title: Asymptomatic Vivax and Falciparum Parasitaemia with Helminth Co-Infection: Major Risk Factors for Anaemia in Early Life.
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 P. vivax parasitaemia and 3.9% (21) had P. falciparum; 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 P. vivax 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 P. vivax parasitaemia (OR = 2.9 [95%CI, 1.7-4.9], p = 0.001), P. falciparum 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 P. vivax and P. falciparum 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 P. vivax parasitaemia should be explored prospectively.
authors: Mimika District Health Authority, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: Faustina Helena
authors: FH
authors: Burdam
authors: Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: Mohammad
authors: M
authors: Hakimi
authors: Mimika District Hospital, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
authors: Franciscus
authors: F
authors: Thio
authors: Mimika District Health Authority, Timika, Papua, Indonesia.|Mimika District Hospital, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
authors: Enny
authors: E
authors: Kenangalem
authors: Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
authors: Ratni
authors: R
authors: Indrawanti
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Rintis
authors: R
authors: Noviyanti
authors: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors: Leily
authors: L
authors: Trianty
authors: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors: Jutta
authors: J
authors: Marfurt
authors: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors: Irene
authors: I
authors: Handayuni
authors: Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
authors: Yati
authors: Y
authors: Soenarto
authors: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors: Nicholas M
authors: NM
authors: Douglas
authors: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors: Nicholas M
authors: NM
authors: Anstey
authors: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors: Ric N
authors: RN
authors: Price
authors: Mimika District Hospital, Timika, Papua, Indonesia.|Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
authors: Jeanne Rini
authors: JR
authors: Poespoprodjo
mesh_terms: D000740:Anemia / Q000097:blood / Q000150:complications* / Q000469:parasitology; D000818:Animals; D058070:Asymptomatic Diseases; D002675:Child, Preschool; D060085:Coinfection / Q000150:complications / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D006373:Helminthiasis / Q000150:complications / Q000453:epidemiology*; D006376:Helminths / Q000502:physiology*; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology; D016780:Malaria, Vivax / Q000150:complications / Q000453:epidemiology; D009752:Nutritional Status; D010963:Plasmodium falciparum / Q000502:physiology*; D010966:Plasmodium vivax / Q000502:physiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires