Impact of school-based deworming on iron status

Document Type

Journal Article

Publication Date



FASEB Journal






School-based deworming in tropical regions is widely advocated, but the impact on iron status has not been evaluated. We measured hemoglobin (Hb), protoporphyrin (PRO) and serum ferritin (SF) concentrations of 3028 children in 12 randomly selected schools on Pemba Island, Zanzibar before the start of a deworming program, and 1 year into the program. Four schools were allocated to thrice-yearly deworming, 4 to twice-yearly deworming, and 4 to no program. At baseline, >99% of children were infected with at least one geohelminth. Overall, the deworming regimens had no impact on Hb concentration or anemia prevalence. However at follow-up, the adjusted prevalence of iron-deficient erythropoiesis (PRO > 80 μmol/mol heme) was 45% in the control group, 43% in the twice-yearly group, and 38% in the thrice-yearly group, and the prevalence of low iron stores (SF < 18 μg/L) was 48%, 42%, and 39%, respectively. Among children with heavier hookworm infections (>2000 eggs per gram feces) or depleted iron stores (<12 μg/L SF) at baseline, thrice-yearly deworming did cause significant improvements in Hb relative to the control group, and the improvements in PRO and SF were greater than for the cohort overall. In this area of intense hookworm transmission, deworming alone improved the iron status of school children.

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