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MODERATE- AND LOW-INTENSITY CO-INFECTIONS BY INTESTINAL HELMINTHS AND SCHISTOSOMA MANSONI, DIETARY IRON INTAKE, AND ANEMIA IN BRAZILIAN CHILDREN

To determine the role of moderate- and low-intensity infections with Schistosoma mansoni and intestinal helminths (hookworm, Trichuris trichiura, Ascaris lumbricoides) on the prevalence of anemia and their relationship to iron consumption, a cross-section of 1,709 children in rural Brazil was studied. All participants were selected for infection with one or multiple helminthic parasites, and demographic, anthropometric, and dietary intake were surveyed. The prevalence and intensity were as follows: hookworm infection, 15.7% and 8.6 eggs/g; T. trichiura, 74.8% and 190.5 eggs/g; A. lumbricoides, 63% and 1,905.5 eggs/g; S. mansoni, 44.5% and 60.3 eggs/g. There was no increase in odds ratio for anemia with any combination of intestinal helminths without S. mansoni infection. By logistic regression, the odds ratio for having anemia when infected with S. mansoni and two intestinal helminths was 1.7 (95% CI, 1.1–2.5) and for S. mansoni and three intestinal helminths was 2.4 (95% CI, 1.2–4.6) compared with children with a single parasite species. Children with an adequate intake of iron had no increased odds of anemia independent of the combination of parasite infections.

Received November 14, 2004. Accepted for publication April 4, 2006.

^* Address correspondence to Luciara Leite Brito, Instituto de Saúde Coletiva, UFBa, Rua Basílio da Gama, s/n, Canela-Salvador Cep 40.110-040, Brazil. E-mail: luciara{at}ufba.br

Authors’ addresses: Ana Marlúcia O. Assis and Rita de Cássia R. Silva, Universidade Federal da Bahia, Escola de Nutrição, Departamento de Ciência da Nutrição, Rua Araújo Pinho, n 42, Canela 40110150, Salvador, BA, Brazil, Telephone: (71) 32637726, E-mails: amos{at}ufba.br and rcrsilva{at}ufba.br. Maurício L. Barreto and Luciara Leite Brito, Rua Basílio da Gama, s/n - Campus Universitário Canela, Departamento de Saúde Coletiva I: (71) 3263-7407 Cep: 40.110-040-Salvador, BA, Brazil, E-mails: mauricio{at}ufba.br and luciara{at}ufba.br. Ronald Blanton, Center for Global Health and Disease, Case Western Reserve University School of Medicine, 2103 Cornell Rd., Cleveland, OH 44106-4983, Telephone: (216) 368-4814, Fax: (216) 368-4825, E-mail: Ronald.Blanton{at}case.edu. Isabel M. Parraga, Department of Nutrition, Case Western Reserve University School of Medicine • W-G48, 10900 Euclid Avenue, Cleveland OH 44106-4954, E-mail: imp{at}cwru.edu. Mitermayer G. Reis, Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - BA, Laboratório de Patologia e Biologia Molecular. Rua Waldemar Falcão, 121, Candeal- Laboratorio de Patologia e Biologia Molecular Candeal 40296710 - Salvador, BA, Brazil, Telephone: (71) 31762202 Ramal: 202 Fax: (71) 31762289, E-mail: miter{at}cpqgm.fiocruz.br.

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