maximize developmental potential and other outcomes. Since 2010, our group has been examining predictors, outcomes, and experiences of neonatal encephalopathy in Uganda. The need for an early child intervention program to maximize participation and improve the quality of life for children and families became apparent. In response, the "ABAaNA early intervention program," (now re-branding as 'Baby Ubuntu') a group participatory early intervention program for young children with developmental disability and their families, was developed and piloted. Piloting has provided early evidence of feasibility, acceptability, and impact and a feasibility trial is underway. Future research aims to develop programmatic capacity across diverse settings and evaluate its impact at scale.

Published
2020

29. Effect of single-dose anthelmintic treatment during pregnancy on an infant's response to immunisation and on susceptibility to infectious diseases in infancy: a randomised, double-blind, placebo-controlled trial

Author

Webb, Emily L, Mawa, Patrice A, Ndibazza, Juliet, Kizito, Dennison, Namatovu, Alice, Kyosiimire-Lugemwa, Jacqueline, Nanteza, Bridget, Nampijja, Margaret, Muhangi, Lawrence, Woodburn, Patrick W, Akurut, Hellen, Mpairwe, Harriet, Akello, Miriam, Lyadda, Nancy, Bukusuba, Joseph, Kihembo, Macklyn, Kizza, Moses, Kizindo, Robert, Nabulime, Juliet, Ameke, Christine, Namujju, Proscovia B, Tweyongyere, Robert, Muwanga, Moses, Whitworth, James AG, and Elliott, Alison M

Published
2011
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41. Surviving and Thriving

Author

Tann, Cally J., primary, Kohli-Lynch, Maya, additional, Nalugya, Ruth, additional, Sadoo, Samantha, additional, Martin, Karen, additional, Lassman, Rachel, additional, Nanyunja, Carol, additional, Musoke, Margaret, additional, Sewagaba, Margaret, additional, Nampijja, Margaret, additional, Seeley, Janet, additional, and Webb, Emily L., additional

Published
2021
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43. Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda

Author

Sanya, Richard E., primary, Andia Biraro, Irene, additional, Nampijja, Margaret, additional, Zziwa, Christopher, additional, Nanyunja, Carol, additional, Nsubuga, Denis, additional, Kiwanuka, Samuel, additional, Tumusiime, Josephine, additional, Nassuuna, Jacent, additional, Walusimbi, Bridgious, additional, Cose, Stephen, additional, Ocama, Ponsiano, additional, Grencis, Richard K., additional, Elliott, Alison M., additional, and Webb, Emily L., additional

Published
2020
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45. Cross‐reactive carbohydrate determinant‐specific IgE obscures true atopy and exhibits ⍺‐1,3‐fucose epitope‐specific inverse associations with asthma

Author

Nkurunungi, Gyaviira, primary, Mpairwe, Harriet, additional, Versteeg, Serge A., additional, Diepen, Angela, additional, Nassuuna, Jacent, additional, Kabagenyi, Joyce, additional, Nambuya, Irene, additional, Sanya, Richard E., additional, Nampijja, Margaret, additional, Serna, Sonia, additional, Reichardt, Niels‐Christian, additional, Hokke, Cornelis H., additional, Webb, Emily L., additional, Ree, Ronald, additional, Yazdanbakhsh, Maria, additional, and Elliott, Alison M., additional

Published
2020
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47. Life‐course of atopy and allergy‐related disease events in tropical sub‐Saharan Africa: A birth cohort study

Author

Lule, Swaib A., Mpairwe, Harriet, Nampijja, Margaret, Akello, Florence, Kabagenyi, Joyce, Namara, Benigna, Nkurunungi, Gyaviira, Kizito, Dennison, Kahwa, Joseph, Muhangi, Lawrence, Nash, Stephen, Muwanga, Moses, Webb, Emily L., and Elliott, Alison M.

Subjects
Hypersensitivity, Immediate, Male, Epidemiology, atopy, Comorbidity, Cohort Studies, urticaria, rhinitis, Surveys and Questionnaires, conjunctivitis, Prevalence, Humans, Uganda, Child, Developing Countries, Poverty, Africa South of the Sahara, Respiratory Sounds, Skin Tests, birth cohort, Original Articles, Allergens, wheeze, Child, Preschool, Africa, Original Article, Female, eczema, Follow-Up Studies
Abstract

Background In high‐income countries, allergy‐related diseases (ARDs) follow a typical sequence, the ‘Atopic March’. Little is known about the life‐course of ARDs in the markedly different, low‐income, tropical environment. We describe ARDs in a tropical, African birth cohort. Methods Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor‐diagnosed ARDs were recorded throughout follow‐up. Skin prick tests (SPTs) were performed at 3 and 9 years. Atopy was defined as ≥1 positive SPT. Results Of the 2345 live‐born children, 1214 (52%) were seen at 9 years. Wheeze and eczema were common in infancy, but by 9 years, only 4% reported recent wheeze, 5% eczema and 5% rhinitis. Between 3 and 9 years, atopy prevalence increased from 19% to 25%. Atopy at 3 or 9 years was associated with reported ARD events at 9 years, for example OR = 5.2 (95% CI 2.9–10.7) for atopy and recent wheeze at 9 years. Reported or doctor‐diagnosed ARD events in early childhood were associated with the same events in later childhood, for example OR = 4.4 (2.3–8.4) for the association between reported wheeze before 3 years with reported recent wheeze at 9 years, but progression from early eczema to later rhinitis or asthma was not observed. Conclusion Allergen sensitization started early in childhood and increased with age. Eczema and wheeze were common in infancy and declined with age. Atopy was strongly associated with ARD among the few affected children. The typical Atopic March did not occur. Environmental exposures during childhood may dissociate atopy and ARD.

Published
2017

48. The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial

Author

Sanya, Richard E, Nkurunungi, Gyaviira, Hoek Spaans, Remy, Nampijja, Margaret, O'Hara, Geraldine, Kizindo, Robert, Oduru, Gloria, Kabuubi Nakawungu, Prossy, Niwagaba, Emmanuel, Abayo, Elson, Kabagenyi, Joyce, Zziwa, Christopher, Tumusiime, Josephine, Nakazibwe, Esther, Kaweesa, James, Muwonge Kakooza, Fred, Akello, Mirriam, Lubyayi, Lawrence, Verweij, Jaco, Nash, Stephen, van Ree, Ronald, Mpairwe, Harriet, Tukahebwa, Edridah, Webb, Emily L, Elliott, Alison M, APH - Personalized Medicine, AII - Inflammatory diseases, APH - Global Health, Experimental Immunology, and Ear, Nose and Throat

Subjects
parasitic diseases
Abstract

BACKGROUND: The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while reducing helminth-related morbidity. METHODS: In an open, cluster-randomized trial (ISRCTN47196031), we randomized 26 high-schistosomiasis-transmission fishing villages in Lake Victoria, Uganda, in a 1:1 ratio to receive community-wide intensive (quarterly single-dose praziquantel plus albendazole daily for 3 days) or standard (annual praziquantel plus 6 monthly single-dose albendazole) MDA. Primary outcomes were recent wheezing, skin prick test positivity (SPT), and allergen-specific immunoglobulin E (asIgE) after 3 years of intervention. Secondary outcomes included helminths, haemoglobin, and hepatosplenomegaly. RESULTS: The outcome survey comprised 3350 individuals. Intensive MDA had no effect on wheezing (risk ratio [RR] 1.11, 95% confidence interval [CI] 0.64-1.93), SPT (RR 1.10, 95% CI 0.85-1.42), or asIgE (RR 0.96, 95% CI 0.82-1.12). Intensive MDA reduced Schistosoma mansoni infection intensity: the prevalence from Kato Katz examinations of single stool samples from each patient was 23% versus 39% (RR 0.70, 95% CI 0.55-0.88), but the urine circulating cathodic antigen test remained positive in 85% participants in both trial arms. Hookworm prevalence was 8% versus 11% (RR 0.55, 95% CI 0.31-1.00). There were no differences in anemia or hepatospenomegaly between trial arms. CONCLUSIONS: Despite reductions in S. mansoni intensity and hookworm prevalence, intensive MDA had no effect on atopy, allergy-related diseases, or helminth-related pathology. This could be due to sustained low-intensity infections; thus, a causal link between helminths and allergy outcomes cannot be discounted. Intensive community-based MDA has a limited impact in high-schistosomiasis-transmission fishing communities, in the absence of other interventions. CLINICAL TRIALS REGISTRATION: ISRCTN47196031.

Published
2019

49. Caring for children with neurodevelopmental disability : Experiences from caretakers and health workers in rural eastern Uganda

Author

Namazzi, Gertrude, Hanson, Claudia, Nalwadda, Christine, Tetui, Moses, Nampijja, Margaret, Waiswa, Peter, Tumwine, James K., Hildenwall, Helena, Namazzi, Gertrude, Hanson, Claudia, Nalwadda, Christine, Tetui, Moses, Nampijja, Margaret, Waiswa, Peter, Tumwine, James K., and Hildenwall, Helena

Abstract

Background: Long term outcomes of children with neurodevelopmental disability are influenced by the condition itself, available health services and caretakers' coping ability to nurture the children which may be related to their beliefs and experiences. Most children with neurodevelopmental disabilities live in resource constrained settings. To inform design of contextually appropriate interventions, this study explored health workers' and caretakers' experiences in caring for infants with neurodevelopmental disability in rural eastern Uganda. Methods: A qualitative case study was carried out in December 2017 and involved in-depth interviews with 14 caretakers of infants with severe neurodevelopmental disability, and five health workers in Iganga/Mayuge Demographic Surveillance Site in eastern Uganda. The interviews with caretakers were conducted inLusoga, the local language, and in English for the health workers, using a pre-determined open-ended interview guide. Data were analyzed using latent content analysis. Results: Caretakers described the experience of caring for children with neurodevelopmental disability as impoverishing and 'imprisoning' due to high care costs, inability to return to income generating activities and nursing challenges. The latter resulted from failure in body control and several aspects of nutrition and maintaining vital functions, coupled with limited support from the community and the health system. Many caretakers expressed beliefs in supernatural causes of neurodevelopmental disability though they reported about complications during and shortly after the birth of the affected child. Care-seeking was often challenging and impeded by costs and the feeling of lack of improvement. The health care system was also found to be incapable of adequately addressing the needs of such children due to lack of commodities, and human resource limitations. Conclusion: The caretakers expressed a feeling of emotional stress due to being left alone with

Published
2020
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50. Effect of intensive versus standard anthelminthic treatment on growth and cognition among children living in a high Schistosoma mansoni transmission setting:a study nested within a cluster-randomised trial

Author

Nampijja, Margaret, Lubyayi, Lawrence, Tumusiime, Josephine, Nabulime, Juliet, Kizindo, Robert, Kabuubi, Prossy, Sanya, Richard E., Kabagenyi, Joy, Akurut, Hellen, Muhangi, Lawrence, Webb, Emily L., Alcock, Katie, Elliott, Alison M., Team, for the LaVIISWA Trial, Nampijja, Margaret, Lubyayi, Lawrence, Tumusiime, Josephine, Nabulime, Juliet, Kizindo, Robert, Kabuubi, Prossy, Sanya, Richard E., Kabagenyi, Joy, Akurut, Hellen, Muhangi, Lawrence, Webb, Emily L., Alcock, Katie, Elliott, Alison M., and Team, for the LaVIISWA Trial

Abstract

Background: Schistosomiasis and other worm infections have been associated with growth and cognitive impairments; however, whether treatment reverses these effects is uncertain. Moreover, mechanisms linking these infections to cognition are not clear. We aimed to compare growth and cognitive benefits of intensive versus standard anthelminthic treatment in school-aged-children and explore processes that might be involved. We hypothesised that intensive treatment would have greater benefits than standard treatment. Methods: The study was nested within a cluster-randomised trial of either quarterly single-dose praziquantel of 40mg/kg to treat Schistosoma mansoni plus triple dose albendazole of 400mg (intensive treatment) to treat soil-transmitted worms including Ascaris lumbricoides, hookworm and Trichuris trichiura, or annual single-dose praziquantel 40mg/kg plus six-monthly single-dose albendazole 400mg (standard treatment) conducted in the Koome islands in Lake Victoria, Uganda (ISRCTN47196031). Children aged 5-9 years (N=384) were assessed on primary outcomes (height, weight and eight measures of cognitive ability), worm infection, and proposed mediators of worm effects (cytokines, iron status, physical activity) at one year (intensive n=85; standard n=64) and at two years (intensive n=158; standard n=128) of the intervention. Linear regression was used to examine intervention effects on height, weight and cognitive performance. Linear mixed effects models were used to study changes in growth and cognitive performance between the two arms across the two time-points. Results: Intensive treatment resulted in lower Schistosoma mansoni prevalence than standard treatment (at one year, 41% versus 70%; adjusted odds ratio (aOR)=0.24, 95% CI: 0.12, 0.49; at two years, 39% versus 69%; aOR=0.27; 95% CI: 0.16, 0.43) but there were no significant differences in growth and cognitive outcomes at either time-point. Worms and treatment showed no consistent association with the pro

Published
2020

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