Soil-transmitted helminths infect 1 in 4 people in endemic countries. Worm infections adversely affect child health and development. Because testing is much more expensive than treatment, mass drug administration (MDA) has been proposed as a cost-effective approach to deworming. However, there has been a debate over evidence on the health benefits of MDA approaches. In this meta-analysis, we reaffirm significant positive health impacts of MDA and show that it is cost-effective.
The WHO recommends mass drug administration (MDA) for intestinal worm infections in areas with over 20% infection prevalence. Recent Cochrane meta-analyses endorse treatment of infected individuals but recommend against MDA. We conducted a theory-agnostic random-effects meta-analysis of the effect of multiple-dose MDA and a cost-effectiveness analysis. We estimate significant effects of MDA on child weight (0.15 kg, 95% CI: 0.07, 0.24; P < 0.001), mid-upper arm circumference (0.20 cm, 95% CI: 0.03, 0.37; P = 0.02), and height (0.09 cm, 95% CI: 0.01, 0.16; P = 0.02) when prevalence is over 20% but not on Hb (0.06 g/dL, 95% CI: −0.01, 0.14; P = 0.1). These results suggest that MDA is a cost-effective intervention, particularly in the settings where it is recommended by the WHO.