Malaria, helminths and malnutrition: a cross-sectional survey of school children in the South-Tongu district of Ghana.
BACKGROUND
As part of malaria characterization study in the South-Tongu district of Ghana, the current study was conducted to explore relationships between malaria, schistosomiasis, soil transmitted helminths and malnutrition in riparian community settings that had hitherto encountered episodes of mass deworming exercises.


METHODS
School-age children were enrolled in a cross-sectional study from April through July 2012. Stool and urine samples were examined respectively for helminths and Schistosoma haematobium. Blood samples were analyzed for malaria parasites and haemoglobin (Hb) concentrations, respectively. Anthropometric indices were measured. Relationships were determined using generalized linear models.


RESULTS
The results show low numbers of asymptomatic Plasmodium falciparum (9.2%, n = 37/404) and S. haematobium (2.5%, n = 10/404) infections. The associations between significance terms in the multivariate analysis for P. falciparum infections were further assessed to test the significance of the product terms directly i.e., age in years [adjusted odds ratio (AOR), 3.1; 95% confidence interval (CI) 1.1-5.6], Hb concentration (AOR = 0.71; 95% CI 0.42-2.3), and stunted malnutrition (AOR, 8.72; 95% CI 4.8-25.1). The P. falciparum-associated decrease in mean Hb concentration was 2.82 g/dl (95% CI 1.63-4.1 g/dl; P = 0.001) in stunted children, and 0.75 g/dl (95% CI 1.59-0.085 g/dl; P = 0.076) in the non-stunted cohort. The anaemia-associated decrease in mean parasitaemia in stunted children was 3500 parasites/µl of blood (95% CI 262.46-6737.54 parasites/µl of blood; P = 0.036), and in non-stunted children 2127 parasites/µl of blood (95% CI -0.27 to 4.53; P = 0.085). Stunted malnutrition was the strongest predictor of S. haematobium infection (AOR = 11; 95% CI 3.1-33.6) but significant associations as described for P. falciparum infections were absent. The population attributable risk of anaemia due to P. falciparum was 6.3% (95% CI 2.5-9.3), 0.9% (95% CI 0.4-2.3) for S. haematobium, and 12.5% (95% CI 9.11-19.52) for stunted malnutrition.


CONCLUSIONS
Plasmodium falciparum, S. haematobium, intestinal helminths and their co-infections were uncommon in our school-age children. Stunting exacerbated the extent to which malaria was associated with loss in Hb concentration.
Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle-bu, Accra, Ghana.
Patrick Ferdinand
PF
Ayeh-Kumi
Department of Microbiology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
Kantanka
K
Addo-Osafo
Department of Microbiology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana. skwakuattah@yahoo.com.
Simon Kwaku
SK
Attah
Department of Microbiology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
Patience Borkor
PB
Tetteh-Quarcoo
Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
Noah
N
Obeng-Nkrumah
Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
Georgina
G
Awuah-Mensah
Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
Harriet Naa Afia
HN
Abbey
Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
Akua
A
Forson
Comboni Catholic Hospital, Sogakope, Ghana.
Momodou
M
Cham
Comboni Catholic Hospital, Sogakope, Ghana.
Listowell
L
Asare
Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health & Allied Sciences, Ho, Ghana.
Kwabena Obeng
KO
Duedu
Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle-bu, Accra, Ghana.
Richard Harry
RH
Asmah
D000293:Adolescent; D000818:Animals; D002648:Child; D060085:Coinfection / Q000453:epidemiology / Q000469:parasitology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D005869:Ghana / Q000453:epidemiology; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006373:Helminthiasis / Q000453:epidemiology* / Q000469:parasitology; D006376:Helminths / Q000502:physiology; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D015999:Multivariate Analysis; D010963:Plasmodium falciparum / Q000502:physiology; D015995:Prevalence; D012547:Schistosoma / Q000502:physiology; D012552:Schistosomiasis / Q000453:epidemiology / Q000469:parasitology; D012572:School Health Services / Q000706:statistics & numerical data; D012987:Soil / Q000469:parasitology
D012987:Soil
Children; Ghana; Haemoglobin; Malaria; Malnutrition; Schistosomiasis; School; Stunting