Disparities in deworming coverage between children with and without disabilities: insights from the DeWorm3 trial in India
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Children with disabilities experience lower school enrollment rates and may be systematically excluded from school-based deworming programs. The DeWorm3 trial provided an opportunity to evaluate whether community-wide mass drug administration (cMDA) could reduce these disparities by reaching children outside the education system.
Methods
We conducted a secondary analysis of the data from the DeWorm3 trial in Tamil Nadu, India. Children aged 5-17 years (n=82,417) who participated in at least one of the six rounds of cMDA were included. Disability was assessed using the UNICEF/Washington Group’s Child Functioning Module. Mixed-effects logistic regression models examined associations between disability status and treatment coverage, adjusting for sociodemographic factors.
Results
Children with disabilities (1.1% of the population) had higher unadjusted odds of not receiving deworming treatment compared to children without disabilities (OR=1.49, 95% CI: 1.19-1.84), though this association was attenuated after adjustment (adjusted OR=1.10, 95% CI: 0.86-1.37). Among school-attending children who received treatment, those with disabilities had significantly lower odds of receiving school-based treatment (adjusted OR=0.57, 95% CI: 0.44-0.73). Subgroup analyses revealed that age, school attendance, parental marital status, geographic location, and the COVID-19 pandemic significantly modified these associations.
Conclusion
While community-wide mass drug administration reduced some disparities in deworming coverage, children with disabilities remained less likely to receive school-based treatment. Public health programs should combine school-based approaches with targeted community outreach strategies to ensure equitable inclusion of children with disabilities, particularly those experiencing multiple vulnerabilities.
