Abstract
Anaemia is multi-factorial in origin and disentangling its aetiology remains problematic, with surprisingly few studies investigating the relative contribution of different parasitic infections to anaemia amongst schoolchildren. We report cross-sectional data on haemoglobin, malaria parasitaemia, helminth infection and undernutrition among 1523 schoolchildren enrolled in classes 5 and 6 (aged 10–21 years) in 30 primary schools in western Kenya. Bayesian hierarchical modelling was used to investigate putative relationships. Children infected with Plasmodium falciparum or with a heavy Schistosoma mansoni infection, stunted children and girls were found to have lower haemoglobin concentrations. Children heavily infected with S. mansoni were also more likely to be anaemic compared with uninfected children. This study further highlights the importance of malaria and intestinal schistosomiasis as contributors to reduced haemoglobin levels among schoolchildren and helps guide the implementation of integrated school health programmes in areas of differing parasite transmission.
Highlights
Anaemia remains one of the most intractable public health problems in Africa, contributing to a quarter of Africa’s nutrition-related Disability Adjusted Life Years (DALYs) lost (World Health Organization, 2002)
We present data from the baseline survey on a subsample of children enrolled in classes 5 and 6 for whom complete data on anaemia, helminth infection, malaria parasitaemia, nutritional status and socioeconomic status (SES) were available
Data on Hb, malaria parasitaemia and helminth infection were available for 1523 children in the 30 schools (Table 1)
Summary
Anaemia remains one of the most intractable public health problems in Africa, contributing to a quarter of Africa’s nutrition-related Disability Adjusted Life Years (DALYs) lost (World Health Organization, 2002). There are surprisingly few published studies describing the relative contribution of these different parasitic infections in populations of school-aged children (Olsen et al, 1998; Tatala et al, 1998; Friis et al, 2003; Leenstra et al, 2003; Leenstra et al, 2004; Desai et al, 2005a; Friedman et al, 2005b). Investigation of this issue is relevant for the design of integrated control strategies aimed at reducing anaemia, including anthelmintic treatment programmes, micronutrient supplementation and malaria control measures, through school health programmes. The same suite of school-based interventions will not be relevant everywhere, and the selection of intervention options will need to be guided by an informed understanding of the epidemiology of parasite-related anaemia (Crawley, 2004), as well as of the geography of infection (Brooker et al, 2007)
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