Meta-analysis and public policy: Reconciling the evidence on deworming.

Eric Hsu, Michael Kremer, Kevin Croke, Joan Hamory, Ricardo Maertens, Edward Miguel, Witold Więcek

Journal: Proceedings of the National Academy of Sciences of the United States of America 2024;121(25):e2308733121

PMID: 38857387

Abstract

The WHO recommends mass drug administration (MDA) for intestinal worm infections in areas with over 20% infection prevalence. Recent Cochrane meta-analyses endorse treatment of infected individuals but recommend against MDA. We conducted a theory-agnostic random-effects meta-analysis of the effect of multiple-dose MDA and a cost-effectiveness analysis. We estimate significant effects of MDA on child weight (0.15 kg, 95% CI: 0.07, 0.24; < 0.001), mid-upper arm circumference (0.20 cm, 95% CI: 0.03, 0.37; = 0.02), and height (0.09 cm, 95% CI: 0.01, 0.16; = 0.02) when prevalence is over 20% but not on Hb (0.06 g/dL, 95% CI: -0.01, 0.14; = 0.1). These results suggest that MDA is a cost-effective intervention, particularly in the settings where it is recommended by the WHO.

Address: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115.; Department of Economics, University of Oklahoma, Norman, OK 73019.; Department of Economics, University of California, Berkeley, CA 94720.; Department of Economics, University of Chicago, Chicago, IL 60637.; National Bureau of Economic Research, Cambridge, MA 02138.; Department of Economics, Harvard University, Cambridge, MA 02138.; Department of Economics, University of California, Berkeley, CA 94720.; National Bureau of Economic Research, Cambridge, MA 02138.; Department of Economics, University of Chicago, Chicago, IL 60637.

DOI: 10.1073/pnas.2308733121

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MeSH Terms: Humans, Intestinal Diseases, Parasitic, Helminthiasis, Mass Drug Administration, Anthelmintics, Public Policy, Cost-Benefit Analysis, Child