Impact of Polyparasitic Infections on Anemia and Undernutrition among Kenyan Children Living in a Schistosoma haematobium-Endemic Area

Amaya L. Bustinduy Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Isabel M. Parraga Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Charles L. Thomas Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Peter L. Mungai Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Francis Mutuku Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Eric M. Muchiri Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Uriel Kitron Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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Charles H. King Center for Global Health, Department of Pediatrics, Center for Health Care Research and Policy, and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Studies, Emory University, Atlanta, Georgia

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We measured prevalence of Schistosoma haematobium, Wuchereria bancrofti, Plasmodium falciparum, hookworm, and other geohelminths among school-aged children in four endemic villages in Kwale County, Kenya and explored the relationship between multiparasite burden, undernutrition, and anemia. In 2009–2010 surveys, cross-sectional data were obtained for 2,030 children 5–18 years old. Infections were most prevalent for S. haematobium (25–62%), hookworm (11–28%), and falciparum malaria (8–24%). Over one-half of children were anemic, with high rates of acute and chronic malnutrition. Associations with infection status showed significant age and sex differences. For boys, young age, low socioeconomic standing (SES), S. haematobium, and/or malaria infections were associated with greater odds of anemia, wasting, and/or stunting; for girls, heavy S. haematobium infection and age were the significant cofactors for anemia, whereas low SES and older age were linked to stunting. The broad overlap of infection-related causes for anemia and malnutrition and the high frequency of polyparasitic infections suggest that there will be significant advantages to integrated parasite control in this area.

Author Notes

* Address correspondence to Amaya L. Bustinduy, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK. E-mail: Amaya.Bustinduy@liverpool.ac.uk

Financial support: This work was supported by National Institutes of Health Research Grant R01TW008067 funded by the Ecology of Infectious Diseases Program of the Fogarty International Center. Funding support was also provided through a National Institutes of Health T32 Ruth L. Kirschstein National Service Research Award Training Grant (to A.L.B.).

Authors' addresses: Amaya L. Bustinduy, CTID Building, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mail: Amaya.Bustinduy@liverpool.ac.uk. Isabel M. Parraga, Department of Nutrition, Case Western Reserve University, Cleveland, OH, E-mail: imp@case.edu. Charles L. Thomas, Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, E-mail: clt6@cwru.edu. Peter L. Mungai and Charles H. King, Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, E-mails: plmungai@yahoo.com and chk@cwru.edu. Francis Mutuku and Uriel Kitron, Department of Environmental Studies, Emory University, Atlanta, GA, E-mails: fmutuku73@gmail.com and ukitron@emory.edu. Eric M. Muchiri, Division of Vector Borne Neglected and Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya, E-mail: ericmmuchiri@gmail.com.

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