Environmental influences on helminthiasis and nutritional status among Pacific schoolchildren

Abstract

This paper describes a study undertaken to: (1) determine the prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm infections and nutritional status among Pacific Island school children; (2) identify factors influencing helminthiasis; (3) identify interventions to improve school health. A total of 3,683 children aged 5-12 years attending 27 primary schools in 13 Pacific Island countries were surveyed along with school environmental data. Stool samples were collected from 1996 children (54.2%) and analysed for ova and helminths. Total prevalence of helminthiasis was 32.8%. Anaemia prevalence was 12.4%. Children with helminthiasis and anaemia were found to be 8.7 times more likely to be stunted and 4.3 times more likely to be underweight than non-anaemic and non-infected children. Four significant environmental influences on helminthiasis were identified: (1) an inadequate water supply; (2); availability of a school canteen; (3) regular water/sanitation maintenance regimes; and (4) overcrowded classrooms. Helminthiasis was found to be strongly associated with anaemia, stunting and underweight and environmental influences identified. Although mass anti-helminthic drug administrations (MDA) have been taking place, reinfection is common as drug therapy alone is not enough. Programme effectiveness depends upon upgrading school environments to include an adequate water supply, controlled food preparation/provision, well-maintained water/sanitation facilities and class sizes of 30 students or less.

Epidemiology of Hookworm Infection in Kintampo North Municipality, Ghana: Patterns of Malaria Coinfection, Anemia, and Albendazole Treatment Failure

“…[58][59][60][61] Treating intestinal helminth infections, particularly in areas with a high prevalence of hookworm, can improve children's nutritional status, 9, 62-65 supporting a causal role for helminth infections in the pathogenesis of malnutrition. However, although the lower BMI may be a consequence of hookworm, we propose that malnutrition could also mediate susceptibility to infection.…”

<i>Ascaris lumbricoides</i>: A Review of Its Epidemiology and Relationship to Other Infections

“…The risk of Ascaris, Trichuris and/or hookworm infection was elevated by 4.1 times in Pacific Island schools that did not have a water supply, regardless of water quality [19] , highlighting the importance of access to water in schools. Interestingly, however, although regular washing of hands before eating reduced the prevalence of Ascaris among 176 subjects aged 2-50 years old from tea plantations in Sri Lanka, Ascaris intensity was unaffected by the source of water for drinking or bathing, by boiling drinking water, or by washing hands before eating and after defecation [85] .…”

“…Among schoolchildren living on Pacific Islands where Ascaris, Trichuris and hookworm are endemic, helminth-infected children had a significantly lower risk of elevated body mass index, an indicator of overweight [19] . This survey of 27 schools found 6 schools where more than 10% of children were overweight, and 5 other schools where more than 10% of children were stunted.…”

“…The set of environmental, social and behavioral predictors of elevated Ascaris egg output are not always consistent across studies, but crowding [18][19][20] , poor education of mothers [18,[20][21][22] , open defecation [20,22] , inadequate water supply [18][19][20] , poverty [18,20,[22][23][24][25] , poor nutritional status [24,26,27] , use of human biosolids for fertilizers and irrigation [16] , geophagy [12] , not washing hands before eating [25] , pig ownership or livestock breeding [20,25,28] , and consumption of raw pork and raw water plants [25] are often reported, depending on the population under consideration (preschool chil-9 dren, schoolchildren, migrant women, street vendors, entire communities).…”

Anaemia, its correlation with overweight and growth patterns in children aged 5–10 years living in American Samoa

“…Helminth infestations can result in iron deficiency and anaemia; however, neither filariasis nor helminth diagnosis or treatment, within the last 6 months as reported by the caregiver, were associated with anaemia in this study. A study conducted in children aged 5-12 years living within the Pacific Islands in 2001-2002 also found no association between helminth infection and anaemia (24) . The American Samoa Department of Public Health is participating in the WHO Filariasis Campaign to control filariasis and helminthes.…”