Nonsterile immunity to cryptosporidiosis in infants is associated with mucosal IgA against the sporozoite and protection from malnutrition.

We conducted a longitudinal study of cryptosporidiosis from birth to three years of age in an urban slum of Dhaka Bangladesh. Fecal DNA was extracted from monthly surveillance samples and diarrheal stool samples collected from 392 infants from birth to three years. A pan-Cryptosporidium qPCR assay was used to identify sub-clinical and symptomatic cryptosporidiosis. Anthropometric measurements were collected quarterly to assess child nutritional status. 31% (121/392) of children experienced a single and 57% (222/392) multiple infections with Cryptosporidium. Repeat infections had a lower burden of parasites in the stool (Cq slope = -1.85; p<0.0001) and were more likely to be sub-clinical (Chi square test for trend; p = 0.01). Repeat infections were associated with the development of growth faltering (Pearson correlation = -0.18; p = 0.0004). High levels of fecal IgA antibodies against the Cryptosporidium Cp23 sporozoite protein at one year of life were associated with a delay in reinfection and amelioration of growth faltering through three years of life (HAZ IgA high responders -1.323 ± 0.932 versus HAZ -1.731 ± 0.984 p = 0.0001). We concluded that nonsterile immunity to cryptosporidiosis in young children was associated with high levels of mucosal IgA anti-Cp23 and protection from diarrhea and growth faltering. Trial Registration: NCT02764918.

Effects of intestinal parasitic infections on nutritional status of primary children in Imo State Nigeria.

INTRODUCTION: A cross-sectional study was conducted between the months of April to October 2015, to determine the effects of intestinal parasitic infections (IPIs) on nutritional status of school age children in Owerri and Orlu geographical zones, in Imo State, Nigeria. METHODS: Faecal samples were examined using Kato Katz method and formol-ether concentration techniques, while blood samples were examined using cyamethahaemoglobin method. Anthropometric indices were used as indicators of nutritional status, children whose Height-for-Age, Weight-for-Age and Weight-for-Height were <-2 standard deviation (SD) were classified as stunted, wasted, and underweight respectively. RESULTS: Total prevalence rate of 16.6% was recorded in the study areas with Ascaris lumbricoides (4.0%), Trichuris trichiura (0.6%), Hookworm (1.0%) Taenia sp (0.3%), Entaomeba histolytica (5.3%), Entamoeba coli (2.7%) and Giardia lambia (2.7) Majority (73.4%) of the children had light intensity. Anthropometric study results showed that 79(31.3%) of the children were malnourished. The prevalence of stunting, under-weight and wasting were higher in uninfected (86.1%, 90.0% and 10%) respectively than in infected children (13.9%, 10.0% and 0.0%) respectively, although not significant at p = 0.857, 0.587 and 0.368 respectively. Prevalence of anaemia was 17.4%, anaemia was insignificantly (p = 0.09) higher in infected (21.1%) than in uninfected (16.5%) children. Children that had co-infection recorded higher prevalence (2.2%) of severe anaemia. There was an association (p = 0.002) between anaemia and intensity of helminth infection. Malnutrition was insignificantly (p = 0.319) higher in children with heavy (100.0%) and moderate (75.0%) intensity of helminth infection than children that had light intensity (41.7%) of helminth infection. CONCLUSION: When compared with previous study, there were decline in the prevalence of intestinal parasitic infections and anaemia among school age children. Low intensity parasitemia with intestinal parasites had no significant effect on the malnutrition and haemoglobin profile of the children in the study areas. Therefore, improved sanitation and more deworming efforts should be intensified to ensure further decline in prevalence of intestinal parasitic infections.

Coinfection of intestinal schistosomiasis and malaria and association with haemoglobin levels and nutritional status in school children in Mara region, Northwestern Tanzania: a cross-sectional exploratory study.

BACKGROUND: Schistosomiasis represents a major public health problem in Tanzania despite ongoing national control efforts. This study examined whether intestinal schistosomiasis is associated with malaria and assessed the contribution of intestinal schistosomiasis and malaria on anaemia and undernutrition in school children in Mara region, North-western Tanzania. METHODS: Stool samples were collected from each of 928 school children randomly selected from 5 schools and examined for intestinal schistosomiasis using the Kato Katz method. Finger prick blood samples were collected and examined for malaria parasites and haemoglobin concentrations using the Giemsa stain and Haemocue methods, respectively. Nutritional status was assessed by taking anthropometric measurements. RESULTS: The overall prevalence and infection intensity of S. mansoni was 85.6% (794/928) and 192 (100-278), respectively. The prevalence of malaria was 27.4% (254/928) with significant differences among villages (χ 2  = 96.11, p < 0.001). The prevalence of anaemia was 42.3% (392/928) with significant differences among villages (χ 2  = 39.61, p < 0.001). The prevalence of stunting, thinness and underweight was 21, 6.8 and 1.3%, respectively. Stunting varied significantly by sex (χ 2  = 267.8, p < 0.001), age group (χ 2  = 96.4, p < 0.001) and by village (χ 2  = 20.5, p < 0.001). Out of the 825 infected children, 217 (26.4%) had multiple parasite infections (two to three parasites). The prevalence of co-infections occurred more frequently in boys than in girls (χ 2  = 21.65, p = 0.010). Mean haemoglobin concentrations for co-infected children was significantly lower than that of children not co-infected (115.2 vs 119.6; t = 0.01, p = 0.002). Co-infected children were more likely to be stunted than children who were not co-infected (χ 2  = 11.6, p = 0.003). On multivariate analysis, age group, village of residence and severe anaemia were significant predictors of stunting after adjusting for sex and infection status. CONCLUSIONS: Intestinal schistosomiasis and malaria are prevalent in Mara region. Coinfections of these parasites as well as chronic undernutrition were also common. We recommend Mara region to be included in national schistosomiasis control programmes.

Association between enteropathogens and malnutrition in children aged 6-23 mo in Bangladesh: a case-control study.

Background: Early exposure to enteropathogens has been associated with malnutrition in children in low-resource settings. However, the contribution of individual enteropathogens remains poorly defined. Molecular diagnostics offer an increase in sensitivity for detecting enteropathogens but have not been comprehensively applied to studies of malnutrition.Objective: We sought to identify enteropathogens associated with malnutrition in Bangladesh.Design: Malnourished children [weight-for-age z score (WAZ) <-2] aged 6-23 mo in Dhaka, Bangladesh, and identified by active community surveillance were enrolled as cases, and normal-weight children (WAZ >-1) of the same age and from the same community were enrolled as controls. Stools were collected at enrollment and, for cases, after a 5-mo nutritional intervention. Enrollment and follow-up stools were tested by quantitative polymerase chain reaction for 32 enteropathogens with the use of a custom-developed TaqMan Array Card.Results: Enteropathogen testing was performed on 486 cases and 442 controls upon enrollment and 365 cases at follow-up. At enrollment, the detection of enteroaggregative Escherichia coli (OR: 1.39; 95% CI: 1.05, 1.83), Campylobacter spp. (OR: 1.46; 95% CI: 1.11, 1.91), heat-labile enterotoxin-producing E. coli (OR: 1.55; 95% CI: 1.04, 2.33), Shigella/enteroinvasive E. coli (OR: 1.65; 95% CI: 1.10, 2.46), norovirus genogroup I (OR: 1.66; 95% CI: 1.23, 2.25), and Giardia (OR: 1.73; 95% CI: 1.20, 2.49) were associated with malnourished cases, and the total burden of these pathogens remained associated with malnutrition after adjusting for sociodemographic factors. The number of these pathogens at follow-up was negatively associated with the change in WAZ during the intervention (-0.10 change in WAZ per pathogen detected; 95% CI: -0.14, -0.06), whereas the number at enrollment was positively associated with the change in WAZ (0.05 change in WAZ per pathogen detected; 95% CI: 0.00, 0.10).Conclusions: A subset of enteropathogens was associated with malnutrition in this setting. Broad interventions designed to reduce the burden of infection with these pathogens are needed. This trial was registered at clinicaltrials.gov as NCT02441426.

Risk Factors and Relationship Between Intestinal Parasites and the Growth Retardation and Psychomotor Development Delays of Children in Sanliurfa, Turkey.

OBJECTIVE: The objective of this study was to determine the risk factors for and relationship among parasitic infections, growth retardation, and psychomotor developmental delays in children aged 6 years and below. METHODS: This case-control study was performed in Sanliurfa in southeastern Turkey between October and December 2007. Data were collected using a structured questionnaire, anthropometry, Ankara Development Screening Inventory, and laboratory analysis of stool specimens. RESULTS: The most common parasite was Giardia intestinalis (42.53%) followed by Enterobius vermicularis (27.58%), Ascaris lumbricoides (18.39%), Hymenolepis nana (5.75%), Trichuris trichiura (3.45%), Escherichia coli (1.15%), and Blastocystis spp. (1.15%). Fifty-eight percent of all children were infected with intestinal parasites; 55.2% had only one parasite, whereas 44.8% had multiple parasites. The children infected with G. intestinalis and other intestinal parasites had significantly higher levels of growth retardation and psychomotor development delay than non-infected children. Children with parasitic infections had growth delay up to 2.9 times, general development delay up to 1.9 times, language-cognitive development delay up to 2.2 times, and fine motor development delay up to 2.9 times higher than children without any parasitic infections. However, no significant relationship among intestinal parasites, gross motor development, social-self skills, and development delay was identified. The education level of parents, poor economic situation, number of households, not washing hands, playing with soil, family history of parasitic infection were the significant risk factors for intestinal parasites. CONCLUSION: Our study indicates that the presence of either malnutrition or intestinal parasites may put a child in a high-risk group for developmental delays and growth retardation. Therefore, public health interventions can embrace nationwide deworming in children.

Intestinal helminthiasis and nutritional status of children living in orphanages in Benin City, Nigeria.

BACKGROUND: Intestinal helminths are often associated with poor growth and reduced physical activities, and may worsen already compromised nutritional status of children living in orphanages. AIMS: To determine the relationship between intestinal helminthiasis and nutritional status of children living in orphanages in Benin City, Nigeria. SETTING AND DESIGN: A cross sectional study carried out from January to April 2011 in orphanages in Benin City, Nigeria. MATERIALS AND METHODS: Fresh stool samples from 140 children (0-17 years) living in 10 orphanages in Benin City, were analyzed using the Kato-Katz technique for the detection of ova of helminths between January and April 2011. Physical growth of the children was classified as stunted, wasted, and under-weight using height for age Z-score, weight for height Z-score, and weight for age Z-score below -2 standard deviation of the reference median, respectively, in the World Health Organization growth chart. STATISTICAL ANALYSIS: The data obtained was entered into spread sheet using the Microsoft Excel 2007 and the analysis was done using the Statistical Package for Social Sciences (SPSS) software versions 11.0 and 16.0 (SPSS Inc Chicago, IL, USA). RESULTS: Prevalence of intestinal helminthiasis was 20.7% and was observed highest in children aged 12-17 years. Ascaris lumbricoides and Trichuris trichiura were the intestinal helminths isolated. Nearly all infected subjects had significant stunted growth ( P = 0.014) and another one-quarter were significantly under-weight ( P = 0.021) when compared with noninfected subjects. CONCLUSION: Intestinal helminthiasis is associated with under-weight and stunted growth.

[Giardia duodenalis and chronic malnutrition in children under five from a rural area of Guinea-Bissau]. / Giardia Duodenalis e Desnutrição Crónica em Crianças Menores de Cinco Anos de uma Região Rural da Guiné-Bissau.

INTRODUCTION: Malnutrition and infections by intestinal parasites such as Giardia duodenalis coexist in the same geographical regions, reaching the highest prevalence in developing countries. The cycle of malnutrition and infection implies that both conditions can aggravate each other and compromise the growth and development of children with special relevance for under-five. The aim of this study was to investigate the association between chronic malnutrition and infection by G. duodenalis in children under five in a rural community in Guinea-Bissau. MATERIAL AND METHODS: A case-control study that included 109 children aged 0 to 59 months of a rural community in Guinea-Bissau was conducted. The anthropometric assessment of children in the study identified 31 cases of chronic malnutrition (z-score height for age < -2) and 78 controls (z-score height for age = -2). Microscopic examination of stools was performed for detection and identification of G. duodenalis and other parasites. RESULTS: The microscopic analysis of stool samples revealed G. duodenalis infection in 29.0% (9/31) of cases and 35.9% (28/78) of controls. No association between the infection with G. duodenalis and chronic malnutrition in children under study could be established. DISCUSSION AND CONCLUSION: The results reinforce the interest in designing further studies exploring this association in different regions and epidemiological settings, while direct to the importance of the criteria for malnutrition definition which influences the subsequent analysis.

Introdução: A desnutrição e as infecções por parasitas intestinais como Giardia duodenalis coexistem nas mesmas regiões geográficas, atingindo maiores prevalências em países em desenvolvimento. O ciclo da desnutrição e infecção implica que ambas as condições se podem agravar mutuamente e comprometer o crescimento e desenvolvimento das crianças, com especial relevância para as menores de cinco anos. O objectivo do presente estudo foi investigar a associação entre a desnutrição crónica e a infecção por G. duodenalis em crianças de uma comunidade rural da Guiné-Bissau.Material e Métodos: Realizou-se um estudo de caso-controlo que incluiu 109 crianças com idades entre os 0 e os 59 meses de uma comunidade rural da Guiné-Bissau. A avaliação antropométrica das crianças em estudo permitiu identificar 31 casos de desnutrição crónica (z-score estatura para a idade < -2) e 78 controlos (z-score estatura para a idade ≥ -2). Foi realizado exame microscópico de fezes para a detecção e identificação de G. duodenalis e de outros parasitas.Resultados: Foi detectada infecção por G. duodenalis em 29,0% (9/31) dos casos e 35,9% (28/78) dos controlos. Não foi encontrada associação entre a infecção por G. duodenalis e a desnutrição crónica nas crianças em estudo.Discussão e Conclusão: Os resultados obtidos mantêm em aberto o interesse em desenhar estudos que explorem esta associação em diferentes regiões e contextos epidemiológicos, apontando para a reflexão sobre a importância dos critérios de definição de desnutrição e concomitantemente da análise subsequente.

Enteroparasitosis en niños desnutridos graves de un hospital de la ciudad de Maracaibo, Venezuela / Intestinal parasitosis in severely malnourished children at a hospital in the city of Maracaibo, Venezuela

Para comparar la prevalencia de enteroparásitos en niños con desnutrición severa de la Unidad de Recuperación Nutricional del Hospital Chiquinquirá de Maracaibo, Estado Zulia, con niños eutróficos que asisten a la consulta de niños sanos del mismo hospital; se realizó un examen coproparasitológico a 50 niños desnutridos graves y 50 niños eutróficos, mediante examen directo; técnica de concentración (Ritchie) y coloración de Ziehl Neelsen. Entre los protozoarios, Cryptosporidium sp. ocupó el primer lugar con un 14% en el grupo de los desnutridos graves y Giardia lamblia en los eutróficos con un 20%. De los helmintos identificados, Trichuruis trichiura prevaleció con 12% en los desnutridos, mientras Ascaris lumbricoides en los eutróficos ocupó el primer lugar con un 8%. No se encontró diferencia estadísticamente significativa entre la prevalencia de parásitos en general con la edad, el sexo o la desnutrición, ni entre poliparasitismo versus monoparasitismo. La medida en que se relacionan la desnutrición y las parasitosis intestinales es difícil de esclarecer, al ser la desnutrición una condición multifactorial ya que depende de la especie parasitaria presente, la intensidad de la parasitosis, las características inmunológicas y genéticas del hospedero, del medio socioeconómico en el que se desenvuelva el individuo, entre otros factores.

To compare the prevalence of intestinal parasites in children with severe malnutrition in the Nutritional Recovery Unit at the Chiquinquirá Hospital of Maracaibo, State of Zulia, with eutrophic children attending consult for healthy children at the same hospital, stool examinations were performed for 50 seriously malnourished children and 50 eutrophic children by direct examination, using the concentration technique (Ritchie) and Ziehl Neelsen. Among the protozoa, Cryptosporidium sp. ranked first, with 14% in the group of severely malnourished and Giardia lamblia in 20% of the eutrophic children. Of the identified helminths, Trichuris trichiura prevailed, with 12% in the malnourished group, while Ascaris lumbricoides took first place with 8% in the eutrophic group. No statistically significant difference was found between the prevalence of parasites in general with age, sex or malnutrition, or between polyparasitism versus monoparasitism. The extent to which malnutrition and intestinal parasites relate is difficult to clarify, since malnutrition is a multifactorial condition that depends on the parasite species present, intensity of the parasitosis, immunologic and genetic characteristics of the host, the socio economic environment in which the individual develops and other factors.

Association of malnutrition with amebiasis.

Observation of a cohort of preschool children in Dhaka, Bangladesh, is beginning to reveal the contributions of environment, host, and parasite to amebiasis. Reviewed here are the associations and interactions of malnutrition, IgA and interferon-gamma, human leukocyte antigen alleles, and parasite genotypes to the outcome of infection. Future efforts aimed at understanding the mechanisms of these effects are described.

Malnutrition and intestinal parasitic infections in school children of Gondar, North West Ethiopia.

BACKGROUND: In developing countries, malnutrition is a considerable health problem with prevalence ranges of 4-46%, with 1-10% severely malnourished. OBJECTIVES: This study aimed to determine the prevalence of malnutrition and intestinal parasitoses and identify risk factors of malnutrition in schoolchildren. SUBJECTS AND METHODS: A cross-sectional study was carried out on 322 schoolchildren, of age 6 to 14 years, attending private and government primary schools, in Gonder town, North West Ethiopia. The study was conducted from December 2006 to February 2007. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and weight-for-height). Epi Info 2000 software was used to evaluate anthropometric results of each individual and formol-ether concentration technique was employed to identify parasites. RESULTS: The prevalence of underweight, stunting, wasting and intestinal parasitoses was 34.8%, 27%, 50% and 55.6%, respectively. Parasites encountered during the study were Ascaris lumbricoides (17.8%), Trichuiris trichiura (3.4%), hookworm (4.3%), Giardia lamblia (9%), Entamoeba histolytica (2.1%), Schistosoma mansoni (2.4%), Hymenolepis nana (4.7%) and Enterobius vermicularis (0.31%), respectively, in single infections. Only two cases of Strongyloides stercoralis was found in multiple infections and none in single infections. The prevalence of multiple parasitoses was 10.9%. Maternal literacy status, sex and age of the child were significantly associated with malnutrition (p < 0.05). CONCLUSION: Even though chronic type of malnutrition (stunting) was decreasing, indicators of acute type of malnutrition were increasing at a higher rate in the area. Implementation of maternal education and school feeding programs, avoidance of students from getting in contact with waste and river water were recommended to avoid malnutrition and intestinal parasitoses in children of the study area.

Influencia de las parasitosis intestinales y otros antecedentes infecciosos sobre el estado nutricional antropométrico de ni±os en situación de pobreza / Intestinal parasitic infestation and others infectious backgrounds influence in the antropometric nutritional status of children in poverty

Las parasitosis afectan principalmente a la población infantil de bajos recursos económicos. A fin de establecer estas asociaciones se evaluaron los antecedentes patológicos previos al estudio (diarrea, infección respiratoria superior e inferior y sarampión) en 257 niños y niñas aparentemente sanos entre 2-18 años de edad, del Sur de Valencia, Edo. Carabobo. 250 muestras de heces fueron sometidas a examen al fresco y Kato. Se determinó el estado nutricional antropométrico utilizando combinación de indicadores (dimensión corporal, composición corporal) e indicadores mixtos y por el método de Graffar-Méndez Castellano se identificó la condición socioeconómica. El análisis estadístico comprendió distribución de frecuencias y Chi2 como medida de asociación; nivel de significancia de p < 0,05. Se encontró 49,6 por ciento de niños parasitados, predominio de estratos socioeconómicos IV y V y de monoparasitismo por protozoarios. El antecedente patológico más prevalente fue infección respiratoria superior. Existió una asociación estadísticamente significativa entre antecedente de diarrea y presencia de parásitos, mas específicamente entre antecedente de diarrea aguda e infestación por Giardia lamblia y Trichuris trichiura. La asociación significativa encontrada entre desnutrición, parasitosis y antecedentes de diarrea, no pudo ser demostrada cuando se discriminó por tipo de parásito y grado de desnutrición. Se evidenció un efecto deletéreo de las parasitosis sobre el estado nutricional. Los antecedentes de diarrea pueden orientar hacia el diagnóstico de parasitosis, causa importante de morbilidad infantil en comunidades en situación de pobreza.

Parasitic infestations affect mainly infantile population of low economic resources. In order to assess this evidence, pathological antecedents of diarrhea, superior and inferior respiratory infection and measles were evaluated in 257 apparently healthy children (boys and girls) aged 2-18 from the South of Valencia city, Edo. Carabobo 250 feces samples were examinationed by fresh and Kato method. The Anthropometric nutritional status was determined by combination of indicators (corporal dimension, corporal composition) and mixed indicators. Sociodemogrßfic evaluation was performed by method of Graffar-Méndez. Frecuency distribution and Chi² association was measure, with a significance value of p < 0,05. It was found 49.6 percent of parasitic infestation with predominance of socioeconomic strata IV and V Monoparasitism and protozoa infestation were highly prevalent. Superior respiratory infection was the most frequent antecedent. A statistically significant association between diarrhea antecedents and parasite infestation, therewas more specifically between antecedent of acute diarrhea and infestación by Giardia lamblia or Trichuris trichiura. A statistically significant association was found among undernourishment, parasitism and antecedent of diarrhea, but it could not be demonstrated when discrimination by type of parasite and degree of undernourishment. Deleterious effect of parasitic infestation on the nutritional status; was found diarrhea antecedents can lead to the diagnosis, important cause of infantile morbidity in communities in poverty situation.

Effects of deworming on malnourished preschool children in India: an open-labelled, cluster-randomized trial.

BACKGROUND: More than a third of the world's children are infected with intestinal nematodes. Current control approaches emphasise treatment of school age children, and there is a lack of information on the effects of deworming preschool children. METHODOLOGY: We studied the effects on the heights and weights of 3,935 children, initially 1 to 5 years of age, of five rounds of anthelmintic treatment (400 mg albendazole) administered every 6 months over 2 years. The children lived in 50 areas, each defined by precise government boundaries as urban slums, in Lucknow, North India. All children were offered vitamin A every 6 months, and children in 25 randomly assigned slum areas also received 6-monthly albendazole. Treatments were delivered by the State Integrated Child Development Scheme (ICDS), and height and weight were monitored at baseline and every 6 months for 24 months (trial registration number NCT00396500). p Value calculations are based only on the 50 area-specific mean values, as randomization was by area. FINDINGS: The ICDS infrastructure proved able to deliver the interventions. 95% (3,712/3,912) of those alive at the end of the study had received all five interventions and had been measured during all four follow-up surveys, and 99% (3,855/3,912) were measured at the last of these surveys. At this final follow up, the albendazole-treated arm exhibited a similar height gain but a 35 (SE 5) % greater weight gain, equivalent to an extra 1 (SE 0.15) kg over 2 years (99% CI 0.6-1.4 kg, p = 10(-11)). CONCLUSIONS: In such urban slums in the 1990s, five 6-monthly rounds of single dose anthelmintic treatment of malnourished, poor children initially aged 1-5 years results in substantial weight gain. The ICDS system could provide a sustainable, inexpensive approach to the delivery of anthelmintics or micronutrient supplements to such populations. As, however, we do not know the control parasite burden, these results are difficult to generalize. TRIAL REGISTRATION: ClinicalTrials.gov NCT00396500.

Giardia lamblia and other intestinal parasitic infections and their relationships with nutritional status in children in Brazilian Amazon.

The objective of this survey was to assess the relationships between intestinal parasitism, nutritional status and hemoglobin level in children with Indian ascendancy living in an urban area in Brazilian Amazon. We carried out a cross-sectional survey obtaining anthropometric, parasitological and socioeconomic data, and hemoglobin measurements of children aged six to 84 months. Anthropometric data were expressed as z-scores for weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and mid upper circumference for age (MUACZ) parameters. Parasitological examinations were performed through Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) and Safranin-methylene blue methods (n = 307). Hemoglobin measurements were obtained with a Hemocue photometer (n = 282). Socioeconomic data were used in order to classify children in three family income strata (n = 242). Multiple linear regression analysis showed independent interactions between Giardia lamblia and WAZ (beta = -0.195, SE = 0.138, p = 0.003), WHZ (beta = -0.161, SE = 0.133, p = 0.018) and MUACZ (beta = -0.197, SE = 0.143, p = 0.011), controlling for age, sex, family income, Ascaris lumbricoides, and hookworm infection. Also, the multivariate model showed that the only variable associated with hemoglobin levels was age. Intestinal parasitism control should increase children's possibilities of full development in the studied area.

Parasite and maternal risk factors for malnutrition in preschool-age children in Belen, Peru using the new WHO Child Growth Standards.

Child malnutrition, including wasting, underweight and stunting, is associated with infections, poor nutrient intake, and environmental and socio-demographic factors. Preschool-age children are especially vulnerable due to their high growth requirements. To target interventions for preschool-age children in a community of extreme poverty in Peru, we conducted a household survey between October 2005 and January 2006 to determine the prevalence of malnutrition and its risk factors. Of 252 children < 5 years old, the prevalence of wasting, underweight and stunting was 26.6, 28.6 and 32.1 %, respectively, based on the new WHO Child Growth Standards. Risk factors for wasting were: (1) moderate-high intensity Trichuris infection (OR 2.50; 95 % CI 1.06, 5.93); (2) hookworm infection (OR 6.67; 95 % CI 1.08, 41.05); (3) age (OR6-month 1.27; 95 % CI 1.11, 1.46); (4) maternal education (secondary incomplete) (OR 5.77; 95 % CI 2.38, 13.99); and (5) decreasing maternal BMI (OR1 kg/m2 1.12; 95 % CI 1.02, 1.23). Risk factors for underweight were: (1) moderate-high intensity Trichuris infection (OR 4.74; 95 % CI 1.99, 11.32); (2) age (OR6-month 1.22; 95 % CI 1.07, 1.38); (3) maternal education (secondary incomplete) (OR 2.92; 95 % CI 1.40, 6.12); and (4) decreasing maternal BMI (OR1 kg/m2 1.11; 95 % CI 1.02, 1.21). Risk factors for stunting were: (1) age (OR6-month 1.14; 95 % CI 1.02, 1.27) and (2) decreasing maternal height (OR1 cm 1.12; 95 % CI 1.06, 1.20). Overall, risk factors for malnutrition included both child and maternal determinants. Based on these data, locally appropriate and cost-effective dietary, de-worming and educational programmes should be targeted to mothers and preschool-age children.

Giardia lamblia and other intestinal parasitic infections and their relationships with nutritional status in children in Brazilian Amazon

The objective of this survey was to assess the relationships between intestinal parasitism, nutritional status and hemoglobin level in children with Indian ascendancy living in an urban area in Brazilian Amazon. We carried out a cross-sectional survey obtaining anthropometric, parasitological and socioeconomic data, and hemoglobin measurements of children aged six to 84 months. Anthropometric data were expressed as z-scores for weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and mid upper circumference for age (MUACZ) parameters. Parasitological examinations were performed through Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) and Safranin-methylene blue methods (n = 307). Hemoglobin measurements were obtained with a Hemocue® photometer (n = 282). Socioeconomic data were used in order to classify children in three family income strata (n = 242). Multiple linear regression analysis showed independent interactions between Giardia lamblia and WAZ (beta = -0.195, SE = 0.138, p = 0.003), WHZ (beta = -0.161, SE = 0.133, p = 0.018) and MUACZ (beta = -0.197, SE = 0.143, p = 0.011), controlling for age, sex, family income, Ascaris lumbricoides, and hookworm infection. Also, the multivariate model showed that the only variable associated with hemoglobin levels was age. Intestinal parasitism control should increase children's possibilities of full development in the studied area.

O presente estudo objetivou avaliar a relação entre as parasitoses intestinais, o status nutricional e os níveis de hemoglobina em crianças vivendo em uma área urbana na Amazônia Brasileira. Foi realizado um estudo seccional, obtendo-se dados antropométricos, parasitológicos e socioeconômicos, além de dosagens de hemoglobina através do fotômetro Hemocue®, de crianças com idade entre seis e 84 meses. Os dados da antropometria foram expressos como escores de desvio-padrão (escores z) para os parâmetros peso-idade (PI), altura-idade (AI), peso-altura (PA) e perímetro braquial-idade (PBI). Os exames parasitológicos foram realizados através dos métodos de Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) e Safranina-Azul-de-Metileno (n = 307). A regressão linear múltipla demonstrou interações independentes entre Giardia lamblia e PI (beta = -0.195, p = 0.003), PA (beta = -0.161, p = 0.018) e PBI (beta = -0.197, p = 0.011), após controle para idade, sexo, renda familiar e infecções por Ascaris lumbricoides e ancilostomídeos. O modelo multivariado demonstrou ainda que a única variável associada aos níveis de hemoglobina foi a idade. O estudo concluiu que a giardíase está associada, nos sujeitos pesquisados, a menores médias para os parâmetros antropométricos estudados e que um controle efetivo das parasitoses intestinais poderia contribuir para o pleno desenvolvimento das crianças na área estudada.

Reduced serum concentrations of retinol and alpha-tocopherol and high concentrations of hydroperoxides are associated with community levels of S. mansoni infection and schistosomal periportal fibrosis in Ethiopian school children.

To study the relationship between micronutrient malnutrition and schistosomiasis mansoni, a cross-sectional study was undertaken involving 421 schoolchildren (mean age 12.6 years; 333 from schistosomiasis mansoni-endemic villages (Workemado and Sille) and 88 non-endemic controls from Sheno). Prevalence of schistosomiasis mansoni infection in Workemado and Sille was comparable (90.6% versus 95%, respectively), and prevalence of PPF in Workemado was significantly higher than in Sille (7.0% versus 0.6%, P < 0.001). Compared with non-endemic controls, serum retinol concentrations were significantly lower and hydroperoxides were significantly higher in subjects from schistosomiasis mansoni-endemic areas. Furthermore, serum alpha-tocopherol concentrations in subjects from an area with high prevalence of PPF were significantly reduced while the concentrations in subjects from an area with low prevalence of PPF were comparable to the levels found in non-endemic healthy controls. In conclusion, micronutrient malnutrition and oxidative stress are associated with Schistosoma mansoni infection and levels of schistosomal PPF.

Determinantes sociales, prácticas de alimentación y consecuencias nutricionales del parasitismo intestinal en niños de 7 a 18 meses de edad en Guapi, Cauca / Social determinants, feeding practices and nutritional consequences of intestinal parasitism in young children

Introducción. Los estudios de parasitismo intestinal en menores de 2 años raramente se realizan. Sus consecuencias nutricionales y la factibilidad de la prevención justifican su estudio. Objetivos. Identificar la prevalencia de parásitos intestinales patógenos, sus asociaciones con los determinantes sociales y las prácticas de alimentación y sus efectos sobre el estado nutricional. Materiales y métodos. Se censó a los niños menores de 18 meses de una comunidad urbana de la región Pacífica colombiana. Se obtuvieron 136 muestras, que representaban 62 por ciento de la población de menores de 18 meses en el área de estudio. Se identificó la presencia de parásitos intestinales patógenos a partir del examen directo y el concentrado de Ritchie-Frick modificado. Se utilizaron regresiones logísticas múltiples para predecir la presencia de parásitos intestinales patógenos. Se calcularon los puntajes Z de longitud para edad (<2 DE, desnutrición crónica) y peso para longitud (<2 DE, desnutrición aguda). Se realizaron análisis de covarianza para determinar la relación entre los parásitos intestinales patógenos y el estado nutricional con ajustes por edad. Resultados. El 30,6 por ciento de los niños estaban infectados: 26,2 por ciento presentaba helmintiasis (Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercolaris); 14,9 por ciento tenía protozoos (Giardia lamblia), y 11,8 por ciento poliparasitismo intestinal. La prevalencia de desnutrición aguda y crónica fue de 2,9 por ciento y 12,5 por ciento, respectivamente. La ausencia de sanitario y una baja escolaridad de la madre se asociaron a una mayor presencia de poliparasitismo y helmintiasis (p<0,05). La suspensión de la lactancia materna se asoció con la presencia de poliparasitismo (RM: 6,5 IC90 por ciento: 1,9 a 21,5) y con la presencia de Giardia (RM: 2,89 IC90 por ciento: 1,0 a 8,34). La desnutrición aguda fue más frecuente en niños infectados con T. trichiura y con varios parásitos (p<0,05). Conclusión. Nuestros resultados sugieren que la desparasitación periódica debe incluir a la población lactante. La promoción de la lactancia materna es un elemento importante en la disminución de la carga de la enfermedad producida por los parásitos intestinales patógenos.

Intestinal parasitosis and nutritional status in schoolchildren of Sahar district, Yemen.

The prevalence and intensity of schistosomiasis and soil-transmitted parasites was estimated among third-year schoolchildren of Sahar district, Sa'dah governorate, Yemen, after 4 schistosomiasis control campaigns. Anthropometric measurements were used to assess nutritional status in relation to infection rates. The prevalence of schistosomiasis infection was low at 5.6%: 3.3% for Schistosoma haematobium (geometric mean 0.16 eggs/10 mL urine) and 2.3% for S. mansoni (0.18 eggs/g faeces). Ascaris lumbricoides was found in 0.4% of the children while other soil-transmitted helminths were not found. Stunting was found in 50.9%, wasting in 4.5% and underweight in 48.7% of the children examined; however, no positive association was found between infection and nutritional status indicators.

[Nutritional evaluation of children with enteroparasitosis]. / Avaliação nutricional em crianças com infecções por enteroparasitas.

PURPOSE: To evaluate the nutritious state in children of low social-economic class in order to look over a possible corelationship among this status and the infections caused by enteroparasites. METHODS: 103 children were submitted to a nutritions evolution and to accomplish a exam of serial samples. The method employed searched protozoan cystos, helmints eggs and larvae and it counted helmint eggs when presented through 4 different methods of diagnosis. RESULTS: The results obtained show that the poor environmental and social-economic conditions helped create a high infectious frequency caused by enteroparasites, mainly by Trichuris trichiura and Ascaris lumbricoides, among the helminthes, and Endolimax nana and Giardia lamblia, among the protozoans. light malnutrition without protein deficit was found in 93.55% and moderate malnutrition in 6.45% of the children malnutrition (30.7%). CONCLUSION: Then, it is possible to suggest that children besides bearing many parasitosis were not weth their nutritional state deeply compromised.