Complexities and Perplexities: A Critical Appraisal of the Evidence for Soil-Transmitted Helminth Infection-Related Morbidity

Suzy Campbell, Susana Vaz Nery, SA Doi, Darren Gray, Ricardo Soares Magalhaes, James McCarthy, Rebecca Traub, Ross Andrews, Archie Clements

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    Abstract

    Background: Soil-transmitted helminths (STH) have acute and chronic manifestations, and can result in lifetime morbidity. Disease burden is difficult to quantify, yet quantitative evidence is required to justify large-scale deworming programmes. A recent Cochrane systematic review, which influences Global Burden of Disease (GBD) estimates for STH, has again called into question the evidence for deworming benefit on morbidity due to STH. In this narrative review, we investigate in detail what the shortfalls in evidence are.

    Methodology/Principal Findings:
    We systematically reviewed recent literature that used direct measures to investigate morbidity from STH and we critically appraised systematic reviews, particularly the most recent Cochrane systematic review investigating deworming impact on morbidity. We included six systematic reviews and meta-analyses, 36 literature reviews, 44 experimental or observational studies, and five case series. We highlight where evidence is insufficient and where research needs to be directed to strengthen morbidity evidence, ideally to prove benefits of deworming.

    Conclusions/Significance:
    Overall, the Cochrane systematic review and recent studies indicate major shortfalls in evidence for direct morbidity. However, it is questionable whether the systematic review methodology should be applied to STH due to heterogeneity of the prevalence of different species in each setting. Urgent investment in studies powered to detect direct morbidity effects due to STH is required.
    Original languageEnglish
    Article numbere0004566
    Pages (from-to)1-29
    Number of pages29
    JournalPLoS Neglected Tropical Diseases
    Volume10
    Issue number5
    DOIs
    Publication statusPublished - 2016

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  • Cite this

    Campbell, S., Vaz Nery, S., Doi, SA., Gray, D., Soares Magalhaes, R., McCarthy, J., Traub, R., Andrews, R., & Clements, A. (2016). Complexities and Perplexities: A Critical Appraisal of the Evidence for Soil-Transmitted Helminth Infection-Related Morbidity. PLoS Neglected Tropical Diseases, 10(5), 1-29. [e0004566]. https://doi.org/10.1371/journal.pntd.0004566