Hemoglobin Level and Risk of Anemia in Soil-Transmitted Helminths Infections among Children: A Systematic Review and Meta-analysis

Abstract

Introduction. Soil Transmitted Helminthiasis (STH) is a Neglected Tropical Disease with almost 25% world population infected. Children were vulnerable to infection with morbidities affecting growth. STH infection alters children nutritional status which potentially causing anemia. Meta-analysis relating STH infections to hemoglobin (Hb) level and risk of anemia in children is limited.
 Aim. To compare hemoglobin levels and risk of anemia in children infected and uninfected with STH.
 Methods. Meta-analysis conducted from journals obtained from Pubmed, ScienceDirect, WileyLibrary, Cochrane, EBSCO, Proquest, DOAJ, and GoogleScholar from 2011-2021. Full text cross sectional studies on children with relevant topic is included, while unclear, inaccessible, or post interventional studies were excluded. Articles were analyzed in Review Manager 5.4 in mean difference (MD) and odds ratio (OR) with Confidence Interval (CI) of 95%.
 Result. Out of 25,683 articles in literature search, 29 were eligible for systematic review and meta-analysis. STH infection significantly decreases hemoglobin level (MD -0.2g/dL; p=0.02) and increases risk of anemia (OR 1.83; p<0.00001). Species analysis presented parallel result on Trichuris trichiura (MD -0.31g/dL; p=0.001 and OR 1.66; p=0.009), Hookworm (MD -0.56g/dL; p=0.02 and OR 3.3; p<0.00001), and multiple infection (MD -0.25g/dL; p=0.03 and OR 4.49; p=0.005). Ascaris lumbricoides didn’t show significance on hemoglobin level but comparable for risk of anemia (MD -0.16g/dL; p=0.17 and OR 1.57; p=0.001).
 Discussion. All STH infections exhibits lower hemoglobin level and higher risk of anemia caused by lower nutrition absorption and occult bleeding in gastrointestinal tract. Hookworm and multiple infections has the highest risk of anemia. Proportion of anemia may vary in studies and influenced by sociodemographic characteristics, but higher proportions occur in STH infected.
 Conclusion. Children infected with STH has lower hemoglobin level and in risk of anemia compared to uninfected children, hence further study is still needed to be conducted.
 Keywords: Anemia, Children, Hemoglobin, Infection, Soil Transmitted Helminths

Soil-transmitted helminths: A critical review of the impact of co-infections and implications for control and elimination

“…A meta-analytical study confirmed the direction of this effect by reporting a high OR 4.49, 95% CI 1.58 to 12.75, p < 0.05 among children with multiple STH infections [50]. The study delineated the effect of single STH parasites on child anemia and reported the greatest risk of anemia among hookworm-infected children with OR 3.3, 95% CI 1.98 to 5.49, p < 0.05, while A. lumbricoides had OR 1.57, 95% CI 1.2 to 2.07, p < 0.05 and T. trichiura with OR 1.66, 95% CI 1.13 to 2.43, p < 0.05 [50]. These results confirm the hypothesis that among children who are infected with STH, the mean hemoglobin levels are significantly lower in individuals with polyparasitism (referring to individuals harboring more than 1 helminth species in their body) [51].…”

“…For example, in Ethiopia, children infected with intestinal helminths were highly likely to have anemia (aOR 8.87, 95% CI 2.28 to 34.58) [ 49 ]. A meta-analytical study confirmed the direction of this effect by reporting a high OR 4.49, 95% CI 1.58 to 12.75, p < 0.05 among children with multiple STH infections [ 50 ]. The study delineated the effect of single STH parasites on child anemia and reported the greatest risk of anemia among hookworm-infected children with OR 3.3, 95% CI 1.98 to 5.49, p < 0.05, while A .…”

“…lumbricoides had OR 1.57, 95% CI 1.2 to 2.07, p < 0.05 and T . trichiura with OR 1.66, 95% CI 1.13 to 2.43, p < 0.05 [ 50 ]. These results confirm the hypothesis that among children who are infected with STH, the mean hemoglobin levels are significantly lower in individuals with polyparasitism (referring to individuals harboring more than 1 helminth species in their body) [ 51 ].…”