Abstract
Background: WHO recommends antenatal (after the first trimester) deworming for pregnant women who live in areas where the prevalence of hookworm infection exceeds 20–30%. However, deworming has not been included in antenatal care packages in most developing countries.
Methods: A review of articles publishing original data identified primarily through Medline was conducted using subject heading terms and text words for “deworming”, “pregnant women”, “hookworm”, “anthelminthic”, “anthelmintic”, “albendazole”, “mebendazole”, “pregnancy” and their combinations. Bibliographies of retrieved articles were scanned to identify any additional relevant documents.
Results: Five articles examined the benefits of antenatal deworming. All provided evidence favourable to deworming, in terms of both maternal and infant outcomes. Comparison of outcome measures could be improved with a more standardized approach to outcome ascertainment and reporting.
Conclusion: The evidence base for the inclusion of deworming in antenatal care packages in hookworm-endemic areas is mostly observational in nature. Future research should be directed towards 1) strengthening the evidence base with empirical data from randomized controlled trials, and 2) furthering our understanding related to government uptake of the WHO policy on deworming.
MeSH terms: Hookworm infections, pregnancy, benzimidazole, developing countries
Résumé
Contexte: L’OMS recommande une vermifugation prénatale (après le premier trimestre) pour les femmes enceintes habitant des régions où la prévalence d’infections à ankylostomes dépasse 20 à 30 %. Cependant, la vermifugation n’est pas incluse dans les soins prénataux dans la plupart des pays en développement.
Méthodologie: Un examen des articles publiant des données originales, recensés principalement dans Medline, a été effectué à l’aide de balises et de mots-clés comme «deworming» (vermifugation), «pregnant women» (femmes enceintes), «hookworm» (ankylostome), «anthelminthic» (anthelminthique), «albendazole», «mebendazole», «pregnancy» (grossesse) et leurs combinaisons. Les bibliographies des articles recensés ont été examinées afin de recenser d’autres documents pertinents, le cas échéant.
Résultats: Cinq articles traitent des avantages de la vermifugation prénatale; tous présentent des données favorables à la vermifugation, pour les résultats concernant la mère et ceux concernant l’enfant. La comparaison des résultats pourrait être améliorée par le recours à une approche plus normalisée de la détermination et de la présentation des résultats.
Conclusion: La preuve en faveur de l’inclusion de la vermifugation dans les soins prénatals pour les femmes habitant dans des régions où il y a endémie d’ankylostomes est surtout fondée sur l’observation. D’autres recherches devraient être menées afin 1) de renforcer la preuve par des données empiriques découlant d’essais contrôlés randomisés et 2) d’approfondir notre compréhension en ce qui concerne l’adoption par le gouvernement de la politique de l’OMS sur la vermifugation.
Footnotes
Acknowledgements: Funding for this research project was provided by the Canadian Institutes of Health Research (CIHR) (grant # MCT 53575). Renée Larocque was the recipient of an FRSQ-FCAR PhD scholarship, a CIHR-Canada Graduate Scholarship Doctoral Award, and a scholarship from the Fondation Ricard et Baxter for her doctoral studies.
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