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Routine deworming during antenatal care decreases risk of neonatal mortality and low birthweight: A retrospective cohort of survey data

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By Bhavneet Walia, Brittany L. Kmush, Sandra D. Lane, Timothy Endy, Antonio Montresor, David A. Larsen

Abstract

Background

Soil transmitted helminths (STH) are a common infection among pregnant women in areas with poor access to sanitation. Deworming medications are cheap and safe; however, the health benefit of deworming during pregnancy is not clear.

Methods / Principal findings

We created a retrospective cohort of more than 800,000 births from 95 Demographic and Health Survey datasets to estimate the impact of deworming medicine during routine antenatal care (ANC) on neonatal mortality and low birthweight. We first matched births on the probability of receiving deworming during ANC. We then modeled the birth outcomes with the matched group as a random intercept to estimate the effect of deworming during antenatal care after accounting for various risk factors. We also tested for effect modification of soil transmitted helminth prevalence on the impact of deworming during ANC. Receipt of deworming medication during ANC was associated with a 14% reduction in the risk of neonatal mortality (95% confidence interval = 10–17%, n = 797,772 births), with no difference between high and low transmission countries. In low transmission countries, we found an 11% reduction in the odds of low birth weight (95% confidence interval = 8–13%) for women receiving deworming medicine, and in high transmission countries, we found a 2% reduction in the odds of low birthweight (95% confidence interval = 0–5%).

Conclusions / Significance

These results suggest a substantial health benefit for deworming during ANC that may be even greater in countries with low STH transmission.

Author summary

Soil-transmitted helminths cause a significant burden of disease throughout the world, particularly in communities with limited access to sanitation facilities and clean drinking water. Deworming medicines effectively clear these parasites, are inexpensive, and are well tolerated. However the effectiveness of deworming medicines, particularly for pregnant women, has not been clearly demonstrated. In this paper we analyze more than 800,000 births to measure the effect that deworming medicine during pregnancy has on birth outcomes. When women receive deworming medicine during pregnancy we saw two specific benefits for the baby: first the risk of neonatal mortality (a baby’s death within first 4 weeks of life) decreases by an estimated 14%, and second, the odds of low birthweight were 11% lower in countries with lower transmission of soil-transmitted helminths. In countries with higher transmission of soil-transmitted helminths we saw no effect of deworming medicine on the odds of low birthweight. Given the results, resources leading to widescale distribution of deworming during pregnancy would have a positive effect on child survival and health.