Podoconiosis and soil-transmitted helminths (STHs): double burden of neglected tropical diseases in Wolaita zone, rural southern Ethiopia

Background Both podoconiosis and soil-transmitted helminth (STH) infections occur among barefoot people in areas of extreme poverty; however, their co-morbidity has not previously been investigated. We explored the overlap of STH infection and podoconiosis in Southern Ethiopia and quantified their separate and combined effects on prevalent anemia and hemoglobin levels in podoconiosis patients and health controls from the same area. Methods and Principal Findings A two-part comparative cross-sectional study was conducted in Wolaita zone, southern Ethiopia. Data were collected from adult patients presenting with clinically confirmed podoconiosis, and unmatched adult neighborhood controls living in the same administrative area. Information on demographic and selected lifestyle factors was collected using interviewer-administered questionnaires. Stool samples were collected and examined qualitatively using the modified formalin-ether sedimentation method. Hemoglobin level was determined using two different methods: hemoglobinometer and automated hematology analyzer. A total of 913 study subjects (677 podoconiosis patients and 236 controls) participated. The prevalence of any STH infection was 47.6% among patients and 33.1% among controls (p<0.001). The prevalence of both hookworm and Trichuris trichiura infections was significantly higher in podoconiosis patients than in controls (AOR 1.74, 95% CI 1.25 to2.42, AOR 6.53, 95% CI 2.34 to 18.22, respectively). Not wearing shoes and being a farmer remained significant independent predictors of infection with any STH. There was a significant interaction between STH infection and podoconiosis on reduction of hemoglobin level (interaction p value = 0.002). Conclusions Prevalence of any STH and hookworm infection was higher among podoconiosis patients than among controls. A significant reduction in hemoglobin level was observed among podoconiosis patients co-infected with hookworm and ‘non-hookworm STH’. Promotion of consistent shoe-wearing practices may have double advantages in controlling both podoconiosis and hookworm infection in the study area

The Synergistic Effect of Concomitant Schistosomiasis, Hookworm, and Trichuris Infections on Children's Anemia Burden

Polyparasitic infections have been recognized as the norm in many tropical developing countries, but the significance of this phenomenon for helminth-associated morbidities is largely unexplored. Earlier studies have suggested that multi-species, low-intensity parasitic infections were associated with higher odds of anemia among school-age children relative to their uninfected counterparts or those with one low-intensity infection. However, specific studies of the nature of interactions between helminth species in the mediation of helminth-associated morbidities are lacking. This study quantifies the extent to which polyparasitic infections have more than the sum of adverse effects associated with individual infections in the context of childhood anemia. This study found that the risk of anemia is amplified beyond the sum of risks for individual infections in children simultaneously exposed to 1) hookworm and schistosomiasis, and 2) hookworm and trichuris, and suggests that combined treatment for some geohelminth species and schistosomiasis could yield greater than additive benefits for the reduction of childhood anemia in helminth-endemic areas. However, more studies to understand the full range of interactions between parasitic species in their joint effects on helminth-associated morbidities will be necessary to better predict the impact of any future public health intervention

The Elderly in Trinidad: Health, Social and Economic Status and Issues of Loneliness

Objectives: To determine the general health and social status of elderly persons surveyed in Trinidad and to explore issues of loneliness. Method: An island-wide survey of persons aged 65 years and older was conducted in early 2002 in Trinidad. Eight hundred and forty-five (845) elderly persons were chosen using systematic random sampling. The main survey instrument for data collection was a questionnaire that included structured as well as open-ended questions. The subjects were chosen in a house-to-house survey conducted in all eight counties in Trinidad. Elderly people who were unable to comprehend the questions were excluded from the survey. Results: Those selected ranged in age from 65–102 years and represented all the ethnic groups in Trinidad. These elderly persons lived in a wide range of housing situations. The majority lived in the homes of family members (57%) and 16% lived on their own. A large proportion (80%) had at least one chronic medical problem, although 44% reported their health as “fairly good” or “good”. More than a half of the males (53%) and 67% of the females were taking at least one prescribed medicine. The main sources of income were old age pension (85%) and National Insurance (15%). Thirty-three per cent reported feelings of loneliness. This figure includes 28% of those who did not live alone. Conclusion: The data revealed that across all ethnic groups more than one-third of the sample reported themselves to be in fair to good health. Many of these elders were lonely because their relatives were quite occupied with their own affairs. Personas de la Tercera Edad en Trinidad: Salud, Problemas y Estatus Social y Económico, así Como Problemas de la Soledad RESUMEN Objetivos: Determinar la salud general y el estatus social de personas de la tercera edad encuestadas en Trinidad, y explorar los problemas de la soledad. Método: Se llevó a cabo una encuesta en toda la isla de Trinidad a comienzos del 2002, con personas de 65 años de edad o más. Se escogieron ochocientos cuarenta y cinco (845) personas de la tercera edad mediante un muestreo aleatorio sistemático. El instrumento principal para la recolección de datos fue un cuestionario que incluía preguntas estructuradas así como preguntas abiertas. Los sujetos fueron escogidos en una encuesta conducida casa por casa en los ocho condados de Trinidad. Los ancianos y ancianas que no podían entender las preguntas, fueron excluidos de la encuesta. Resultados: Los seleccionados tenían edades entre 65-102 años, y representaban todos los grupos étnicos de Trinidad. Estas personas mayores vivían en un amplio especto de situaciones de vivienda. La mayor parte de ellos vivía en hogares de miembros de su familia (57%) y el 16% vivían solos. Un gran número de ellos (80%) tenía por lo menos un problema médico crónico, aunque el 44% reportó que su salud era “bastante buena” o “buena.” Más de la mitad de los hombres (53%) y el 67% de las mujeres se encontraban tomando al menos una medicina por prescripción médica. Las principalesfuentes de ingreso fueron las pensiones por vejez (85%) y Seguro Nacional (15%). El treinta y tres por ciento reportó sentirse solo. Esta cifra incluye el 28% de los que no vivían solos. Conclusión: Los datos revelaron que en todos los grupos étnicos, más de un tercio de la muestra reportó su estado de salud entre bueno y satisfactorio. Muchas de estos ancianos y ancianas estaban solos porque sus familiares se hallaban muy ocupados con sus asuntos

Cord blood apolipoprotein-E genotype distribution and plasma lipid indices in newborns of different ethnicity

We hypothesized that apolipoprotein-E (apo-E) genotypes would be associated with plasma lipid indices in newborns of South Asian (SA) ancestry but not in newborns of African (Afr) ancestry. Cord blood was obtained by consecutive sampling at maternity hospitals in the Caribbean Islands of Trinidad and Curacao. Apolipoprotein-E genotypes, cholesterol, triglycerides, apo-A, apo-B and Lipoprotein (a) (Lp(a)) were measured in 294 newborns in Trinidad and 234 in Curacao. The apo-B/apo-AI ratio and an adapted lipid tetrad index (i.e. cholesterol x triglycerides x Lp(a)/apo-AI) were calculated. In Trinidad, apo-E allele frequencies and genotype distributions of Afr and SA were significantly (p <0.001) different (Afr: n = 71: apo-e2 :e3 :e4 = 10.4: 66.4: 23.2%; SA: n = 98; e2 :e3 :e4 = 3.5:83.1 : 13.4%). The Mixed group (SA + Afr) had apo-E allele frequencies in between those of SA and Afr groups (n = 115; e2 : e3 : e4 = 7 : 76 : 17%). Lipid indices of appropriate for gestational age and term newborns were comparable, except For lower Lp(a) (SA = 29 +/- 4; Afr = 46 +/- 5; Mixed = 41 +/- 5 mfi L-1) and lower adapted lipid tetrad index (29.4 +/- 4.8; 41.9 +/- 5.4; 41.4 +/- 7.0) in SA. Apo-E allele frequencies of Curacao newborns were: apo-e2:e3:e4 = 10.5:72.6: 16.9%. Their Lp(a) levels were significantly]) (68 +/-3 mg L-1) than that of the Trinidadian sample (38 +/- 3; p <0.0001). Apolipoprotein-E4 had an apo-B-increasing effect and apo-E2 an apo-B-decreasing effect in Afr (r = 0.192, p = 0.003). Among African from Trinidad and Curacao variation sin apo-E4 and apo-E2 are associated with an apo-B-increasing effect and an apo-B-decreasing effect, respectively. There was no relationship between apo-E polymorphism and lipids among South Asians