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

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. This review was prospectively registered in the PROSPERO database (CRD4201...

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Bibliographic Details
Published in:PLoS neglected tropical diseases 2018-01, Vol.12 (1), p.e0005524-e0005524
Main Authors: Ezeamama, Amara E, Bustinduy, Amaya L, Nkwata, Allan K, Martinez, Leonardo, Pabalan, Noel, Boivin, Michael J, King, Charles H
Format: Article
Language:English
Subjects:
Adolescent
Animals
Anthelmintics - therapeutic use
Biology and Life Sciences
Child
Child, Preschool
Children
Cognition
Cognition & reasoning
Cognition - physiology
Cognitive ability
Cognitive Dysfunction - parasitology
Confidence intervals
Design
Education
Educational aspects
Elementary school students
Epidemiology
Health aspects
Humans
Hygiene
Infections
Intelligence
Intelligence - physiology
Learning
Learning Disorders - parasitology
Medicine
Medicine and Health Sciences
Memory
Memory - physiology
Memory and Learning Tests
Memory Disorders - parasitology
Meta-analysis
Osteopathic medicine
People and Places
Praziquantel
Praziquantel - therapeutic use
Quality assessment
Quality control
R&D
Reaction time
Reaction Time - physiology
Research & development
Risk factors
Schistosoma
Schistosoma - pathogenicity
Schistosoma japonicum
Schistosoma mansoni
Schistosomiasis
Schistosomiasis - complications
Schistosomiasis - drug therapy
Schistosomiasis - psychology
School attendance
Sensitivity analysis
Social Sciences
Studies
Systematic review
Tests
Tropical diseases
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Summary: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. 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. 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. ClinicalTrials.gov CRD42016040052.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0005524