Epidemiology of intestinal parasite infections and multiparasitism and their impact on growth and hemoglobin levels during childhood in tropical Ecuador: a longitudinal study using molecular detection methods
Bibliographic record
Abstract
Abstract Background There are few longitudinal epidemiological studies of intestinal parasitic infections (IPI) and their health effects. We studied the epidemiology and determinants of IPI and multiparasitism during childhood using molecular methods for parasite detection and analysed their effects on growth and hemoglobin levels. Methods Random sample of 401 children from an Ecuadorian birth cohort studied to 8 years. Data on environmental and sociodemographic characteristics were collected by questionnaires. Stool samples were collected, and weight, height, and hemoglobin levels were measured at 7 and 13 months, and 2, 3, 5, and 8 years. Stool samples were analysed using multi-parallel quantitative polymerase chain reaction for the presence of soil-transmitted helminth (STH) ( Ascaris lumbricoides , Trichuris trichiura , Ancylostoma spp. Necator americanus , and Strongyloides stercoralis ) and protozoal ( Giardia lamblia , Entamoeba histolytica , and Cryptosporidium spp.) parasites. Associations between risk factors and infections, and between infections and nutritional outcomes were estimated using generalized estimated equations applied to longitudinal binary or continuous outcomes. Results IPI were observed in 91.3% of the cohort during follow-up with peak proportions between 3 and 8 years, while multiparasitism increased more gradually (32.5% at 8 years). Factors significantly associated with multiparasitism included lower birth order, day care, Afro-Ecuadorian ethnicity, urban residence, lower household income, and maternal STH infections. IPI during follow-up were associated with lower hemoglobin (difference=-0.102, 95% CI −0.192 - −0.013, P=0.025), height-for-age (difference= −0.126, 95% CI −0.233 - −0.019, P=0.021) and weight-for-age (difference, −0.129, 95% CI −0.257 - −0.022, P=0.018) z scores. Multiparasitism had the strongest negative effects on growth (height-for-age, −0.289, 95% CI −0.441-−0.137, P<0.001; weight-for-age, −0.228, 95% CI - 0.379 - −0.077, P=0.003), with some evidence of greater effects with greater parasite numbers. Conclusion IPI infections and multiparasitism were frequent during early childhood in this Ecuadorian cohort. IPI was associated with reduced weight, height, and hemoglobin trajectories while children with multiparasitism showing the greatest growth deficits. Our data highlight the adverse health childhood effects of multiparasitism in endemic settings and the need for integrated programmes of control and prevention to eliminate associated morbidity. Author Summary Intestinal parasite infections (IPI) and co-infections with several parasite species (multiparasitism) are considered to cause significant disease among young children in low and middle-income countries (LMICs), and elimination of mortality and morbidity attributable to IPI among preschool children by 2030 has been prioritized by WHO. We followed a random sample of children from a birth cohort to 8 years of age in a rural area of coastal Ecuador for the acquisition of IPI with parasite detection being done using highly sensitive molecular methods. Almost all children acquired IPI during follow-up and approximately half had multiparasitism by 8 years. Risk of multiparasitism was associated with indicators of marginalisation (Afro-Ecuadorian ethnicity and peri-urban residence), household poverty (low household income), exposure to other children inside (being lower in the birth order) and outside (day care attendance) the household, and parasite infections among household members. IPI during childhood was associated with reduced growth (height and weight), and lower hemoglobin levels, while children with multiparasitism suffered the greatest growth deficits. There remains a need for the implementation of integrated control strategies including access to clean water and improved sanitation, health education, and preventive chemotherapy that could target whole communities to reduce the infection reservoir. Preventive chemotherapy with broad-spectrum broad-spectrum drugs (e.g. nitazoxanide) with anthelmintic and antiprotozoal effects, even if targeted only to pre-school and school-age children and women of child-bearing age, could improve growth during childhood in marginalized populations living in endemic settings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".