A comparison of intervention strategies to improve helminthiasis, nutrition and cognitive status among school-age children in helminth endemic farming and fishing areas in Ghana

To evaluate the impact of intervention strategies on helminthiasis, the nutritional and cognitive status of School-Age Children (SAC), we conducted a community trial with 4 intervention arms; “Nutrition Education Only” (NutEd), “Supplementation Only” (Suppl), “Nutrition Education+Supplementation” (NutEd+Suppl) versus a ‘Non-intervention‘(Control) group. The intervention was conducted on 358 SAC from 8 randomly selected schools (4 schools from fishing and 4 schools from farming communities) in the Kwahu Afram Plains South District of Ghana. Data were collected at baseline, third, and sixth-month post-intervention. Data were obtained through questionnaire, anthropometry, parasitology (faecal and urine analysis), hemoglobin levels (Hb) and whole blood zinc levels. The Ravens Colored Progressive Matrices (RCPM) were used for the cognitive assessment. At baseline, the overall helminthiasis prevalence was 29.6%, which decreased to 6.3% at the 6th-month post-intervention. About 7.5% of all the children were underweight, 11.2% were stunted, 21.5% were acutely malnourished, 46.1% were anemic and 31.4% were zinc deficient. These decreased to 5.3% (underweight), 8.5% (stunting), 9.8% (acute malnutrition), 16.1% (anemia) and 9.3% (zinc deficiency), respectively, at the 6th-month post-intervention. At baseline, 15.6% of the children passed the cognitive test which increased to 32.4% at the 6th-month post-intervention. The “NutEd” treatment recorded the most significantly improved of bmi-for-age z-score (0.27 ± 0.88, p = 0.002), height-for-age z-score (0.16 ± 0.38, p < 0.0001) and anemia (Hb levels; 1.22 ± 1.13 g/dL, p < 0.0001), The “NutEd+Suppl” group recorded the highest improvement in zinc levels (46.39 ± 22.30 µmol/L, p < 0.0001) and the “Suppl” group the highest improvement in cognitive performance (3.08 ± 6.07, p < 0.0001) between the baseline and the 6th-month post-intervention.

为评估干预策略对学龄儿童（School-Age Children, SAC）蠕虫病感染、营养与认知状况的影响，我们开展了一项社区试验，共设置4个干预组：仅营养教育组（Nutrition Education Only, NutEd）、仅补充剂组（Supplementation Only, Suppl）、营养教育+补充剂联合组（Nutrition Education+Supplementation, NutEd+Suppl），以及非干预对照组（Non-intervention, Control）。本试验纳入加纳夸胡阿夫拉姆平原南区8所随机选取学校的358名学龄儿童，其中渔业社区与农业社区学校各4所。数据分别于干预前基线期、干预后第3个月及第6个月采集，采集方式包括问卷调查、人体测量学检测、寄生虫学检测（粪便与尿液分析）、血红蛋白（hemoglobin, Hb）水平检测及全血锌水平检测；认知评估采用雷文彩色渐进式矩阵测验（Ravens Colored Progressive Matrices, RCPM）。基线期整体蠕虫病感染率为29.6%，至干预后第6个月降至6.3%。基线时，约7.5%的儿童存在体重不足问题，11.2%存在生长迟缓，21.5%为急性营养不良，46.1%患有贫血，31.4%存在锌缺乏；至干预后第6个月，上述指标比例分别降至5.3%、8.5%、9.8%、16.1%及9.3%。基线期通过认知测验的儿童占比为15.6%，干预后第6个月提升至32.4%。干预后第6个月与基线期相比，仅营养教育组在年龄别BMI Z评分（0.27±0.88, p=0.002）、年龄别身高Z评分（0.16±0.38, p<0.0001）及贫血改善（血红蛋白水平提升1.22±1.13g/dL, p<0.0001）方面效果最为显著；营养教育+补充剂联合组的全血锌水平改善幅度最大（46.39±22.30µmol/L, p<0.0001）；仅补充剂组的认知表现提升最为突出（3.08±6.07, p<0.0001）。