Abstract:
Background: Despite the existence of a population-based control program using single dose albendazole or
mebendazole as a preventive chemotherapy, hookworm transmission remains high. It causes a negative impact on
the growth and school performance of children. In connection to this preventive chemotherapy, different studies
produced conflicting results. This study aimed at evaluating the efficacy of single (500 mg) versus multiple doses
(100 mg twice a day during three consecutive days) of mebendazole against hookworm infections among schoolaged children.
Methods: This randomized open-label clinical trial took place among school-aged children (6–14 years old) in Burie
and Debre Elias towns, Northwest Ethiopia. Using simple randomization, eligible hookworm-positive children were
allocated (1:1) to either a single or multiple dose treatment arms. Stool samples were collected and processed
using McMaster method at baseline and follow-up period (14–21 days after treatment). Only laboratory technicians
were blinded. The cure and egg reduction rates were the primary and secondary therapeutic outcome measures
against hookworm infections, respectively. An independent t-test was used to compare group means, and logistic
regression was used to calculate odds ratio (OR). P-value < 0.05 at 95% CI was considered statistically significant.
Result: One hundred eight children, 54 in each treatment arm had completed baseline data and received allocated
treatment. One hundred three children had completed follow-up data records and included for the final efficacy
analysis. Cure rate against hookworm was significantly higher in the multiple dose (96.1%) than in the single dose
(30.8%) with OR = 55.125; 95% CI: 11.92–254.9; P < 0.001. The egg reduction rate in the multiple dose treatment arm
(99.5%) was also significantly higher than in the single dose arm (68.9%) with difference t (101) =5.38; 95% CI
230.95–505.36; P < 0.001.
Conclusion: The single dose regimen of mebendazole for the treatment of hookworm infections showed poor
cure and egg reduction rates, while the multiple doses revealed satisfactory. Although multiple dose regimen
administration is a bit more complex than the single dose, we strongly encourage replacing it with multiple dose
regimen during deworming programs in hookworm endemic areas.
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Trial registration: This trial is retrospectively registered in www.pactr.org, number PACTR201911466695052 on
November 26, 2019
