Multiple infection with Plasmodium and helminths in communities of low and relatively high socio-economic status

Abstract

A study was conducted in the city of Lubumbashi, Zaire: (1) to survey parasitic infections and clinical conditions in the local children and their mothers; (2) to identify combinations of parasites and clinical conditions that commonly occurred together in individuals; and (3) to determine whether single- and/or multiple-species infections were risk determinants of the observed clinical conditions. Overall, 1100 children and mothers from three subdivisions, two of low socio-economic status (LSES) and one of relatively high socio-economic status (HSES), provided stool and blood samples and were clinically examined. Plasmodium prevalence was higher in the two LSES subdivisions than in the HSES subdivision. Prevalence and intensity of Ascaris lumbricoides infection were low in the HSES subdivision and one of the two LSES subdivisions. In contrast, prevalence and intensity of Trichuris trichiura and of hookworms were similar in all subdivisions. Plasmodium and A. lumbricoides were the most frequently found single-species infections. The combination of A. lumbricoides and Plasmodium was the most frequent double-species infection and that of A. lumbricoides, Plasmodium and T. trichiura was the most frequent triple-species infection. Significant positive associations between parasite species were detected in the HSES subdivision, and in one of the two LSES subdivisions. Because the relationships were not consistently detected, it is hypothesized that the associations are determined by environmental conditions rather than synergy between the parasites in the host. The most commonly observed clinical conditions were abdominal pain, diarrhoea, fever, and low packed-cell volume (PCV). The occurrence of each was significantly lower in the HSES subdivision than in at least one of the two LSES subdivisions. Abdominal pain and low PCV were most common in individuals presenting with only a single clinical condition, and the combination of this symptom and sign was the most commonly observed pair of conditions. Abdominal pain, low PCV and diarrhoea was the most common combination in individuals with three clinical conditions. Logistic regression revealed that hookworm infection, T. trichiura infection, young age and residence in an LSES subdivision were determinants of diarrhoea. Trichuris trichiura infection, young age and living in an LSES subdivision were risk factors for abdominal pain. Plasmodium infection and young age were risk factors for fever. LSES was the only predictor of low PCV. Infection with A. lumbricoides did not enter any of the models. No significant interactions were detected among parasites, indicating that there was no synergism or antagonism among parasites in the induced disease.