Remarks

• This recommendation has been adapted and integrated from the 2017 WHO guideline Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups (83), where it was considered a strong recommendation based on moderate-certainty evidence.
• Although the original recommendation was formulated for non-pregnant adolescent girls and women of reproductive age, it also applies for lactating women as studies reviewed found there is no harm in its use (low concentration in breastmilk was considered unlikely to be harmful for the breastfed infant).
• During the deliberations, the Guideline Development Group (GDG) responsible for the original recommendation took into particular consideration the following evidence that resulted in a strong recommendation:
• non-pregnant adolescent girls and women of reproductive age benefit significantly from anthelminthic treatment in terms of a reduction in worm burden;
• the morbidity caused by the different soil-transmitted helminth species in heavily infected individuals is well documented and severe;
• albendazole and mebendazole are well tolerated among non-pregnant adolescent girls and nonpregnant women, with only minor and transient adverse effects reported;
• preventive chemotherapy is generally well accepted among women, health workers and policy-makers, though uncertainty exists around the feasibility of providing this intervention among adolescent girls, as existing infrastructure may vary by country and context;
• logistical difficulties and additional costs of alternative methods to identify and treat infected individuals can be prohibitive; and
• soil-transmitted helminth-endemic areas with at least 20% soil-transmitted helminth prevalence were considered the priority for large-scale programmes due to the presence of infections of moderate and heavy intensity and, therefore, soil-transmitted helminth-related morbidity.
• The postnatal care GDG agreed that, in endemic areas, preventive anthelminthic treatment could also be provided to pregnant women after the first trimester as part of worm infection reduction programmes, as per the 2017 WHO guideline Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups (83) and the 2016 WHO recommendations on antenatal care for a positive pregnancy experience (16). a Biannual administration is recommended where the baseline prevalence exceeds 50%.