Abstract
BackgroundAs traditional lifestyle and diets change with social and economic development, disadvantaged communities in low- and middle-income countries increasingly face a double burden of communicable and non-communicable diseases. We studied the relationship between physical fitness and infections with soil-transmitted helminths (STHs), intestinal protozoa and Helicobacter pylori among schoolchildren in Port Elizabeth, South Africa.MethodsWe conducted a cross-sectional survey among 1009 children, aged 9 to 12 years, from eight primary schools in socioeconomically disadvantaged neighbourhoods of Port Elizabeth. Physical fitness was determined using field-deployable tests of the Eurofit fitness test battery. Stool samples were analysed with the Kato-Katz thick smear technique to diagnose STHs and with rapid diagnostic tests (RDTs) to detect intestinal protozoa and H. pylori infections. Haemoglobin (Hb) levels were assessed and anthropometric indicators determined.ResultsComplete data were available for 934 children (92 %). In two schools, high STH prevalences were found (Ascaris lumbricoides 60 and 72 %; Trichuris trichiura 65 % each). For boys and girls co-infected with A. lumbricoides and T. trichiura (n = 155) the maximal oxygen uptake (VO2 max) was estimated to be 50.1 and 47.2 ml kg-1 min-1, compared to 51.5 and 47.4 ml kg-1 min-1 for their non-infected peers (n = 278), respectively. On average, children without helminth infections had greater body mass (P = 0.011), height (P = 0.009) and a higher body mass index (P = 0.024) and were less often stunted (P = 0.006), but not significantly less wasted compared to their peers with a single or dual species infection. Among 9-year-old boys, a negative correlation between helminth infections and VO2 max, grip strength and standing broad jump distance was observed (P = 0.038). The overall mean Hb level was 122.2 g l-1. In the two schools with the highest prevalence of STHs the Hb means were 119.7 and 120.5 g l-1, respectively.ConclusionsIntestinal parasite infections appear to have a small but significant negative effect on the physical fitness of infected children, as expressed by their maximal oxygen uptake. We observed a clear impact on anthropometric indicators.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1761-5) contains supplementary material, which is available to authorized users.
Highlights
As traditional lifestyle and diets change with social and economic development, disadvantaged communities in low- and middle-income countries increasingly face a double burden of communicable and non-communicable diseases
The study population consisted of coloured children and black African children, residing in areas previously demarcated for these specific race groups, in accordance with past Apartheid legislation
Reasons for exclusion were age outside the target range of 9–12 years, no stool or urine sample submitted for diagnostic workup, lack of clinical examination, reported health problems precluding participation in the physical fitness tests, or incomplete physical test battery
Summary
As traditional lifestyle and diets change with social and economic development, disadvantaged communities in low- and middle-income countries increasingly face a double burden of communicable and non-communicable diseases. Permissive conditions are commonly found in socioeconomically deprived neighbourhoods in low- and middle-income countries, including in South Africa [8] Intestinal protozoa such as Cryptosporidium parvum, Entamoeba spp. and Giardia intestinalis are associated with poor living conditions [9]. In South Africa, a country that shows considerable health inequity in global terms (e.g. Gini index of 0.63 in 2011 [12]), socioeconomically deprived communities with a high burden of infectious diseases live in close proximity to affluent ones with a disease burden profile typical of western societies Among both populations, non-communicable diseases (e.g. diabetes, cardiovascular- and obesity-related conditions and cancers) are rapidly increasing, fuelled by unhealthy lifestyles including poor nutritional habits and sedentary lifestyles [13]. South Africa’s 2014 Report Card on Physical Activity for Children and Youth [14] highlights the current concerns for the health and well-being of children and youth in relation to declining physical activity levels and increasing rates of consumption of soft-drinks and fast food
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