Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama

Abstract

Abstract.Hookworm infection affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children. Because of the environmental conditions needed for the hookworm life-cycle, this parasite is endemic to resource-limited countries. Necator americanus was endemic in the southern United States before improvement of sewage disposal systems and eradication programs. With continued poverty, poor sanitation, and an environment suitable for the hookworm life-cycle in some regions of the southern United States, a current prevalence study using modern molecular diagnostics is warranted. Lowndes County, Alabama, was chosen as the study site given previous high hookworm burdens, degree of poverty, and use of open-sewage systems. Participants were interviewed, and stool, serum, and soil samples were tested for nine intestinal parasites using a multiparallel quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assays. We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for N. americanus, four (7.3%) for Strongyloides stercoralis, and one (1.8%) for Entamoeba histolytica. Stool tested positive for N. americanus contained low levels of parasite DNA (geometric mean 0.0302 fg/μL). Soil studies detected one (2.9%) Cryptosporidium species, and Toxocara serology assay detected one (5.2%) positive in this population. Individuals living in this high-risk environment within the United States continue to have stool samples positive for N. americanus. Gastrointestinal parasites known to be endemic to developing countries are identifiable in American poverty regions, and areas with lower disease burden are more likely to be identified by using qPCR.

The cognitive performance of indigenous schoolchildren in relation to their feeding during infancy

“…Belonging to rural areas and native communities predisposes people to poverty and inequality (BM, 2015;Freire et al, 2013), which may lead to food insecurity and affect neurocognitive outcomes (Jensen et al, 2017). In such contexts, poor hygienic practices (Makoge, Vaandrager, Maat, & Koelen, 2017), intestinal parasitosis (McKenna et al, 2017), and diarrhea (Makoge et al, 2017) are frequent. Thus, under these conditions, breastfeeding may be the best option to feed the infants.…”

Hookworm: a neglected resurgent infection

“…4 Hookworms were rampant in the southern US in the early 1900s; the prevalence was around 40%. In 1913 the Rockefeller Foundation set up the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (RSC), the first public health intervention providing community based treatment, together with detailed mapping of the infection, health education, and promotion of sanitation.…”

“…4 This is the reason hookworm has re-emerged and thrives in poverty stricken settings in industrialised nations.…”

Prevalence of parasitic infections among recent immigrants to Chicago

“…[3, 24–27] Additionally, recent immigrants may be more likely to have a decreased socioeconomic status and therefore frequently reside in the underserved areas within the US that have an increased prevalence of parasitic infections. [2–4, 22] This population thus possesses a dual risk for parasites. [7] However, published prevalence estimates vary widely and therefore the true prevalence and health impacts of parasitic infections on US immigrant populations is unknown.…”

“…Most studies evaluating the impact of parasitic infections in the US have focused on the Southern states because of a warmer climate (facilitating the acquisition of soil-transmitted helminths) and a comparatively high population of immigrants. [5, 12, 13, 22, 47] According to US Census reports, however, Illinois is among the states with the highest percentages of immigrants; 10-15% of the state’s population is foreign born. [48] Thus, this study was conducted with the overall aim of evaluating the prevalence of parasitic infections among recent immigrants living in Chicago.…”