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Deworming in children

Intervention | Last updated: 9 August 2023

Soil-transmitted helminth infections are among the most common infections in humans, caused by a group of parasites commonly referred to as worms, including roundworms, whipworms and hookworms. Those living in poverty are most vulnerable to infection which can impair nutritional status by causing:

  • internal bleeding which can lead to loss of iron and anaemia;
  • intestinal inflammation and obstruction;
  • diarrhoea; and
  • impairment of nutrient intake, digestion and absorption.

Evidence shows that preventive chemotherapy, or the periodic large-scale administration of anthelminthic medicines to populations at risk, can dramatically reduce the burden of worms caused by soil-transmitted helminth infections.

Preventive chemotherapy is an important part of a comprehensive package to eliminate morbidity due to soil-transmitted helminths in at-risk populations. However, long-term solutions to soil-transmitted helminth infections will need to address many factors, including improvements in water, sanitation and hygiene.

WHO Recommendations

Preventive chemotherapy (deworming), using annual or biannuala single-dose albendazole (400 mg) or mebendazole (500 mg)b is recommended as a public health intervention for all young children 12–23 months of age, preschool children 1–4 years of age, and school-age children 5–12 years of age (in some settings up to 14 years of age) living in areas where the baseline prevalence of any soil-transmitted infection is 20% or more among children, in order to reduce the worm burden of soil-transmitted helminth infection.

a Biannual administration is recommended where the baseline prevalence is more than 50%.
b A half-dose of albendazole (i.e. 200 mg) is recommended for children younger than 24 months of age.



Evidence

Systematic reviews used to develop the guidelines

Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance

Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Cochrane Database of Systematic Reviews. 2015; Issue 7. Art. No.: CD000371.

Summary of this review Alternate Text

Deworming and adjuvant interventions for improving the developmental health and well-being of children in low- and middle-income countries: a systematic review and meta-analysis

Welch VA. Awasthi S, Cumberbatch C, Fletcher R, McGown J, Merritt K et al. Campbell Systematic Reviews. 2016;12.

Related Cochrane reviews

Public health deworming programmes for soil‐transmitted helminths in children living in endemic areas

Taylor‐Robinson DC, Maayan N, Donegan S, Chaplin M, Garner P. Cochrane Database of Systematic Reviews. 2019; Issue 9. Art. No.: CD000371.

Other related systematic reviews

Differential effect of mass deworming and targeted deworming for soil-transmitted helminth control in children: a systematic review and meta-analysis

Clarke NE, Clements AC A, Doi SA, Wang D, Campbell SJ, Gray D, Nery SV. Lancet. 2017;389(10066):287-297.

A review and meta-analysis of the impact of intestinal worms on child growth and nutrition.

Hall A, Hewitt G, Tuffrey V, De Silva N. Maternal and Child Nutrition. 2008, 4:118–236.

Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis

Welch VA, Ghogomu E, Hossain A, Awasthi S, Bhutta ZA, Cumberbatch C, et al. The Lancet Global Health. 2017;5:e40-e50.

Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review.

Smith JL, Brooker S. Tropical Medicine & International Health. 2010; 15:776–795.

Does mass deworming affect child nutrition? Meta-analysis, cost-effectiveness, and statistical power

Croke K, Hamory Hicks J, Hsu E, Kremer M, Miguel E. Policy Research working paper; no. WPS 7921. Washington, D.C.: World Bank Group; 2016.

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Systematic reviews

Cost and cost-effectiveness of soil-transmitted helminth treatment programmes: systematic review and research needs

Turner HC, Truscott JE, Hollingsworth TD, Bettis AA, Brooker SJ, Anderson RM. Parasit Vectors. 2015; 8:355.

Cost-effectiveness analyses

Does mass deworming affect child nutrition? Meta-analysis, cost-effectiveness, and statistical power

Croke K, Hamory Hicks J, Hsu E, Kremer M, Miguel E. Policy Research working paper; no. WPS 7921. Washington, D.C.: World Bank Group; 2016.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

The costs and cost-effectiveness of mass treatment for intestinal nematode worm infections using different treatment thresholds

Hall A, Horton S, de Silva N. PLoS Negl Trop Dis. 2009; 3(3):e402.

Effectiveness and cost-effectiveness of albendazole in improving nutritional status of pre-school children in urban slums

Awasthi S, Pande VK, Fletcher RH. Indian Pediatr. 2000; 37(1):19-29.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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