The epidemiology of polyparasitism and implications for morbidity in two rural communities of Côte d'Ivoire - PubMed (original) (raw)
The epidemiology of polyparasitism and implications for morbidity in two rural communities of Côte d'Ivoire
Eveline Hürlimann et al. Parasit Vectors. 2014.
Abstract
Background: Polyparasitism is still widespread in rural communities of the developing world. However, the epidemiology of polyparasitism and implications for morbidity are poorly understood. We studied patterns of multiple species parasite infection in two rural communities of Côte d'Ivoire, including associations and interactions between infection, clinical indicators and self-reported morbidity.
Methods: Between August and September 2011, two purposely selected rural communities in southern Côte d'Ivoire were screened for helminth, intestinal protozoa and Plasmodium infection, using a suite of quality-controlled diagnostic methods. Additionally, participants were examined clinically and we measured haemoglobin level, height, weight and mid-upper arm circumference to determine nutritional status. An anamnestic questionnaire was administered to assess people's recent history of diseases and symptoms, while a household questionnaire was administered to heads of household to collect socioeconomic data. Multivariate logistic regression models were applied for assessment of possible associations between parasitic (co-)infections and morbidity outcomes.
Results: 912/1,095 (83.3%) study participants had complete parasitological data and 852 individuals were considered for in-depth analysis. The rate of polyparasitism was high, with Plasmodium falciparum diagnosed as the predominant species, followed by Schistosoma haematobium, Schistosoma mansoni and hookworm. There were considerable differences in polyparasitic infection profiles among the two settings. Clinical morbidity such as anaemia, splenomegaly and malnutrition was mainly found in young age groups, while in adults, self-reported morbidity dominated. High parasitaemia of P. falciparum was significantly associated with several clinical manifestations such as anaemia, splenomegaly and fever, while light-intensity helminth infections seemed to have beneficial effects, particularly for co-infected individuals.
Conclusions: Clinical morbidity is disturbingly high in young age groups in rural communities of Côte d'Ivoire and mainly related to very high P. falciparum endemicity. Interactions between helminth infections and P. falciparum burden (parasitaemia and clinical morbidity) are evident and must be taken into account to design future interventions.
Figures
Figure 1
Flow chart illustrating study participation and compliance. The cross-sectional surveys were conducted in two rural settings in south and south-central Côte d’Ivoire in August and September 2011. Urine examination was done in Sahoua exclusively. AC = Ancien Carrefour, S = Sahoua.
Figure 2
Number of concurrent parasitic infections, stratified by age group. Rate of polyparasitism among 912 study participants with complete parasitological data. Box plot: boxes illustrate the 25th and 75th percentiles (ptile), while the whiskers indicate the adjacent lower and upper values (most extreme values which are within 25th ptile - 1.5*(75th-25th ptile) and 75th ptile + 1.5*(75th-25th ptile), respectively). The median is shown by the line within the boxes, outliers are indicated with dots.
Figure 3
Prevalence of at least one clinical and/or self-reported morbid sequelae, stratified by age group. Clinical outcomes included: anaemia, splenomegaly, pallor, fever and malnutrition (z-scores <-2), while self-reported morbidity comprised reported symptoms of diarrhoea, abdominal pain, blood in the stool, blood in urine and chronic morbidity. All morbidity data were assessed during medical examination in 852 study participants.
Figure 4
Prevalence of different nutritional indicators used to assess malnutrition in children aged <5 years, stratified by sex. *Considered are only individuals showing moderate or severe signs for malnutrition; #MUAC = mid-upper-arm-circumference; §BMI = body mass index (weight / height2).
Figure 5
Comparison of mean haemoglobin levels in different age groups, stratified by sex in relation to helminth- P. falciparum co-infection from one-way ANOVA and Kruskal-Wallis test. A: Comparison of mean haemoglobin (Hb) level in children aged 5-11 years (n = 224) shown for both sexes with different infection categories for hookworm (Hk) and P. falciparum (Pf). One-way ANOVA analysis showed significant differences in Hb for the total sample (not shown, p = 0.008) and in males (p = 0.028) B: Comparison of mean Hb level in participants aged 16-39 years (n = 243) shown for both sexes with different infection categories for S. mansoni (Sm) and P. falciparum (Pf). Kruskal-Wallis test showed significant differences in Hb for the total sample (not shown, p = 0.021) and in males (p = 0.015). Pregnant women (n = 31) were excluded from the analysis since pregnancy significantly lowers the Hb levels. In this sample of women aged 16-39 years, pregnant women had a mean Hb of 113.5 g/l vs. 123.3 g/l in non-pregnant women (p = 0.001).
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