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Epidemiological and clinical correlates of malaria-helminth co-infections in southern Ethiopia

Andargachew Mulu12, Mengistu Legesse3, Berhanu Erko3, Yeshambel Belyhun12, Demise Nugussie4, Techalew Shimelis4, Afework Kassu1, Daniel Elias5 and Beyene Moges1*

Author Affiliations

1 School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia

2 Institute of Virology, University of Leipzig, Leipzig, Germany

3 Akililu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia

4 School of Medical Laboratory Technology, Hawassa University, Hawassa, Ethiopia

5 ACE Biosciences, Unsbjergvej 2A, Odense SOE 5220, Denmark

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Malaria Journal 2013, 12:227  doi:10.1186/1475-2875-12-227

Published: 3 July 2013

Abstract

Background

In many areas of the world, including Ethiopia, malaria and helminths are co-endemic, therefore, co-infections are common. However, little is known how concurrent infections affect the epidemiology and/or pathogenesis of each other. Therefore, this study was conducted to assess the effects of intestinal helminth infections on the epidemiology and clinical patterns of malaria in southern Ethiopia where both infections are prevalent.

Methods

A cross-sectional study was conducted in 2006 at Wondo Genet Health Center and Bussa Clinic, southern Ethiopia. Consecutive blood film positive malaria patients (N=230) and malaria negative asymptomatic individuals (N=233) were recruited. Malaria parasite detection and quantification was diagnosed using Giemsa-stained thick and thin blood films, respectively. Helminths were detected using direct microscopy and formol-ether concentration techniques. Coarse quantification of helminths ova was made using Kato Katz method.

Results

The over all magnitude of intestinal parasitic infection was high irrespective of malaria infection (67% among malaria positive patients versus 53.1% among malaria non-infected asymptomatic individuals). Trichuris trichiura infection was associated with increased malaria prevalence while increased worm burden of helminths as expressed by egg intensity was associated with increased malaria parasitaemia which could be a potential factor for development of severe malarial infection with the course of the disease. Majority (77%) of the subjects had multiple helminths infection. T. trichiura, Ascaris lumbricoides, Schistosoma mansoni, and hookworm infestation accounted for 64.5, 57.7 %, 28.4%, and 12.2% of the infections, respectively.

Conclusions

Populations in malaria-endemic areas of southern Ethiopia are multi-parasitized with up to four helminths. Mass deworming may be a simple practical approach in endemic areas in reducing the risk of severe malarial attack particularly for those at high risk of both infections.

Keywords:
Malaria; Helminthic infections; Co-infection; Ethiopia