Anemia and intestinal parasitic infections in primary school students in Aracaju, Sergipe, Brazil

Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review

Intestinal parasitic infections are common infectious diseases causing many health problems and impaired growth and physical development.. Children under five years old are the most vulnerable to infections, due to their immature immunity and feeding and exploratory behaviours. This systematic review aimed to assess the relationship between intestinal parasitic infections and undernutrition among children under 5 years old. Fifteen studies met the inclusion and exclusion criteria and were classified as high-quality studies. Twelve parasites were reported, including Ascaris lumbricoides, Cryptosporodium spp., Entamoeba histolytica, Enterobius vermicularis, Giardia lamblia, hookworm, Hymenolepis nana, Strongyloides sterocalis, Taenia spp. and Trichuris trichuria. Ascariasis is the most reported infection, with a prevalence ranging from 10.77% in Ethiopia to 57.14% in Malaysia, and is correlated with stunting (OR 2.17 (95% CI 1.14, 4.13), p = 0.02). Giardiasis is the second most reported infection, with a prevalence ranging from 4.43% in Ethiopia to 66.33% in the Central African Republic, and is related to an increased risk of stunting (OR 2.34 (95% CI 1.07, 5.10), p = 0.03)), wasting (OR 2.90 (95% CI 1.12, 7.49, p = 0.03)), and being underweight (OR 1.53 (95% CI 1.02, 2.29, p = 0.04)). The third and fourth most prevalent infections are T. trichiura and hookworm infections. Intestinal parasitic infections can occur very early in life and cause significant growth retardation. It is important to understand the prevalence and effects of infection based on the parasite species in order to implement therapeutic interventions and prevention controls.

Magnitude and associated factors of anemia among adolescent girls in Ethiopia: a systematic review and meta-analysis

Background

In Ethiopia, there are primary studies on adolescent anemia with imprecise and inconclusive findings. Besides, there was no meta-analysis pooled the magnitude and associated factors of anemia among adolescent girls in Ethiopia. Estimating the pooled magnitude and associated factors of anemia among adolescent girls is helpful for evidence-based interventions in Ethiopia.

Methods

The authors used a preferred reporting item for systematic reviews and meta-analysis (PRISMA). We included articles and survey reports published until May 2021 using searching engines of Google, Google Scholar, PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature. To assess the quality of studies, we used Newcastle–Ottawa quality assessment scale for non-randomized. Two authors independently assessed the quality of the studies. We computed the pool magnitude and odds ratio of the associated factors with their 95%CI using Comprehensive Meta-Analysis software. Publication bias assessed using funnel plots and Egger’s test.

Result

In this review, we included a total of 15 studies with 9,669 adolescent girls. Using the random-effects model, the pooled magnitude of anemia among the Ethiopian adolescent girls was 19.1% (95%CI: 16.1%, 24.6%). The associated factors were attained menarche (adjusted odds ratio (AOR) = 1.96), ≥ 5 days of blood flow during menses (AOR = 6.21), food insecurity (AOR = 1.48), inadequate diet diversity score (AOR = 2.81), presence of intestinal parasite (AOR = 3.51), low body mass index (AOR = 2.49), and rural residence (AOR = 1.79).

Conclusion

The pooled magnitude of anemia among adolescent girls in Ethiopia was 19.1% depicting a mild public health problem; while attained menarche, ≥ 5 days’ blood flow during menses, food insecurity, inadequate diet diversity score, intestinal parasites, low body mass index, and rural residence were the associated factors. Hence, addressing health and nutrition wellness of adolescent girls should be center of concern in health, nutrition, agriculture, research, strategies and policies in Ethiopia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00942-y.

Echinostomiasis in a child with severe anemia

A child had presented with complaints of dark green-colored loose stools, nonbilious vomiting, and fever for a day. Blood investigations revealed low hemoglobin levels. Abdominal ultrasonography showed features suggestive of worms. Wet mount examination of stool showed eggs of Echinostoma species and Trichuris trichiura and fertilized and unfertilized eggs of Ascaris lumbricoides. High incidences of intestinal parasitic infections in children can lead to anemia, consequently disturbing the development of these children. Such intestinal parasitic infections seem to be associated directly due to the unclean living settings linked with lack of awareness regarding the communicable disease and diversity of influences that need to be further elucidated. In humans, Echinostoma species have seldom been detected perhaps for the reason of its complexity in diagnosis by fecal examination as the eggs generated per worm are relatively less in contrast to other helminthic parasites.

Effects of water, sanitation and hygiene (WASH) education on childhood intestinal parasitic infections in rural Dembiya, northwest Ethiopia: an uncontrolled before-and-after intervention study

BACKGROUND

Soil-transmitted helminthes (STH) infections are among the most common infections worldwide and affect the most deprived communities. Adequate water, sanitation, and hygiene (WASH) prevents environmental contamination, thereby preventing transmission of STH. Cognizant of this, WASH education was implemented in rural Dembiya to reduce intestinal parasitic infections. This study was, therefore, conducted to assess the impacts of the intervention on households' WASH conditions and prevalence of intestinal parasitic infections.

METHOD

An uncontrolled before-and-after intervention study was used. Cross-sectional studies were done before and after the intervention. Two hundred twenty-five and 302 under five children were recruited randomly at the baseline and endline, respectively. Data were collected using a structured questionnaire and observational checklists. Direct stool examination and Kato-Katz methods were used to identify parasites in the stool. We used percent point change and prevalence ratio (PR) to see the effects of the intervention on WASH conditions and prevalence of intestinal parasitic infections respectively. Pearson chi-squared and Fisher's exact tests were used to test for statistically significant percentage point changes of WASH conditions. The effect of the intervention on intestinal parasitic infections was statistically tested on the basis of PR with 95% confidence interval (CI).

RESULTS

The baseline prevalence of intestinal parasitic infections was 25.8%, and the endline prevalence was 23.8%. The prevalence of intestinal parasitic infections was not significantly decreased at the endline compared with the baseline [PR = 0.92, 95% CI = (0.62, 1.38)]. Ascaris Lumbricoides was the most prevalent parasitic infection both at the baseline and endline. The proportion of children who had good hygienic condition increased from 1.3% at the baseline to 34.4% at the end line (p <  0.05). The percentage of mothers/care givers who washed hands at different pick times was significantly increased from 24.4% at the baseline to 68.2% at the endline (p <  0.001). The proportion of households who practiced home-based water treatment was significantly increased from 7.6% at the baseline to 47% at the endline (p <  0.001). The proportion of households who used sanitary latrine was increased from 32% at the baseline to 49% at the endline (p <  0.05).

CONCLUSION

This before-and-after intervention study found that households' WASH performance was significantly improved at the endline compared with the baseline. The endline prevalence of intestinal parasitic infections was slightly lower than the baseline prevalence; however, the reduction was not statistically significant. The local health office needs to strengthen the WASH education program, mobilize the community to construct WASH facilities, and support the community to sustain households' WASH performance.

Intestinal parasitic infestations and anemia among urban female school children in Kancheepuram district, Tamil Nadu

INTRODUCTION

In India, intestinal parasitic infection and anemia remain the most important cause of morbidity especially among the adolescent school children due to lack of awareness of personal hygiene practices, leading to intestinal parasite infections which could in turn lead to anemia.

AIM

This study was conducted with the aim to find out the prevalence of intestinal parasitic infection and anemia among adolescent female school children in an urban area of Tamil Nadu.

MATERIALS AND METHOD

This descriptive cross-sectional study was done among adolescent female school children in Anakaputhur area of Kancheepuram district. Three schools were selected randomly from a total of eight schools in the study area. Universal sampling was applied in each school, and a total of 250 willing children participated in the study. Early morning stool specimen was collected for microscopic examination and hemoglobin estimation was done. A pretested structured questionnaire was used to collect relevant data which were analyzed using SPSS version 22.

RESULTS

The prevalence of intestinal parasitic infection was found to be 36% with Entamoeba histolytica being the commonly isolated organism (23.2%) followed by Giardia intestinalis (5.2%), Hookworm (4.4%), and Ascaris lumbricoides (3.2%). The prevalence of anemia among them was found to be 84.8% with mild, moderate, and severe anemia being 12.8%, 46.8%, and 25.2%, respectively. Statistically significant association was found between intestinal parasitic infection and open field defecation, inadequate hand washing practices, and anemia.

CONCLUSION

The study reveals high prevalence of anemia and intestinal parasitic infection among female school children. Preventive measures such as periodic deworming and health education about nutritional balanced diet, iron supplements, and personal hygiene practices have to be given to both the parents and their children to prevent and reduce disease burden.

Schistosoma mansoni Infections, Undernutrition and Anaemia among Primary Schoolchildren in Two Onshore Villages in Rorya District, North-Western Tanzania

BACKGROUND

Undernutrition and anaemia remains to be a major public health problem in many developing countries, where they mostly affect children. Intestinal parasitic infections are known to affect both growth and haemoglobin levels. Much has been reported on the impact of geohelminths on anaemia and undernutrition, leaving that of Schistosoma mansoni not well studied. Therefore this study intended to determine the association between S.mansoni infections, anaemia and undernutrition among schoolchildren in Rorya district, Northwestern Tanzania.

METHODOLOGY

A cross-sectional study was carried among schoolchildren in two onshore villages namely Busanga and Kibuyi in Rorya district. Single stool specimens were collected from 513 randomly selected schoolchildren and processed for microscopic examination using the Kato-Katz method. Nutritional status was determined by anthropometry. Blood samples were also collected and examined for malaria parasites and haemoglobin levels using the Giemsa stain and HaemoCue methods, respectively. A pretested questionnaire was used to collect socio-demographic data and associated factors.

RESULTS

The prevalence of S. mansoni infection and malaria was 84.02% and 9.16%, respectively. Other parasites found were Ascaris lumbricoides (1.36%) and Hookworm (1.36%). The prevalence of stunting and wasting was 38.21% and 14.42%, respectively. The prevalence of anaemia was 29.43%, whereby 0.58% had severe anaemia. S. mansoni infection was not found to be associated with undernutrition or anaemia (p>0.05). The risk of stunting and wasting increased with increasing age (p<0.001). Anaemia was associated with age, sex and village of residence (p<0.05).

CONCLUSIONS

S.mansoni, undernutrition and anaemia are highly prevalent in the study area. The observed rates of undernutrition and anaemia were seen not to be associated with S.mansoni infection suggesting possibly being a result of poor dietary nutrients. This study suggests that policy makers should consider Rorya district for inclusion into national schistosomiasis control and school feeding programmes.

Factors Associated with Gastrointestinal Parasitic Infections among Young Population in Northeast Brazil

Background. Intestinal parasitic infections constitute a major public health problem that is frequently associated with poverty, inadequate sanitation, and the nutritional status of the population. Objective. The aim of the present study is to investigate the possible association of parasitic infections, sanitary conditions, hygiene practices, and the nutritional and socioeconomic status of a poor youth population. Methods. A cross-sectional study was conducted with 367 children and adolescents inhabiting a substandard settlement in the urban area of Maceió (Alagoas State, Brazil). Data collection included socioeconomic status, anthropometric measurements, fecal sample examinations, and laboratory blood analysis. The identification of factors associated with gastrointestinal parasitic infections was undertaken through bi- and multivariate analyses. Results. Stool sample analysis obtained from 300 individuals revealed that 204 (68%) were infected with at least one parasite species and of these 130 (63.7%) were polyparasitized. No significant associations were identified between low height for age (stunted), parasitic infections, and polyparasitism. There was also no association between family income and parasitosis. However, low socioeconomic status proved to be a potential risk factor for parasitic infections. Conclusion. Actions must be taken to improve sanitation, housing, and environmental conditions in order to eliminate the risk factors for parasitic infections, and thereby guarantee a better quality of life for this population.

The Stool Examination Reports Amoeba Cysts: Should You Treat in the Face of over Diagnosis and Lack of Specificity of Light Microscopy?

Amoebiasis is a common clinical diagnosis in tropical settings and clinicians continue to treat asymptomatic carriers diagnosed by light microscopy. A minority of carriers, however, are infected with Entamoeba histolytica and the remaining with the non-pathogenic Entamoeba dispar. We compared the diagnostic results of 298 asymptomatic residents of Aracaju, Brazil, obtained by different diagnostic methods, and ascertained their clinical symptoms, to highlight the implications for practitioners. Fifty-eight (19.4%) specimens were amoebae positive by microscopy. Of these, 38 (13%) were E. histolytica IE. dispar enzyme-linked immunosorbent assay (ELISA) positive and 4 (1%) E. histolytica ELISA positive. The frequent use of anti-amoebic treatment on the basis of non-specific symptoms and the findings of light microscopy tests is not justified. Methods for the specific diagnosis of E. histolytica infection for developing countries are urgently needed.

The Effect of Intestinal Parasitic Infection on the Clinical Outcome of Malaria in Coinfected Children in Cameroon

Background

The interaction between intestinal parasites and malaria is still not clear. Data in published literature are conflicting. We studied the effect of intestinal parasitic infection (IPI) on the clinical outcome of malaria in coinfected children.

Methods

In a cross sectional study performed between October 2014 and September 2015, children infected with malaria, as demonstrated by the presence of asexual parasites in Giemsa stained blood films, were enrolled. Stool samples were obtained from participants and subjected to the formol-ether concentration technique for the detection of intestinal parasites. The Complete blood count was performed using an automated haematology analyser (Mindray, BC-2800). The risk ratio, Pearson’s chi-square and the student T test were all performed as part of the statistical analyses. Statistical significance was set at p < 0.05.

Results

In all, 405 children successfully took part in the study. The children were between 1 week and 120 months of age (mean ± SD = 41.5 ± 33.5). Coinfection with intestinal parasites was observed in 11.6%. The rate of severe malaria (SM) attack in this study was 10.9%. SM was not observed to be associated with age (p = 0.377) or gender (p = 0.387), meanwhile coinfection with intestinal parasites was associated with age (p = 0.003). Among SM cases, IPI prevalence was higher in children with mild (WHO group 3) severe malaria (p = 0.027). Overall, IPI was not observed to be associated with SM (p = 0.656) or malaria parasite density (p = 0.185) or haemoglobin concentration (p = 0.205). The main clinical features of SM observed were hyperpyrexia (68.2%), severe malarial anaemia (61.4%), and multiple convulsion (52.3%).

Conclusion

IPI was not observed to be associated with the severity of malaria, the malaria parasite density, and the haemoglobin concentration in coinfected children in Cameroon. The clinical outcome of malaria in children coinfected with intestinal parasites may depend on the geographical setting after all.

Coinfection with malaria and intestinal parasites are common in Sub-Saharan Africa, particularly in impoverished and poor sanitary settings. The interaction between intestinal parasites and malaria in coinfected children is still not clear. Some published papers suggest intestinal parasites, especially Ascaris lumbricoides, may attenuate the severity of malaria in the presence of coinfection. In this cross-sectional study, we evaluated the effect of intestinal parasitic infection on the severity of malaria, malaria parasite density and the haemoglobin concentration in children coinfected with malaria and intestinal parasites in Cameroon. We did not observe any significant association between intestinal parasitic infection and severe malaria or malaria parasite density or haemoglobin concentration. Stratification of severe malaria according to the degree of severity revealed a significant association with intestinal parasitic infection, in which prevalence of intestinal parasites was higher in children with mild severe malaria. Analyzing the different species of intestinal parasite did not yield any significant association either. These findings are contrary to many research publication on the subject. Several factors could have contributed to our observation, including the regular deworming campaign organized by the Cameroon Ministry of Public health, accounting for the lower prevalence of intestinal parasitic infection, and also the geographical setting.

Coinfection with malaria and intestinal parasites, and its association with anaemia in children in Cameroon

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.

Soil-transmitted helminth prevalence and infection intensity among geographically and economically distinct Shuar communities in the Ecuadorian Amazon

Soil-transmitted helminth (STH) infections can result in a variety of negative health outcomes (e.g., diarrhea, nutritional deficiencies). Market integration (MI; participation in market-based economies) has been suggested to alter levels of STH exposure due to associated changes in diet, sanitation, and behavior, but the effects are complicated and not well understood. Some effects of economic development result in decreased exposure to certain pathogens, and other factors can lead to higher pathogen exposure. With geographic location used as a proxy, the present study investigates the effects of economic development on parasite load among an indigenous population at multiple points along the spectrum of MI. This research has many implications for public health, including an increased understanding of how social and economic changes alter disease risk around the world and how changing parasite load affects other health outcomes (i.e., allergy, autoimmunity). Specifically, this study examines the prevalence of intestinal helminths among the Shuar, an indigenous group in the Morona-Santiago region of Ecuador, from 2 geographically/economically separated areas, with the following objectives: (1) report STH infection prevalence and intensity among Shuar; (2) explore STH infection prevalence and intensity as it relates to age distribution in the Shuar population; (3) compare STH infection patterns in geographically and economically separated Shuar communities at different levels of MI. Kato-Katz thick smears were made from fresh stool samples and examined to determine STH presence/intensity. Results indicate that 65% of the 211 participants were infected with at least 1 STH. Twenty-five percent of the sample had coinfections with at least 2 species of helminth. Infection was more common among juveniles (<15 yr) than adults. Infection prevalence and intensity was highest among more isolated communities with less market access. This study documents preliminary associations between STH infection and exposure to MI, with implications for public health research and interventions.

Overweight is associated with low hemoglobin levels in adolescent girls

OBJECTIVE

To verify the prevalence of iron deficiency anemia according to sexual maturation stages and its association with overweight as well as excessive body fat in adolescents.

DESIGN

A school-based cross-sectional study was performed. Anemia was assessed by measuring the hemoglobin level (Hb). Nutritional status was defined by sex and age specific body mass index (BMI) cutoffs, and body fat (BF) was determined by bioelectrical impedance. Sexual maturation was assessed by breasts/genitalia and pubic hair development stages. Statistical analyses considered the effect of cluster sampling design (classes) and sampling expansion corrected by relative weight. Odds ratio and general linear modeling were used to assess the associations, regarding the value of p < 0.05 for statistical significance.

SETTING

Public schools in the Metropolitan area of Rio de Janeiro, Brazil.

SUBJECTS

Probabilistic sample of 707 teenagers between 11.0 and 19.9 years old.

RESULTS

The prevalence of anemia among the adolescents was 22.8% (95%CI 16.7-30.2%), higher among girls than among boys (30.9% vs. 10.9%; p < 0.01). The chance of developing anemia did not change with the nutritional status according BMI or BF percentage, however, overweight girls presented lower Hb levels than those who were not overweight (12.2 g/dL vs. 12.8 g/dL, p < 0.01). In boys this association was not observed. Sexual maturation did not change the association of Hb and anemia with overweight and excessive body fat.

CONCLUSION

The reduction of Hb levels points at overweight as a risk factor for the development of iron deficiency among adolescents.

HOOKWORM AND THREADWORM INFECTIONS AND THEIR ASSOCIATION WITH HEMOGLOBIN AND EOSINOPHIL CONCENTRATIONS IN RESIDENTS OF SALVADOR-BAHIA, BRAZIL

SUMMARY Parasitic infections are responsible for substantial mortality and morbidity worldwide. In most healthy individuals, little overt pathology is observed during infection with S. stercoralis. However, the symptoms in advanced cases may include gastrointestinal bleeding. Anemia is most commonly associated with hookworm infection, especially when several hundred worms are present. Our study evaluates the relationship between the hookworm or S. stercoralis infection status and the hemoglobin concentration of individuals examined by a private network of laboratories in Salvador, Bahia, Brazil. We examined 374,120 samples from middle-class individuals living in Salvador City from January 2004 to April 2008. The stool samples were analyzed by the Lutz and Baermann-Moraes methods, and the blood samples were analyzed for hemoglobin concentration and eosinophil counting. The prevalence of hookworm and S. stercoralis were 0.27% (1,027) and 0.34% (1,286), respectively. The prevalence of hookworm and S. stercoralis infection was significantly higher in males than in females and increased with age. Eosinophilia was a common laboratorial finding in individuals infected with hookworm and S. stercoralis. The hemoglobin concentration was lower in the hookworm-infected individuals than in non-infected ones, but none of the examined patients were anemic. Lack of anemia could be a consequence of the socioeconomic status of these patients.

Nutritional status, intestinal parasite infection and allergy among school children in northwest Ethiopia

BACKGROUND

Parasitic infections have been shown to have deleterious effects on host nutritional status. In addition, although helmintic infection can modulate the host inflammatory response directed against the parasite, a causal association between helminths and allergy remains uncertain. The present study was therefore designed to evaluate the relationship between nutritional status, parasite infection and prevalence of allergy among school children.

METHODS

A cross sectional study was performed involving school children in two elementary schools in Gondar, Ethiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined using standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer's instruction.

RESULT

A total of 405 children (with mean age of 12.09.1 ± 2.54 years) completed a self-administered allergy questionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/wasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites. The most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total serum IgE level was 344 IU/ml (IQR 117-2076, n=80) and 610 IU/ml (143-1833, n=20), respectively, in children without and with intestinal parasite infection (Z=-0.198, P>0.8). The prevalence of self reported allergy among the subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of allergy.

CONCLUSION

The prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population. In addition, there was no significant association between the prevalence of allergy and their nutritional status, and parasite infection. Further research prospective observational and intervention studies are required to address the question of causality between nutritional factors, parasites, and allergy.

Parasitoses intestinais se associam a menores índices de peso e estatura em escolares de baixo estrato socioeconômico

OBJETIVO: Avaliar a prevalência de parasitoses intestinais, correlacionando-as com os fatores socioeconômicos e ambientais, peso, estatura e hemoglobina, em crianças de dois estratos socioeconômicos, no município de Osasco (SP). MÉTODOS: Estudo transversal, comparando 84 crianças de seis a dez anos, residentes em área sem saneamento básico e moradia precária, com 35 crianças de escola particular no mesmo município, que possuíam boas condições socioeconômicas e de moradia. Excluíram-se aquelas com diarreia há menos de 30 dias ou doença grave. Utilizou-se questionário padronizado para avaliar as condições socioambientais. A avaliação nutricional foi realizada mediante escores Z de peso para idade, estatura para idade e índice de massa corpórea. A determinação da hemoglobina em amostra de sangue capilar foi realizada pelo método Hemocue® e a pesquisa de parasitas intestinais, pelos métodos de Hoffman, Ritchie, Kinyoun e swab anal. RESULTADOS: Parasitose intestinal ocorreu em 60,7% das crianças da favela e em 5,9% das crianças da escola particular (p<0,001; OR 24,7). A média dos escores Z de peso para idade, estatura para idade e índice de massa corpórea foi menor nas crianças parasitadas (-0,78±0,84; +0,50±0,90; -0,76±0,96) em relação àquelas não parasitadas (-0,18±1,18; +0,03±1,10; -0,28±1,16), sendo as diferenças estatisticamente significantes (p<0,05). Não houve diferença nos valores médios de hemoglobina entre as crianças parasitadas e não parasitadas do grupo da favela (12,6±1,1g/dL e 12,8±1,2g/dL); p=0,58. CONCLUSÕES: A parasitose intestinal foi mais prevalente em crianças da favela e se associou a menores índices de peso e de estatura.

Social and biological determinants of iron deficiency anemia

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.

[Prevalence and factors associated with geohelminth infections in children living in municipalities with low HDI in North and Northeast Brazil]

Stool surveys were conducted to estimate the prevalence and identify risk factors for geohelminth infections among children in ten Brazilian municipalities with low human development indices (HDI). Socioeconomic and environmental data were obtained from the children's parents or guardians, and stool samples were examined. The proportion of geohelminth infections according to target variables was calculated. Risk factors were evaluated using multilevel logistic regression. Of the 2,523 children, 36.5% were infected with one or more geohelminths (Ascaris lumbricoides, 25.1%; hookworm, 15.3%; Trichuris trichiura, 12.2%). Overall prevalence of geohelminth infections was 45.7% in rural areas and 32.2% in urban areas. Low family income (OR = 1.75; 1.38-2.23), low maternal schooling (OR = 1.69; 1.39-2.06), presence of garbage near the home (OR = 1.50; 1.22-1.84), and number of individuals in the household (OR = 1.41; 1.17-1.71) were associated with infection. In conclusion, geohelminth infections were closely related to socioeconomic conditions, thus emphasizing the importance of targeted public interventions to improve living conditions as part of sustainable prevention.

Classic and molecular study of Giardia duodenalis in children from a daycare center in the region of Presidente Prudente, São Paulo, Brazil

Epidemiological studies on giardiasis by using molecular techniques such as RAPD (Randomly Amplified Polymorphic DNA) may give information on factors related to the transmission of Giardia duodenalis. The aim of this work was to assess the epidemiology of G. duodenalis in 101 children attended at a daycare center in Presidente Bernardes, SP, Brazil. After parasitological examinations in feces samples, 15 children presented cysts of G. duodenalis. Their respective parents, brothers and pets, besides the daycare center workers, also had their feces submitted to parasitological analysis. Seven mothers and nine brothers also presented G. duodenalis cysts, while fathers, daycare workers and pets (dogs) did not presented the parasite. Besides the 15 cases with G. duodenalis, other 23 children presented other enteroparasites (Entamoeba coli, Endolimax nana, Enterobius vermicularis, Ascaris lumbricoides and Trichuris trichiura). Samples of G. duodenalis cysts from children and their relatives were submitted to molecular typing by RAPD after genomic DNA extraction and amplification of a fragment of the 18S rDNA region by PCR. After examining 31 isolates of G. duodenalis (children and their respective mothers and brothers), it was concluded that the parasite transmission occurred in children, probably during daily cohabitation at the daycare center, but not at home among their relatives or pets.

Fatores associados à anemia em crianças e adolescentes de escolas públicas de Salvador, Bahia, Brasil

Trata-se de um estudo para avaliar os fatores associados à anemia. Participaram deste estudo 1.013 indivíduos com idade entre 7 e 14 anos, matriculados na rede pública de ensino em Salvador, Bahia, Brasil. Os participantes foram submetidos a exame de sangue para dosagem de hemoglobina, exame antropométrico e obtiveram-se informações sobre consumo alimentar e condições sócio-econômicas, domiciliares e ambientais da família, além do cuidado materno dispensado à criança. Foi detectada uma prevalência de 24,5% de anêmicos entre os participantes, com valor médio dos níveis de hemoglobina de 12,68g/dL, concentração mínima de 7,7g/dL e máxima de 16,8g/dL. A anemia foi significativamente associada à inadequação crescente de consumo de ferro biodisponível (ORadequação entre 50% a 99,9% = 1,57; IC95%: 1,07-2,29;p = 0,020 e ORadequação < 50% = 1,68; IC95%: 1,10-2,56; p = 0,016) e à renda familiar menor do que 1 salário mínimo (OR = 1,42; IC95%: 1,03-1,96; p = 0,035). A prevalência de anemia em crianças e adolescentes é elevada, especialmente em indivíduos mais pobres e com baixo consumo de ferro biodisponível.

Concentrações de hemoglobina e ferritina sérica em escolares da rede pública municipal de Teresina, Piauí, Nordeste do Brasil

OBJETIVOS: avaliar o estado nutricional de ferro em escolares de instituições públicas de ensino de Teresina, Piauí, Brasil. MÉTODOS: corte transversal, envolvendo amostra aleatória, selecionada em duas etapas, de 747 escolares (7-11 anos), de ambos os sexos, no período de agosto / setembro de 2000. A anemia foi rastreada em 747 escolares e para o diagnóstico adotou-se a concentração de hemoglobina (Hb) <11,5g/dL. As reservas corporais de ferro foram estimadas em 207 escolares, mediante análise das concentrações de ferritina sérica (FerS), considerando-se baixas reservas valores <15 µg/L. RESULTADOS: a prevalência de concentrações inadequadas de Hb (< 11,5g/dL) foi de 14,3% (IC95% 12,2-17,4) e de reservas inadequadas de ferro (FerS< 15,0µg/L) de 20,3% (IC95% 15,2-26,6). A prevalência de anemia foi semelhante entre os sexos (p=0,60) e as faixas etárias (p=0,85). Comportamento distributivo similar foi observado no que diz respeito às reservas inadequadas de ferro, frentes às variáveis sexo (p=0,19) e idade (p=0,24). As concentrações de FerS não mostraram correlação (r=0,1; p=0,168) com as de Hb. A prevalência de anemia ferropênica (Hb< 11,5 g/dL e FerS< 15,0 µg/L) foi de 26,3% (IC95% 17,3-37,5). CONCLUSÕES: em Teresina, a deficiência de ferro e a anemia em escolares devem ser consideradas como um problema de saúde pública que requer efetivo programa de prevenção e controle. No entanto, a anemia parece não ser explicada apenas pela deficiência de ferro; outros fatores etiológicos devem, portanto, ser considerados, a exemplo da deficiência de outros micronutrientes, infecções/infestações parasitárias, distúrbios hereditários e exposição a poluentes ambientais.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Parasitic infestation and nutritional status among schoolchildren in Vientiane, Lao PDR

AIMS

To investigate the prevalence of intestinal parasitic infestation among school-aged children residing in Vientiane capital city; and to assess the impact of its infestation on nutrition status of those children.

METHODS

The school-based cross-sectional study was conducted from December 2005 to February 2006. The systemic random samplings were employed to select schools and schoolchildren. Five hundred and thirty-six schoolchildren (350 high-school children and 186 parents of elementary-school children) were completely interviewed by semistructured questionnaire and performed anthropometric measurement. The direct faecal smear was employed to analyse 299 (55.8%) stool samples. The SPSS version 12.01 and Epi Info version 6.0 were used for data analysis.

RESULTS

The overall prevalence of parasitic infestation was 38.1%, with 18.1% of Opisthorchis viverrini and 14.7% of Ascaris lumbricoides. The prevalences of stunting and underweight were 20.2% and 20.0%, respectively. The prevalences of stunting (OR = 3.28; P < 0.01) and underweight (OR = 2.69; P < 0.05) were higher among high-school children who were infested by intestinal parasites.

CONCLUSION

Approximately one-third of schoolchildren in Vientiane capital city were infested by intestinal parasites. The persistent parasitic infestation seemed to be associated with growth rate pattern among those children. School-based parasite control programme and health promotion are needed to eliminate this major public health problem in Lao People Democratic Republic.

Age-related changes in hookworm infection, anaemia and iron deficiency in an area of high Necator americanus hookworm transmission in south-eastern Brazil

Surprisingly few detailed age-stratified data exist on the epidemiology of hookworm and iron status, especially in Latin America. We present data from a cross-sectional survey examining 1332 individuals aged 0-86 years from a community in south-east Brazil for hookworm, anaemia and iron deficiency. Sixty-eight percent of individuals were infected with the human hookworm Necator americanus. The force of infection (lambda=0.354) was similar to estimates from other areas of high hookworm transmission. Individuals from poorer households had significantly higher prevalence and intensity of infection than individuals from better-off households. The prevalence of anaemia, iron deficiency and iron-deficiency anaemia was 11.8%, 12.7% and 4.3%, respectively. Anaemia was most prevalent among young children and the elderly. Univariate analysis showed that haemoglobin and serum ferritin were both significantly negatively associated with hookworm intensity among both school-aged children and adults. Multivariate analysis showed that, after controlling for socio-economic status, iron indicators were significantly associated with heavy hookworm infection. Our results indicate that, even in areas where there is a low overall prevalence of anaemia, hookworm can still have an important impact on host iron status, especially in school-aged children and the elderly.

Parasitosis intestinales en poblaciones Mbyá-Guaraní de la Provincia de Misiones, Argentina: aspectos epidemiológicos y nutricionales

Se describieron las enteroparasitosis más frecuentes en dos comunidades Mbyá-Guaraní de Misiones, Argentina: Kaaguy Poty e Yvy Pytá. Las parasitosis intestinales se asociaron con el estado nutricional de los individuos infectados y los factores ambientales y culturales que caracterizan a las poblaciones estudiadas. Los resultados se compararon con los obtenidos en una población aborigen vecina, Takuapí, y la población urbana más cercana: Aristóbulo del Valle. Se utilizaron las técnicas de Ritchie, Willis y Kato Katz para las muestras fecales. Se analizaron los parámetros antropométricos y se procesaron muestras de tierra. De un total 296 individuos en las cuarto poblaciones, 100 (87,7%), 63 (88,7%), 49 (96,1%) y 50 (82%) estuvieron parasitados en Kaaguy Poty, Yvy Pytá, Takuapí, y Aristóbulo del Valle respectivamente. El 84% de los individuos parasitados estuvieron poliparasitados. El 43% de los individuos medidos presentaron desnutrición y el 87% de ellos estaban parasitados. Hubo asociación entre el uso de letrinas y Giardia lamblia (p < 0,01); defecación a cielo abierto, ausencia de calzado y ancilostomídeos (p < 0,01); el tipo de vivienda y los helmintos en general (p < 0,01). En el suelo se hallaron formas parasitarias, sugiriendo la relación entre la contaminación del entorno ambiental y la elevada prevalencia de parasitosis intestinales en las poblaciones estudiadas.

Prevalência e fatores associados à ocorrência de anemia entre menores de seis anos de idade em Pelotas, RS

OBJETIVOS: Determinar a prevalência e investigar fatores associados à ocorrência de anemia entre menores de seis anos de idade atendidos pela Pastoral da Criança em Pelotas, RS. MÉTODOS: Na fase de rastreamento de uma intervenção nutricional, as crianças foram avaliadas através de estudo transversal. No domicílio, após consentimento informado, a mãe foi entrevistada, sendo coletadas informações sobre características demográficas e socioeconômicas da família, saúde da criança, características ao nascer, amamentação e freqüência semanal de consumo de alimentos. As crianças foram pesadas e medidas. Foi coletada uma amostra de sangue capilar da polpa digital em microcuveta e a leitura da concentração de hemoglobina foi feita em fotômetro portátil (Hemocue). Considerou-se como tendo anemia quando a concentração de hemoglobina era inferior a 11 g/dl. Por se tratar de desfecho freqüente, a associação com as variáveis independentes foi analisada por regressão de Poisson. A análise obedeceu a modelo hierárquico previamente definido. RESULTADOS: Foram identificadas 362 crianças menores de seis anos, sendo a hemoglobina dosada em 304 (84,0%) delas. A prevalência de anemia foi de 53,0% (IC95% 47,2% - 58,7%). Os fatores de risco foram a menor idade da criança, cor não branca, presença de família numerosa e classe social E (em comparação à D). A disponibilidade de água encanada dentro de casa e o maior peso ao nascer mostraram-se fatores protetores. CONCLUSÕES: os achados deste estudo mostram uma alta prevalência de anemia entre as crianças alvo da ação da Pastoral da Criança, bem como a presença de diversos fatores de risco e poucos fatores de proteção, o que mostra a necessidade de intervenções preventivas.

Enteroparasitic occurrence in fecal samples analyzed at the University of Western São Paulo-UNOESTE Clinical Laboratory, Presidente Prudente, São Paulo State, Brazil

This study aims to analyze the enteroparasitic occurrence in children from 0 to 12 years old consulted at the University of western Sao Paulo Clinical Laboratory, Presidente Prudente, SP, Brazil, in relation to the socioeconomic profile of the attended children. Stool samples were examined and a questionnaire was applied with the objective of knowing the patient's age, sex, medical attendance, characteristic of the habitation, provisioning of water, dejection and domestic waste fates, use of footwear and clinical signs. The software EPI INFO 6 (Version 6.04b) was used for the elaboration of the data bank structure and analysis after previous data codification. Among 1,000 children analyzed, as many as 21.3% presented some kind of parasite. The most frequent protozoan was Giardia lamblia (7.3%) followed by Entamoeba coli (3.9%). The most frequent helminth was Enterobius vermicularis (1.9%) followed by Hymenolepis nana (0.5%). The most frequent protozoan association was Giardia lamblia / Entamoeba coli (0.9%).

[Anemia in public school first graders in the city of Maceió, Alagoas, Brazil]

A cross-sectional study was conducted in a representative sample of 426 randomly selected first graders (ages 6 to 10 years) from public schools in Maceió, State of Alagoas, Brazil. The aim was to determine the prevalence of anemia, as well as its association with growth retardation. Data were collected from May to July 2000, and determination of hemoglobin (HGB) employed an STKS Coulter counter. Two cut-off points were used to classify anemia, both established by the World Health Organization: HGB < 11.5g/dl and HGB < 12.0g/dl. The indicators height/age (H/A), weight/age (W/A), and weight/height (W/H) below -2.0 standard deviations from the NCHS reference were diagnosed as growth retardation. Prevalence of anemia was 9.9% when HGB < 11.5g/dl was used, and 25.4% when the cut-off point was HGB < 12.0g/dl. Growth retardation was detected in 6.2% of children according to H/A, 4.0% for W/A, and 3.0% for W/H. There was no statistically significant association between the variables in the study. These findings confirm results of previous surveys where prevalence of anemia was much higher than that of growth retardation. The severe consequences of anemia in this age group justify the implementation of broad public policies to overcome this nutritional deficiency.

Saúde de populações marginalizadas: desnutrição, anemia e enteroparasitoses em crianças de uma favela do "Movimento dos Sem Teto", Maceió, Alagoas

OBJETIVOS: verificar a prevalência de desnutrição energético-protéica (DEP), anemia e enteroparasitoses em crianças de uma favela do "Movimento dos Sem Teto". MÉTODOS: estudo transversal envolvendo 137 crianças (6-60 meses). Como indicador da DEP aplicou-se o ponto de corte z < -2 aos indicadores peso para idade (P/I), altura para idade (A/I) e peso para altura (P/A), relativamente ao padrão do NCHS. Para caracterização da anemia, usou-se método da Organização Mundial de Saúde, (haemoglobin colour scale). Concentração de hemoglobina < 11g/dl caracterizou o estado de anemia. Todas as crianças foram submetidas a exame parasitológico de fezes. RESULTADOS: as prevalências de deficits nutricionais para os indicadores A/I, P/I e P/A foram, respectivamente, 22,6%, 16,1% e 1,5%. Quase todas as crianças apresentaram pelo menos um tipo de parasita (83,2%). Destas, 50,9% eram poliparasitadas. As associações mais freqüentes foram Ascaris + Trichuris (15,7%) e Ascaris + Giardia (13%). A anemia foi detectada em 96,4% das crianças. CONCLUSÕES: em virtude das altas prevalências de DEP, anemia e parasitoses e, considerando o efeito sinérgico entre desnutrição e infecções, conclui-se que o quadro de saúde verificado é extremamente precário, requerendo intervenção imediata a fim de garantir melhores condições de crescimento, desenvolvimento para essas crianças.

[Physical growth in schoolchildren from Florianópolis, Santa Catarina State, Brazil: a case-control study]

This study was undertaken using a case-control, prevalence survey design, aimed at verifying the effects of socioeconomic, environmental, and biological/morbidity variables on the growth of schoolchildren from low-income families. The study focused on schoolchildren whose height/age (H/A) ratio was < or = 2SD (NCHS). Control groups were paired according to sex into two groups: C1, whose H/A ratio was between -1SD (NCHS) and the median, and C2, with the H/A ratio > median to +1 SD (NCHS). The Mantel-Haenszel test was used to verify each variable with regard to the H/A ratio, while non-conditional multivariate analysis was used to identify which of the variable blocks had a significant effect and, in the following stage, to identify the variables with a significant effect within each block. In the first stage, the variables with a significant effect for C1 were socioeconomic. For C2, socioeconomic, environmental, and morbidity/biological variables were significant. In the final model, the remaining significant variables for C1 were socioeconomic, while those for C2 were socioeconomic and morbidity/biological. The authors conclude that socioeconomic variables are hierarchically superior to other risk factors.