Schistosomiasis, malaria, and co-infection: Contributions to anemia in Kenyan schoolchildren Open Access

Valice, Emily Martha (2017)

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We assessed the impact of schistosomiasis drug treatment strategies and the interactive effect of schistosomiasis and malaria on anemia in schoolchildren in western Kenya. Using a cohort nested within a 5-year longitudinal study that evaluated different treatment approaches on Schistosoma mansoni infection levels, we ran a village-clustered, multilevel model examining the crude association of schistosomiasis treatment regimen on hemoglobin levels. A separate village-clustered, multilevel model was run assessing the impact of and interaction between categorized schistosome infection and malaria on hemoglobin level from baseline to year 5. Mean hemoglobin level in the study decreased from baseline to year 5; correspondingly, anemia prevalence increased from baseline to year 5. Treatment arms comparing annual community-based treatment and biennial school-based treatment were not significantly associated with the change in hemoglobin level. There was also no significant interactive effect of schistosomiasis and malaria on hemoglobin level. The overall negative temporal trend of hemoglobin levels as well as the lack of heterogeneity in hemoglobin levels between treatment arms indicates that the health benefit of schistosomiasis drug treatment with respect to anemia requires further evaluation. If no differences are found between other key health indicators by treatment arm, public health programs may be able to treat schoolchildren rather than full communities every other year rather than annually with no loss of public health impact. Though our research did not find significant interaction between schistosomiasis and malaria on hemoglobin level, it may have been underpowered; further studies are needed to better elucidate the nature of this relationship.

Table of Contents

Table of Contents

Literature Review: 1

Anemia as a Public Health Problem.. 1

Schistosomiasis as a Public Health Problem.. 3

Malaria as a Public Health Problem.. 5

Interaction of Schistosomiasis and Malaria on Anemia. 6

Need, Goals, and Aims. 8

Significance. 9

Methods: 11

Study Context 11

Institutional Review Boards. 12

Study Area and Population. 12

Data Collection. 13

Data Handling and Analysis 14

Results: 17

Impact of Treatment Arms 17

Interaction between Schistosomiasis and Malaria. 19

Discussion: 22

Impact of Treatment Arms 22

Interaction between Schistosomiasis and Malaria. 26

Strengths 27

Weaknesses. 27

Future Directions: 28

Tables and Figures: 30

Table 1a. 30

Table 1b. 31

Table 2. 32

Table 3. 33

Table 4. 34

Figure 1. 35

Figure 2. 36

Figure 3. 37

Appendix A: 38

References: 39

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