title: Infection and co-infection with helminths and Plasmodium among school children in Côte d'Ivoire: results from a National Cross-Sectional Survey.
abstract: BACKGROUND
  Helminth infection and malaria remain major causes of ill-health in the tropics and subtropics. There are several shared risk factors (e.g., poverty), and hence, helminth infection and malaria overlap geographically and temporally. However, the extent and consequences of helminth-Plasmodium co-infection at different spatial scales are poorly understood.
  
  
  METHODS
  This study was conducted in 92 schools across Côte d'Ivoire during the dry season, from November 2011 to February 2012. School children provided blood samples for detection of Plasmodium infection, stool samples for diagnosis of soil-transmitted helminth (STH) and Schistosoma mansoni infections, and urine samples for appraisal of Schistosoma haematobium infection. A questionnaire was administered to obtain demographic, socioeconomic, and behavioral data. Multinomial regression models were utilized to determine risk factors for STH-Plasmodium and Schistosoma-Plasmodium co-infection.
  
  
  RESULTS
  Complete parasitological and questionnaire data were available for 5,104 children aged 5-16 years. 26.2% of the children were infected with any helminth species, whilst the prevalence of Plasmodium infection was 63.3%. STH-Plasmodium co-infection was detected in 13.5% and Schistosoma-Plasmodium in 5.6% of the children. Multinomial regression analysis revealed that boys, children aged 10 years and above, and activities involving close contact to water were significantly and positively associated with STH-Plasmodium co-infection. Boys, wells as source of drinking water, and water contact were significantly and positively associated with Schistosoma-Plasmodium co-infection. Access to latrines, deworming, higher socioeconomic status, and living in urban settings were negatively associated with STH-Plasmodium co-infection; whilst use of deworming drugs and access to modern latrines were negatively associated with Schistosoma-Plasmodium co-infection.
  
  
  CONCLUSIONS
  More than 60% of the school children surveyed were infected with Plasmodium across Côte d'Ivoire, and about one out of six had a helminth-Plasmodium co-infection. Our findings provide a rationale to combine control interventions that simultaneously aim at helminthiases and malaria.
authors.affiliation: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Yapi
authors.affiliation: Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Eveline
authors.initials: E
authors.lastname: Hürlimann
authors.affiliation: Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d'Ivoire.
authors.forename: Clarisse A
authors.initials: CA
authors.lastname: Houngbedji
authors.affiliation: Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d'Ivoire.
authors.forename: Prisca B
authors.initials: PB
authors.lastname: Ndri
authors.affiliation: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
authors.forename: Kigbafori D
authors.initials: KD
authors.lastname: Silué
authors.affiliation: Programme National de Santé Scolaire et Universitaire, Abidjan, Côte d'Ivoire.
authors.forename: Gotianwa
authors.initials: G
authors.lastname: Soro
authors.affiliation: Programme National de Santé Scolaire et Universitaire, Abidjan, Côte d'Ivoire.
authors.forename: Ferdinand N
authors.initials: FN
authors.lastname: Kouamé
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Penelope
authors.initials: P
authors.lastname: Vounatsou
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Centre for Health Policy, Imperial College London, London, United Kingdom; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fürst
authors.affiliation: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
authors.forename: Eliézer K
authors.initials: EK
authors.lastname: N'Goran
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.affiliation: Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Raso
mesh_terms: D000293:Adolescent; D000818:Animals; D001769:Blood / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology*; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012555:Schistosomiasis mansoni / Q000453:epidemiology*; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires; D014556:Urine / Q000469:parasitology