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Meta-Analysis
. 2020 Nov;103(5):1958-1968.
doi: 10.4269/ajtmh.20-0503.

Maternal Hookworm Infection and Its Effects on Maternal Health: A Systematic Review and Meta-Analysis

Tara E Ness  1 , Vedika Agrawal  2 , Kathryn Bedard  1 , Lara Ouellette  3 , Timothy A Erickson  4   1 , Peter Hotez  5   6   4   7   1 , Jill E Weatherhead  4   2   1
Affiliations
Meta-Analysis

Maternal Hookworm Infection and Its Effects on Maternal Health: A Systematic Review and Meta-Analysis

Tara E Ness et al. Am J Trop Med Hyg. 2020 Nov.

Abstract

Hookworm is an intestinal parasite that infects nearly 230 million people, with another 5.1 billion at risk, especially in poverty-stricken tropical and subtropical regions. Pregnancy is an especially vulnerable time for hookworm infection because of its effect on both maternal and subsequently fetal health. A systematic review and meta-analysis was conducted. The meta-analysis was performed on the association between maternal hookworm and maternal anemia, as well as maternal hookworm coinfection with malaria. The prevalence of hookworm ranged from 1% to 78% in pregnant women, whereas malaria prevalence ranged from 11% to 81%. Pregnant women with hookworm infection were more likely to have anemia (combined odds ratio [cOR] 2.55 [2.20, 2.96], P < 0.001). In addition, pregnant woman with hookworm were more likely to have malaria coinfection (cOR 1.60 [1.38, 1.86], P < 0.001). Other effects on maternal and child health were investigated and summarized without systematic review or meta-analysis because of the limited study numbers. Despite current deworming recommendations in pregnant women, heavy hookworm burden, coinfection with malaria, and subsequent anemia persist. Although this is likely due, in part, to a lack of implementation of preventive chemotherapy, additional interventions such as health education, proper waste management, or linking malaria and soil-transmitted helminth treatment and prevention programs may also be needed. Further investigations on maternal-child outcomes as a result of hookworm infection during pregnancy will highlight public health interventional targets to reduce morbidity in pregnant women and children globally.

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Conflict of interest statement

Disclosure: P. H. is a patent holder and lead investigator on vaccines against hookworm both in clinical trials and in development.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of study selection. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Forest plot of studies investigating maternal hookworm and anemia. This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
Forest plot of studies investigating maternal hookworm and malaria coinfection. This figure appears in color at www.ajtmh.org.
See this image and copyright information in PMC

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