A comparison of intervention strategies to improve helminthiasis, nutrition and cognitive status among school-age children in helminth endemic farming and fishing areas in Ghana

Abstract

To evaluate the impact of intervention strategies on helminthiasis, the nutritional and cognitive status of School-Age Children (SAC), we conducted a community trial with 4 intervention arms; “Nutrition Education Only” (NutEd), “Supplementation Only” (Suppl), “Nutrition Education+Supplementation” (NutEd+Suppl) versus a ‘Non-intervention‘(Control) group. The intervention was conducted on 358 SAC from 8 randomly selected schools (4 schools from fishing and 4 schools from farming communities) in the Kwahu Afram Plains South District of Ghana. Data were collected at baseline, third, and sixth-month post-intervention. Data were obtained through questionnaire, anthropometry, parasitology (faecal and urine analysis), hemoglobin levels (Hb) and whole blood zinc levels. The Ravens Colored Progressive Matrices (RCPM) were used for the cognitive assessment. At baseline, the overall helminthiasis prevalence was 29.6%, which decreased to 6.3% at the 6th-month post-intervention. About 7.5% of all the children were underweight, 11.2% were stunted, 21.5% were acutely malnourished, 46.1% were anemic and 31.4% were zinc deficient. These decreased to 5.3% (underweight), 8.5% (stunting), 9.8% (acute malnutrition), 16.1% (anemia) and 9.3% (zinc deficiency), respectively, at the 6th-month post-intervention. At baseline, 15.6% of the children passed the cognitive test which increased to 32.4% at the 6th-month post-intervention. The “NutEd” treatment recorded the most significantly improved of bmi-for-age z-score (0.27 ± 0.88, p = 0.002), height-for-age z-score (0.16 ± 0.38, p < 0.0001) and anemia (Hb levels; 1.22 ± 1.13 g/dL, p < 0.0001), The “NutEd+Suppl” group recorded the highest improvement in zinc levels (46.39 ± 22.30 µmol/L, p < 0.0001) and the “Suppl” group the highest improvement in cognitive performance (3.08 ± 6.07, p < 0.0001) between the baseline and the 6th-month post-intervention.