Nutritional Status Improves after Treatment of Schistosoma japonicum-Infected Children and Adolescents

Abstract

Studies addressing the relation between chronic schistosomiasis japonica and nutritional status are limited. We conducted a longitudinal treatment-reinfection study in Leyte, the Philippines, among 477 Schistosoma japonicum-infected subjects aged 7-20 y, to evaluate changes in nutritional status after treatment with praziquantel. Stool, Tanner stage, anthropometric indices, and hemoglobin (Hb) were evaluated at baseline, 4 wk post-treatment, and every 3 mo for 18 mo. Height-for-age Z-score (HAZ) and BMI Z-score (BMIZ) were calculated. Change scores relative to baseline were created for all outcome measures. Multilevel repeated-measures analyses were used to adjust for socioeconomic status, sex, either pubertal status or age, and household-level clustering. Z-scores improved modestly but significantly over time. BMIZ in children wasted at baseline improved the most [0.41 (0.26-0.56) Z-score unit] and HAZ improved only in children stunted at baseline [0.17 (0.l2-0.21) Z-score unit]. Hb improvement peaked at 15 mo and occurred only in subjects that were anemic at baseline [peak improvement: 8.3 (6.0-10.6) g/L] and in males [peak improvement 4.7 (2.9-6.6) g/L]. Reinfection, evaluated as egg count over time and egg count 3 mo earlier to assess a delay in effect, was inversely associated with improvement in Hb (P = 0.06 and 0.004, respectively). High-intensity reinfection at 18 mo was associated with significantly less absolute growth from baseline compared with lower-intensity and no reinfection. Based on the peak Hb improvement at 15 mo post-treatment, annual treatment intervals are recommended to reduce schistosomiasis-associated nutritional morbidity.

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

“…6,25 Infection-related AI has been strongly linked to the presence of subclinical infection, both for children with subclinical malaria in Cote d'Ivoire, 6 and for Philippine children having persistent or recurrent low-level Schistosoma japonicum infection after praziquantel therapy. 25,26 Our current study of the mechanisms of anemia associated with prevalence parasitic infections suggests that AI combined with true iron deficiency is the primary source of childhood anemia in this area of coastal Kenya.…”

Intestinal helminth infections and dietary diversity score predict nutritional status of urban schoolchildren from southern Ethiopia

“…The odds of stunting was 5 times higher among the schoolchildren infected with A.lumbricoides [AOR (95% CI) = 5.0 (2.7, 9. [15,36] and intervention studies that showed improved growth performance after schoolchildren were treated with anthelminthic drugs [37][38][39][40]. Intestinal helminth infections could affect linear growth and nutritional status through several mechanisms including decline in food intake [39,41]; nutrient wastage from blood loss, malabsorption and diarrheal episodes [41,42]; and suppression of hormones required for bone growth like the growth hormone (GH) and insulin-like growth factor-1 (IGF-1) [43].…”

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

“…Although much of impaired early childhood development in sub-Saharan Africa has been ascribed to protein, calorie, and micronutrient deficiencies, it is becoming increasingly apparent that the process of chronic parasitic infection is associated with continuing inflammation that can limit childhood growth 6,7,37 and cause persistent or recurrent anemia of chronic inflammation. 18 Despite the difficulties in isolating individual causes of undernutrition and anemia in developing areas, we were able to show a clear association between infection and both anemia and undernutrition after adjusting for sex-specific effects and possible SES and environmental confounders.…”

“…4,6 Previous studies have examined the overlapping effects of infection by soil-transmitted helminths (STHs), including hookworm, Ascaris lumbricoides, and Trichuris trichiura, on these outcomes, and more recently, studies have examined the combined effects of STH with schistosomiasis. 3,7,8 The public health importance of chronic malnutrition and anemia is in their intrinsically disabling effects. Related manifestations can often include reduced global functioning, 9 decreased physical performance, 10,11 and impaired cognition, 2,12,13 resulting in decreased human capital among adults in affected populations 14,15 with a related loss in years of healthy life.…”

“…9 Past studies showing improvements in nutritional status and cognition after adequate antiparasitic treatment highlight the importance of effective control to prevent cognitive and growth impairment before they become irreversible. 5,7,16 Catch-up growth (or increased linear growth velocity after growth insult resolves) 17 can happen if inflammation is alleviated and chronic diseases are controlled before children mature. Likewise, anemia of inflammation, the leading cause of the anemia associated with schistosomiasis, 18 can be significantly improved by curative therapy.…”