title: High malnutrition rate in Venezuelan Yanomami compared to Warao Amerindians and Creoles: significant associations with intestinal parasites and anemia.
abstract: BACKGROUND
  Children in rural areas experience the interrelated problems of poor growth, anemia and parasitic infections. We investigated the prevalence of and associations between intestinal helminth and protozoan infections, malnutrition and anemia in school-age Venezuelan children.
  
  
  METHODS
  This cross-sectional study was conducted in 390 children aged 4-16 years from three rural areas of Venezuela: the Amazon Region, Orinoco Delta and Carabobo State. Stool samples were collected for direct parasitic examinations. Anthropometric indicators of chronic (height-for-age Z score) and acute (weight-for-height and Body Mass Index (BMI)-for-age Z score in respectively children under 5 years of age and children aged 5 years and above) malnutrition were calculated. Multivariate linear and logistic regression models were built to determine factors associated with nutritional status and polyparasitism.
  
  
  RESULTS
  Hookworm and Strongyloides stercoralis prevalences were highest in children from the Amazon rainforest (respectively 72% and 18%) while children from the Orinoco Delta and Carabobo State showed higher rates of Ascaris lumbricoides (respectively 28% and 37%) and Trichuris trichiura (40% in both regions). The prevalence of Giardia lamblia infection was not significantly different between regions (average: 18%). Anemia prevalence was highest in the Amazon Region (24%). Hemoglobin levels were significantly decreased in children with a hookworm infection. Malnutrition was present in respectively 84%, 30% and 13% of children from the Amazon Region, Orinoco Delta and Carabobo State. In multivariate analysis including all regions, G. lamblia and helminth infections were significantly and negatively associated with respectively height-for-age and weight-for-height/BMI-for-age Z scores. Furthermore, hemoglobin levels were positively associated with the height-for-age Z score (0.11, 95% CI 0.02 - 0.20).
  
  
  CONCLUSIONS
  In rural populations in Venezuela helminthiasis and giardiasis were associated with acute and chronic nutritional status respectively. These data highlight the need for an integrated approach to control transmission of parasites and improve the health status of rural Venezuelan children.
authors.affiliation: Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela ; Laboratory of Pediatric Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Lilly M
authors.initials: LM
authors.lastname: Verhagen
authors.forename: Renzo N
authors.initials: RN
authors.lastname: Incani
authors.forename: Carolina R
authors.initials: CR
authors.lastname: Franco
authors.forename: Alejandra
authors.initials: A
authors.lastname: Ugarte
authors.forename: Yeneska
authors.initials: Y
authors.lastname: Cadenas
authors.forename: Carmen I
authors.initials: CI
authors.lastname: Sierra Ruiz
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Hermans
authors.forename: Denise
authors.initials: D
authors.lastname: Hoek
authors.forename: Maiza
authors.initials: M
authors.lastname: Campos Ponce
authors.forename: Jacobus H
authors.initials: JH
authors.lastname: de Waard
authors.forename: Elena
authors.initials: E
authors.lastname: Pinelli
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007422:Intestines / Q000469:parasitology*; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology* / Q000469:parasitology; D015999:Multivariate Analysis; D014687:Venezuela / Q000453:epidemiology / Q000208:ethnology