TABLE 6

Review of Key Impacts for Infectious Disease Prevention and Treatment Delivered During Infancy and Childhood

Key InterventionsSummary Effects With implications for Developmental Outcomes (Direct Developmental Effects)
Rotavirus, H. influenzae B, pneumococcal vaccines, and routine immunization, 2 SRs, LMICReduced diarrheal morbidity: rotavirus vaccine reduced risk of severe rotavirus infection (RR 0.39, 95% CI 0.25 to 0.62; N = 1081 in 1 study) and severe gastrointestinal infection (RR 0.68, 95% CI 0.57 to 0.81; N = 2901 in 6 studies)
Reduced pneumonia morbidity: HiB and pneumococcal vaccine reduced risk of clinically severe HiB pneumonia (RR 0.94, 95% CI 0.89 to 0.99; N = 5304 in 3 studies) and radiologically confirmed pneumococcal pneumonia (RR 0.74, 95% CI 0.63 to 0.88; N = 1619 in 3 studies)
Improved water, sanitation, and hygiene, 2 SRs, LMICImproved growth in girls: increased weight-for-age z score (MD 0.11, 95% CI 0.01 to 0.21; N = 2283 in 7 studies) and height-for-age z score (MD 0.15, 95% CI 0.04 to 0.26; N = 2283 in 5 studies) in girls only
Water quality improvement: reduced diarrheal morbidity in children <5 y (RR 0.60, 95% CI 0.44 to 0.81; N = 5682 in 29 studies)
Hand-washing with soap: reduced diarrheal morbidity (RR 0.53, 95% CI 0.37 to 0.76; N = 1896 in 7 studies)
Excreta disposal: reduced diarrheal morbidity (RR 95% CI 0.37 to 0.92; 4 studies)
Zinc supplementation and diarrhea treatment, 5 SRs, HIC, and LMICImproved growth: increased height gain (SMD 0.19, 95% CI 0.08 to 0.30; 34 studies), height (SMD 0.09, 95% CI 0.06 to 0.13; N = 13 669 in 50 studies) and weight gain (SMD 0.10, 95% CI 0.07 to 0.14; N = 12 305 in 44 studies)
Improved zinc status but lowered iron status: reduced zinc deficiency (RR 0.49, 95% CI 0.45 to 0.53; 15 studies) and reduced serum ferritin (SMD −0.07, 95% CI −0.13 to 0.00; 18 studies)
Mixed effects on respiratory infection prevalence, more vomiting: increased lower respiratory tract infection prevalence (RR 1.20, 95% CI 1.10 to 1.30; 3 studies), decreased pneumonia morbidity (RR 0.81, 95% CI 0.73 to 0.90; 6 studies), and more vomiting episodes (RR 1.68, 95% CI 1.61 to 1.75; N = 4095 in 5 studies)
Reduced infectious disease morbidity: lower incidence of diarrhea (RR 0.87, 95% CI 0.81 to 0.94; 14 studies), persistent diarrhea (RR 0.73, 95% CI 0.62 to 0.85; 8 studies), and severe diarrhea (RR 0.89, 95% CI 0.84 to 0.95; 6 studies)
Less diarrhea, more vomiting: reduced duration of persistent diarrhea (MD −15.84 h, 95% CI −25.43 to −6.24; N = 529 in 5 studies) and increased risk of vomiting (RR 1.59, 95% CI 1.27 to 1.99; N = 5189 in 10 studies)
Nonsignificant effects: mental development score (MD −0.5, 95% CI −2.06 to 1.06; N = 2134 in 8 studies) and psychomotor development score (MD 1.54, 95% CI −2.26 to 5.34; N = 2134 in 8 studies)
Intermittent preventive therapy and bed nets, 2 SR, LMICImproved hemoglobin status: during intervention, reduced risk of severe anemia (RR 0.24, 95% CI 0.06 to 0.94; N = 3282 in 2 studies) and moderately severe anemia (RR 0.71, 95% CI 0.52 to 0.98; N = 8805 in 5 studies), and higher change in hemoglobin at 12 wk follow-up (MD 0.32 g/dL, 95% CI 0.19 to 0.45; N = 1672 in 4 studies)
Reduced malaria morbidity: reduced risk of severe malaria (RR 0.27, 95% CI 0.10 to 0.76; N = 5964 in 2 studies) and clinical malaria (RR 0.26, 95% CI 0.17 to 0.38; N = 9321 in 6 studies)
Deworming drugs, 1 SR, LMICImproved anthropometric measures: treatment of infected children increased weight (MD 0.75 kg, 95% CI 0.24 to 1.26; N = 627 in 5 studies), height (MD 0.25 cm, 95% CI 0.01 to 0.49; N = 647 in 5 studies), and mid-upper arm circumference (MD 0.49 cm, 95% CI 0.39 to 0.58; N = 396 in 4 studies)
  • CI, confidence interval; HiB, Haemophilus influenzae B; HIC, high-income country; MD, mean difference; RR, risk ratio; SMD, standard mean difference; SR, systematic review.