Evaluating the Impact Adding Iron Supplementation to School-based Deworming Programs on Cognitive Development for School-age Children Open Access

Abstract

School-age children bear the most burden of worm infection, and are therefore at highest risk for developing iron deficiency anemia. Routine deworming of school children in schools in areas that are endemic of soil-transmitted helminths (STH) is among the most safe and cost-effective way to deliver deworming pills regularly to children. Schools offer a readily available, extensive and sustained infrastructure with a skilled workforce that is in close contact with the community (The World Bank., 2009). The impact of routine school-based deworming on nutrition status, hemoglobin, cognition, or school performance of school aged children has recently been questioned in two systemic reviews (Taylor-Robinson, Maayan, Soares-Weiser, Donegan, & Garner, 2015), (Hall, 2007). While experts agree that deworming is a necessary intervention to stop the spread of STH infections (Mascarini-Serra, 2011), (Taylor-Robinson et al., 2015), there is a question on the need to integrate interventions such as iron supplementation with nutrition supplementation programs that contributes to improving health status, productivity, economic development, and poverty reduction. This systematic literature review analyzed and compared twenty-four studies (randomized control trials and program evaluations) of iron supplementation carried out on children aged 5-19 years in STH endemic areas. Although only a limited number of studies examined the effects of iron supplementation on school performance, at least 20 of the studies showed an improvement in hemoglobin status and anemia prevalence. Additionally, studies in the review shows that integrating iron supplementation if feasible and there have been no adverse events reported, with the exception of two studies that showed increased morbidity with supplementation in South Africa and Kenya.

Table of Contents

CHAPTER 1: INTRODUCTION. 1

Problem Statement. 3

Theoretical Framework. 3

Research Questions. 7

Significance Statement. 8

Definition of terms. 9

CHAPTER 2: BACKGROUND. 10

Introduction. 10

Socio-economic Burden of Iron Deficiency anemia due to STH infections. 10

Risk Factors for Iron Deficiency Anemia in STH Endemic Countries. 15

Interventions. 16

a) School Based Deworming. 16

b) Iron Supplementation for School Children.18

Summary. 21

CHAPTER 3: METHODOLOGY-A SYSTEMATIC REVIEW OF LITERATURE. 23

Introduction. 23

Population. 22

Data Extraction and Analysis Methodology. 27

Summary. 27

CHAPTER 4: RESULTS. 29

Introduction. 29

Key Findings. 31

Description of Studies. 31

1. Location. 31

2. Population. 34

3. Study Designs. 34

4. Deworming. 34

5. Accompanying Health promotion activities. 35

Outcome Measures. 35

Summary. 39

Limitations. 40

CHAPTER 5: DISCUSSION. 41

Introduction. 41

Summary of Study. 41

Conclusion. 42

Recommendations. 42

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Education, Health
Keyword	school age children soil transmitted helminthes iron deficiency anemia
Committee Chair / Thesis Advisor	Ng'eno, Bernadette N., EIS Officer at the Center for Disease Control and Prevention

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