Publication: Evaluation of the Integrated Management of Childhood Illness guidelines for treatment of intestinal helminth infections among sick children aged 2-4 years in western Kenya
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2002-09
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Transactions of the Royal Society of Tropical Medicine and Hygiene
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Abstract
Anthelmintic treatment of sick preschool-age children at health facilities is a potentially effective strategy
for intestinal helminth control in this age-group. We conducted a study from July 1998 to February 1999
in western Kenya to determine whether the Integrated Management of Childhood Illness (IMCI)
guidelines’ clinical assessment can be used to identify helminth-infected children, and to evaluate the
nutritional benefit of treating sick children without pallor with an anthelmintic (mebendazole is already
part of IMCI treatment for sick children aged 2-4 years with palmar pallor in areas where hookworm
and Trichuris trichiura infections are endemic). Sick children aged 2-4 years seen at 3 rural health
facilities were clinically evaluated and tested for haemoglobin concentration, malaria parasites, and
intestinal helminths. Children without pallor were randomly assigned to receive a single dose of 500 mg
of mebendazole or a placebo and re-examined 6 months later. Among the 574 children enroIled, 11%
had one or more intestinal helminths. Most infections were of light intensity. Selected clinical signs and
symptoms available from the IMCI assessment, including palmar pallor and low weight-for-age, were not
associated with helminth infection. Six months after enrolment, no differences in growth of children
without pallor were observed between the mebendazole (n = 166) and placebo (n = 181) groups.
However, there was a significantly greater mean increase in weight, height, and weight-for-age 2 score
among the helminth-infected children in the mebendazole group (n = 22) as compared with helminth-
infected children in the placebo group (n = 20). We conclude that even lightly infected preschool-age
children without palmar pallor benefit from anthelmintic treatment; however, in this study setting of low
helminth prevalence and intensity, helminth-infected children could not be identified using the IMCI
guidelines. Cost-effectiveness studies are needed to help define helminth prevalence thresholds for
routine anthelmintic treatment of sick preschool-age children seen at first-level health facilities.