Risk of adverse swallowing events and choking during deworming for preschool-aged children

In areas where the prevalence of soil-transmitted helminthiasis (STH) is >20%, the World Health Organization (WHO) recommends that deworming medication be given periodically to preschool-age children. To reduce risk of choking-related deaths in children <3 years old, WHO recommends that deworm...

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Bibliographic Details
Published in:	PLoS neglected tropical diseases Vol. 12; no. 6; p. e0006578
Main Authors:	Kernell, James Wyatt, DePaola, Rosalie V, Maglione, Alec M, Ahern, Lacey N, Penney, Naomi G, Addiss, David G
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 01-06-2018 Public Library of Science (PLoS)
Subjects:	Age Airway Obstruction - mortality Albendazole Albendazole - administration & dosage Albendazole - adverse effects Anthelmintics Ascaris lumbricoides Biology and Life Sciences Chemotherapy Child, Preschool Children Children & youth Childrens health Choking Crushing Deglutition Demographics Demography Disease control Dosage and administration Drug therapy Fatalities Female Gender Genetic aspects Health aspects Heimlich maneuver Helminthiasis Helminthiasis - drug therapy Humans Infant Infections Male Medicine and Health Sciences Multivariate Analysis Organizations Parasitic diseases Pediatrics People and Places Physical Sciences Powder Public health Risk Risk analysis Risk Factors Software Soil Soil - parasitology Supervision Swallowing Tablets Task forces Trichuris trichiura Tropical diseases Vitamin A Vomiting Worms Indiana United States > US Georgia
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Summary:	In areas where the prevalence of soil-transmitted helminthiasis (STH) is >20%, the World Health Organization (WHO) recommends that deworming medication be given periodically to preschool-age children. To reduce risk of choking-related deaths in children <3 years old, WHO recommends that deworming tablets be crushed and given with water. Little is known about how widely this is practiced or its effectiveness. Albendazole distributions for STH were observed for children 1-4 years old in 65 sites in India and Haiti. Information was recorded on child demographics; child demeanor immediately before, as well as struggling or resistance during albendazole administration; tablet form (i.e., crushed or not); and adverse swallowing events (ASEs), including choking, spitting; coughing; gagging; vomiting; and expelling a crushed tablet in a "cloud" of powder. Of 1677 children observed, 248 (14.8%) had one or more ASEs. ASE risk was 3.6% with whole tablets, 25.4% with crushed tablets, and 34.6% when crushed tablets were mixed with water. In multivariate analysis, ASE risk was significantly associated with children 1 year (OR 2.7) or 2 years (OR 2.9) of age; male gender (OR 1.6); non-content child demeanor (fearful, fussy, or combative) before albendazole administration (OR 4.3); child struggling when given albendazole (OR 2.1); and giving water, either after the tablet or mixed with it (OR 5.8). Eighteen (1.1%) children choked, none fatally; 17 choking incidents occurred with crushed tablets. In a multivariate analysis that controlled for distribution site, the only significant risk factor for choking was non-content demeanor (OR 20.6). Deworming-related choking deaths in young children are preventable. In our sample, risk of choking could have been reduced by 79.5% if deworming tablets were not given to young children who were fussy, fearful, or combative or who struggled to resist tablet administration, with only an 18.4% reduction in drug coverage.
Bibliography:	I have read the journal's policy and the authors of this manuscript have the following competing interests: At the beginning of this project David Addiss was Director of Children Without Worms, a program at the Task Force for Global Health that receives funding from Johnson & Johnson and GlaxoSmithKline for control of soil-transmitted helminthiasis and for coordinating the work of the STH Coalition.
ISSN:	1935-2735 1935-2727 1935-2735
DOI:	10.1371/journal.pntd.0006578