Parasitism in Children Aged Three Years and Under: Relationship between Infection and Growth in Rural Coastal Kenya

Abstract

BackgroundParasitic infections, which are among the most common infections worldwide, disproportionately affect children; however, little is known about the impact of parasitic disease on growth in very early childhood. Our objective was to document the prevalence of parasitic infections and examine their association with growth during the first three years of life among children in coastal Kenya.Methodology/Principal FindingsChildren enrolled in a maternal-child cohort were tested for soil transmitted helminths (STHs: Ascaris, Trichuris, hookworm, Strongyloides), protozoa (malaria, Entamoeba histolytica and Giardia lamblia), filaria, and Schistosoma infection every six months from birth until age three years. Anthropometrics were measured at each visit. We used generalized estimating equation (GEE) models to examine the relationship between parasitic infections experienced in the first three years of life and growth outcomes (weight, length and head circumference). Of 545 children, STHs were the most common infection with 106 infections (19%) by age three years. Malaria followed in period prevalence with 68 infections (12%) by three years of age. Filaria and Schistosoma infection occurred in 26 (4.8%) and 16 (2.9%) children, respectively. Seven percent were infected with multiple parasites by three years of age. Each infection type (when all STHs were combined) was documented by six months of age. Decreases in growth of weight, length and head circumference during the first 36 months of life were associated with hookworm, Ascaris, E. histolytica, malaria and Schistosoma infection. In a subset analysis of 180 children who followed up at every visit through 24 months, infection with any parasite was associated with decelerations in weight, length and head circumference growth velocity. Multiple infections were associated with greater impairment of linear growth.Conclusions/SignificanceOur results demonstrate an under-recognized burden of parasitism in the first three years of childhood in rural Kenya. Parasitic infection and polyparasitism were common, and were associated with a range of significant growth impairment in terms of weight, length and/or head circumference.

Invited Commentary on Growth and Development in Children with Gastrointestinal Parasitic Infections

“…Recent prospective data supports a greater focus on younger age groups at risk for GI parasitic infections. These prospective findings on children in Kenya indicated that STH infection by 2 years of age was associated with lower growth attainment in terms of length and head circumference relative to WHO standards [7]. Significant growth deficits, such as stunting, among children living in endemic areas commonly occur between 6 months and 2 years of age and overlap when STH infections become established [16].…”

“…Significant growth deficits, such as stunting, among children living in endemic areas commonly occur between 6 months and 2 years of age and overlap when STH infections become established [16]. Upon evaluating STH infections individually, infection with hookworm in 2 year olds was associated with below-average growth in length and head circumference; infection with Ascaris lumbricoides by 12 to 18 months was associated with decreased z-scores for all anthropometric indices at these ages [7]. Furthermore, infection with Strongyloides stercoralis by 30 months of age was associated with lower head circumference measures at this age [7].…”

“…Although infections with Cryptosporidium spp. are uncommon in industrialized countries, they are widespread geographically and are a leading cause of waterborne outbreaks with the greatest number of reported cases occurring among children from 1 to 9 years of age [7]. The incidence of infection with Cryptosporidium spp.…”

“…peaks in preschool-age children, with children often infected by 2 years of age [8•]. Additionally, infections with both STHs and parasitic protozoa, namely Giardia lamblia, have been increasingly recognized as commonly occurring together in children younger than 5 years of age [7].…”

Досвід Проведення Дегельмінтизації У Дітей

“…Серед 545 дітей віком до 3 років геогельмінтами було інфіковано 109 дітей (19 %), причому 7 % з них мали мультипаразитарну інфекцію. Зменшення антропометричних показників (маси тіла, довжини тіла, окружності голови) протягом перших 36 місяців життя було пов'язане поряд з іншими парази-тарними інфекціями з аскаридозом [7]. Паразитичне втручання іншого організму у процеси зростання дити-ни, «обкрадання», механічне пошкодження, алергізація, токсичне засмічення організму хазяїна не можна зали-шати без прицільної уваги, оскільки наслідки для макро-організму глобальні.…”