Hookworm in Georgia

I. Survey of Intestinal Helminth Infections and Anemia in Rural School Children

Larry K. Martin Department of Parasitology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112

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In a survey in rural Georgia, 3,729 white elementary school children were examined for intestinal helminth infections and 5,016 were tested for anemia. The state was divided into four domains of study (I, north; II, north-central; III, south-central; IV, southeast), each having a different expected hookworm prevalence. Sample clusters were classrooms, grades 1, 3, 5, and 7, in pairs of rural schools in each of seven randomly selected counties of every domain. Hematocrit and hemoglobin determinations were made at the schools, and fecal specimens were mailed to a central laboratory for quantitative diagnosis of helminthiases by a thick-smear technique. Data were recorded on mark-sensing sheets and analyzed by computer. In domains I to IV, 869, 959, 862, and 1,039 children, respectively, were examined for parasites, and 0%, 1%, 4%, and 12%, respectively, were positive for hookworm. Of the 172 hookworm infections, 48 were moderate or heavy in intensity. From 3 to 10% of the children had low hematocrit or hemoglobin levels, but fewer than half of the moderate to heavy hookworm cases were categorized as anemic, and even some very heavy infections were in children with normal hematocrit and hemoglobin. Of the 48 Ascaris infections detected, 4 were in domain I (<1% prevalence), 10 in domain II (1%), 3 in domain III (<1%), and 31 in domain IV (3%). More than twice as many Ascaris infections occurred in 1st-grade children than in children of any of the other three grades. About one-third of the cases were in the moderate to heavy category; 11 of these were in domain IV. Trichuriasis was not found in the children in domain I, 5 cases (<1%) were found in domain II, 3 (<1%) in domain III, and 12 (1%) in domain IV. Among these 20 infections, 14 were light and 6 were of moderate to heavy intensity. The results of this survey indicate that hookworm remains endemic in rural southern Georgia, and it is expected that hookworm infections will persist in scattered families for the foreseeable future. But hookworm disease is not common and must be treated on an individual basis. Ascariasis and trichuriasis no longer appear to be of public health significance in white children in Georgia but, again, occasional cases, some of clinical significance, can be expected to appear throughout the next few decades.

Author Notes

Present address: Department of Medical Zoology, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Washington, D. C. 20012.