The Interplay of Soil-Transmitted Helminth Infection, Stunting, Anemia, and Wealth in Ranomafana Commune, Ifanadiana District, Madagascar Open Access

Smith, Katie (2015)

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Background: PIVOT, a new healthcare NGO, recently began operating in Ranomafana Commune, Madagascar, with the mission of scientifically identifying areas of intervention in order to break the cycle of poverty and disease. Due to previously described associations of soil-transmitted helminth (STH) infection and anemia, this study describes the current prevalence of STHs and anemia, and uses logistic regression to evaluate their association with wealth and developmental indicators.

Methodology: This was a cross-sectional study that randomly selected 80 households, within 4 census tracts, to participate in the study from July 1st - July 14th, 2014. For each household, in-person surveys were administered, anthropometric measurement and rapid detection anemia tests were performed, and fecal samples were obtained. A total of 76 households and 365 individuals participated in the study, with anemia data and fecal samples collected from 221 and 238 individuals, respectively. Current prevalence of STH infection in children was compared to STH prevalence twenty years ago. STH infection was evaluated for associations with anemia and wealth, as well as stunting among children.

Principle Findings: Seventy-eight percent of the population was positive for at least one STH. Forty-four percent of children less than 5 were anemic, while 12% of adults age 15-49 were. In multivariable regression, those living in the bottom 75% of the wealth distribution and who were infected with any STH had significantly lower odds [odds ratio (OR) 0.24; 95% confidence interval (CI) 0.08, 0.74] of being anemic, while those in the bottom 75% of the wealth distribution and anemic were significantly more likely to be infected with any STH (OR 3.16; 95% CI 1.61, 6.19). Those in the bottom 75% of the wealth distribution were also significantly less likely to be infected with Trichuris trichiura only (OR 0.35; 95% CI 0.15, 0.78).

Conclusions: Comparison to historical STH prevalence shows that current strategies to control STH infection are ineffective or have broken down over the past twenty years.Investigation into the associations between STHs, anemia, and wealth can further the understanding of how poverty and disease cycles work, and help with the design of targeted interventions to break these cycles.

Table of Contents

I. Introduction Page 1

II. Background Page 2

III. Methods Page 6

IV. Results Page 10

V. Discussion Page 14

VI. Conclusions and Recommendations Page 17

VII. References Page 18

VIII. Tables Page 20

IX. Appendix I Page 26

X. Appendix II Page 28

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