Please select the eligibility criteria that correspond to the clinical trial below.
Title: Evaluation of Anthelminthics and Multivitamins for Treatment of Severe Anemia in Pregnant Women and Children 6-24 Months of Age in Pakistan
Brief Summary: The purpose of this study is to test the efficacy of two enhanced regimens (deworming and multivitamins) in the treatment of severe anemia in pregnant women and children 6-24 months of age in Karachi, Pakistan.


Options:
A: Treatment Inclusion Criteria:

* Ages 12 months and older

Treatment Exclusion Criteria:

* Children under 12 months of age
* Pregnant women in their first trimester
* History of adverse reaction to benzimidazoles

Outcome Sampling Inclusion Criteria:

* Resident of study clusters
* Ages 12 months and older
* Willingness of adult aged 18 years and above (or age as per country specific ethical guidelines) or parent/guardian of child to provide written informed consent
* Provision of written assent to participate from children aged 8 years and above (or age as per country specific ethical guidelines)

Outcome Sampling Exclusion Criteria:

* Less than 12 months of age
* Individuals who do not typically reside in the study cluster
* Nonconsenting or assenting individuals, as applicable
B: Inclusion Criteria:

For screening:

* Female, age 18 or over.
* Present to a study midwife with suspected pregnancy.
* Live in a study village.

For the main study:

* Infected with S. japonicum.
* Pregnancy as determined by urine pregnancy test.
* Age 18 or older.
* Participant is otherwise healthy as determined by history, physical exam, ultrasound and laboratory assessment.
* Pregnancy between 12-16 weeks gestation.
* Ability to provide informed consent to participate.

Exclusion Criteria:

* Presence of significant disease/illness that is either acute or chronic. This will be defined by history, physical examination, ultrasound and laboratory assessment. In particular:

  1. History of seizures or other neurologic disorder, chronic medical problem determined by history or physical examination, e.g. active hepatitis, tuberculosis, heart disease.
  2. Grade 3 or higher laboratory abnormality of blood urea nitrogen (BUN), Creatinine, bilirubin, white blood cell count, or platelet count will warrant exclusion. Grade 2 or higher abnormality of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) will warrant exclusion. For hemoglobin, women with severe anemia defined as hemoglobin less than 7.0 g/dl will be excluded.
  3. Women with myoma on ultrasound that are sub-mucosal or women with myoma that is in any location and greater than 5 cm in size.
  4. Women with congenital anomalies of the reproductive tract that would be expected to cause decreased fetal weight or greatly increase the risk of prematurity such as duplicate uterus, uterine septum.
  5. For less clear cases, the researchers will define significant illness as one that significantly alters a woman's ability to perform activities of daily living, causes symptoms at least two days per week, or necessitates regular use of medication. In the case of acute medical conditions such as urinary tract infection, pneumonia, febrile illness, enrollment may be postponed until the illness is successfully treated (not currently on any medication for the illness) or the illness self resolves if this occurs before 16 weeks gestation.
* Presence of cysts in the eye suggestive of neurocysticercosis.
* Regular use of a medication for a chronic medical condition.
* History of severe allergic reaction (anaphylaxis, facial swelling, or difficulty breathing) or seizure with praziquantel administration.
* Fetus has congenital anomaly determined by 12-16 week ultrasound or is determined to be nonviable (e.g. blighted ovum).
* Twin or higher order pregnancy.
* Woman has been enrolled into this study for a previous pregnancy.
* Inability to comprehend study procedures and provide informed consent due to limited cognitive abilities or other, or refuses to provide informed consent.
C: Inclusion Criteria:

* Pregnant women after first trimester and before 28th week of pregnancy
* HIV negative
* Egg excretion of Schistosoma haematobium (mean \>10 eggs per mL urine)
* Asymptomatic (no signs of complicated Schistosomiasis, no severe anemia)
* Ability to comply with study protocol

Exclusion Criteria:

* Intake of anthelminthic or antimalarial drug within 2 months prior to inclusion
* Allergy to study drugs
D: Inclusion Criteria:

* Pregnant women with severe anemia (Hb\<70g/L)
* Children 6-24 months with severe anemia (Hb\<70 g/L)

Exclusion Criteria:

* Gestational age \>=36 weeks
* Edema
* Breathlessness

Answer: D