Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste

Suzy J. Campbell, Susana V. Nery, Catherine A. D'Este, Darren J. Gray, James S. McCarthy, Rebecca J. Traub, Ross M. Andrews, Stacey Llewellyn, Andrew J. Vallely, Gail M. Williams, Archie C A Clements

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    Abstract

    Background: Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste.

    Methods: Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight.

    Results: Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses.

    Conclusions: According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies.

    Original languageEnglish
    Article number192
    Pages (from-to)1-15
    Number of pages15
    JournalParasites and Vectors
    Volume10
    Issue number1
    DOIs
    Publication statusPublished - 19 Apr 2017

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    Helminths
    Child Development
    Hemoglobins
    Soil
    Thinness
    Growth Disorders
    Infection
    Morbidity
    Anemia
    Social Planning
    Timor-Leste
    Feces
    Eggs
    Population
    Emergencies
    Iron
    Randomized Controlled Trials
    Public Health
    Logistic Models
    Demography

    Cite this

    Campbell, Suzy J. ; Nery, Susana V. ; D'Este, Catherine A. ; Gray, Darren J. ; McCarthy, James S. ; Traub, Rebecca J. ; Andrews, Ross M. ; Llewellyn, Stacey ; Vallely, Andrew J. ; Williams, Gail M. ; Clements, Archie C A. / Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste. In: Parasites and Vectors. 2017 ; Vol. 10, No. 1. pp. 1-15.
    @article{177d4d99639e461997bd3597af1f86cb,
    title = "Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste",
    abstract = "Background: Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. Methods: Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. Results: Very high stunting (60{\%}), underweight (60{\%}), and wasting (20{\%}) in children, but low anaemia prevalence (15{\%}), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. Conclusions: According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies.",
    keywords = "Anaemia, Ascaris, Morbidity, Necator americanus, PCR, Soil-transmitted helminths, Stunting, Wasting",
    author = "Campbell, {Suzy J.} and Nery, {Susana V.} and D'Este, {Catherine A.} and Gray, {Darren J.} and McCarthy, {James S.} and Traub, {Rebecca J.} and Andrews, {Ross M.} and Stacey Llewellyn and Vallely, {Andrew J.} and Williams, {Gail M.} and Clements, {Archie C A}",
    year = "2017",
    month = "4",
    day = "19",
    doi = "10.1186/s13071-017-2084-x",
    language = "English",
    volume = "10",
    pages = "1--15",
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    issn = "1756-3305",
    publisher = "BioMed Central",
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    }

    Campbell, SJ, Nery, SV, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM & Clements, ACA 2017, 'Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste', Parasites and Vectors, vol. 10, no. 1, 192, pp. 1-15. https://doi.org/10.1186/s13071-017-2084-x

    Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste. / Campbell, Suzy J.; Nery, Susana V.; D'Este, Catherine A.; Gray, Darren J.; McCarthy, James S.; Traub, Rebecca J.; Andrews, Ross M.; Llewellyn, Stacey; Vallely, Andrew J.; Williams, Gail M.; Clements, Archie C A.

    In: Parasites and Vectors, Vol. 10, No. 1, 192, 19.04.2017, p. 1-15.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste

    AU - Campbell, Suzy J.

    AU - Nery, Susana V.

    AU - D'Este, Catherine A.

    AU - Gray, Darren J.

    AU - McCarthy, James S.

    AU - Traub, Rebecca J.

    AU - Andrews, Ross M.

    AU - Llewellyn, Stacey

    AU - Vallely, Andrew J.

    AU - Williams, Gail M.

    AU - Clements, Archie C A

    PY - 2017/4/19

    Y1 - 2017/4/19

    N2 - Background: Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. Methods: Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. Results: Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. Conclusions: According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies.

    AB - Background: Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. Methods: Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. Results: Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. Conclusions: According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies.

    KW - Anaemia

    KW - Ascaris

    KW - Morbidity

    KW - Necator americanus

    KW - PCR

    KW - Soil-transmitted helminths

    KW - Stunting

    KW - Wasting

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    EP - 15

    JO - Parasites and Vectors

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