***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We studied physical fitness with the Harvard Step Test , growth , and appetite in primary school boys infected with hookworm ( 96 % baseline prevalence ) , Trichuris trichiura ( 98 % prevalence ) and Ascaris lumbricoides ( 41 % prevalence ) who received a single 600-mg dose of albendazole or an identical placebo . Boys were examined , allocated at r and om within pairs by descending hookworm egg count to placebo ( n = 26 ) or albendazole ( n = 27 ) groups , treated , and re-examined 4 mo later . Four months after treatment , the albendazole group showed highly significant improvements in fitness score , resting heart rate , and heart rates at 1 , 2 , 3 and 4 min after the Harvard Step Test , whereas the placebo group had not changed significantly . The albendazole group also exhibited significantly more rapid growth judged by weight gain ( 1.0 kg greater than the placebo group , P < 0.0002 ) , height increment ( 0.6 cm more , P < 0.003 ) , arm circumference ( 0.3 cm more , P < 0.0002 ) , and triceps and subscapular skinfolds ( 1.0 mm more , P < 0.0002 ) , and showed improved appetite with objective and subjective measures . We conclude that single-dose treatment with albendazole can allow improved physical fitness , growth , and appetite in school-age children in areas where these helminths and poor growth are highly prevalent We evaluated the effects of the  Zanzibar school-based deworming program  on the iron status of primary school children . Parasitologic and nutritional assessment s were carried out at baseline , 6 mo , and 12 mo in 4 nonprogram schools ( n = 1002 ) , 4 schools in which students received twice-yearly deworming ( n = 952 ) , and 4 schools in which students received thrice-yearly deworming ( n = 970 ) with 500 mg generic mebendazole .  Schools were r and omly selected for evaluation and allocated to program groups . Relative to no treatment , thrice-yearly deworming caused significant decreases in protoporphyrin concentrations and both deworming regimens caused marginally significant increases in serum ferritin concentrations . The average annual changes in protoporphyrin concentrations were -5.9 and -23.5 micromol/mol heme in the control and thrice-yearly deworming groups , respectively ( P < 0.001 ) . The average changes in ferritin concentration were 2.8 and 4.5 microg/L , respectively ( P = 0.07 ) . Deworming had no effect on annual hemoglobin change or prevalence of anemia . However , the relative risk of severe anemia ( hemoglobin < 70 g/L ) was 0.77 ( 95 % confidence limits : 0.39 , 1.51 ) in the twice-yearly deworming group and 0.45 ( 0.19 , 1.08 ) in the thrice-yearly deworming group . The effects on prevalence of high protoporphyrin values and incidence of moderate-to-severe anemia ( hemoglobin < 90 g/L ) were significantly greater in children with > 2000 hookworm eggs/g feces at baseline . We estimate that this deworming program prevented 1260 cases of moderate-to-severe anemia and 276 cases of severe anemia in a population of 30,000 schoolchildren in 1 y. Where hookworm is heavily endemic , deworming programs can improve iron status and prevent moderate and severe anemia , but deworming may be needed at least twice yearly Iron deficiency and helminth infections are two common conditions of children in developing countries . The consequences of helminth infection in young children are not well described , and the efficacy of low dose iron supplementation is not well documented in malaria-endemic setting s. A 12-mo r and omized , placebo controlled , double-blind trial of 10 mg daily iron and /or mebendazole ( 500 mg ) every 3 mo was conducted in a community-based sample of 459 Zanzibari children age 6 - 71 mo with hemoglobin > 70 g/L at baseline . The trial was design ed to examine treatment effects on growth , anemia and appetite in two age subgroups . Iron did not affect growth retardation , hemoglobin concentration or mild or moderate anemia ( hemoglobin < 110 g/L or < 90 g/L , respectively ) , but iron significantly improved serum ferritin and erythrocyte protoporphyrin .  Mebendazole significantly reduced wasting malnutrition . but only in children < 30 mo old . The adjusted odds ratios ( AORs ) for mebendazole in this age group were 0.38 ( 95 % CI : 0.16 , 0.90 ) for weight-for-height less than -1 Z-score and 0.29 ( 0.09 , 0.91 ) for small arm circumference . In children < 24 mo old , mebendazole also reduced moderate anemia ( AOR : 0.41 , 0.18 , 0.94 ) . Both iron and mebendazole improved children 's appetite , according to mothers ' report . In this study , iron 's effect on anemia was limited , likely constrained by infection , inflammation and perhaps other nutrient deficiencies . Mebendazole treatment caused unexpected and significant reductions in wasting malnutrition and anemia in very young children with light infections . We hypothesize that incident helminth infections may stimulate inflammatory immune responses in young children , with deleterious effects on protein metabolism and erythropoiesis Growth , activity , appetite and intestinal helminth infections were compared for 55 Kenyan primary school children with hookworm ( 93 % prevalence ) , T. trichiura ( 84 % prevalence ) and A. lumbricoides ( 29 % prevalence ) before and 9 wk after treatment with three 400-mg doses of albendazole ( Zentel ) or placebo .  Fecal sample s were examined for helminth eggs using a modified Kato technique . Activity was measured during free-play with motion recorders on the dominant thigh . Children rated their appetites on a 5-point scale . After baseline measurements , children were r and omly allocated to the albendazole-treated ( n = 28 ) and placebo ( n = 27 ) groups , treated , and re-examined 9 wk later . At follow-up , egg counts were significantly lower than at baseline in the albendazole-treated group ( P < or = 0.002 ) , and gains in activity , reported appetite and most indices of growth were significantly greater for the albendazole-treated group than for the placebo group . We conclude that treatment of undernourished school children for intestinal helminth infections with albendazole may improve growth and appetite and increase spontaneous physical activity Background In the framework of the monitoring and evaluation of the Nigerien schistosomiasis and soil-transmitted helminth control programme , a follow-up of children took place in eight sentinel sites . The objective of the study was to assess the evolution of Schistosoma haematobium infection and anaemia in schoolchildren after a single administration of praziquantel ( PZQ ) and albendazole . Methods /Principal Findings Pre-treatment examination and follow-up at one year post-treatment of schoolchildren aged 7 , 8 , and 11 years , including interview , urine examination , ultrasound examination of the urinary tract , and measurement of haemoglobin . Before treatment , the overall prevalence of S. heamatobium infection was 75.4 % of the 1,642 enrolled children , and 21.8 % of children excreted more than 50 eggs/10 ml urine . Prevalence increased with age . The overall prevalence of anaemia ( haemoglobin < 11.5 g/dl ) was 61.6 % , decreasing significantly with increasing age . The mean haemoglobinemia was 11 g/dl . In bivariate analysis , anaemia was significantly more frequent in children infected with S. haematobium , although it was not correlated to the intensity of infection . Anaemia was also associated with micro-haematuria and to kidney distensions . In a sub- sample of 636 children tested for P. falciparum infection , anaemia was significantly more frequent in malaria-infected children . In multivariate analysis , significant predictors of anaemia were P. falciparum infection , kidney distension , and the village . One year after a single-dose praziquantel treatment ( administered using the WHO PZQ dose pole ) co-administered with albendazole ( 400 mg single dose ) for de-worming , the prevalence of S. haematobium infection was 38 % , while the prevalence of anaemia fell to 50.4 % . The mean haemoglobinemia showed a statistically significant increase of 0.39 g/dl to reach 11.4 g/dl . Anaemia was no longer associated with S. haematobium or to P. falciparum infections , or to haematuria or ultrasound abnormalities of the urinary tract . Conclusions The high prevalence of anaemia in Nigerien children is clearly a result of many factors and not of schistosomiasis alone . Nevertheless , treatment of schistosomiasis and de-worming were followed by a partial , but significant , reduction of anaemia in schoolchildren , not explainable by any other obvious intervention A cross-sectional study of 729 children and adults in western Kenya investigated the impact of infection with hookworm , Ascaris lumbricoides , Trichuris trichiura , Schistosoma mansoni and malaria on iron status . In bivariate analyses , hookworm intensities as low as 300 eggs/g of faeces were negatively related to levels of haemoglobin ( Hb ) and serum ferritin ( SF ) . Malaria parasitaemia was negatively related to Hb and positively related to SF , while S. mansoni intensities were negatively related to SF . Multivariate regression analysis was done to identify predictors of Hb and SF levels . In children , age ( in years ) was the only predictor for Hb ( B = 1.7 g/L ) and only malaria parasitaemia ( negative , light , moderate , heavy ) was retained in the model for log10 SF ( B = 0.097 microgram/L ) . In adults , hookworm infection and malaria parasitaemia together with age , sex , pregnancy , SF levels < 12 micrograms/L and elevated body temperature were significant predictors of low Hb . The regression coefficient for hookworm egg count ( for increments of 100 eggs/g ) was -1.3 g/L. Significant interactions between sex and age and between sex and malaria parasitaemia were revealed . Age and malaria parasitaemia were significant predictors only among females , with a regression coefficient for malaria parasitaemia of -6.9 g/L. The regression coefficient for hookworm did not change when SF < 12 micrograms/L was taken out of the model , indicating that the effect of hookworm can not be explained by low iron stores alone . Using SF as the dependent variable , hookworm and S. mansoni intensities together with age and sex were retained in the model . The regression coefficients for hookworm egg count ( increments of 100 eggs/g ) and S. mansoni egg count ( increments of 10 eggs/g ) were -0.011 microgram/L and -0.012 microgram/L , respectively . Iron deficiency was a problem in this population and hookworm infections contributed significantly to this situation Objective : To assess the effects of iron and deworming on linear growth performance of preschoolers . Design : Three-month r and omized , double-blind and placebo-controlled trial . The children were allocated to four treatments : iron ( 60 mg elemental iron/day)+albendazole ( 200 mg/day for 3 consecutive days , repeated 1 month later ) , iron+albendazole-placebo , albendazole+iron-placebo or placebos . The supplementation was supervised . Subjects : A group of 177 children aged 3–5 y was selected from low-income households in a rural area in southern Bénin . A complete data set was analysed for 140 subjects . Many children were stunted ( 58 % had height-for-age Z-score < −2 ) , none were wasted ( 2 % had weight-for-height Z-score < −2 ) and 76 % were anemic ( Hb<110 g/l).Main outcome measures : Anthropometric parameters , hemoglobin and eggs per gram feces . Results : No significant difference in changes in anthropometric parameters was observed between study groups , and also not in a sub- sample of stunted and anemic subjects . Changes in hemoglobin were highest in the iron-treated subjects at the end of the 3-month intervention period ( P=0.032 ) . The difference between the iron and the placebo groups remained significant even 7 months later ( P=0.022 ) . The difference was 5 g/l in both periods . Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects ( P<0.05 ) . Conclusions : In addition to recurrent parasitic infection burden , the children may have multiple micronutrient deficiencies . Therefore , it may be interesting to study appetite and food intake of young toddlers in relation to health and linear growth performance in poor environments . Sponsorship : The Nest 
    Output:
    
Anaemia is most strongly associated with moderate and heavy hookworm infection .
The impact of anthelmintic treatment is greatest when albendazole is co-administered with praziquantel