Hookworm-Related Anaemia among Pregnant Women: A Systematic Review

Abstract

Background and ObjectivesHookworm infection is among the major causes of anaemia in poor communities, but its importance in causing maternal anaemia is poorly understood, and this has hampered effective lobbying for the inclusion of anthelmintic treatment in maternal health packages. We sought to review existing evidence on the role of hookworm as a risk factor for anaemia among pregnant women. We also estimate the number of hookworm infections in pregnant women in sub-Saharan Africa (SSA).MethodsStructured searches using MEDLINE and EMBASE as well as manual searches of reference lists were conducted, and unpublished data were obtained by contacting authors. Papers were independently reviewed by two authors, and relevant data were extracted. We compared haemoglobin concentration (Hb) according to intensity of hookworm infection and calculated standardised mean differences and 95% confidence intervals. To estimate the number of pregnant women, we used population surfaces and a spatial model of hookworm prevalence.FindingsOne hundred and five reports were screened and 19 were eligible for inclusion: 13 cross-sectional studies, 2 randomised controlled trials, 2 non-randomised treatment trials and 2 observational studies. Comparing uninfected women and women lightly (1–1,999 eggs/gram [epg]) infected with hookworm, the standardised mean difference (SMD) was −0.24 (95% CI: −0.36 to −0.13). The SMD between women heavily (4000+ epg) infected and those lightly infected was −0.57 (95% CI: −0.87 to −0.26). All identified intervention studies showed a benefit of deworming for maternal or child health, but since a variety of outcomes measures were employed, quantitative evaluation was not possible. We estimate that 37.7 million women of reproductive age in SSA are infected with hookworm in 2005 and that approximately 6.9 million pregnant women are infected.ConclusionsEvidence indicates that increasing hookworm infection intensity is associated with lower haemoglobin levels in pregnant women in poor countries. There are insufficient data to quantify the benefits of deworming, and further studies are warranted. Given that between a quarter and a third of pregnant women in SSA are infected with hookworm and at risk of preventable hookworm-related anaemia, efforts should be made to increase the coverage of anthelmintic treatment among pregnant women.

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

“…Both hookworm infection and malaria are known to cause anemia, especially in children and women of childbearing age. 49,50 In this study population, the risk of anemia among children ages 6-15 years was highest in those who had isolated malaria infection (OR = 4.92), and this risk was greater than in those who were infected with both hookworm and malaria (OR = 2.34) ( Table 3 ). Despite the small sample size, this pattern (greater risk of anemia with isolated malaria infection compared with coinfection) was observed across three of four age groups studied, the exception being adults ages 16-40 years old (data not shown).…”

Maternal Mortality in India: An Overview of social causes

“…Anemia, one of the leading causes of poor pregnancy outcomes, can be a result of hookworm infection due to poor sanitation practices during pregnancy (Brooker et al, 2008;Cheng JJ, 2012). Sepsis, which accounts for around 11 % of all maternal deaths at the global level and 10-15 % of maternal deaths in developing countries, is the result of poor hand hygiene and contaminated surfaces during delivery (Seale A, 2009;Gravett CA et al 2012;WHO, UNICEF, 2012;Say, 2014).…”

Point-of-care mobile digital microscopy and deep learning for the detection of soil-transmitted helminths and Schistosoma haematobium

“…Compared with other age groups, preschool, school-aged and adolescent children tend to harbor higher numbers of parasites, resulting in impaired growth and development, diminished physical fitness and decreased neurocognitive abilities [5]. Hookworms and schistosomiasis also represent a significant cause of maternal morbidity and pregnancy complications [6,7]. …”