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      Effect of deworming on school-aged children’s physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic area of Côte d’Ivoire

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          Malaria and helminth infections are thought to negatively affect children’s nutritional status and to impair their physical and cognitive development. Yet, the current evidence-base is weak. The purpose of this study was to determine the effect of deworming against soil-transmitted helminthiasis and schistosomiasis on children’s physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic setting of Côte d’Ivoire.


          We designed an intervention study with a 5-month follow-up among schoolchildren aged 5–14 years from Niablé, eastern Côte d’Ivoire. In late 2012, a baseline cross-sectional survey was conducted. Finger-prick blood, stool and urine samples were subjected to standardised, quality-controlled techniques for the diagnosis of Plasmodium spp., Schistosoma spp., soil-transmitted helminths and intestinal protozoa infections. Haemoglobin level was determined and anthropometric measurements were taken for appraisal of anaemia and nutritional status. Children underwent memory (digit span) and attention (code transmission) cognitive testing, and their physical fitness and strength were determined (20 m shuttle run, standing broad jump and grip strength test). All children were treated with albendazole (against soil-transmitted helminthiasis) and praziquantel (against schistosomiasis) after the baseline cross-sectional survey and again 2 months later. Five months after the initial deworming, the same battery of clinical, cognitive and physical fitness tests was performed on the same children.


          Lower scores in strength tests were significantly associated with children with harbouring nutritional deficiencies. Surprisingly, boys infected with Schistosoma mansoni achieved longer jumping distances than their non-infected counterparts. Light-intensity infection with S. mansoni was associated with slightly better aerobic capacity. Deworming showed no effect on haemoglobin levels and anaemia, but children with moderate- to heavy-intensity Schistosoma infection at baseline gained weight more pronouncedly than non-infected children. Interestingly, children with soil-transmitted helminth or Schistosoma infection at baseline performed significantly better in the sustained attention test than their non-infected counterparts at the 5-month follow-up.


          This study revealed conflicting results regarding clinical parameters and cognitive behaviour of children after two rounds of deworming. We speculate that potential beneficial effects of deworming are likely to be undermined in areas where malaria is co-endemic and nutritional deficiencies are widespread.

          Electronic supplementary material

          The online version of this article (doi:10.1186/1471-2334-14-411) contains supplementary material, which is available to authorized users.

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          Most cited references 73

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          A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni.

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            Helminth infections: the great neglected tropical diseases.

            Helminths are parasitic worms. They are the most common infectious agents of humans in developing countries and produce a global burden of disease that exceeds better-known conditions, including malaria and tuberculosis. As we discuss here, new insights into fundamental helminth biology are accumulating through newly completed genome projects and the nascent application of transgenesis and RNA interference technologies. At the same time, our understanding of the dynamics of the transmission of helminths and the mechanisms of the Th2-type immune responses that are induced by infection with these parasitic worms has increased markedly. Ultimately, these advances in molecular and medical helminth biology should one day translate into a new and robust pipeline of drugs, diagnostics, and vaccines for targeting parasitic worms that infect humans.
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              The multistage 20 metre shuttle run test for aerobic fitness.

              A maximal multistage 20 m shuttle run test was designed to determine the maximal aerobic power of schoolchildren, healthy adults attending fitness class and athletes performing in sports with frequent stops and starts (e.g. basketball, fencing and so on). Subjects run back and forth on a 20 m course and must touch the 20 m line; at the same time a sound signal is emitted from a prerecorded tape. Frequency of the sound signals is increased 0.5 km h-1 each minute from a starting speed of 8.5 km h-1. When the subject can no longer follow the pace, the last stage number announced is used to predict maximal oxygen uptake (VO2max) (Y, ml kg-1 min-1) from the speed (X, km h-1) corresponding to that stage (speed = 8 + 0.5 stage no.) and age (A, year): Y = 31.025 + 3.238 X - 3.248A + 0.1536AX, r = 0.71 with 188 boys and girls aged 8-19 years. To obtain this regression, the test was performed individually. Right upon termination VO2 was measured with four 20 s samples and VO2max was estimated by retroextrapolating the O2 recovery curve at time zero of recovery. For adults, similar measurements indicated that the same equation could be used keeping age constant at 18 (r = 0.90, n = 77 men and women 18-50 years old). Test-retest reliability coefficients were 0.89 for children (139 boys and girls 6-16 years old) and 0.95 for adults (81 men and women, 20-45 years old).(ABSTRACT TRUNCATED AT 250 WORDS)

                Author and article information

                [ ]Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
                [ ]University of Basel, Basel, Switzerland
                [ ]Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
                [ ]Unité de Formation et de Recherche Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d’Ivoire
                [ ]Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                25 July 2014
                25 July 2014
                : 14
                : 1
                © Hürlimann et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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