Vinod Kumar Pande

Six-monthly de-worming in infants to study effects on growth

Objective: The study was conducted to assess the effectiveness of six monthly albendazole (ABZ) for improving the weight and height of preschool children when initia ted at 0.5–1 year of age in populations with a high transmission rate of intestinal roundworm,Ascaris lumbricoides. It was a cluster randomized trial in the urban slums of Lucknow, North India.Methods: Control children received 2 ml (1 ml to infants) of Vitamin A every six month whereas those in the ABZ areas received, in addition, 400 mg of ABZ suspension (Zentel, SKB) every six month. Sixty-three and sixty-one slum areas were randomized to albendazole (ABZ) or to control groups, respectively. Children aged 0.5–1 year were recruited in April 1996 and followed up for 1.5 years. Of 1022 children recruited from control and 988 from ABZ areas, the loss to follow-up at 1.5 year was 15.6% and 14.6% respectively. Mean (±SE) weight gain in Kg in control versus ABZ areas was 3.04 (0.03) versus 3.22 (0.03), (p=0.01).Results: After controlling for the presence of weight-for age z-score <-2.00 at enrollment in the ordinary least square’s regression model, the extra weight gain in 1.5 years in those who received ABZ plus vitamin A was 0.13 Kg (95% Cl:0.004 to 0.26 Kg., p value=0.043) when compared to those who received only vitamin A; underweight children at enrollment benefiting more than the normal ones.Conclusion: It was concluded that there was an improvement in weight with six monthly ABZ over 1.5 years. However, a much larger trial would be needed to determine whether there is any net effect of improvement in weight on under five mortality rate.

Family expenditure on sickness episodes of pre-school children in urban slums of Lucknow, north India.

This study investigated family expenditure on the sickness episodes of pre-school children in 32 urban slums of Lucknow, North India. Between July 1995 and January 1996, 396 children between the ages of 1.5 to 3.5 years were contacted. The main objective was to discover the direct medical cost of illness incurred by their families in the preceding months. Point prevalence of major morbidities, in the preceding month, were as follows: 17.2% respiratory and 6.3% diarrhoeal. A health care provider saw 31.4% [95% confidence interval (CI): 26.9–36.01] children. In >95% of the cases, the health care provider was a self-employed, non-governmental dispenser (NGD). More than half of NGDs did not have a recognized medical degree. The mean family expenditure on sickness in 1 month was RS 12.27 [standard deviation (SD): RS 23.81], approximately 1% of their income (1 US

Effectiveness and cost-effectiveness of albendazole in improving nutritional status of pre-school children in urban slums.

= RS 32). Respiratory illness was the primary cause of financial burden to the community. The isolated symptom of fever was the most expensive to treat, with diarrhoea and dysentery costs being similar. Immunizing a child saved money. We conclude that since the NGDs are the predominant health care providers in the urban slums, and since neither the nature of medicines dispensed by them nor their additional costs can be ascertained, steps must be taken to monitor their dispensing practices and to educate them about rational drug therapy.