Intestinal helminths and risk of anaemia among Nepalese children

Relationships between hookworm, A. lumbricoides and anaemia were studied utilising egg count in faecal specimens and haemoglobin levels from a cross-sectional sample of 641 Nepalese children, 6 to 120 months of age. Additional analyses were performed to assess the level of risk by age and worm load. Kato thick-smear technique was used to perform faecal analyses, recording the number of hookworm eggs and A. lumbricoides eggs in each sample of 50 mg of faeces. Haemoglobin levels were assessed by the Sahli method. The presence of eggs for each parasite was significantly associated with lower levels of haemoglobin (P < 0.001). Children infected with both parasites or hookworm alone presented higher depletion of haemoglobin. The presence of A. lumbricoides was more closely related with anaemia in the age group 72 to 119 months and for an intensity of infection higher than 8000 eggs per gram of faeces. Hookworm, correlated with lower levels of haemoglobin, affected less than 4% of the children in the sample and appear to be a serious risk factor at the individual level. A. lumbricoides, present in 51% of the children, was associated with moderate anaemia and represents a more important risk factor at the community level, especially if coupled with inadequate food and iron intake. Any public health intervention aimed at reducing anaemia prevalence in Nepal should consider effective measures for the control of soil-transmitted helminths.