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Early Helminth Infections Are Inversely Related to Anemia, Malnutrition, and Malaria and Are Not Associated with Inflammation in 6- to 23-Month-Old Zanzibari Children

Helminths aggravate anemia and malnutrition among school children. We studied this association in a cross-sectional study of 6- to 23-month-old Zanzibari children (N = 2322) and a sub-sample of 690 children matched on age and helminth infection status. Ascaris, hookworm, and Trichuris infections were diagnosed along with recent fever, malaria infection, mid-upper arm circumference (MUAC) and hemoglobin concentration (Hb). Alpha-1-acid glycoprotein (AGP), C-reactive protein (CRP), height, and weight were measured in the sub-sample. Infected children had higher Hb (β = 5.44 g/L, P < 0.001) and MUAC-for-age Z score (β = 0.30 Z, P < 0.001) compared with uninfected children after adjusting for covariates. Although helminths were not associated with inflammation, their association with Hb or MUAC-for-age Z score was modified by inflammation. Malaria-infected children were less likely to be infected with helminths (adjusted odds ratios 0.63 [95% confidence interval: 0.49, 0.81]). Non-anemic, better nourished, or non-malaria-infected children may be more exploratory of their environments and therefore increase their exposure to soil-transmitted helminths.

Received February 16, 2009. Accepted for publication July 7, 2009.

Acknowledgments: We thank the field and lab staff at the Public Health Laboratory-Ivo de Carneri for the field work and collection of blood and stool samples, and for sample aliquoting, the community of Pemba Island for their participation, Cornell University Human Metabolic Research Unit for generating the AGP data, and Joanna Szaub at the London School of Hygiene and Tropical Medicine for CRP data generation.

Financial support: This study was supported by a grant from the Wellcome Trust.

^* Address correspondence to Jacqueline K. Kung’u, Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853. E-mail: jm453{at}cornell.edu

Authors’ addresses: Jacqueline K. Kung’u and Rebecca J. Stoltzfus, Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853, Tel: 607-379-3315, Fax: 607-255-1033, E-mail: jm453{at}cornell.edu. David Goodman and James M. Tielsch, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. Hamad J. Haji and Mahdi Ramsan, Pemba Public Health Laboratory, Ivo de Carneri, Box 122, Chake-Chake, Pemba Island, Zanzibar, The United Republic of Tanzania. Victoria J. Wright, Quentin D. Bickle, and John G. Raynes, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom WC1E 7HT.