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Cognitive deficits and educational loss in children with schistosome infection—A systematic review and meta-analysis

Author

Listed:
  • Amara E Ezeamama
  • Amaya L Bustinduy
  • Allan K Nkwata
  • Leonardo Martinez
  • Noel Pabalan
  • Michael J Boivin
  • Charles H King

Abstract

Background: By means of meta-analysis of information from all relevant epidemiologic studies, we examined the hypothesis that Schistosoma infection in school-aged children (SAC) is associated with educational loss and cognitive deficits. Methodology/Principal findings: This review was prospectively registered in the PROSPERO database (CRD42016040052). Medline, Biosis, and Web of Science were searched for studies published before August 2016 that evaluated associations between Schistosoma infection and cognitive or educational outcomes. Cognitive function was defined in four domains—learning, memory, reaction time, and innate intelligence. Educational outcome measures were defined as attendance and scholastic achievement. Risk of bias (ROB) was evaluated using the Newcastle-Ottawa quality assessment scale. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated to compare cognitive and educational measures for Schistosoma infected /not dewormed vs. uninfected/dewormed children. Sensitivity analyses by study design, ROB, and sequential exclusion of individual studies were implemented. Thirty studies from 14 countries, including 38,992 SAC between 5–19 years old, were identified. Compared to uninfected children and children dewormed with praziquantel, the presence of Schistosoma infection and/or non-dewormed status was associated with deficits in school attendance (SMD = -0.36, 95%CI: -0.60, -0.12), scholastic achievement (SMD = -0.58, 95%CI: -0.96, -0.20), learning (SMD = -0.39, 95%CI: -0.70, -0.09) and memory (SMD = -0.28, 95%CI: -0.52, -0.04) tests. By contrast, Schistosoma-infected/non-dewormed and uninfected/dewormed children were similar with respect to performance in tests of reaction time (SMD = -0.06, 95%CI: -0.42, 0.30) and intelligence (SMD = -0.25, 95%CI: -0.57, 0.06). Schistosoma infection-associated deficits in educational measures were robust among observational studies, but not among interventional studies. The significance of infection-associated deficits in scholastic achievement was sensitive to ROB. Schistosoma infection-related deficits in learning and memory tests were invariant by ROB and study design. Conclusion/Significance: Schistosoma infection/non-treatment was significantly associated with educational, learning, and memory deficits in SAC. Early treatment of children in Schistosoma-endemic regions could potentially mitigate these deficits. Trial registration: ClinicalTrials.gov CRD42016040052 Author summary: Empirical evidence for cognitive or educational benefits of anti-Schistosoma treatment is currently uncertain, despite the recommended practice of wide-scale deworming with praziquantel. We addressed this knowledge gap by synthesizing information from 30 relevant epidemiologic studies reporting on 38,992 children between 5–19 years old from 14 countries. In those studies, Schistosoma infection or non-dewormed status was associated with educational loss and cognitive deficits. Specifically, there were small to moderate deficits in both school attendance and scholastic achievement. Similarly, Schistosoma infection or non-dewormed status was associated with deficits in learning and memory domains of psychometrically tested cognitive function. However, there was no evidence of Schistosoma infection- or non-deworming-associated deficits on tests of innate intelligence or reaction-time. Overall, compared to Schistosoma-uninfected or to dewormed children, the presence of Schistosoma infection or non-dewormed status was associated with educational, learning, and memory deficits in school-aged children. The combined evidence suggests that early treatment of children in Schistosoma-endemic regions could mitigate these deficits.

Suggested Citation

  • Amara E Ezeamama & Amaya L Bustinduy & Allan K Nkwata & Leonardo Martinez & Noel Pabalan & Michael J Boivin & Charles H King, 2018. "Cognitive deficits and educational loss in children with schistosome infection—A systematic review and meta-analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(1), pages 1-23, January.
    • Handle: RePEc:plo:pntd00:0005524
    DOI: 10.1371/journal.pntd.0005524
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    References listed on IDEAS

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    1. Gisele Andrade & David J Bertsch & Andrea Gazzinelli & Charles H King, 2017. "Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(2), pages 1-23, February.
    2. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    3. Fentiman, Alicia & Hall, Andrew & Bundy, Don, 2001. "Health and cultural factors associated with enrolment in basic education: a study in rural Ghana," Social Science & Medicine, Elsevier, vol. 52(3), pages 429-439, February.
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    1. Yan Jin & Young-Ha Lee & Seungman Cha & In-Uk Choi & Hassan Ahmed Hassan Ahmed Ismail & Mousab Siddig Elhag & Sung-Tae Hong, 2021. "Transmission Dynamics of Schistosoma haematobium among School-Aged Children: A Cohort Study on Prevalence, Reinfection and Incidence after Mass Drug Administration in the White Nile State of Sudan," IJERPH, MDPI, vol. 18(21), pages 1-14, November.
    2. Andrea J. Lund & David Lopez-Carr & Susanne H. Sokolow & Jason R. Rohr & Giulio A. De Leo, 2021. "Agricultural Innovations to Reduce the Health Impacts of Dams," Sustainability, MDPI, vol. 13(4), pages 1-8, February.
    3. Johanna Beckmann & Christin Lang & Rosa du Randt & Annelie Gresse & Kurt Z. Long & Sebastian Ludyga & Ivan Müller & Siphesihle Nqweniso & Uwe Pühse & Jürg Utzinger & Cheryl Walter & Markus Gerber, 2021. "Prevalence of Stunting and Relationship between Stunting and Associated Risk Factors with Academic Achievement and Cognitive Function: A Cross-Sectional Study with South African Primary School Childre," IJERPH, MDPI, vol. 18(8), pages 1-17, April.

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