BackgroundNeglected tropical diseases (NTDs) are major public health problems in developing countries where they contribute to suffering of populations living in poor settings. As part of a research project started in September 2009 in Kwale district, Coast Region, Kenya, a baseline cross-sectional survey was conducted in 5 rural villages to provide information on the status of NTDs, including urinary schistosomiasis, soil-transmitted helminthiasis (STH), and lymphatic filariasis. This paper presents the results of a parasitological investigation among adults in the study villages.MethodsA total of 599 adults in the 5 study villages were tested for NTD infections in urine, stool and blood. The presence of Schistosoma haematobium infection was determined by the urine filtration method. The presence of STH in stool was determined by Kato-Katz method while filarial antigenaemia was determined using immunochromatographic (ICT) test.ResultsThe study revealed high prevalence of hookworm (41.7%) and schistosomiasis (18.2%) infections among adults in the study villages. Of the 599 individuals examined, 50.1% had one or more helminthic infections. There was low level of polyparasitism with helminthic NTDs in the study population with 9.5% and 1.7% of the participants having two and three infections, respectively.ConclusionsIn the current study, hookworm and schistosomiasis infections were identified as important infections among adults living in areas of high endemicity for these infections. Thus, if this section of the population is left untreated it may remain an important potential reservoir and a source of re-infection for school-age children treated in school deworming programmes. Therefore, there is a need to design novel strategies for preventive chemotherapy interventions that could allow inclusion of adults in an effort to reduce force of infection in high endemic communities.

Parasitic determinants of serum retinol concentrations were studied in 159 preschool (0.25-5.1 y) and 695 primary school (9.2-17 y) children in western Kenya. Mean serum retinol was 0.63 micromol/L in preschool and 0.94 micromol/L in primary school children; 62% and 24%, respectively, had serum retinol < 0.70 micromol/L. Serum retinol was lower in boys than in girls among both preschool (P = 0.04) and primary school children (P = 0.0001). Schistosoma mansoni, Ascaris lumbricoides, hookworm, and Trichuris trichiura egg output and malarial parasitemia were determined and their relation with serum retinol assessed. Among preschool children, sex, elevated serum concentrations of C-reactive protein, and malarial parasitemia were significant predictors of serum retinol. Among the 63 children from whom stool samples were available, none of the helminth infections were significant predictors of serum retinol. For primary school children, age, sex, and S. mansoni egg output were predictors of serum retinol. Malarial parasitemia among nonimmune preschool children may contribute to low serum retinol, whereas malarial parasitemia did not have any effects in semiimmune primary school children. In contrast, the inverse relation between S. mansoni and serum retinol found in primary school children could be due to an effect of infection on serum retinol or an increased susceptibility to infection among children with low serum retinol. Although parasitic infections may contribute to poor vitamin A status in children, they do not explain the age and sex differences.

Objective: To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on haemoglobin concentration (Hb), using schools as a health delivery system. Study area and population: Nine hundred seventy-seven children between 9 and 18 y of age from 19 primary schools in Bondo District, western Kenya, were included in the trial. The 746 (76.4%) children on whom baseline Hb was available were included in this study. Design: The study was a randomized, placebo-controlled, double-blind, two-by-two factorial trial of the effects of multimicronutrient supplementation and multi-helminth chemotherapy on Hb after 8 months. Intervention: Single treatment of infected children with albendazole (600 mg) for geohelminths and praziquantel (40 mg=kg) for Schistosoma mansoni and daily supplementation with 13 micronutrients. Results: Multi-micronutrient supplementation (3.5 g=l, 95% CI 1.7, 5.3; P ¼ 0.0002) and anthelminthic treatment (2.0 g=l, 95% CI 0.2, 3.9; P ¼ 0.03) increased Hb independently (interaction, P ¼ 0.33). The effects were also independent of baseline Hb and general nutritional status. The treatment effect was due to reductions in S. mansoni and hookworm intensities of infection, in that Hb increased by 0.4 and 0.2 g=l, respectively, per 100 epg reductions in egg output. Interestingly, among S. mansoniinfected children, the effect of treatment seemed stronger in those with compared to those without co-existing malaria parasitaemia (interaction, P ¼ 0.09). Conclusion: Multi-micronutrient supplementation and multi-helminth chemotherapy increased Hb among school children, irrespective of initial Hb and nutritional status.

Inflammation influences the assessment of nutritional status. For example, inflammation reduces plasma retinol concentrations and vitamin A deficiency is overestimated. Conversely inflammation increases plasma ferritin concentrations and Fe deficiency is underestimated. Blood samples were obtained from 163 free-living HIV-1-infected adults, not on continuous medication, anti-retroviral drugs or micronutrients, not unwell and who had not reached WHO stage IV of HIV/AIDS. We used four markers of inflammation, C-reactive protein (CRP), a1-acid glycoprotein (AGP), a1-antichymotrypsin and erythrocyte sedimentation rate but mainly CRP and AGP were used to separate the subjects into four groups: 'healthy' where both CRP and AGP were normal; 'incubation phase' where CRP was elevated; 'early convalescence' where AGP and CRP were elevated and 'late convalescence' where only AGP was elevated. Correction factors were calculated to remove the influence of inflammation from each biomarker and group where inflammation was present and the data are shown before and after recalculation. The correction increased median plasma retinol concentrations of the whole group from 1·16 to 1·33 mmol/l, comparable with values (mean 1·29 mmol/l) in HIV-negative Kenyan women. Median ferritin concentrations fell by about 50 % in both sexes and the number of women with plasma ferritin concentrations #12 mg/l increased from eleven to twenty. The correction also increased plasma carotenoids and Hb but not a-tocopherol concentrations. We suggest that the method described to remove the influence of inflammation from nutritional biomarkers should be generally applicable in apparently healthy people and prevents discarding valuable data because of mild inflammation. The method does now need to be tested in other populations.

Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin) increased in both men (48 microg/L; P = 0.02) and women (12 microg/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation.