Malaria, Hookworms and Schistomiasis coinfection and its effect on anaemia among School children in Zambezi District of Zambia

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Rutagwera, Gatsinzi David
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Introduction: Malaria, hookworm and schistosomiasis are wide spread in most parts of Zambia and often occur in same communities at high frequencies particularly in schoolchildren thereby making co-infection of these parasites very likely. In this study we determined the co-infection rate of malaria, hookworm and schistosomiasis and investigated the effect this co-infection has on anaemia in children living in Zambezi district of Zambia. Methodology: This was a cross sectional study conducted in 263 school going children sampled using a random multistage sampling method from school going children in Zambezi district. Kato-Katz technique was used to screen stool samples for soil transmitted helminthes and Schistosoma mansoni. Urine filtration microscopy was use to screen urine samples for Schistosoma haematobium. Geimsa thick blood smear microscopy was used for malaria testing and HemoCue photometer used to measure haemoglobin concentration. Association between parasitic infections and anaemia were measured using odds ratios calculated by both bivariate and multivariate logistic regression. 8 of the study participants did not return stool samples while 2 participants did not return urine samples however all participants were included in the analysis. Results and discussion: District anaemia prevalence rate was 46% (n = 263, 95% CI: 40.4% - 52.06%) and the overall district prevalence rates of parasites, namely; Malaria, Hookworm, S. haematobium, S. mansoni, and Enterobius were 50.6% (n = 263; 95% CI: 44.5% – 56.6%), 42.4% (n = 255; 95% CI: 36.4% – 48.5%), 29.5% (n = 261; 95% CI: 24.2% – 35.2%), 14.5% (n = 255; 95% CI: 10.6% – 19.2%), and 1.2% (n = 255; 95% CI: 0.3% - 3.2%) respectively. Both Ascaris lumbricoides and Trichiura Trichuris had a prevalence rate of 0.0% (n = 255; 95% CI: 0.0% - 1.2%). The majority of parasitic infections (55.7%) detected were multiparasitic in nature. The overall prevalence rate of malaria, hookworm and S. haematobium co-infection was 8.9% (n = 258; 95% CI: 5.9% - 12.9%) while that of malaria, hookworm and S. mansoni co-infection was 2.7% (n = 255; 95% CI: 1.2% - 5.3%). Other significant co-infections detected included malaria and hookworm co-infection, malaria and S. haematobium co-infection, hookworm and S haematobium co-infection, Malaria and S. mansoni co-infection and hookworm and S. mansoni co-infection with prevalence rates of 11.8% (n = 255; 95% CI: 8.2% – 16.2%), 10.7% (n = 262; 95% CI: 7.4% - 14.9%), 4.3% ( n = 255; 95% CI: 2.3% - 7.4%), 2.7% (n = 255; 95% CI: 1.2% - 5.8%) and 2.0% (n = 255; 95% CI: 0.7% – 4.3% respectively. Several other detected co-infections had prevalence rates below 1%.This study did not detect significant association between anaemia and co-infection with malaria, hookworm and schistosomiasis. However we have shown that co-infection with malaria and hookworm (n = 255; OR: 5.0; 95% CI: 1.7 -14.1) doubles the anaemia odds ratio in malaria (n = 263; OR: 2.2, 95% CI: 1.2 - 4.3) alone. Conclusion and recommendations: There is high prevalence of anaemia, malaria, hookworm and schistosomiasis and high levels of multiparasitism in schoolchildren in Zambezi District. The main predictors of anaemia were age, being underweight, location, and parasitic infections. We therefore recommend integration in the School Health Nutrition programme of anti helminth, anti malaria and iron status improvement activities to reduce morbidity of anaemia, parasitic infections and co-infections and accelerate the reduction in the prevalence of parasitic infections.