Asymptomatic Vivax and Falciparum Parasitaemia with Helminth Co-Infection: Major Risk Factors for Anaemia in Early Life

Published: August 9, 2016

Citation

Burdam FH, Hakimi M, Thio F, Kenangalem E, Indrawanti R, Noviyanti R, Trianty L, Marfurt J, Handayuni I, Soenarto Y, Douglas NM, Anstey NM, Price RN, Poespoprodjo JR. Asymptomatic Vivax and Falciparum Parasitaemia with Helminth Co-Infection: Major Risk Factors for Anaemia in Early Life. PLoS One, 2016; 11(8):e0160917. doi: 10.1371/journal.pone.0160917.

Abstract

Background

Anaemia in children under five years old is associated with poor health, growth and developmental outcomes. In Papua, Indonesia, where the burden of anaemia in infants is high, we conducted a community survey to assess the association between Plasmodium infection, helminth carriage and the risk of anaemia.

Methods

A cross sectional household survey was carried out between April and July 2013 in 16 villages in the District of Mimika using a multistage sampling procedure. A total of 629 children aged 1–59 months from 800 households were included in the study. Demographic, symptom and anthropometry data were recorded using a standardized questionnaire. Blood and stool samples were collected for examination.

Results

Of the 533 children with blood film examination, 8.8% (47) had Pvivax parasitaemia and 3.9% (21) had Pfalciparum; the majority of children with malaria were asymptomatic (94.4%, 68/72). Soil transmitted helminth (STH) infection was present in 43% (105/269) of children assessed; those with STH were at significantly greater risk of Pvivax parasitaemia compared to those without STH (OR = 3.7 [95%CI 1.5–9.2], p = 0.004). Anaemia (Hb<10 g/dl) was present in 24.5% (122/497) of children and associated with Pvivax parasitaemia (OR = 2.9 [95%CI, 1.7–4.9], p = 0.001), Pfalciparum parasitaemia (OR = 4.3 [95%CI, 2.0–9.4], p<0.001), hookworm carriage (OR = 2.6 [95%CI, 1.2–5.8], p = 0.026), Plasmodium–helminth coinfection (OR 4.0 [95%CI, 1.4–11.3], p = 0.008) and severe stunting (OR = 1.9 ([95%CI, 1.1–3.3], p = 0.012).

Conclusions

Asymptomatic Pvivax and Pfalciparum infections and hookworm all contribute to risk of paediatric anaemia in coendemic areas and should be targeted with prevention and treatment programs. The relationship between helminth infections and the increased risk of Pvivaxparasitaemia should be explored prospectively.