Brett Davis



Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


More than two billion persons globally are estimated to be infected with intestinal parasites, with over 900 million of these estimated to be infected with hookworm. When measured in disability-adjusted life years, the global disease burden from hookworm alone exceeds all other major tropical infectious diseases (with the exception of malaria, leishmaniasis, and lymphatic filariasis), and includes an estimated blood loss of 7 million liters per day. 65, 000 persons are estimated to die from hookworm infection each year. A 2010 study of the global prevalence and burden of soil-transmitted helminths (STH) estimated that, of the 4.98 million years lived with disability (YLDs) attributable to STH, 65% were attributable to hookworm alone. Children and child-bearing women are particularly vulnerable to serious morbidities and outcomes associated with intestinal parasitic infections, especially hookworm. In children, chronic heavy-intensity infections are associated with growth retardation, iron-deficiency anemia, as well as intellectual and cognitive impairments. Due to the relative high prevalence among the poor—particularly persons who live on less than US $2/day—soil-transmitted helminth infections have received relatively little global attention—despite annual morbidities and mortalities in the hundreds and tens of millions, respectively. Methods In partnership with a successful, community-directed, local NGO (Bharati Integrated Rural Development Society, “BIRDS”), we performed a comparative, cross-sectional analysis of the prevalence of hookworm infection and associated health behaviors and symptoms among two groups of severely marginalized and impoverished rural southern Indian children aged 3-16 years: 72 residents of the NGO school campus and 95 non-resident students living in vi surrounding villages. We collected data on several covariates to test for association with hookworm infection, including: risk behaviors (latrine use, frequency of hand washing, et al); anthropometrics (BMI-for-age percentile); and symptoms (gastro-intestinal and pulmonary). We tested the hypothesis that resident students on BIRDS campus have a lower crude prevalence of intestinal parasitosis relative to non-resident students (anticipated due to reports of more sanitary facilities available and comparatively advanced hygienic culture on BIRDS campus). Results We identified 14 total cases of infection with Ancylostoma duodenale for an overall prevalence of 8.4% (90%CI: 4.8, 12). Prevalence of A. duodenale infection among BIRDS residents was found to be 7%(5/72) (90CI: 2.1%, 12%) versus 9.5%(9/95) (90CI: 4.6%, 14%) among the group of children residing in surrounding communities. The difference in crude prevalence between the two groups was not statistically significant (p-value = 0.56) at an α-level of 0.10. Non-residents reported a higher frequency of two significant risk behaviors compared to residents: defecating outdoors more frequently (56% of nonresidents claiming to do so “every time” compared to 7% of residents) and wearing footwear less frequently than the resident group (43% of non-residents reported wearing shoes “most of the time” compared to 67% of residents) (both differences significant, pvalue




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