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Epidemiology of Plasmodium-Helminth Co-Infection in Africa: Populations at Risk, Potential Impact on Anemia, and Prospects for Combining Control

Human co-infection with Plasmodium falciparum and helminths is ubiquitous throughout Africa, although its public health significance remains a topic for which there are many unknowns. In this review, we adopted an empirical approach to studying the geography and epidemiology of co-infection and associations between patterns of co-infection and hemoglobin in different age groups. Analysis highlights the extensive geographic overlap between P. falciparum and the major human helminth infections in Africa, with the population at coincident risk of infection greatest for hookworm. Age infection profiles indicate that school-age children are at the highest risk of co-infection, and re-analysis of existing data suggests that co-infection with P. falciparum and hookworm has an additive impact on hemoglobin, exacerbating anemia-related malarial disease burden. We suggest that both school-age children and pregnant women—groups which have the highest risk of anemia—would benefit from an integrated approach to malaria and helminth control.

Received January 5, 2007. Accepted for publication February 23, 2007.

Acknowledgments: The authors thank Lani Stephenson and Caroline Shulman for allowing us to re-analyse their data.

Financial support: SB is supported by a Wellcome Trust Research Career Fellowship (081673). SB and PJH acknowledge support of the Albert B. Sabin Vaccine Institute’s Human Hookworm Vaccine Initiative (HHVI) funded by the Bill and Melinda Gates Foundation. RP is supported by a Medical Research Council DTA-funded studentship. RWS is a Wellcome Trust Principal Research Fellow (079080) and acknowledges the support of the Kenyan Medical Research Institute.

^* Address correspondence to Simon Brooker, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: simon.brooker{at}lshtm.ac.uk

Authors’ addresses: Simon Brooker, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, Telephone: 44-207-927-2614, E-mail: simon.brooker{at}lshtm.ac.uk. Willis Akhwale, Division of Malaria Control, Ministry of Health, PO Box 20750, Nairobi, Kenya, E-mail: head.nmcp{at}domckenya.or.ke. Rachel Pullan, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, E-mail: rachel.pullan{at}lshtm.ac.uk. Benson Estambale, Institute of Tropical and Infectious Diseases, University of Nairobi, PO Box 19676-00202, Nairobi, Kenya, E-mail: bestambale{at}uonbi.ac.ke. Sian Clarke, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, E-mail: sian.clarke{at}lshtm.ac.uk. Robert W Snow, Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI/Wellcome Trust Research Laboratories, Nairobi, Kenya, E-mail: rsnow{at}nairobi.kemri-wellcome.org. Peter J Hotez, Department of Microbiology and Tropical Medicine, The George Washington University, 2300 Eye Sreet, NW, Washington, DC 20037 and Sabine Vaccine Institute, Telephone: 202-994-3532, E-mail: mtmpjh{at}gwumc.edu.

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