Ascariasis and malnutrition. A study in urban Ethiopian children

Abstract

Treatment of 13 urban Ethiopian children with mild ascariasis did not produce any evidence of improved intestinal morphology and absorption or nutritional status. Ascariasis treatment had no impact on anthropometric measures in an additional study group of 84 children. A review of the literature reveals that the nutritional consequences of ascariasis are uncertain.

PIP: Ascariasis, highly prevalent among children in developing countries, is thought to cause widespread and important morbidity. The role of ascariasis as a contributory factor in the etiology of childhood malnutrition has been illustrated by clinical observation of patients with massive infection; however, systematic evidence and objective information are scanty. The prevalence of ascariasis among Ethiopian children is about 10% in infants, 28% in children 1-2 years old, and 62% in children over 3 years. 2 clinical trials were conducted to determine the effect of the infection on childhood nutrition and to assess the desirability of allocating scarce resources to treatment and control. In a double blind trial, 13 boys with the infection were given piperazine citrate or a placebo syrup. Stool analyses for worm load, fat and nitrogen excretion, and anthropometric measurements, tests for xylose absorption, and jejunal biopsies were conducted. 24 hour dietary recalls were obtained from the mothers. In the 2nd trial, complete information including anthropometric measurements and incidence of morbidity was obtained on 44 infected and 40 uninfected children between the ages of 1-4 as part of a community study. A double blind system of allocating treatment and placebo to underweight infected and noninfected children and normal weight infected and uninfected children was implemented. The results showed that the individual wormload in the children was low. Initial treatment did not result in complete deworming. The nutritional status of the children was unaffected by treatment, although in the community study, a somewhat lower rate of acute morbidity was noted in treated children. The results of other metabolic and functional studies are inconsistent; in some studies, a treatment effect was noted. However, the results of these studies are questionable because intervening factors, such as the presence of infection in the study groups, were not adequately controlled. The results of other community studies are also inconsistent. So far little clear cut epidemiological evidence exists regarding the relative importance of ascariasis in the causation of malnutrition in communities suffering from concommitant infection and other ills of poverty. Clinical evidence suggests that massive infection may result in malnutrition, and treatment of symptomatic ascariasis is justified. At the community level, deworming programs do not have a clear beneficial nutrition effect.