Impact of Polyparasitic Infections on Anemia and Undernutrition among Kenyan Children Living in a Schistosoma haematobium-Endemic Area

Bustinduy, Amaya L.; Parraga, Isabel M.; Thomas, Charles L.; Mungai, Peter; Mutuku, Francis; Muchiri, Eric M.; Kitron, Uriel; King, Charles H.

doi:10.4269/ajtmh.12-0552

Cited by 65 publications

(76 citation statements)

References 39 publications

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“…For early life/low intensity infections, prevalence estimates based on egg detection are known to be significant underestimates of the true infection rate. 15,27 Adequately powered studies, applying sensitive antigen-detection tests for the diagnosis of Schistosoma infection, are needed to further investigate the likely association between the inflammation caused by schistosomiasis haematobia and anemia. While it is unlikely that children in this age group were HIV positive, we did not determine HIV status for study participants, however there is always a chance that some of these children were HIV infected, which could have allowed additional undetected opportunistic infections that could have contributed to AI and so obscure the results of our parasite-focused analysis.…”

Section: Discussionmentioning

confidence: 99%

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

Cojulun

Bustinduy

Sutherland

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool-and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9-11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia.

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Section: Discussionmentioning

confidence: 99%

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

Cojulun

Bustinduy

Sutherland

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…Seven studies 34,42,43,45,47,49,51 assessed hookworm only, while four studies 25,27,31,50 assessed A. lumbricoides only. Three studies described STH without speciation.…”

Section: 33mentioning

confidence: 99%

“…Three studies described STH without speciation. 35,36,46 Twelve studies 8,26,28,32,33,35,41,43,46,[49][50][51] assessed the impact of co-infection on anemia, using various measurements. Five studies 26,28,32,33,49 quantitatively reported anemia with the mean Hb level in various age groups and pregnant women.…”

Section: 33mentioning

confidence: 99%

Malaria and soil-transmitted intestinal helminth co-infection and its effect on anemia: a meta-analysis

Naing

Whittaker

Nyunt-Wai

et al. 2013

Transactions of the Royal Society of Tropical Medicine and Hygiene

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This study aimed to synthesize available evidence on the extent of malaria and soil-transmitted intestinal helminth (STH) co-infections in people living in endemic countries and to explore the effect of interactions between malaria and STHs on anemia. We searched relevant studies in electronic databases up to March 2013. Studies comparing malaria and STH co-infected patients with those not co-infected were included and the effect estimates were pooled using a random-effects model. We identified 30 studies for meta-analyses of which 17 were cross-sectional design. The majority of included studies (80%) were carried out in African countries. Among pregnant women, those infected with hookworm were found to have higher association with malaria infection compared with those without (summary OR: 1.36; 95% CI: 1.17-1.59; I 2 : 0%). Among nonpregnant adults, the summary OR of the association between anemia and the combined malaria and STH was 2.91 (1.38-6.14). The summary OR of the association between anemia and malaria alone was 1.53 (0.97-2.42), while the association between anemia and STH alone was 0.28 (0.04-1.95). There is no good evidence to support a different effect of malaria and STH on anemia. A subgroup analysis showed a higher risk of malaria infection in the primigravidae (summary OR: 1.61; 95% CI: 1.3-1.99; I 2 : 0%). In conclusion, the malaria-STH co-infection was variable with complex outcomes on anemia.

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“…However, within the Americas, the Central American Republic of Guatemala has the highest rate of stunting, with a 49·8 % prevalence according to the most recent national nutrition survey (3) , when measured with respect to the WHO standards (4) . The designation of stunting as 'chronic malnutrition' would implicitly suggest a dietary origin, but a diverse series of environmental influences including microbial contamination (5) , mycotoxins (6,7) , indoor smoke (8) , recurrent diarrhoea (9,10) , helminth infection (11,12) and environmental enteric dysfunction (13,14) have been postulated to explain more of the variance than can be explained simply by poor nutrient intake (5,15) . On a global basis, UN statistics document a progressive and steep decline in length-for-age status during the first three years of life (16) .…”

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confidence: 99%

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

Solomons¹,

Vossenaar²,

Chomat

et al. 2014

Public Health Nutr.

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Objective: Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49·8 %), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1·5 months of life among Guatemalan infants. Design: As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ < − 2 using WHO growth standards. Setting: Eight rural, indigenous Mam-Mayan villages (n 200, 100 % of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27 % of Mayan indigenous origin), Guatemala. Subjects: Three hundred and six newborns with a median age of 19 d. Results: The median rural HAZ was − 1·56 and prevalence of stunting was 38 %; the respective urban values were − 1·41 and 25 %. Linear regression revealed no relationship between infant age and HAZ (r = 0·101, r 2 = 0·010, P = 0·077). Maternal height explained 3 % of the variability in HAZ (r = 0·171, r 2 = 0·029, P = 0·003). Conclusions: Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.

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Impact of Polyparasitic Infections on Anemia and Undernutrition among Kenyan Children Living in a Schistosoma haematobium-Endemic Area

Cited by 65 publications

References 39 publications

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

Malaria and soil-transmitted intestinal helminth co-infection and its effect on anemia: a meta-analysis

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

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