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Afolabi MO, Adebiyi A, Cano J, Sartorius B, Greenwood B, Johnson O, Wariri O. Prevalence and distribution pattern of malaria and soil-transmitted helminth co-endemicity in sub-Saharan Africa, 2000-2018: A geospatial analysis. PLoS Negl Trop Dis 2022; 16:e0010321. [PMID: 36178964 PMCID: PMC9555675 DOI: 10.1371/journal.pntd.0010321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/12/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited understanding exists about the interactions between malaria and soil-transmitted helminths (STH), their potential geographical overlap and the factors driving it. This study characterised the geographical and co-clustered distribution patterns of malaria and STH infections among vulnerable populations in sub-Saharan Africa (SSA). METHODOLOGY/PRINCIPAL FINDINGS We obtained continuous estimates of malaria prevalence from the Malaria Atlas Project (MAP) and STH prevalence surveys from the WHO-driven Expanded Special Project for the Elimination of NTDs (ESPEN) from Jan 1, 2000, to Dec 31, 2018. Although, MAP provides datasets on the estimated prevalence of Plasmodium falciparum at 5km x 5km fine-scale resolution, we calculated the population-weighted prevalence of malaria for each implementation unit to ensure that both malaria and STH datasets were on the same spatial resolution. We incorporated survey data from 5,935 implementation units for STH prevalence and conducted the prevalence point estimates before and after 2003. We used the bivariate local indicator of spatial association (LISA analysis) to explore potential co-clustering of both diseases at the implementation unit levels among children aged 2-10 years for P. falciparum and 5-14 years for STH, living in SSA. Our analysis shows that prior to 2003, a greater number of SSA countries had a high prevalence of co-endemicity with P.falciparium and any STH species than during the period from 2003-2018. Similar prevalence and distribution patterns were observed for the co-endemicity involving P.falciparum-hookworm, P.falciparum-Ascaris lumbricoides and P.falciparum-Trichuris trichiura, before and after 2003. We also observed spatial variations in the estimates of the prevalence of P. falciparum-STH co-endemicity and identified hotspots across many countries in SSA with inter-and intra-country variations. High P. falciparum and high hookworm co-endemicity was more prevalent in West and Central Africa, whereas high P. falciparum with high A. lumbricoides and high P. falciparum with high T. trichiura co-endemicity were more predominant in Central Africa, compared to other sub-regions in SSA. CONCLUSIONS/SIGNIFICANCE Wide spatial heterogeneity exists in the prevalence of malaria and STH co-endemicity within the regions and within countries in SSA. The geographical overlap and spatial co-existence of malaria and STH could be exploited to achieve effective control and elimination agendas through the integration of the vertical control programmes designed for malaria and STH into a more comprehensive and sustainable community-based paradigm.
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Affiliation(s)
- Muhammed O. Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adekola Adebiyi
- College of Agriculture, Engineering and Environmental Design, Legacy University, Banjul, The Gambia
| | - Jorge Cano
- Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Benn Sartorius
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Department of Health Metric Sciences, University of Washington, Seattle, Washington, United States of America
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Olatunji Johnson
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Oghenebrume Wariri
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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Al-Jermmy ASM, Idris SM, Coulibaly-Zerbo F, Nasreddine L, Al-Jawaldeh A. Prevalence and Correlates of Anemia among Adolescents Living in Hodeida, Yemen. CHILDREN 2022; 9:children9070977. [PMID: 35883960 PMCID: PMC9322810 DOI: 10.3390/children9070977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
This study assesses the prevalence and correlates of anemia among adolescents living in the war-affected region of Hodeida in Yemen. A secondary objective was to examine the effect of a nutrition education intervention on hemoglobin levels among anemic adolescents. A cross-sectional study was conducted on a random sample of adolescents aged 15–19 years in Hodeida (n = 400). A questionnaire was administered to inquire about demographic, socioeconomic, lifestyle and clinical characteristics. Capillary blood was obtained, anthropometric characteristics were measured and stool samples were collected. As for the secondary objective, anemic adolescents were randomly assigned to an intervention group (nutrition education and iron supplementation) and a control group (iron supplements only). The prevalence of anemia was 37.8%. Female gender, khat chewing, excessive menstruation, and experiencing headaches, fatigue, or dizziness were independent predictors of anemia. In contrast, adolescents who attended private schools, and reported snack consumption or handwashing had a significantly lower risk of anemia. A sample of 116 adolescents participated in the intervention (3 months). Hemoglobin levels were significantly higher in the intervention group compared to the control. Our findings contribute to the identification of high-risk groups that should be targeted by context-specific interventions. The implemented multicomponent intervention may serve as a prototype for larger-scale preventive programs.
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Affiliation(s)
| | - Shadia Mohamed Idris
- College of Public and Environmental Health, University of Bahri, Khartoum 12217, Sudan;
| | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
- Correspondence: ; Tel.: +961-1-350000 (ext. 4547)
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 7608, Egypt;
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Abstract
Coinfection with Plasmodium falciparum and helminths may impact the immune response to these parasites because they induce different immune profiles. We studied the effects of coinfections on the antibody profile in a cohort of 715 Mozambican children and adults using the Luminex technology with a panel of 16 antigens from P. falciparum and 11 antigens from helminths (Ascaris lumbricoides, hookworm, Trichuris trichiura, Strongyloides stercoralis, and Schistosoma spp.) and measured antigen-specific IgG and total IgE responses. We compared the antibody profile between groups defined by P. falciparum and helminth previous exposure (based on serology) and/or current infection (determined by microscopy and/or qPCR). In multivariable regression models adjusted by demographic, socioeconomic, water, and sanitation variables, individuals exposed/infected with P. falciparum and helminths had significantly higher total IgE and antigen-specific IgG levels, magnitude (sum of all levels) and breadth of response to both types of parasites compared to individuals exposed/infected with only one type of parasite (P ≤ 0.05). There was a positive association between exposure/infection with P. falciparum and exposure/infection with helminths or the number of helminth species, and vice versa (P ≤ 0.001). In addition, children coexposed/coinfected tended (P = 0.062) to have higher P. falciparum parasitemia than those single exposed/infected. Our results suggest that an increase in the antibody responses in coexposed/coinfected individuals may reflect higher exposure and be due to a more permissive immune environment to infection in the host. IMPORTANCE Coinfection with Plasmodium falciparum and helminths may impact the immune response to these parasites because they induce different immune profiles. We compared the antibody profile between groups of Mozambican individuals defined by P. falciparum and helminth previous exposure and/or current infection. Our results show a significant increase in antibody responses in individuals coexposed/coinfected with P. falciparum and helminths in comparison with individuals exposed/infected with only one of these parasites, and suggest that this increase is due to a more permissive immune environment to infection in the host. Importantly, this study takes previous exposure into account, which is particularly relevant in endemic areas where continuous infections imprint and shape the immune system. Deciphering the implications of coinfections deserves attention because accounting for the real interactions that occur in nature could improve the design of integrated disease control strategies.
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Wait LF, Kamiya T, Fairlie-Clarke KJ, Metcalf CJE, Graham AL, Mideo N. Differential drivers of intraspecific and interspecific competition during malaria-helminth co-infection. Parasitology 2021; 148:1030-1039. [PMID: 33971991 PMCID: PMC11010048 DOI: 10.1017/s003118202100072x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/05/2022]
Abstract
Various host and parasite factors interact to determine the outcome of infection. We investigated the effects of two factors on the within-host dynamics of malaria in mice: initial infectious dose and co-infection with a helminth that limits the availability of red blood cells (RBCs). Using a statistical, time-series approach to model the within-host ‘epidemiology’ of malaria, we found that increasing initial dose reduced the time to peak cell-to-cell parasite propagation, but also reduced its magnitude, while helminth co-infection delayed peak cell-to-cell propagation, except at the highest malaria doses. Using a mechanistic model of within-host infection dynamics, we identified dose-dependence in parameters describing host responses to malaria infection and uncovered a plausible explanation of the observed differences in single vs co-infections. Specifically, in co-infections, our model predicted a higher background death rate of RBCs. However, at the highest dose, when intraspecific competition between malaria parasites would be highest, these effects of co-infection were not observed. Such interactions between initial dose and co-infection, although difficult to predict a priori, are key to understanding variation in the severity of disease experienced by hosts and could inform studies of malaria transmission dynamics in nature, where co-infection and low doses are the norm.
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Affiliation(s)
- L. F. Wait
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - T. Kamiya
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, Ontario, Canada
| | | | - C. J. E. Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - A. L. Graham
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - N. Mideo
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, Ontario, Canada
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Magalhães L, Nogueira DS, Gazzinelli-Guimarães PH, Oliveira FMS, Kraemer L, Gazzinelli-Guimarães AC, Vieira-Santos F, Fujiwara RT, Bueno LL. Immunological underpinnings of Ascaris infection, reinfection and co-infection and their associated co-morbidities. Parasitology 2021; 148:1-10. [PMID: 33843506 DOI: 10.1017/s0031182021000627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Human ascariasis is the most common and prevalent neglected tropical disease and is estimated that ~819 million people are infected around the globe, accounting for 0.861 million years of disability-adjusted life years in 2017. Even with the existence of highly effective drugs, the constant presence of infective parasite eggs in the environment contribute to a high reinfection rate after treatment. Due to its high prevalence and broad geographic distribution Ascaris infection is associated with a variety of co-morbidities and co-infections. Here, we provide data from both experimental models and humans studies that illustrate how complex is the interaction of Ascaris with the host immune system, especially, in the context of reinfections, co-infections and associated co-morbidities.
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Affiliation(s)
- Luisa Magalhães
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise S Nogueira
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro H Gazzinelli-Guimarães
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Fabricio M S Oliveira
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Kraemer
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Flaviane Vieira-Santos
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo T Fujiwara
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lilian L Bueno
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Odoemene SN, Oluwole AS, Mogaji HO, Adegbola MV, Omitola OO, Bayegun AA, Ojo DA, Sam-Wobo SO, Ekpo UF. Polyparasitism with Malaria and Intestinal Parasite Infections among Infants and Preschool-Aged Children in Egbedore, Osun State, Nigeria. J Parasitol Res 2020; 2020:8810148. [PMID: 32774897 PMCID: PMC7396011 DOI: 10.1155/2020/8810148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
Polyparasitism is widespread in many communities in Sub-Saharan Africa. However, there is paucity of data on polyparasitism in infants and preschool-aged children (IPSAC), to inform policy developments. Therefore, a survey of 1110 consented IPSAC was undertaken in Egbedore Local Government Area (LGA), Osun State, Nigeria, to determine the prevalence of polyparasitism in IPSAC in ten randomly selected rural communities. Fresh stool and blood samples were collected and processed for intestinal parasites and malaria infection. Mothers/caregivers were interviewed using a structured questionnaire to obtain demographic data of their IPSAC and to document knowledge, attitude, and practice (KAP) on parasitic infections. Data obtained through the questionnaire were analyzed using EpiData version 3.1, while parasitological data were analyzed using Statistical Package for Social Sciences (version 20.0). Descriptive statistics were computed for demographic data and association which were tested using bivariate analysis at a 95% confidence level while significance was set at p < 0.05. The results showed that 349 (46.29%) were infected with a single parasite. Infants and preschool-aged children infected with double, triple, and quadruple parasites are 268 (35.54%), 122 (16.18%), and 15 (1.99%), respectively. The prevalence of polyparasitism is 405 (53.71%). Although females (54.07%) were more infected than males (45.93%), there was no significant difference (p > 0.05) observed. Significantly (p < 0.05) more preschool children (65.93%) harbour more infections than the infants do (34.07%). Ara community (14.81%) had the highest cases of polyparasitized IPSAC, but no significant difference (p > 0.05) was observed across the communities. Double parasitic infection of Plasmodium falciparum and Ascaris lumbricoides (30.12%) and triple parasitic infection of P. falciparum, A. lumbricoides, and T. trichiura (14.81%) were the most common forms of polyparasitism encountered in the study. This study showed that polyparasitism is a burden in IPSAC and needs further investigation.
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Affiliation(s)
- S N Odoemene
- Department of Basic Sciences, Adeleke University, Ede, Osun State, Nigeria
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - A S Oluwole
- The COUNTDOWN Project, Department of Neglected Tropical Diseases, Sightsavers, Nigeria Country Office, Kaduna, Nigeria
| | - H O Mogaji
- Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Ekiti State, Nigeria
| | - M V Adegbola
- Department of Science Laboratory Technology, Federal Polytechnics Ede, Nigeria
| | - O O Omitola
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - A A Bayegun
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - D A Ojo
- Department of Microbiology, Federal University of Agriculture, Abeokuta, Nigeria
| | - S O Sam-Wobo
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - U F Ekpo
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
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de Glanville WA, Thomas LF, Cook EAJ, Bronsvoort BMDC, Wamae NC, Kariuki S, Fèvre EM. Household socio-economic position and individual infectious disease risk in rural Kenya. Sci Rep 2019; 9:2972. [PMID: 30814567 PMCID: PMC6393457 DOI: 10.1038/s41598-019-39375-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/22/2019] [Indexed: 11/21/2022] Open
Abstract
The importance of household socio-economic position (SEP) in shaping individual infectious disease risk is increasingly recognised, particularly in low income settings. However, few studies have measured the extent to which this association is consistent for the range of pathogens that are typically endemic among the rural poor in the tropics. This cross-sectional study assessed the relationship between SEP and human infection within a single community in western Kenya using a set of pathogens with diverse transmission routes. The relationships between household SEP and individual infection with Plasmodium falciparum, hookworm (Ancylostoma duodenale and/or Necator americanus), Entamoeba histolytica/dispar, Mycobacterium tuberculosis, and HIV, and co-infections between hookworm, P. falciparum and E. histolytica/dispar, were assessed using multivariable logistic and multinomial regression. Individuals in households with the lowest SEP were at greatest risk of infection with P. falciparum, hookworm and E. histolytica/dispar, as well as co-infection with each pathogen. Infection with M. tuberculosis, by contrast, was most likely in individuals living in households with the highest SEP. There was no evidence of a relationship between individual HIV infection and household SEP. We demonstrate the existence of a household socio-economic gradient within a rural farming community in Kenya which impacts upon individual infectious disease risk. Structural adjustments that seek to reduce poverty, and therefore the socio-economic inequalities that exist in this community, would be expected to substantially reduce overall infectious disease burden. However, policy makers and researchers should be aware that heterogeneous relationships can exist between household SEP and infection risk for different pathogens in low income settings.
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Affiliation(s)
- W A de Glanville
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT, UK.
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya.
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
| | - L F Thomas
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT, UK
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya
| | - E A J Cook
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT, UK
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya
| | - B M de C Bronsvoort
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian, EH25 9RG, UK
- Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian, EH25 9RG, UK
| | - N C Wamae
- School of Pharmacy and Health Sciences, United States International University-Africa, PO Box 14634-01000, Nairobi, Kenya
| | - S Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, PO Box 19464-00200, Nairobi, Kenya
| | - E M Fèvre
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya.
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK.
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Seroepidemiology of helminths and the association with severe malaria among infants and young children in Tanzania. PLoS Negl Trop Dis 2018; 12:e0006345. [PMID: 29579050 PMCID: PMC5886694 DOI: 10.1371/journal.pntd.0006345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/05/2018] [Accepted: 02/24/2018] [Indexed: 01/23/2023] Open
Abstract
The disease burden of Wuchereria bancrofti and Plasmodium falciparum malaria is high, particularly in Africa, and co-infection is common. However, the effects of filarial infection on the risk of severe malaria are unknown. We used the remaining serum samples from a large cohort study in Muheza, Tanzania to describe vector-borne filarial sero-reactivity among young children and to identify associations between exposure to filarial parasites and subsequent severe malaria infections. We identified positive filarial antibody responses (as well as positive antibody responses to Strongyloides stercoralis) among infants as young as six months. In addition, we found a significant association between filarial seropositivity at six months of age and subsequent severe malaria. Specifically, infants who developed severe malaria by one year of age were 3.9 times more likely (OR = 3.9, 95% CI: 1.2, 13.0) to have been seropositive for filarial antigen at six months of age compared with infants who did not develop severe malaria. In this paper, we used a multiplexed, serologic assessment to identify children with previous or current exposure to or infection with filarial parasites or S. stercoralis (a soil transmitted helminth), enhancing our understanding of co-infections in early childhood. We identified an increasing prevalence of filarial antibodies over time in a population of children as young as 6 months old. In addition, we found a significant association between filarial seropositivity at six months of age and subsequent severe malaria.
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Quiner CA, Moses C, Monroe BP, Nakazawa Y, Doty JB, Hughes CM, McCollum AM, Ibata S, Malekani J, Okitolonda E, Carroll DS, Reynolds MG. Presumptive risk factors for monkeypox in rural communities in the Democratic Republic of the Congo. PLoS One 2017; 12:e0168664. [PMID: 28192435 PMCID: PMC5305065 DOI: 10.1371/journal.pone.0168664] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
Monkeypox virus (MPXV), a close relative of Variola virus, is a zoonotic virus with an unknown reservoir. Interaction with infected wildlife, bites from peri-domestic animals, and bushmeat hunting are hypothesized routes of infection from wildlife to humans. Using a Risk Questionnaire, performed in monkeypox-affected areas of rural Democratic Republic of the Congo, we describe the lifestyles and demographics associated with presumptive risk factors for MPXV infection. We generated two indices to assess risk: Household Materials Index (HMI), a proxy for socioeconomic status of households and Risk Activity Index (RAI), which describes presumptive risk for animal-to-human transmission of MPXV. Based on participant self-reported activity patterns, we found that people in this population are more likely to visit the forest than a market to fulfill material needs, and that the reported occupation is limited in describing behavior of individuals may participate. Being bitten by rodents in the home was commonly reported, and this was significantly associated with a low HMI. The highest scoring RAI sub-groups were 'hunters' and males aged ≥ 18 years; however, several activities involving MPXV-implicated animals were distributed across all sub-groups. The current analysis may be useful in identifying at-risk groups and help to direct education, outreach and prevention efforts more efficiently.
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Affiliation(s)
- Claire A. Quiner
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Cynthia Moses
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Benjamin P. Monroe
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Yoshinori Nakazawa
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Jeffrey B. Doty
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Christine M. Hughes
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Andrea M. McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Saturnin Ibata
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Jean Malekani
- University of Kinshasa, Department of Biology, Kinshasa, Democratic Republic of Congo
| | - Emile Okitolonda
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Darin S. Carroll
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Mary G. Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
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Parreira DR, Jansen AM, Abreu UGP, Macedo GC, Silva ARS, Mazur C, Andrade GB, Herrera HM. Health and epidemiological approaches of Trypanosoma evansi and equine infectious anemia virus in naturally infected horses at southern Pantanal. Acta Trop 2016; 163:98-102. [PMID: 27497875 DOI: 10.1016/j.actatropica.2016.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
Equine infectious anemia virus (EIAV) and Trypanossoma evansi are endemic in Brazilian Pantanal Biome, an important area for livestock production. In this sense, we evaluated the epidemiological single and co-infection effects of T. evansi and EIAV in naturally infected horses in the southern Pantanal wetland by serological tests and hematological assays. Both higher seroprevalence and heath poor condition of the sampled animals were associated with differences in horse management between farms. We found that the negative animals for both infectious agents (NN) represented the major group in F1 (37%), and the smallest group in F2 (19%). Furthermore, we recorded higher EIAV seroprevalence (56%) in F2, compared to F1 (38%). We observed that T. evansi infection was mostly related to young horses, as seen by their higher seroprevalence, ranging from 70.7% in the beginning of the rainy season to 81% in the end of flood period, in comparison with the values of 42% and 68%, respectively, in working animals. on the other hand, working animals showed a higher seroprevalence for EIAV (48%) in both seasons than young horses. We observed that the management of working horses could be a risk factor of EIAV infection. On the other hand, as T. evansi is maintained in the study region by many species of wild mammals, the mechanical transmission through blood-sucking vectors ensures the infection to horses since early. Our results showed that single or co-infection by EIAV and T. evansi caused different degree of anemia in the infected animals. Moreover, the health of horses in Brazilian Pantanal is also influenced by differences in horse management and environmental circumstances.
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Affiliation(s)
| | - Ana M Jansen
- Fundação Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, CEP 21040-900, Brazil
| | - Urbano G P Abreu
- Empresa Brasileira de Pesquisa Agropecuária - EMBRAPA Pantanal, Corumbá, CEP 79320-900, Brazil
| | - Gabriel C Macedo
- Universidade Católica Dom Bosco - UCDB, Campo Grande, CEP 79117-900, Brazil
| | - Antônia R S Silva
- Universidade Federal Rural do Rio de Janeiro - UFRRJ, Seropédica, CEP 23890-000, Brazil
| | - Carlos Mazur
- Universidade Federal Rural do Rio de Janeiro - UFRRJ, Seropédica, CEP 23890-000, Brazil
| | - Gisele B Andrade
- Universidade Católica Dom Bosco - UCDB, Campo Grande, CEP 79117-900, Brazil
| | - Heitor M Herrera
- Universidade Católica Dom Bosco - UCDB, Campo Grande, CEP 79117-900, Brazil.
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Degarege A, Veledar E, Degarege D, Erko B, Nacher M, Madhivanan P. Plasmodium falciparum and soil-transmitted helminth co-infections among children in sub-Saharan Africa: a systematic review and meta-analysis. Parasit Vectors 2016; 9:344. [PMID: 27306987 PMCID: PMC4908807 DOI: 10.1186/s13071-016-1594-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/17/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The epidemiology of soil-transmitted helminth (STH) and Plasmodium co-infections need better understanding. The findings of the individual studies are inconclusive. A systematic review was conducted to synthesize evidence on the association of STH infection with the prevalence and density of Plasmodium falciparum infection, and its effect on anaemia among children in sub-Saharan Africa (SSA). METHODS Relevant studies published before March 6, 2015 were identified by searching Medline (via Pubmed), Embase, Cochrane Library and CINAHL without any language restriction. Studies on P. falciparum and STH co-infection among children in SSA except for case studies were included in this study. Studies were screened for eligibility and data extracted independently by two authors. The primary outcome assessed was the prevalence of P. falciparum infection and the secondary outcomes included P. falciparum density and prevalence of anaemia. Heterogeneity was assessed using Cochrane Q and Moran's I (2) and publication bias was evaluated using Egger test. A random-effects model was used to estimate the summary odds ratio (OR) and the corresponding 95 % confidence intervals (CI). RESULTS Out of 2985 articles screened, 11 articles were included in the systematic review; of these seven were considered in the meta-analysis. Of the 11 studies with 7458 study participants, seven were cross-sectional, one prospective cohort and three were randomized controlled trials. Four studies examined the outcome for hookworms, one for Ascaris lumbricoides and six for pooled (at least one) STH species. Eight studies measured prevalence/incidence of uncomplicated P. falciparum infection, two calculated prevalence of asymptomatic P. falciparum infection, three evaluated P. falciparum density and four considered prevalence of P. falciparum infection related anaemia/mean haemoglobin reduction. The odds of asymptomatic/uncomplicated P. falciparum infection were higher among children infected with STH than those uninfected with intestinal helminths (summary Odds Ratio [OR]: 1.4; 95 % Confidence Interval [CI]: 1.05-1.87; I (2) = 36.8 %). Plasmodium falciparum density tended to be higher among children infected with STH than those uninfected with intestinal helminths. However, STH infection was associated with lower odds of P. falciparum infection related anaemia (summary OR: 0.5; 95 % CI: 0.21-0.78; I (2) = 43.3 %). CONCLUSIONS The findings suggest that STH infection may increase susceptibility to asymptomatic/uncomplicated P. falciparum infection but may protect malaria-related anaemia in children. Future studies should investigate the effect of STH infection upon the incidence of severe P. falciparum infection among children in SSA.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, Robert Stemple College of Public Health, Florida International University, Miami, USA.
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Emir Veledar
- Department of Epidemiology, Robert Stemple College of Public Health, Florida International University, Miami, USA
| | - Dawit Degarege
- Ethiopian Ministry of Health Office, Addis Ababa, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Purnima Madhivanan
- Department of Epidemiology, Robert Stemple College of Public Health, Florida International University, Miami, USA
- Public Health Research Institute of India, Mysore, India
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12
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Nyakundi RK, Nyamongo O, Maamun J, Akinyi M, Mulei I, Farah IO, Blankenship D, Grimberg B, Hau J, Malhotra I, Ozwara H, King CL, Kariuki TM. Protective Effect of Chronic Schistosomiasis in Baboons Coinfected with Schistosoma mansoni and Plasmodium knowlesi. Infect Immun 2016; 84:1320-1330. [PMID: 26883586 PMCID: PMC4862699 DOI: 10.1128/iai.00490-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/08/2016] [Indexed: 11/20/2022] Open
Abstract
Malaria and schistosomiasis coinfections are common, and chronic schistosomiasis has been implicated in affecting the severity of acute malaria. However, whether it enhances or attenuates malaria has been controversial due the lack of appropriately controlled human studies and relevant animal models. To examine this interaction, we conducted a randomized controlled study using the baboon (Papio anubis) to analyze the effect of chronic schistosomiasis on severe malaria. Two groups of baboons (n = 8 each) and a schistosomiasis control group (n = 3) were infected with 500 Schistosoma mansoni cercariae. At 14 and 15 weeks postinfection, one group was given praziquantel to treat schistosomiasis infection. Four weeks later, the two groups plus a new malaria control group (n = 8) were intravenously inoculated with 10(5) Plasmodium knowlesi parasites and monitored daily for development of severe malaria. A total of 81% of baboons exposed to chronic S. mansoni infection with or without praziquantel treatment survived malaria, compared to only 25% of animals infected with P. knowlesi only (P = 0.01). Schistosome-infected animals also had significantly lower parasite burdens (P = 0.004) than the baboons in the P. knowlesi-only group and were protected from severe anemia. Coinfection was associated with increased spontaneous production of interleukin-6 (IL-6), suggesting an enhanced innate immune response, whereas animals infected with P. knowlesi alone failed to develop mitogen-driven tumor necrosis factor alpha and IL-10, indicating the inability to generate adequate protective and balancing immunoregulatory responses. These results indicate that chronic S. mansoni attenuates the severity of P. knowlesi coinfection in baboons by mechanisms that may enhance innate immunity to malaria.
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Affiliation(s)
- Ruth K Nyakundi
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
- University of Copenhagen, Copenhagen, Denmark
| | - Onkoba Nyamongo
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Jeneby Maamun
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Mercy Akinyi
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Isaac Mulei
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Idle O Farah
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | | | | | - Jann Hau
- University of Copenhagen, Copenhagen, Denmark
| | - Indu Malhotra
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Hastings Ozwara
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | | | - Thomas M Kariuki
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
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13
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Sharma RK, Singh MP, Saha KB, Bharti PK, Jain V, Singh PP, Silawat N, Patel R, Hussain M, Chand SK, Pandey A, Singh N. Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India. Indian J Med Res 2016; 141:567-75. [PMID: 26139773 PMCID: PMC4510754 DOI: 10.4103/0971-5916.159515] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background & objectives: Malaria is a major public health problem in many States of the country, particularly, in Madhya Pradesh where both Plasmodium vivax and P. falciparum are endemic. Although many studies have been conducted to investigate risk factors for malaria, but only a few have examined household and socio-economic risk factors. The present study was, therefore, undertaken to explore the relationship of different socio-demographic, socio-economic and behavioural risk factors with malaria prevalence in tribal areas of Madhya Pradesh, India. Methods: This study was undertaken in all 62 villages of Bargi Primary Health Centre from May 2005 to June 2008. These villages comprised 7117 households with an average family size of five members. Fortnightly fever surveys were conducted in all villages to assess prevalence of malaria infection in the community. The distinct univariate and multivariate logistic regression models were fitted on the data set. Results: The important socio-demographic risk factors like age of household head, social group, occupation and family size; socio-economic factors like type of walls of house, place of drinking water source, irrigated land, cash crop; and behavioural variables like place of sleeping, use of bed nets, etc. were found significantly associated with malaria in univariate analyses. In multivariate analyses only social groups, family size, type of walls of house, and place of sleeping had strong significant association with prevalence of malaria. Interpretation & conclusions: The study shows that in tribal areas where people are living in poor quality of houses with no proper use of preventive measures, malaria is firmly established. We conclude that community based interventions which bring improvement in standard of living, access to healthcare facilities and health awareness, will have a significant impact on malaria prevention in these areas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Neeru Singh
- National Institue for Research in Tribal Health (ICMR); National Institute of Malaria Research (Field Station) (ICMR), Jabalpur, Madhya Pradesh, India
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14
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Kateera F, Ingabire CM, Hakizimana E, Kalinda P, Mens PF, Grobusch MP, Mutesa L, van Vugt M. Malaria, anaemia and under-nutrition: three frequently co-existing conditions among preschool children in rural Rwanda. Malar J 2015; 14:440. [PMID: 26542672 PMCID: PMC4635556 DOI: 10.1186/s12936-015-0973-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/28/2015] [Indexed: 11/23/2022] Open
Abstract
Background Malaria, anaemia and under-nutrition are three highly prevalent and frequently co-existing diseases that cause significant morbidity and mortality particularly among children aged less than 5 years. Currently, there is paucity of conclusive studies on the burden of and associations between malaria, anaemia and under-nutrition in Rwanda and comparable sub-Saharan and thus, this study measured the prevalence of malaria parasitaemia, anaemia and under-nutrition among preschool age children in a rural Rwandan setting and evaluated for interactions between and risk determinants for these three conditions. Methods A cross-sectional household (HH) survey involving children aged 6–59 months was conducted. Data on malaria parasitaemia, haemoglobin densities, anthropometry, demographics, socioeconomic status (SES) and malaria prevention knowledge and practices were collected. Results The prevalences of malaria parasitaemia and anaemia were 5.9 and 7.0 %, respectively, whilst the prevalence of stunting was 41.3 %. Malaria parasitaemia risk differed by age groups with odds ratio (OR) = 2.53; P = 0.04 for age group 24–35 months, OR = 3.5; P = 0.037 for age group 36–47 months, and OR = 3.03; P = 0.014 for age group 48–60 months, whilst a reduced risk was found among children living in high SES HHs (OR = 0.37; P = 0.029). Risk of anaemia was high among children aged ≥12 months, those with malaria parasitaemia (OR = 3.86; P ≤ 0.0001) and children living in HHs of lower SES. Overall, under-nutrition was not associated with malaria parasitaemia. Underweight was higher among males (OR = 1.444; P = 0.019) and children with anaemia (OR = 1.98; P = 0.004). Conclusions In this study group, four in 10 and one in 10 children were found stunted and underweight, respectively, in an area of low malaria transmission. Under-nutrition was not associated with malaria risk. While the high prevalence of stunting requires urgent response, reductions in malaria parasitaemia and anaemia rates may require, in addition to scaled-up use of insecticide-treated bed nets and indoor residual insecticide spraying, improvements in HH SES and better housing to reduce risk of malaria.
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Affiliation(s)
- Fredrick Kateera
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. .,Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda.
| | - Chantal M Ingabire
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda.
| | - Emmanuel Hakizimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda.
| | - Parfait Kalinda
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda.
| | - Petra F Mens
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. .,Royal Tropical Institute, Koninklijk Instituut voor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands.
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
| | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Michèle van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
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15
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Njunda AL, Fon SG, Assob JCN, Nsagha DS, Kwenti TDB, Kwenti TE. Coinfection with malaria and intestinal parasites, and its association with anaemia in children in Cameroon. Infect Dis Poverty 2015; 4:43. [PMID: 26445484 PMCID: PMC4595138 DOI: 10.1186/s40249-015-0078-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to determine the prevalence of coinfection with malaria and intestinal parasites, as well as to determine its association with anaemia in children aged 10 years and below in Muyuka, Cameroon. Materials and methods This was a cross-sectional study. Participants were febrile children who were admitted to the Muyuka district hospital between April and October 2012. Blood and stool samples were collected from those participants who gave consent to take part in the study. Haemoglobin concentration (Hb) and complete blood count (CBC) were performed using an automated haematology analyser (Mindray®, BC-2800). Giemsa-stained blood film was examined to detect malaria parasites, while the formol-ether concentration technique was used to detect intestinal parasitic infections (IPIs). The Pearson’s chi-square, Student’s T-test and correlation analysis were all performed as part of the statistical analyses. Results Four hundred and eleven (411) children successfully took part in this study. The prevalence of malaria, IPIs, malaria and IPI coinfection, and anaemia observed were 98.5 %, 11.9 %, 11.9 % and 44.8 %, respectively. Anaemia and IPIs were significantly associated with age; anaemia was more prevalent in children under five years of age (p = 0.000), whereas IPIs were more prevalent in children aged between five and 10 years (p = 0.006). The parasite species isolated included Ascaris lumbricoides (36 [73.5 %]), Entamoeba histolytica/dispar (9 [18.4 %]) and hookworm (4 [8.2 %]). The mean Hb observed was 10.64 g/dl (±1.82). A significant negative correlation was observed between malaria parasite density and Hb. There was no significant difference in the prevalence of anaemia among children infected with malaria, IPIs, or malaria and IPI coinfection, or among non-infected children. Similarly, the mean Hb did not differ among infected and non-infected children. Conclusion This study showed that malaria and IPIs still constitute a major public health problem in the study area despite a lack of any significant association between these infections and anaemia. The findings suggest that there is a need for the implementation of control measures to curb the rate of malaria and IPIs in the study area.
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Affiliation(s)
- Anna Longdoh Njunda
- Department of Medical Laboratory Sciences, University of Buea, P.B. 63, Buea, Cameroon.
| | - Shuri Ghasarah Fon
- Department of Medical Laboratory Sciences, University of Buea, P.B. 63, Buea, Cameroon.
| | | | - Dickson Shey Nsagha
- Department of Public Health and Hygiene, University of Buea, P.B. 63, Buea, Cameroon.
| | | | - Tebit Emmanuel Kwenti
- Department of Medical Laboratory Sciences, University of Buea, P.B. 63, Buea, Cameroon. .,Department of Microbiology and Parasitology, University of Buea, P.B. 63, Buea, Cameroon.
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16
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Kepha S, Nuwaha F, Nikolay B, Gichuki P, Edwards T, Allen E, Njenga SM, Mwandawiro CS, Brooker SJ. Epidemiology of coinfection with soil transmitted helminths and Plasmodium falciparum among school children in Bumula District in western Kenya. Parasit Vectors 2015; 8:314. [PMID: 26063324 PMCID: PMC4486705 DOI: 10.1186/s13071-015-0891-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/07/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many school children living in Africa are infected with plasmodia and helminth species and are consequently at risk of coinfection. However, the epidemiology of such coinfection and the implications of coinfection for children's health remain poorly understood. This study describes the epidemiology of Ascaris lumbricoides-Plasmodium and hookworm-Plasmodium coinfection among school children living in western Kenya and investigates the associated risk factors. METHODS As part of a randomized trial, a baseline cross-sectional survey was conducted among school children aged 5-18 years in 23 schools in Bumula District. Single stool samples were collected to screen for helminth infections using the Kato-Katz technique and malaria parasitaemia was determined from a finger prick blood sample. Demographic and anthropometric data were also collected. RESULTS Overall, 46.4% of the children were infected with Plasmodium falciparum while 27.6% of the children were infected with at least one soil transmitted helminth (STH) species, with hookworm being the most common (16.8%) followed by A. lumbricoides (15.3%). Overall 14.3% of the children had STH-Plasmodium coinfection, with hookworm-Plasmodium (9.0%) coinfection being the most common. Geographical variation in the prevalence of coinfection occurred between schools. In multivariable logistic regression analysis, hookworm was positively associated with P. falciparum infection. In stratified analysis, hookworm infection was associated with increased odds of P. falciparum infection among both boys (P < 0.001) and girls (P = 0.01), whereas there was no association between A. lumbricoides and P. falciparum. CONCLUSION These findings demonstrate STH infections are still prevalent, despite the ongoing national deworming programme in Kenya, and that malaria parasitaemia is widespread, such that coinfection occurs among a proportion of children. A subsequent trial will allow us to investigate the implications of coinfection for the risk of clinical malaria.
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Affiliation(s)
- Stella Kepha
- College of Health Sciences, Makerere University, Kampala, Uganda. .,Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Fred Nuwaha
- College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Birgit Nikolay
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Paul Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Tansy Edwards
- London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Charles S Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Simon J Brooker
- London School of Hygiene & Tropical Medicine, London, UK. .,KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
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17
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Kinung'hi SM, Magnussen P, Kishamawe C, Todd J, Vennervald BJ. The impact of anthelmintic treatment intervention on malaria infection and anaemia in school and preschool children in Magu district, Tanzania: an open label randomised intervention trial. BMC Infect Dis 2015; 15:136. [PMID: 25887977 PMCID: PMC4391149 DOI: 10.1186/s12879-015-0864-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/02/2015] [Indexed: 01/12/2023] Open
Abstract
Background Some studies have suggested that helminth infections increase the risk of malaria infection and are associated with increased number of malaria attacks and anaemia. Thus interventions to control helminth infections may have an impact on incidence of clinical malaria and anaemia. The current study assessed the impact of two anthelmintic treatment approaches on malaria infection and on anaemia in school and pre-school children in Magu district, Tanzania. Methods A total of 765 children were enrolled into a prospective randomized anthelmintic intervention trial following a baseline study of 1546 children. Enrolled children were randomized to receive either repeated treatment with praziquantel and albendazole four times a year (intervention group, 394 children) or single dose treatment with praziquantel and albendazole once a year (control group, 371 children). Follow up examinations were conducted at 12 and 24 months after baseline to assess the impact of the intervention. Stool and urine samples were collected and examined for schistosome and soil transmitted helminth infections. Blood samples were also collected and examined for malaria parasites and haemoglobin concentrations. Monitoring of clinical malaria attacks was performed at each school during the two years of the intervention. Results Out of 1546 children screened for P. falciparum, S. mansoni, S. haematobium, hookworm and T. Trichiura at baseline, 1079 (69.8%) were infected with at least one of the four parasites. There was no significant difference in malaria infection (prevalence, parasite density and frequency of malaria attacks) and in the prevalence of anaemia between the repeated and single dose anthelmintic treatment groups at 12 and 24 months follow up (p > 0.05). However, overall, there was significant improvement in mean haemoglobin concentrations (p < 0.001) from baseline levels of 122.0g/L and 123.0g/L to 136.0g/L and 136.8g/L for the repeated and single dose treatment groups, respectively, at 24 months follow-up which resulted in significant reduction in prevalence of anaemia. Conclusions These results suggest that repeated anthelmintic treatment did not have an impact on malaria infection compared to single dose treatment. However, both treatment approaches had overall impact in terms of improvements of haemoglobin levels and hence reductions in prevalence of anaemia.
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Affiliation(s)
- Safari M Kinung'hi
- National Institute for Medical Research (NIMR), Mwanza Centre, Isamilo Road, PO Box 1462, Mwanza, Tanzania.
| | - Pascal Magnussen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 15 DK-1870 Frederiksberg C, Copenhagen, Denmark.
| | - Coleman Kishamawe
- National Institute for Medical Research (NIMR), Mwanza Centre, Isamilo Road, PO Box 1462, Mwanza, Tanzania.
| | - Jim Todd
- Depatment of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E, 7HT, London, UK.
| | - Birgitte J Vennervald
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 15 DK-1870 Frederiksberg C, Copenhagen, Denmark.
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18
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Wumba RD, Zanga J, Aloni MN, Mbanzulu K, Kahindo A, Mandina MN, Ekila MB, Mouri O, Kendjo E. Interactions between malaria and HIV infections in pregnant women: a first report of the magnitude, clinical and laboratory features, and predictive factors in Kinshasa, the Democratic Republic of Congo. Malar J 2015; 14:82. [PMID: 25884992 PMCID: PMC4336768 DOI: 10.1186/s12936-015-0598-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/30/2015] [Indexed: 11/12/2022] Open
Abstract
Background HIV and malaria are among the leading causes of morbidity and mortality during pregnancy in Africa. However, data from Congolese pregnant women are lacking. The aim of the study was to determine the magnitude, predictive factors, clinical, biologic and anthropometric consequences of malaria infection, HIV infection, and interactions between malaria and HIV infections in pregnant women. Methods A cross-sectional study was conducted among pregnant women admitted and followed up at Camp Kokolo Military Hospital from 2009 to 2012 in Kinshasa, the Democratic Republic of Congo. Differences in means between malaria-positive and malaria-negative cases or between HIV-positive and HIV-negative cases were compared using the Student’s t-test or a non-parametric test, if appropriate. Categorical variables were compared using the Chi-square or Fisher’s exact test, if appropriate. Backward multivariable analysis was used to evaluate the potential risk factors of malaria and HIV infections. The odds ratios with their 95% confidence interval (95% CI) were estimated to measure the strengths of the associations. Analyses resulting in values of P < 0.05 were considered significant. Results A malaria infection was detected in 246/332 (74.1%) pregnant women, and 31.9% were anaemic. Overall, 7.5% (25/332) of mothers were infected by HIV, with a median CD4 count of 375 (191; 669) cells/μL. The mean (±SD) birth weight was 2,613 ± 227 g, with 35.7% of newborns weighing less than 2,500 g (low birth weight). Low birth weight, parity and occupation were significantly different between malaria-infected and uninfected women in adjusted models. However, fever, anemia, placenta previa, marital status and district of residence were significantly associated to HIV infection. Conclusion The prevalence of malaria infection was high in pregnant women attending the antenatal facilities or hospitalized and increased when associated with HIV infection.
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Affiliation(s)
- Roger D Wumba
- Department of Tropical Medicine, Infectious and Parasitic Diseases, Department of Parasitology, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo.
| | - Josué Zanga
- Department of Tropical Medicine, Infectious and Parasitic Diseases, Department of Parasitology, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo.
| | - Michel N Aloni
- Department of Pediatrics, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshas, Kinshasa, the Democratic Republic of Congo.
| | - Kennedy Mbanzulu
- Department of Tropical Medicine, Infectious and Parasitic Diseases, Department of Parasitology, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo.
| | - Aimé Kahindo
- Department of Tropical Medicine, Infectious and Parasitic Diseases, Department of Parasitology, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo.
| | - Madone N Mandina
- Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo.
| | - Mathilde B Ekila
- Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo.
| | - Oussama Mouri
- Centre Nationale de Référence du Paludisme, AP-HP, CHU Pitie Salpêtrière-Charles Foix, 47, boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. .,Laboratory of Parasitology and Mycology, Pitié Salpêtrière Hospital, Public Assistance-Hospitals of Paris, Pierre and Marie Curie University, Paris, France.
| | - Eric Kendjo
- Centre Nationale de Référence du Paludisme, AP-HP, CHU Pitie Salpêtrière-Charles Foix, 47, boulevard de l'Hôpital, 75651, Paris, Cedex 13, France. .,Laboratory of Parasitology and Mycology, Pitié Salpêtrière Hospital, Public Assistance-Hospitals of Paris, Pierre and Marie Curie University, Paris, France. .,Department of Parasitology, Mycology and Tropical Medicine, Faculty of Medicine, University of Health Sciences, Libreville, Gabon. .,Institute of Tropical Medicine, University of Tubingen, Tubingen, Germany.
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19
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Kateera F, Mens PF, Hakizimana E, Ingabire CM, Muragijemariya L, Karinda P, Grobusch MP, Mutesa L, van Vugt M. Malaria parasite carriage and risk determinants in a rural population: a malariometric survey in Rwanda. Malar J 2015; 14:16. [PMID: 25604040 PMCID: PMC4308829 DOI: 10.1186/s12936-014-0534-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/27/2014] [Indexed: 01/05/2023] Open
Abstract
Background Based on routine health facility case data, Rwanda has achieved a significant malaria burden reduction in the past ten years. However, community-based malaria parasitaemia burden and reasons for continued residual infections, despite a high coverage of control interventions, have yet to be characterized. Measurement of malaria parasitaemia rates and evaluation of associated risk factors among asymptomatic household members in a rural community in Rwanda were conducted. Methods A malariometric household survey was conducted between June and November 2013, involving 12,965 persons living in 3,989 households located in 35 villages in a sector in eastern Rwanda. Screening for malaria parasite carriage and collection of demographic, socio-economic, house structural features, and prior fever management data, were performed. Logistic regression models with adjustment for within- and between-households clustering were used to assess malaria parasitaemia risk determinants. Results Overall, malaria parasitaemia was found in 652 (5%) individuals, with 518 (13%) of households having at least one parasitaemic member. High malaria parasite carriage risk was associated with being male, child or adolescent (age group 4–15), reported history of fever and living in a household with multiple occupants. A malaria parasite carriage risk-protective effect was associated with living in households of, higher socio-economic status, where the head of household was educated and where the house floor or walls were made of cement/bricks rather than mud/earth/wood materials. Parasitaemia cases were found to significantly cluster in the Gikundamvura area that neighbours marshlands. Conclusion Overall, Ruhuha Sector can be classified as hypo-endemic, albeit with a particular ‘cell of villages’ posing a higher risk for malaria parasitaemia than others. Efforts to further reduce transmission and eventually eliminate malaria locally should focus on investments in programmes that improve house structure features (that limit indoor malaria transmission), making insecticide-treated bed nets and indoor residual spraying implementation more effective.
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Affiliation(s)
- Fredrick Kateera
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1100 DE, The Netherlands.
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Zoungrana A, Chou YJ, Pu C. Socioeconomic and environment determinants as predictors of severe malaria in children under 5 years of age admitted in two hospitals in Koudougou district, Burkina Faso: a cross sectional study. Acta Trop 2014; 139:109-14. [PMID: 25076108 DOI: 10.1016/j.actatropica.2014.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
Burkina Faso has a high incidence and death rate of severe malaria, especially for children under 5 years of age. Although the malaria elimination program is a high-priority public health project, finding an effective strategy for managing the problem is a major challenge. Understanding the various factors that contribute to the severity of malaria is essential in designing an effective strategy. In this study, parental and environmental factors associated with severe malaria in Burkinabè children were investigated in two hospitals in Koudougou Health District, Burkina Faso. Between July and September 2012, a cross-sectional study was used to test 510 children under 5 years of age (mean age: 23.5 months) admitted with suspected malaria. Each child was screened using a blood smear to identify whether he or she had severe malaria based on the criteria established by the World Health Organization (WHO). When a child was diagnosed with malaria, either severe or not severe, the parents were interviewed by a trained interviewer using a structured questionnaire. A logistic regression was used to identify the determinants of severe malaria and associated deaths. Of the 510 children having malaria, 201 (39.4%) had severe malaria. Most of the patients (54.9%) lived in rural areas. The main factors associated with severe malaria were low education level of the father, low socioeconomic status [odds ratio (OR)=4.11, 95% confidence interval (CI)=1.44-11.75], delayed treatment [OR=4.53, 95% CI=1.76-11.65], treating children at home as a typical practice when the child has a fever [OR=3.24, 95% CI=1.40-7.51], living in rural area [OR=6.66, 95% CI=3.36-13.22], and living beside a water gathering pond (OR=1.67, 95% CI=1.02-2.74]. Parental and environmental context associated with severe malaria for children under 5 years of age remains a serious public health problem that affects malaria outcomes in resource-limited areas. Promotion of early care is urgently required. Parents should be given information on the risks of not consulting a health facility when children exhibit symptoms of malaria.
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Intestinal parasites coinfection does not alter plasma cytokines profile elicited in acute malaria in subjects from endemic area of Brazil. Mediators Inflamm 2014; 2014:857245. [PMID: 25309052 PMCID: PMC4182071 DOI: 10.1155/2014/857245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/01/2014] [Indexed: 01/13/2023] Open
Abstract
In Brazil, malaria is prevalent in the Amazon region and these regions coincide with high prevalence of intestinal parasites but few studies explore the interaction between malaria and other parasites. Therefore, the present study evaluates changes in cytokine, chemokine, C-reactive protein, and nitric oxide (NO) concentrations in 264 individuals, comparing plasma from infected individuals with concurrent malaria and intestinal parasites to individuals with either malaria infection alone and uninfected. In the studied population 24% of the individuals were infected with Plasmodium and 18% coinfected with intestinal parasites. Protozoan parasites comprised the bulk of the intestinal parasites infections and subjects infected with intestinal parasites were more likely to have malaria. The use of principal component analysis and cluster analysis associated increased levels of IL-6, TNF-α, IL-10, and CRP and low levels of IL-17A predominantly with individuals with malaria alone and coinfected individuals. In contrast, low levels of almost all inflammatory mediators were associated predominantly with individuals uninfected while increased levels of IL-17A were associated predominantly with individuals with intestinal parasites only. In conclusion, our data suggest that, in our population, the infection with intestinal parasites (mainly protozoan) does not modify the pattern of cytokine production in individuals infected with P. falciparum and P. vivax.
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Kinung'hi SM, Magnussen P, Kaatano GM, Kishamawe C, Vennervald BJ. Malaria and helminth co-infections in school and preschool children: a cross-sectional study in Magu district, north-western Tanzania. PLoS One 2014; 9:e86510. [PMID: 24489732 PMCID: PMC3906044 DOI: 10.1371/journal.pone.0086510] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malaria, schistosomiasis and soil transmitted helminth infections (STH) are important parasitic infections in Sub-Saharan Africa where a significant proportion of people are exposed to co-infections of more than one parasite. In Tanzania, these infections are a major public health problem particularly in school and pre-school children. The current study investigated malaria and helminth co-infections and anaemia in school and pre-school children in Magu district, Tanzania. METHODOLOGY School and pre-school children were enrolled in a cross-sectional study. Stool samples were examined for Schistosoma mansoni and STH infections using Kato Katz technique. Urine samples were examined for Schistosoma haematobium using the urine filtration method. Blood samples were examined for malaria parasites and haemoglobin concentrations using the Giemsa stain and Haemoque methods, respectively. PRINCIPAL FINDINGS Out of 1,546 children examined, 1,079 (69.8%) were infected with one or more parasites. Malaria-helminth co-infections were observed in 276 children (60% of all children with P. falciparum infection). Malaria parasites were significantly more prevalent in hookworm infected children than in hookworm free children (p = 0.046). However, this association was non-significant on multivariate logistic regression analysis (OR = 1.320, p = 0.064). Malaria parasite density decreased with increasing infection intensity of S. mansoni and with increasing number of co-infecting helminth species. Anaemia prevalence was 34.4% and was significantly associated with malaria infection, S. haematobium infection and with multiple parasite infections. Whereas S. mansoni infection was a significant predictor of malaria parasite density, P. falciparum and S. haematobium infections were significant predictors of anaemia. CONCLUSIONS/SIGNIFICANCE These findings suggest that multiple parasite infections are common in school and pre-school children in Magu district. Concurrent P. falciparum, S. mansoni and S. haematobium infections increase the risk of lower Hb levels and anaemia, which in turn calls for integrated disease control interventions. The associations between malaria and helminth infections detected in this study need further investigation.
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Affiliation(s)
- Safari M. Kinung'hi
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza, Tanzania
| | - Pascal Magnussen
- DBL-Centre for Health Research and Development, Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Godfrey M. Kaatano
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza, Tanzania
| | - Birgitte J. Vennervald
- DBL-Centre for Health Research and Development, Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
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Helpful or a Hindrance: Co-infections with Helminths During Malaria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 828:99-129. [DOI: 10.1007/978-1-4939-1489-0_5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Co-infection of individual hosts by multiple parasite species is a pattern that is very commonly observed in natural populations. Understanding the processes that generate these patterns poses a challenge. For example, it is difficult to discern the relative roles of exposure and susceptibility in generating the mixture and density of parasites within hosts. Yet discern them we must, if we are to design and deliver successful medical interventions for co-infected populations. Here, we synthesise an emergent understanding of how processes operate and interact to generate patterns of co-infection. We consider within-host communities (or infracommunities) generally, that is including not only classical parasites but also the microbiota that are so abundant on mucosal surfaces and which are increasingly understood to be so influential on host biology. We focus on communities that include a helminth, but we expect similar inferences to pertain to other taxa. We suggest that, thanks to recent research at both the within-host (e.g. immunological) and between-host (e.g. epidemiological) scales, researchers are poised to reveal the processes that generate the observed distribution of parasite communities among hosts. Progress will be facilitated by using new technologies as well as statistical and experimental tools to test competing hypotheses about processes that might generate patterns in co-infection data. By understanding the multiple interactions that underlie patterns of co-infection, we will be able to understand and intelligently predict how a suite of co-infections (and thus the host that bears them) will together respond to medical interventions as well as other environmental changes. The challenge for us all is to become scholars of co-infections.
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Affiliation(s)
- Mark E Viney
- School of Biological Sciences, University of Bristol, Woodland Road, UK.
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Dantur Juri MJ, Veggiani Aybar CA, Ortega ES, Galante GB, Zaidenberg MO. Plasmodium vivax and Mansonella ozzardi co-infection in north-western Argentina. Malar J 2013; 12:248. [PMID: 23866313 PMCID: PMC3718665 DOI: 10.1186/1475-2875-12-248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/13/2013] [Indexed: 11/18/2022] Open
Abstract
A case of co-infection with Plasmodium vivax and Mansonella ozzardi was detected in a blood sample from a person who had shown symptoms of malaria and lived in a city that was close to the Argentina/Bolivia border. The case was detected during a random revision of thick and thin smears from patients diagnosed with malaria from various towns and cities located in north-western Argentina between 1983 and 2001. Trophozoites of P. vivax were observed in the thin blood smear along with M. ozzardi microfilaria (larval form), which presented a long, slender, pointed anucleate tail and the absence of the sheath. This last characteristic is shared with Mansonella perstans, Mansonella streptocerca and Onchocerca volvulus. More rigorously controlled studies to detect other co-infection cases in the area as well as the possibility of importation from Bolivia into Argentina are currently ongoing. The relationship between the malaria parasite and microfilaria, the potential effect of malaria treatment on the development of M. ozzardi, and the possible impact of this microfilaria on the immunity of a person against P. vivax are all still unknown. This contribution constitutes a point of focus for future studies involving the interaction between the parasites and the potential risk that humans are exposed to.
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Affiliation(s)
- María J Dantur Juri
- Instituto Superior de Entomología Dr. Abraham Willink, Facultad de Ciencias Naturales e Instituto Miguel Lillo, Universidad Nacional de Tucumán, Miguel Lillo 205, San Miguel de Tucumán, Tucumán, Argentina.
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Getachew M, Tafess K, Zeynudin A, Yewhalaw D. Prevalence soil transmitted helminthiasis and malaria co-infection among pregnant women and risk factors in Gilgel Gibe Dam area, southwest Ethiopia. BMC Res Notes 2013; 6:263. [PMID: 23837685 PMCID: PMC3710253 DOI: 10.1186/1756-0500-6-263] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022] Open
Abstract
Background Malaria and Soil Transmitted Helminthiasis (STH) are co-endemic and major public health problems in Ethiopia. The aim of the study was to assess the prevalence of malaria and STHs co-infection and to determine the association risk factors. Methods A cross-sectional community based study was conducted on 388 pregnant women living in three districts around Gilgel Gibe Dam area, southwestern Ethiopia. Socio-demographic and socio-economic data, single stool sample and blood sample were collected from each participant. Results The prevalence of STH and malaria was 159 (41%) and 45 (11.6%), respectively and the prevalence of STHs/malaria co-infection was 30 (7.7%). Hookworm was the most prevalent 114 (29.4%) soil transmitted helminthiasis infection followed by Ascaris lumbricoides (A. lumbricoides) 58 (15%) and Trichuris trichiura (T. trichiura) 13 (3.4%). Habit of eating soil (Adjusted Odds Ratio (AOR) = 4.64, 95% CI: 1.50-14.36, P=0.008), presence of stagnant water near study participants’ house (AOR=2.99, 95% CI: 1.28-6.99, P=0.012) and habit of using human feces as a fertilizer (AOR= 5.34, 95% CI: 1.99-14.28, P<0.001) were found to be significantly associated with malaria and STH co-infection among the pregnant women. Hookworm parasitic load was positively correlated with malaria parasitic load (r = 0.299, P<0.001) while A. lumbricoides parasitic load was negatively correlated with malaria parasitic load (r = −0.095, P<0.001). Conclusion Intestinal parasite and/or malaria co-infection is a health problem among pregnant women living around Gilgel Gibe dam area. Therefore, intervention including improving sanitation, removing stagnant water, and health education to the pregnant women should be given.
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Affiliation(s)
- Million Getachew
- Department of Biomedical Science, School of Health and Hospital, Adama Science and Technology University, Asella, Ethiopia
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Severity of outcomes associated to types of HIV coinfection with TB and malaria in a setting where the three pandemics overlap. J Community Health 2013; 37:1234-8. [PMID: 22477668 DOI: 10.1007/s10900-012-9559-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objectives of this study is to (1) characterize profiles of HIV coinfection with TB and malaria; (2) estimate the severity of outcome associated with each type of coinfection; (3) identify most severe coinfection type, and populations most affected. Data on 1,302 HIV/AIDS patients were collected from hospital record books for 2007 and 2008. Distribution patterns of types of HIV coinfection with TB and malaria were assessed among low and high SES (socioeconomic status) inpatients. Case fatality rate for each type of coinfection was estimated as the ratio of number of deaths associated with a specific type of coinfection over the number of cases, times 100. Case fatality rates were compared among coinfection types and between low and high SES inpatients. Four types of coinfections were identified: single-HIV, HIV-TB, HIV-malaria and HIV-TB-malaria. Single-HIV infection was the most prevalent, and predominant among high SES inpatients; HIV-TB was the second most prevalent, and predominant among low SES inpatients; HIV-malaria and HIV-TB-malaria coinfections were the least prevalent, they were relatively comparable between both SES groups. HIV-TB coinfection was the deadliest type of coinfection, followed by HIV-TB-malaria and HIV-malaria. Single-HIV infection was the least deadly of the four conditions. Aside from HIV-malaria, the proportion of fatalities associated with each coinfection type was higher among low SES inpatients when compared with high SES inpatients. HIV/AIDS treatment and care programs in communities with limited resources and high prevalence of malaria and TB should give priority attention to low socioeconomic status patients coinfected with TB to prevent unnecessary deaths among those living with HIV.
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Abanyie FA, McCracken C, Kirwan P, Molloy SF, Asaolu SO, Holland CV, Gutman J, Lamb TJ. Ascaris co-infection does not alter malaria-induced anaemia in a cohort of Nigerian preschool children. Malar J 2013; 12:1. [PMID: 23282136 PMCID: PMC3544581 DOI: 10.1186/1475-2875-12-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/26/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Co-infection with malaria and intestinal parasites such as Ascaris lumbricoides is common. Malaria parasites induce a pro-inflammatory immune response that contributes to the pathogenic sequelae, such as malarial anaemia, that occur in malaria infection. Ascaris is known to create an anti-inflammatory immune environment which could, in theory, counteract the anti-malarial inflammatory immune response, minimizing the severity of malarial anaemia. This study examined whether Ascaris co-infection can minimize the severity of malarial anaemia. METHODS Data from a randomized controlled trial on the effect of antihelminthic treatment in Nigerian preschool-aged (6-59 months) children conducted in 2006-2007 were analysed to examine the effect of malaria and Ascaris co-infection on anaemia severity. Children were enrolled and tested for malaria, helminths and anaemia at baseline, four, and eight months. Six hundred and ninety subjects were analysed in this study. Generalized linear mixed models were used to assess the relationship between infection status and Ascaris and Plasmodium parasite intensity on severity of anaemia, defined as a haemoglobin less than 11 g/dL. RESULTS Malaria prevalence ranged from 35-78% over the course of this study. Of the malaria-infected children, 55% were co-infected with Ascaris at baseline, 60% were co-infected four months later and 48% were co-infected eight months later, underlining the persistent prevalence of malaria-nematode co-infections in this population. Over the course of the study the percentage of anaemic subjects in the population ranged between 84% at baseline and 77% at the eight-month time point. The odds of being anaemic were four to five times higher in children infected with malaria compared to those without malaria. Ascaris infection alone did not increase the odds of being anaemic, indicating that malaria was the main cause of anaemia in this population. There was no significant difference in the severity of anaemia between children singly infected with malaria and co-infected with malaria and Ascaris. CONCLUSION In this cohort of Nigerian preschool children, malaria infection was the major contributor to anaemia status. Ascaris co-infection neither exacerbated nor ameliorated the severity of malarial anaemia.
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Degarege A, Legesse M, Medhin G, Animut A, Erko B. Malaria and related outcomes in patients with intestinal helminths: a cross-sectional study. BMC Infect Dis 2012; 12:291. [PMID: 23136960 PMCID: PMC3519704 DOI: 10.1186/1471-2334-12-291] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/03/2012] [Indexed: 11/30/2022] Open
Abstract
Background The effects of helminth co-infection on malaria in humans remain uncertain. This study aimed to evaluate the nature of association of intestinal helminths with prevalence and clinical outcomes of Plasmodium infection. Methods A cross-sectional study involving 1,065 malaria suspected febrile patients was conducted at Dore Bafeno Health Center, Southern Ethiopia, from December 2010 to February 2011. Plasmodium and intestinal helminth infections were diagnosed using Giemsa-stained blood films and Kato-Katz technique, respectively. Haemoglobin level was determined using a haemocue machine. Results Among 1,065 malaria suspected febrile patients, 28.8% were positive for Plasmodium parasites (P. falciparum =13.0%, P. vivax =14.5%, P. falciparum and P. vivax =1.3%). Among 702 patients who provided stool samples, 53.8%, 31.6% and 19.4% were infected with intestinal helminths, Plasmodium alone and with both Plasmodium and intestinal helminths, respectively. The prevalence of infections with Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), Schistosoma mansoni (S. mansoni) and hookworm (9.8%) were 35.9%, 15.8%, 11.7% and 9.8%, respectively. Out of the 222 (31.6%) Plasmodium infected cases, 9 (4.1%) had severe malaria. P. falciparum infection was more common in febrile patients infected with A. lumbricoides alone (21.3%), T. trichiura alone (23.1%) and S. mansoni alone (23.1%) compared to those without intestinal helminth infections (9.3%) (p<0.001 for all). Prevalence of non-severe malaria was significantly higher in individuals infected with intestinal helminths than in those who were not infected with intestinal helminths (adjusted OR=1.58, 95% CI=1.13-2.22). The chance of developing non-severe P. falciparum malaria were 2.6, 2.8 and 3.3 times higher in individuals infected with A. lumbricoides alone, T. trichiura alone and S. mansoni alone, respectively, compared to intestinal helminth-free individuals (p<0.05 for all). The odds ratio for being infected with non-severe P. falciparum increased with the number of intestinal helminth species (p<0.001). Mean Plasmodium density among intestinal helminth infected individuals was significantly increased with the number of intestinal helminths species (p=0.027). Individuals who were co-infected with different species of intestinal helminths and Plasmodium showed lower mean haemoglobin concentration than individuals who were infected only with Plasmodium. Conclusions Infections with A. lumbricoides, T. trichiura and S. mansoni were positively associated with P. falciparum infection. However, further studies are required to investigate how these helminths could contribute to increased prevalence of P. falciparum infection.
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Affiliation(s)
- Abraham Degarege
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia.
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Novignon J, Nonvignon J. Socioeconomic status and the prevalence of fever in children under age five: evidence from four sub-Saharan African countries. BMC Res Notes 2012; 5:380. [PMID: 22840190 PMCID: PMC3502087 DOI: 10.1186/1756-0500-5-380] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/13/2012] [Indexed: 01/15/2023] Open
Abstract
Background The burden of fevers remains enormous in sub-Saharan Africa. While several efforts at reducing the burden of fevers have been made at the macro level, the relationship between socioeconomic status and fever prevalence has been inconclusive at the household and individual levels. The purpose of this study was to examine how individual and household socioeconomic status influences the prevalence of fever among children under age five in four sub-Saharan African countries. Methods The study used data from the 2008 Demographic and Health Survey (DHS) from Ghana, Nigeria, Kenya and Sierra Leone with a total of 38,990 children below age five. A multi-level random effects logistic model was fitted to examine the socioeconomic factors that influence the prevalence of fever in the two weeks preceding the survey. Data from the four countries were also combined to estimate this relationship, after country-specific analysis. Results The results show that children from wealthier households reported lower prevalence of fever in Ghana, Nigeria and Kenya. Result from the combined dataset shows that children from wealthier households were less likely to report fever. In general, vaccination against fever-related diseases and the use of improved toilet facility reduces fever prevalence. The use of bed nets by children and mothers did not show consistent relationship across the countries. Conclusion Poverty does not only influence prevalence of fever at the macro level as shown in other studies but also the individual and household levels. Policies directed towards preventing childhood fevers should take a close account of issues of poverty alleviation. There is also the need to ensure that prevention and treatment mechanisms directed towards fever related diseases (such as malaria, pneumonia, measles, diarrhoea, polio, tuberculosis etc.) are accessible and effectively used.
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Affiliation(s)
- Jacob Novignon
- Department of Economics, University of Ibadan, Ibadan, Nigeria.
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Plasmodium falciparum and helminth coinfections among schoolchildren in relation to agro-ecosystems in Mvomero District, Tanzania. Acta Trop 2011; 120:95-102. [PMID: 21741929 DOI: 10.1016/j.actatropica.2011.06.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/08/2011] [Accepted: 06/23/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND In Sub-Saharan Africa, some individuals infected with malaria are also infected with helminths. However, the magnitude and distribution of such coinfections in relation to eco-systems remains poorly defined. This study was undertaken to determine the prevalence of Plasmodium falciparum and helminth coinfections among schoolchildren in relation to agro-ecosystems in Mvomero District, Tanzania. METHODS The agro-ecosystems were categorised as sugarcane, traditional flooding rice irrigation, improved non-flooding rice irrigation and savannah. Schoolchildren had their blood examined for P. falciparum and Wuchereria bancrofti; urine for Schistosoma haematobium and stool for intestinal helminths. Blood samples were also examined for haemoglobin concentration. RESULTS A total of 578 schoolchildren (mean age = 7.96 years) were involved in the study. Overall, 60% of all schoolchildren had at least an infection of either P. falciparum, W. bancrofti, S. haematobium or hookworm. The highest prevalence of P. falciparum (75.3%), W. bancrofti (62.9%) and hookworm (24.7%) infections was observed among children in flooding rice irrigation ecosystem. P. falciparum+S. haematobium (10.9%) and P. falciparum+W. bancrofti (11.1%) were the most prevalent types of coinfection in the area. The highest prevalence of double parasitic infections was observed among children in the flooding rice irrigation ecosystems. The risk for acquiring coinfections of P. falciparum+W. bancrofti was significantly higher among children in the flooding rice irrigation ecosystem. Forty-five (7.8%) children were coinfected with three types of parasitic infections. The risk of acquiring triple infection among children from flooding rice irrigation was higher for P. falciparum+S. haematobium+W. bancrofti (p<0.001). Seven schoolchildren (1.2%) were found infected with four parasites and all were from the flooding rice irrigation ecosystem. Significantly high P. falciparum geometric parasite density was observed among children coinfected with either hookworms or W. bancrofti (p<0.001). On average, 17.8% (103/578) of the children had enlarged spleens. Over 3- and 4-folds increase in the risk of having an enlarged spleen were observed among children coinfected with P. falciparum+S. haematobium and P. falciparum+W. bancrofti, respectively. The overall prevalence of anaemia (<11.5g/dl) was 61.9% (358/578). CONCLUSION Malaria-helminth coinfections are prevalent among schoolchildren in rural Tanzania and the pattern varies between agro-ecosystems. Results of this study suggest that integrated control of malaria and helminthes should be designed based on the local agro-ecosystems.
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Thigpen MC, Filler SJ, Kazembe PN, Parise ME, Macheso A, Campbell CH, Newman RD, Steketee RW, Hamel M. Associations between peripheral Plasmodium falciparum malaria parasitemia, human immunodeficiency virus, and concurrent helminthic infection among pregnant women in Malawi. Am J Trop Med Hyg 2011; 84:379-85. [PMID: 21363973 DOI: 10.4269/ajtmh.2011.10-0186] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Approximately 2 billion persons worldwide are infected with schistosomiasis and soil-transmitted helminths (STH), many in areas where endemic malaria transmission coexists. Few data exist on associations between these infections. Nested within a larger clinical trial, primigravid and secundigravid women provided blood samples for human immunodeficiency virus (HIV) testing and peripheral malaria films and stool and urine for evaluation of STH and Schistosoma spp. during their initial antenatal clinic visit. The most common parasitic infections were malaria (37.6%), S. haematobium (32.3%), and hookworm (14.4%); 14.2% of women were HIV-infected. S. haematobium infection was associated with lower malarial parasite densities (344 versus 557 parasites/μL blood; P < 0.05). In multivariate analysis, HIV and hookworm infection were independently associated with malaria infection (adjusted odds ratio = 1.9 and 95% confidence interval = 1.2-3.0 for HIV; adjusted odds ratio = 1.9 and 95% confidence interval = 1.03-3.5 for hookworm). Concurrent helminthic infection had both positive and negative effects on malaria parasitemia among pregnant women in Malawi.
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Affiliation(s)
- Michael C Thigpen
- Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Pullan RL, Kabatereine NB, Bukirwa H, Staedke SG, Brooker S. Heterogeneities and consequences of Plasmodium species and hookworm coinfection: a population based study in Uganda. J Infect Dis 2010; 203:406-17. [PMID: 21187338 PMCID: PMC3038339 DOI: 10.1093/infdis/jiq063] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. Previous studies have suggested that helminth infection exacerbates malaria, but few existing epidemiological studies adequately control for infection heterogeneities and confounding factors. In this study, we investigate spatial and household heterogeneities, predictors, and consequences of Plasmodium species and hookworm coinfection in rural communities in Uganda. Methods. A cross-sectional study was conducted among 1770 individuals aged 0–88 years in 4 villages. We recorded demographic, socioeconomic, and microgeographic factors during household surveys. We determined malaria parasitemia and hemoglobin concentration and collected stool samples on 2 consecutive days. For data analysis, we used a hierarchical, spatially explicit Bayesian framework. Results. Prevalence of Plasmodium-hookworm coinfection was 15.5% overall and highest among school-aged children. We found strong evidence of spatial and household clustering of coinfection and an enduring positive association between Plasmodium-species and hookworm infection among preschool-aged children (odds ratio [OR], 2.36; 95% Bayesian credible interval [BCI], 1.26–4.30) and adults (OR, 2.09; 95% BCI, 1.35–3.16) but not among school-aged children. Coinfection was associated with lower hemoglobin level only among school-aged children. Conclusions.Plasmodium-hookworm coinfection exhibits marked age dependency and significant spatial and household heterogeneity, and among preschool-aged children and adults, occurs more than would be expected by chance. Such heterogeneities provide insight into factors underlying observed patterns and the design of integrated control strategies.
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Affiliation(s)
- Rachel L Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Sangweme DT, Midzi N, Zinyowera-Mutapuri S, Mduluza T, Diener-West M, Kumar N. Impact of schistosome infection on Plasmodium falciparum Malariometric indices and immune correlates in school age children in Burma Valley, Zimbabwe. PLoS Negl Trop Dis 2010; 4:e882. [PMID: 21085468 PMCID: PMC2976682 DOI: 10.1371/journal.pntd.0000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 10/13/2010] [Indexed: 11/19/2022] Open
Abstract
A group of children aged 6-17 years was recruited and followed up for 12 months to study the impact of schistosome infection on malaria parasite prevalence, density, distribution and anemia. Levels of cytokines, malaria specific antibodies in plasma and parasite growth inhibition capacities were assessed. Baseline results suggested an increased prevalence of malaria parasites in children co-infected with schistosomiasis (31%) compared to children infected with malaria only (25%) (p = 0.064). Moreover, children co-infected with schistosomes and malaria had higher sexual stage geometric mean malaria parasite density (189 gametocytes/µl) than children infected with malaria only (73/µl gametocytes) (p = 0.043). In addition, a larger percentage of co-infected children (57%) had gametocytes as observed by microscopy compared to the malaria only infected children (36%) (p = 0.06). There was no difference between the two groups in terms of the prevalence of anemia, which was approximately 64% in both groups (p = 0.9). Plasma from malaria-infected children exhibited higher malaria antibody activity compared to the controls (p = 0.001) but was not different between malaria and schistosome plus malaria infected groups (p = 0.44) and malaria parasite growth inhibition activity at baseline was higher in the malaria-only infected group of children than in the co-infected group though not reaching statistical significance (p = 0.5). Higher prevalence and higher mean gametocyte density in the peripheral blood may have implications in malaria transmission dynamics during co-infection with helminths.
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Affiliation(s)
- Davison T. Sangweme
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nicholas Midzi
- Schistosomiasis Section, National Institute of Health Research, Harare, Zimbabwe
| | - Sekesai Zinyowera-Mutapuri
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Takafira Mduluza
- Biochemistry Department, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nirbhay Kumar
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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Steinmann P, Utzinger J, Du ZW, Zhou XN. Multiparasitism a neglected reality on global, regional and local scale. ADVANCES IN PARASITOLOGY 2010; 73:21-50. [PMID: 20627138 DOI: 10.1016/s0065-308x(10)73002-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review focuses on the issue of multiparasitism, with a special emphasis on its characteristics, its extent in eastern Asia and its significance for infectious disease control. Multiparasitism is pervasive among socially and economically disadvantaged or marginalised communities, particularly in tropical and subtropical areas. Intestinal parasites are the most numerous group, but an array of parasites is located elsewhere than in the human gastrointestinal tract. Although multiparasitism has been recognised for decades, in-depth studies are rare, and its public health and economic implications have yet to be fully elucidated. The assessment of multiparasitism is hampered by a lack of sensitive broad-spectrum diagnostic tools and the need to collect multiple biological samples for detailed appraisal. Non-specific symptoms and mainly subtle effects complicate the appreciation of its influence on cognitive and physical development, health, economic productivity and general well-being. Multiparasitism has been reported from virtually every eastern Asian country, and studies regarding the extent of multiparasitism and its effects on child health have been implemented in the region. However, new research is needed, as no comprehensive evaluations of multiparasitism in eastern Asia could be identified. Two case studies pertaining to multiparasitism at the local and regional scale are presented. Multiparasitism was rampant in an ethnic minority village in southern People's Republic of China where the challenges associated with its thorough evaluation are illustrated. The results from a cross-sectional survey covering 35 villages highlight the significance of its evaluation for the design of locally adapted and sustainable parasite control and poverty alleviation programmes. We conclude by listing a set of research needs for future investigations.
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Affiliation(s)
- Peter Steinmann
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
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Midzi N, Mtapuri-Zinyowera S, Mapingure M, Sangweme D, Chirehwa M, Brouwer K, Mudzori J, Hlerema G, Mutapi F, Kumar N, Mduluza T. Consequences of polyparasitism on anaemia among primary school children in Zimbabwe. Acta Trop 2010; 115:103-11. [PMID: 20175980 DOI: 10.1016/j.actatropica.2010.02.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 02/05/2010] [Accepted: 02/13/2010] [Indexed: 10/19/2022]
Abstract
The effect of concomitant infection with schistosomes, Plasmodium falciparum and soil transmitted helminths (STHs) on anaemia was determined in 609 Zimbabwean primary school children. P. falciparum, haemoglobin levels and serum ferritin were determined from venous blood. Kato Katz, formal ether concentration and urine filtration techniques were used to assess prevalence of Schistosoma mansoni, STHs and Schistosoma haematobium infections. The prevalence of S. haematobium, S. mansoni, P. falciparum, hookworm, Trichuris trichiura and Ascaris lumbricoides were 52.3%, 22.7%, 27.9%, 23.7%, 2.3% and 2.1%, respectively. The overall prevalence of anaemia and iron deficiency anaemia (IDA) were 48.4% (277/572) and 38.1% (181/475). Haemoglobin levels among children who had P. falciparum, S. haematobium and hookworm were lower than negative individuals, p<0.001, p<0.001 and p=0.030, respectively. The prevalence of anaemia and IDA in co-infections was almost double that in single infection. Children with P. falciparum/STHs/schistosome and schistosomes/P. falciparum co-infections recorded higher prevalence of anaemia and IDA (80.8% and 57.4%, respectively) than other combinations, p<0.001. Logistic regression revealed that, age group > or = 14 years, P. falciparum, S. haematobium light and heavy infections, and S. mansoni moderate and heavy infection, hookworm light infection were predictors of anaemia. This study suggests that integrated school based de-worming and malaria control have the potential to reduce the burden of anaemia.
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Immune responses during helminth-malaria co-infection: a pilot study in Ghanaian school children. Parasitology 2008; 135:855-60. [PMID: 18474122 DOI: 10.1017/s0031182008000401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Malaria and helminth infections have a shared geographical distribution and therefore co-infections are frequent in tropical areas of the world. Human populations of helminth and malaria co-infection have shown contradictory results for the course of malarial infection and disease, possibly depending on the type of helminth studied, the intensity of helminth infection and the age of the study population. Although immunological studies might clarify the underlying mechanisms of protection or increased susceptibility, there are very few studies that have looked at immunological parameters in helminth and malaria co-infection. After discussing the available immunological data on co-infection, we describe a pilot study performed in Ghanaian school children where we compare anti-malarial responses in children living in an urban area, where the prevalence of helminth and Plasmodium falciparum infections was low, with that of children living in a rural area with high prevalence of helminth and Plasmodium falciparum infections.
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Noland GS, Urban JF, Fried B, Kumar N. Counter-regulatory anti-parasite cytokine responses during concurrent Plasmodium yoelii and intestinal helminth infections in mice. Exp Parasitol 2008; 119:272-8. [PMID: 18396282 DOI: 10.1016/j.exppara.2008.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 02/20/2008] [Accepted: 02/27/2008] [Indexed: 11/19/2022]
Abstract
Malaria and helminth infections are two of the most prevalent parasitic diseases globally. While concomitant infection is common, mechanisms contributing to altered disease outcomes during co-infection remain poorly defined. We have previously reported exacerbation of normally non-lethal Plasmodium yoelii malaria in BALB/c mice chronically infected with the intestinal trematode Echinostoma caproni. The goal of the present studies was to determine the effect of helminth infection on IFN-gamma and other key cytokines during malaria co-infection in the P. yoelii-E. caproni and P. yoelii-Heligmosomoides polygyrus model systems. Polyclonally stimulated spleen cells from both E. caproni- and H. polygyrus-infected mice produced significantly lower amounts of IFN-gamma during P. yoelii co-infection than malaria-only infected mice. Furthermore, the magnitude of IFN-gamma suppression was correlated with the relative amounts of IL-4 induced by these helminths (E. caproni=low; H. polygyrus=high), but not IL-10. Concurrent malaria infection also suppressed helminth-associated IL-4 responses, indicating that immunologic counter-regulation occurs during co-infection with malaria and intestinal helminths.
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Affiliation(s)
- Gregory S Noland
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Co-infection with Trypanosoma cruzi protects mice against early death by neurological or pulmonary disorders induced by Plasmodium berghei ANKA. Malar J 2007; 6:90. [PMID: 17620126 PMCID: PMC1965473 DOI: 10.1186/1475-2875-6-90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 07/09/2007] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of this study was to investigate whether the infection of C57BL/6 mice by P. berghei ANKA, which causes severe malaria, was modulated by co-infection with Trypanosoma cruzi. Methods Groups of C57BL/6 mice were infected either with P. berghei ANKA, T. cruzi strain G, or with both parasites. The presence of parasites was checked by microscopic examination of blood samples. Symptoms of neurological or respiratory disorders, as well as mortality, were registered. Breakdown of the blood brain barrier was determined by injecting the dye Evans blue. Histological sections of the lung were prepared and stained with hematoxilin-eosin. Results All mice infected only with P. berghei ANKA died within 7–11 days post-infection, either with symptoms of cerebral malaria or with respiratory abnormalities. The animals co-infected with T. cruzi strain G survived longer, without any of the referred to symptoms. Protection against the early death by severe malaria was effective when mice were given T. cruzi 15 days before P. berghei inoculation. Breakdown of the blood brain barrier and extensive pulmonary oedema, caused by malaria parasites, were much less pronounced in co-infected mice. The degree of protection to severe malaria and early death, conferred by co-infection with T. cruzi, was comparable to that conferred by treatment with anti-CD8 antibodies. Conclusion Co-infection with T. cruzi protects C57BL/6 against the early death by malaria infection, by partially preventing either the breakdown of the blood brain, and cerebral malaria as a consequence, or the pulmonary oedema.
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Mwangi TW, Bethony JM, Brooker S. Malaria and helminth interactions in humans: an epidemiological viewpoint. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2007; 100:551-70. [PMID: 16989681 PMCID: PMC1858631 DOI: 10.1179/136485906x118468] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the tropics, helminths are among the most common chronic infections of humans and Plasmodium infections the most deadly. As these two groups of parasites have similar geographical distributions, co-infection is commonplace. It has increasingly been speculated that helminth infections may alter susceptibility to clinical malaria, and there is now increasing interest in investigating the consequences of co-infection, with studies yielding contrasting results. The immunological interactions between helminths and malarial parasites are unclear, although several hypotheses have been proposed. This review provides an epidemiological overview of the possible interactions between helminths and malarial parasites, in relation to geographical distributions and disease patterns, and provides a critical discussion of the results of the epidemiological studies that have so far been conducted to investigate the possible associations. Future studies that might be considered, in order to address the gaps in knowledge, are also considered.
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Affiliation(s)
- T W Mwangi
- Kenya Medical Research Institute, Centre for Geographic Medicine and Research, P.O. Box 230, 80108 Kilifi, Kenya.
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41
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Hartgers FC, Yazdanbakhsh M. Co-infection of helminths and malaria: modulation of the immune responses to malaria. Parasite Immunol 2006; 28:497-506. [PMID: 16965285 DOI: 10.1111/j.1365-3024.2006.00901.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic helminth infections induce strong type 2 and regulatory immune responses and are known to influence immune activity to other antigens such as allergens and vaccines. Since malaria and helminth infections often coincide geographically in the same tropical regions, the question arises whether helminth infections modulate the immune responses towards the malaria parasite and affect its course of disease. Here, we will review studies on co-infections in both animal models and in human populations, and discuss the changes in the immune system seen. Furthermore, the implications of helminth infection for the efficacy of malaria vaccines will be discussed.
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Affiliation(s)
- F C Hartgers
- Department of Parasitology, Leiden University Medical Centre, Leiden, the Netherlands.
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Abstract
OBJECTIVE To review the evidence on the link between malaria and poverty. METHODS Review of the published and grey literature to identify (i) the data available on the socio-economic distribution of malaria incidence and vulnerability, and (ii) the uptake of malaria control interventions. RESULTS We found mixed evidence on malaria incidence, with a number of studies identifying no relationship between socio-economic status and incidence, although a larger number of studies do find a link. There is strong evidence that uptake of preventive and treatment interventions is closely related to proxies for socio-economic status. More generally, the quality of the literature examining this issue is highly variable, with many different measures of socio-economic status and often inadequate descriptions of methods of data collection and analysis in relation to socio-economic status. CONCLUSIONS Important socio-economic differentials exist in access to malaria interventions, increasing the vulnerability of the poorest. More information is needed about how other methods of delivering malaria treatment and prevention can redress these inequalities.
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Affiliation(s)
- Eve Worrall
- Liverpool Associates in Tropical Health, Liverpool, UK.
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43
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Shapiro AE, Tukahebwa EM, Kasten J, Clarke SE, Magnussen P, Olsen A, Kabatereine NB, Ndyomugyenyi R, Brooker S. Epidemiology of helminth infections and their relationship to clinical malaria in southwest Uganda. Trans R Soc Trop Med Hyg 2005; 99:18-24. [PMID: 15550257 DOI: 10.1016/j.trstmh.2004.02.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Revised: 01/26/2004] [Accepted: 02/04/2004] [Indexed: 11/18/2022] Open
Abstract
It has recently been suggested that helminth infections may adversely influence susceptibility to other infections, including malaria. To investigate this hypothesis in a sub-Saharan African setting, surveys of helminth infections were conducted in 2003 among individuals who had been under weekly active case detection for clinical malaria during the preceding 18 months in four villages in Kabale District, southwest Uganda. Overall, 47.3% of individuals had at least one intestinal nematode species infection: hookworm, Ascaris lumbricoides and Trichuris trichiura were detected in 32.1, 17.4 and 8.1% of individuals, respectively. We found evidence of significant household clustering of A. lumbricoides, T. trichiura and hookworm, and clustering of heavy infection of each species. The association between helminth infection and clinical malaria was investigated in two villages and no evidence for an association was observed between the presence of infection or heavy infection and risk of malaria.
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Affiliation(s)
- Adrienne E Shapiro
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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44
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Affiliation(s)
- FE McKENZIE
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892 USA. E-mail:
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45
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Raso G, Utzinger J, Silué KD, Ouattara M, Yapi A, Toty A, Matthys B, Vounatsou P, Tanner M, N'Goran EK. Disparities in parasitic infections, perceived ill health and access to health care among poorer and less poor schoolchildren of rural Cote d'Ivoire. Trop Med Int Health 2005; 10:42-57. [PMID: 15655013 DOI: 10.1111/j.1365-3156.2004.01352.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Differences in the state of health between rural and urban populations living in Africa have been described, yet only few studies analysed inequities within poor rural communities. We investigated disparities in parasitic infections, perceived ill health and access to formal health services among more than 4000 schoolchildren from 57 primary schools in a rural area of western Côte d'Ivoire, as measured by their socioeconomic status. In a first step, we carried out a cross-sectional parasitological survey. Stool specimens and finger prick blood samples were collected and processed with standardized, quality-controlled methods, for diagnosis of Schistosoma mansoni, soil-transmitted helminths, intestinal protozoa and Plasmodium. Then, a questionnaire survey was carried out for the appraisal of self-reported morbidity indicators, as well as housing characteristics and household assets ownership. Mean travel distance from each village to the nearest health care delivery structure was provided by the regional health authorities. Poorer schoolchildren showed a significantly higher infection prevalence of hookworm than better-off children. However, higher infection prevalences of intestinal protozoa (i.e. Blastocystis hominis, Endolimax nana and Iodamoeba butschlii) were found with increasing socioeconomic status. Significant negative associations were observed between socioeconomic status and light infection intensities with hookworm and S. mansoni, as well as with several self-reported morbidity indicators. The poorest school-attending children lived significantly further away from formal health services than their richer counterparts. Our study provides evidence for inequities among schoolchildren's parasitic infection status, perceived ill health and access to health care in a large rural part of Côte d'Ivoire. These findings call for more equity-balanced parasitic disease control interventions, which in turn might be an important strategy for poverty alleviation.
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Affiliation(s)
- Giovanna Raso
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
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Graham AL. When T-helper cells don't help: immunopathology during concomitant infection. THE QUARTERLY REVIEW OF BIOLOGY 2002; 77:409-34. [PMID: 12599914 DOI: 10.1086/344414] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Disease directly caused by immune system action is known as immunopathology. Many factors may lead the immune system to cause rather than cure disease, and autoimmune, allergic, and infection-related immunopathological diseases affect millions of people worldwide. This review presents an analysis of T-helper cell mediated, infection-related immunopathology within the framework of evolutionary ecology. A proximate cause of infection-related immunopathology is an error in the type of T-helper response induced. Distinct subsets of T-helper cells enable different effector mechanisms and therefore work optimally against different types of parasites (e.g., extracellular versus intracellular parasites). Immune responses that cure rather than cause disease require that the T-helper subset be tailored to the parasite. It is thus critical for the immunophenotype to match the "environment" of the parasitic infection. As in other cases of adaptive plasticity, a mismatch between an organism's phenotype and the selective environment can decrease fitness. T-helper response induction may be confounded by coinfection of a single host by multiple parasite species. Because of normally adaptive feedback loops that lend to polarize T-helper responses, it can become impossible for the immune system to mount effective, conflicting responses concurrently. Immunophenotype-environment mismatches may thus be inevitable when simultaneous, conflicting immune responses are required. An ultimate cause of infection-related immunopathology in a multiparasite selection regime is the T-helper response polarization that can propagate response errors and constrain the ability of the immune system to resolve conflicting response requirements. A case study is used to illustrate how coinfection can exacerbate immunopathology and to frame testable predictions about optimal responses to coinfection (e.g., is the observed joint response to coinfection accurately predicted by the average of the component single-infection optimal responses, where the single-infection optima are weighted by the contribution of each to fitness). The case study includes immunological and pathological data from mice infected by Schistosoma mansoni alone and by S. mansoni in combination with Toxoplasma gondii. Such data can inform hypothesis tests of evolutionary ecological principles, and ecological analysis can in turn clarify assumptions about responses to coinfection for a greater understanding of the immune system. The synthesis of evolutionary ecology and immunology could therefore be of mutual benefit to the two disciplines.
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Affiliation(s)
- Andrea L Graham
- Department of Ecology & Evolutionary Biology, Cornell University, Ithaca, New York 14853, USA.
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Kahigwa E, Schellenberg D, Sanz S, Aponte JJ, Wigayi J, Mshinda H, Alonso P, Menendez C. Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case-control study. Trop Med Int Health 2002; 7:823-30. [PMID: 12358616 DOI: 10.1046/j.1365-3156.2002.00938.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In malaria endemic areas anaemia is a usually silent condition that nevertheless places a considerable burden on health services. Cases of severe anaemia often require hospitalization and blood transfusions. The objective of this study was to assess risk factors for admission with anaemia to facilitate the design of anaemia control programmes. We conducted a prospective case-control study of children aged 2-59 months admitted to a district hospital in southern Tanzania. There were 216 cases of severe anaemia [packed cell volume (PCV) < 25%] and 234 age-matched controls (PCV > or = 25%). Most cases [55.6% (n = 120)] were < 1 year of age. Anaemia was significantly associated with the educational level of parents, type of accommodation, health-seeking behaviour, the child's nutritional status and recent and current medical history. Of these, the single most important factor was Plasmodium falciparum parasitaemia [OR 4.3, 95% confidence interval (CI) 2.9-6.5, P < 0.001]. Multivariate analysis showed that increased recent health expenditure [OR 2.2 (95% CI 1.3-3.9), P = 0.005], malnutrition [OR 2.4 (95%CI 1.3-4.3), P < 0.001], living > 10 km from the hospital [OR 3.0 (95% CI 1.9-4.9), P < 0.001], a history of previous blood transfusion [OR 3.8 (95% CI 1.7-9.1), P < 0.001] and P. falciparum parasitaemia [OR 9.5 (95% CI 4.3-21.3), P < 0.001] were independently related to risk of being admitted with anaemia. These findings are considered in terms of the pathophysiological pathway leading to anaemia. The concentration of anaemia in infants and problems of access to health services and adequate case management underline the need for targeted preventive strategies for anaemia control.
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Affiliation(s)
- Elizeus Kahigwa
- Ifakara Health Research and Development Centre, Ifakara, Tanzania
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van der Werf MJ, de Vlas SJ, Looman CWN, Nagelkerke NJD, Habbema JDF, Engels D. Associating community prevalence of Schistosoma mansoni infection with prevalence of signs and symptoms. Acta Trop 2002; 82:127-37. [PMID: 12020885 DOI: 10.1016/s0001-706x(02)00007-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Information on the prevalence of morbidity is needed for re-calculation of the Global Burden of Disease (WHO) due to Schistosoma mansoni. This study presents a statistical association which can be used to predict the prevalence of morbidity from the prevalence of S. mansoni in a community. We collected data from field studies reporting prevalence of infection and prevalence of morbidity. Data on infection prevalence were standardised to a default diagnostic sensitivity (i.e. Kato-Katz technique 41.7 mg). The data were described by an expression related to logistic regression. We determined associations between prevalence of infection and prevalence of early morbidity (diarrhoea, blood in stool and abdominal pain), hepatosplenic morbidity and late morbidity (haematemesis and ascitis). Diarrhoea and blood in stool due to S. mansoni infection mainly occurs in communities with a high prevalence of infection. An influence on hepatosplenic morbidity is already present at low community prevalence of infection. For the aspecific symptom abdominal pain we did not find an association.
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Affiliation(s)
- Marieke J van der Werf
- Department of Public Health, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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49
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Abstract
Multiple parasitic infections have become increasingly recognized as a result of improvements in laboratory diagnosis and a growing population of immunocompromised individuals. This review examines the principles of chemotherapy in groupings of multiple infections which are of particular clinical significance.
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Affiliation(s)
- P L Chiodini
- Department of Clinical Parasitology, The Hospital for Tropical Diseases, London.
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50
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Utzinger J, N'Goran EK, Marti HP, Tanner M, Lengeler C. Intestinal amoebiasis, giardiasis and geohelminthiases: their association with other intestinal parasites and reported intestinal symptoms. Trans R Soc Trop Med Hyg 1999; 93:137-41. [PMID: 10450435 DOI: 10.1016/s0035-9203(99)90287-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In order to determine reported signs and symptoms that may predict an intestinal parasitic infection, 241 schoolchildren in western Côte d'Ivoire were interviewed with a simple questionnaire and their stool specimens were examined over several consecutive days. Special emphasis was placed on (i) assessing infections by Entamoeba histolytica/E. dispar, Giardia duodenalis and by intestinal worms, (ii) looking for associations between these parasites, and (iii) looking for associations between these parasites and commonly perceived intestinal signs and symptoms. Complete questionnaire results, intestinal helminth infections derived from 4 Kato-Katz thick smears, and intestinal protozoa infections assessed on a single day by a formalin-ether concentration procedure were obtained from 209 children (87%). A logistic regression modelling approach showed that an infection with E. histolytica/E. dispar was significantly associated with an Entamoeba coli infection. However, for G. duodenalis, hookworm and Ascaris lumbricoides, no association was found between any of these parasites and other intestinal parasites. In a multivariate analysis reported diarrhoea was the only symptom positively associated with an E. histolytica/E. dispar infection (P = 0.028). Its diagnostic performance showed a low sensitivity (28%), a high specificity (85%) and moderate positive and negative predictive values (52% and 67%, respectively). Surprisingly, reported 'turning stomach' was less often reported by children infected with G. duodenalis (borderline significance, P = 0.057). It is concluded that reported diarrhoea could be a symptom worth exploring further for the rapid identification of schoolchildren infected with E. histolytica/E. dispar.
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Affiliation(s)
- J Utzinger
- Swiss Tropical Institute, Department of Public Health and Epidemiology, Basle, Switzerland
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