Helminth Infections

Abstract

Emerging evidence over the past decade has implicated helminth infections as important yet stealth causes of adverse pregnancy outcomes and impaired women's reproductive health. The two most important helminth infections affecting women living in poverty in Africa and elsewhere in the developing world are hookworm infection and schistosomiasis. In Africa alone, almost 40 million women of childbearing age are infected with hookworms, including almost 7 million pregnant women who are at greater risk of severe anemia, higher mortality, and experiencing poor neonatal outcome (reduced birth weight and increased infant mortality). Possibly, tens of millions of women in Africa also suffer from female genital schistosomiasis associated with genital itching and pain, stress incontinence, dyspareunia, and infertility and experience social stigma and depression. Female genital schistosomiasis also is linked to horizontal transmission of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and it may represent one of Africa's major cofactors in its AIDS epidemic. There is urgency to expand mass drug administration efforts for hookworm and schistosomiasis to include women of reproductive age and to shape new policies and advocacy initiatives for women's global health to include helminth control. In parallel is a requirement to better link global health programs for HIV and AIDS and malaria with helminth control and to simultaneously launch initiatives for research and development.

The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals

“…Whilst McDonald and co-workers found that gendered division of household tasks means that women and girls are usually in charge of washing clothes and collecting water and thus more exposed to contaminated water, and therefore schistosomiasis and other water-borne infections [68]. However, there can be little debate regarding the impact of schistosomiasis infection on pregnant women, with urogenital schistosomiasis [69, 70] being a common gynaecologic condition among African women [71], a significant cause of pregnancy complications [66, 72, 73] with an increased risk of HIV transmission in women due to the presence of genital lesions [74, 75]. Pregnant women also suffer from hookworm-associated anaemia and dengue in pregnancy [76, 77].…”

The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections

“…Helminths, including hookworm (mostly Necator americanus ), whipworms ( Trichuris trichiura ), roundworms ( Ascaris lumbricoides ), and schistosomes (mostly Schistosoma haematobium and Schistosoma mansoni ) cause chronic, debilitating diseases—which include iron deficiency anemia, asthma, vitamin deficiency, abdominal pain, colitis, and dysentery—leading to growth failure and impaired cognitive development [ 7 ]. Schistosomiasis is associated with ulcerative genital disease, infertility, and increased transmission of human immunodeficiency virus [ 8 ]. According to the Global Burden of Disease Study 2010, overall helminth infections account for more than 14 million disability adjusted life years (DALYs), ranking these diseases among the greatest global health threats [ 6 ].…”

The Global State of Helminth Control and Elimination in Children

“…In resource-poor areas, women of reproductive age or those that are pregnant are at high risk of hookworm-induced iron-deficiency anemia. 5,13 In Africa and elsewhere, hookworm-induced anemia is also exacerbated by malaria coinfections. 14 Similarly, schistosomiasis is a major cause of chronic pediatric inflammation and anemia.…”

“…15 In addition, schistosomiasis caused by Schistosoma haematobium causes lesions in the female genital tract that result in a 2.9-to 4-fold increase in HIV transmission and increased risk of progress to AIDS. 13 Schistosomiasis has also been linked to female infertility and the development of noncommunicable diseases such as cancer. 16–18 Because these infections commonly have subclinical symptoms in children and young adults, the evidence of morbidity may not become apparent until adulthood, leading to limitations in adult workforce capability and wage potential, creating a cycle of poverty within the community.…”