I think it would be a good starting point. But you would need to know the magnitude of the effect, and whether it benefited low birthweight children substantiallly (ie not just by a few grams). Also, would there be any other factor that could explain the results (eg social class - higher class taking the antiworm medicine)? Could the study be duplicated, and could the results be examined by standard epidemiological effect measures - like odds ratio (of birtweight categories,, and , attributable risk (attributing birthweight category to deworming status). And was there any prior evidence that worm-infected women, after adjusting for social class, age, parity (etc), were at higher risk of low birthweight (full term) or low birthweight (premature)?

It will be good to pilot test the scheme before introducing it on a national scale. This will provide the opportunity to assess though on asmller scale the benefits or otherwise of the scheme. M.M Dogara

Thanks Adrain and Musa. Adrian, very good points on the covariates to watch out for. Well - if we could design a study with some prior evidence of worm-infected women being at higher risk of low birthweight - that would be fantastic. What we have is a sample of women (not random) that took amtihelmintic drugs during pregnancy; we have no information of whether they had infection to begin with - but there are quite a few studies reporting high rates (70-90%) of intestinal parasitic infection in the south region of India and (30-40%) in the north region.

Methodology: propensity score matching with a list of controls (I think we account for all of the one that you have mentioned).

We are using the national survey - we find an increase in birth weight of 65 grams.

Another issue - Control group also includes mothers who did not have any infection.

We are trying to make a case that since all these issues wold lead to underestimation - we can make a case for a national program.

I feel as though we need better information about the risk of taking mebendazole, albendazole, and ivermectan during pregnancy. There is evidence of problems in animals. I would vote for sticking with prenatal vitamins, particularly folate and iron supplementation.

I check this so infrequently.

WHO recommends routine deworming in areas where hook worm infestation is a public health concern. Nevertheless, evidence for this recommendation was weak and further studies in endemic areas are necessary.

Positive correlation between birth weight & deworming may not be enough. The major outcomes should be related to maternal Haemoglobin concentration / maternal aneamia, and maternal weight gain in pregnancy; then, neonatal outcomes may follow.

Thankyou Cyrill - I think since the WHO's recommendation more studies are being conducted. I think srilanka and Nepal already have de-worming in their antenatal programs.

Sri Lanka introduced routine antenatal deworming several decades ago because maternal anaemia was a significant problem, and so was hookworm infection. The idea was that if hookworm infection is endemic, it will aggravate maternal anaemia due to nutritional causes. Mebendazole is safe during pregnancy (we showed that in a study published in the Lancet in 2003), and routine deworming costs much less than screening and treating only the positives. As Cyril Dim notes, the major outcome of antenatal deworming relates to maternal anaemia; improved birthweight may or may not follow.

Thank you Nilanthi for your input. Your paper is the main reference in my study. After reading you work - I started thinking about the project for India.

The anemia rated among pregnant women have risen over time despite a well functioning national programs to control anaemia via IFA tablets...