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. 2008 Jun 4;2(6):e245.
doi: 10.1371/journal.pntd.0000245.

The synergistic effect of concomitant schistosomiasis, hookworm, and trichuris infections on children's anemia burden

Amara E Ezeamama  1 , Stephen T McGarvey, Luz P Acosta, Sally Zierler, Daria L Manalo, Hai-Wei Wu, Jonathan D Kurtis, Vincent Mor, Remigio M Olveda, Jennifer F Friedman
Affiliations

The synergistic effect of concomitant schistosomiasis, hookworm, and trichuris infections on children's anemia burden

Amara E Ezeamama et al. PLoS Negl Trop Dis. .

Abstract

Objective: To estimate the degree of synergism between helminth species in their combined effects on anemia.

Methods: Quantitative egg counts using the Kato-Katz method were determined for Ascaris lumbricoides, hookworm, Trichuris trichiura, and Schistosoma japonicum in 507 school-age children from helminth-endemic villages in The Philippines. Infection intensity was defined in three categories: uninfected, low, or moderate/high (M+). Anemia was defined as hemoglobin <11 g/dL. Logistic regression models were used to estimate odds ratios (OR), 95% confidence intervals (CI), and synergy index for pairs of concurrent infections.

Results: M+ co-infection of hookworm and S. japonicum (OR = 13.2, 95% CI: 3.82-45.5) and of hookworm and T. trichiura (OR = 5.34, 95% CI: 1.76-16.2) were associated with higher odds of anemia relative to children without respective M+ co-infections. For co-infections of hookworm and S. japonicum and of T. trichiura and hookworm, the estimated indices of synergy were 2.9 (95% CI: 1.1-4.6) and 1.4 (95% CI: 0.9-2.0), respectively.

Conclusion: Co-infections of hookworm and either S. japonicum or T. trichiura were associated with higher levels of anemia than would be expected if the effects of these species had only independent effects on anemia. This suggests that integrated anti-helminthic treatment programs with simultaneous deworming for S. japonicum and some geohelminths could yield a greater than additive benefit for reducing anemia in helminth-endemic regions.

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Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Buck AA, Anderson RI, MacRae AA. Epidemiology of poly-parasitism. I. Occurrence, frequency and distribution of multiple infections in rural communities in Chad, Peru, Afghanistan, and Zaire. Tropenmed Parasitol. 1978;29:61–70. - PubMed
    1. Bahri M, Chouikha M, Khediri F. [Intestinal polyparasitism in a military milieu]. Tunis Med. 1987;65:705–707. - PubMed
    1. Ashford RW, Craig PS, Oppenheimer SJ. Polyparasitism on the Kenya coast. 2. Spatial heterogeneity in parasite distributions. Ann Trop Med Parasitol. 1993;87:283–293. - PubMed
    1. Chunge RN, Karumba N, Ouma JH, Thiongo FW, Sturrock RF, et al. Polyparasitism in two rural communities with endemic Schistosoma mansoni infection in Machakos District, Kenya. J Trop Med Hyg. 1995;98:440–444. - PubMed
    1. Rietveld E, Vetter JC, Stilma JS. Concurrent parasitic infections among patients with onchocerciasis and controls in Sierra Leone, West Africa. Doc Ophthalmol. 1987;67:25–32. - PubMed

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