ПАРАЗИТОЛОГИЯ, 2020, том 54, № 3, с. 198-204.

Удк 616:576.8

Soil Transmitted Helminth infection and its effect

on nutritional status of children in Kashmir

Department of Zoology, S. P. College Campus, Cluster University,

Srinagar, 190001 India

*e-mail: drshowkat78@gmail.com

Phone: 09596168675, 07006314731

Received 26.03.2020

Received in revised form 19.05.2020

Accepted 22.05.2020

The high prevalence of intestinal helminth infections among children living in developing countries

impairs growth in these populations. Present study was aimed at comparing the nutritional status of

children infected by soil-transmitted helminths (STH) with that of uninfected children. Stool samples

and anthropometric measurements were taken from 382 children. Stool samples were processed by

using both simple smear and zinc sulphate concentration methods. Nutritional status was assessed

by Waterlow classification. Of the 382 children surveyed, 78.27 % were infected with either Ascaris

lumbricoides or Trichuris trichiura, or both. Children infected with STH were found to be more

malnourished than uninfected children. The present study concludes that soil-transmitted helminths are

abundant among school children of Kashmir valley, with negative impact on their nutritional status.

Keywords: Children, Nutrition, Helminth, Nematode, Kashmir

DOI: 10.31857/S1234567806030025

Soil-transmitted helminth infection is a major factor predisposing to poor nutritional

status among children of low socioeconomic status in developing countries. However, studies

on the impact of soil-transmitted helminth infection on nutritional status are limited (Hall,

1993). Furthermore, most studies on the prevalence of helminth infections focus on preschool

children (De Silva et al., 1994). It is also important to determine the prevalence of helminth

infections in older children and the effect of helminth infections on their nutritional status.

This paper presents data comparing the prevalence of soil-transmitted helminth infections

in children of Kashmir valley and the effect of these infections on their nutritional status.

Material and Methods

Kashmir valley, situated at an altitude of 6000 feet, constitutes the major portion of Jammu and

Kashmir State India, consisting of 10 districts, namely, Annantnag, Kulgam, Shopian, Baramulla,

198

Ganderbal, Bandipora, Budgam, Kupwara, Pulwama, and Srinagar with about 46 Tehsils and about

50 towns. The study was carried out in all the 10 districts. This study was conducted from October

2016 to March 2017. Official meetings with the personnel from health services, city councils and

schools, as well as parents and school children from the study sites, were carried out in order to

explain the protocol of the study. In total 382 children, 219 male and 163 female aged 5-15 yrs.

(9.2 ± 2.3) without disabilities and not receiving antiparasitic treatment, were included in the study.

Initially 480 children were accepted to participate but 98 were rejected during the study because

they had contaminated faecal samples. Written consents were required from both parents in order for

the children to participate. Children requiring medical assistance were properly treated or referred to

medical specialist. The children’s ages were obtained through school records.

Stool examination

Fresh morning stool samples were collected in nylon containers containing 10 ml of 10 %

formaldehyde. The containers were labeled, and immediately transported to the parasitology laboratory,

Department of Zoology, S. P. College campus, Cluster University of Srinagar, for further processing.

The stool specimens were processed using direct smear and zinc sulphate concentration techniques.

Assessment of nutritional status

To study whether there is any relation between the helminth infection and the malnutrition in

the children, nutritional status of the infected and normal children was estimated by using Waterlow

classification.

Waterlow’s Classification

When a childʼs age is known, measurement of weight enables almost instant monitoring of growth.

Measurements of height assess the effect of nutritional status on long-term growth (Waterlow et al.,

1977).

Waterlowʼs classification defines two groups for protein energy malnutrition.

1. Malnutrition with retarded growth, in which a drop in height/age ratio points to chronic condi-

tion - shortness or stunting.

2. Malnutrition with low weight for a normal height, in which the weight for height ratio is

indicative of an acute condition of rapid weight loss or wasting.

This combination of indicators makes it possible to label and classify children with reference to

two poles: children with insufficient but well-proportioned growth and those with a normal height

but who are wasted.

Interpretation of indications (Table 1)

Weight/Height =

Weight of the child

× 100

Weight of the normal child at same height

Height/Age =

Height of the child

× 100

Height of the normal child at same age

Weight in children was measured in kilograms to the nearest decimal point, using a spring balance.

Height was measured in centimeters to the nearest decimal point, using a measuring tape fixed to a wall.

Table 1. Different categories of children with relation to nutritional status

Nutritional status

Stunting, % age of height/age

Wasting, % age of weight/height

Normal

> 95

>90

Mildly impaired

87.5-95

80-90

Moderately impaired

80-87.5

70-80

199

Data entry and analysis

A computer program (SPSS 10.05 for windows; SPSS Inc., Chicago, Illinois, USA) was used for

data analysis. The chi-square test was used to associate risk factors with infection status. Differences

were considered significant when P values of less than 0.05 were obtained.

Results

Among 382 children subjected to stool examination, 299 (78.27 %) were infected with

either Ascaris lumbricoides or Trichuris trichiura, or both. Single and mixed type infections

were observed almost in equal proportions. 149 (39.0 %) children were infected with a single

type of helminth: Ascaris lumbricoides was found in 91 (23.82 %) and Trichuris trichiura in

58 (15.18 %) children. Mixed type infection by Ascaris lumbricoides and Trichuris trichiura

was observed in 150 (39.26 %) children.

In the present study, nutritional status of the infected and uninfected children was

observed (Table 2). It was found that infected children were more prone to malnutrition (158,

52.84 %) than uninfected children (17. 20.48 %) [P<0.05]. Children infected with multiple

types of helminths were found to be more malnourished (92) than children infected with

a single type helminth (65). Ascaris lumbricoides is the main helminth responsible for

causing malnutrition, when present as a single infecting parasite.

Discussion

The present study found a prevalence of 78.27 % for soil-transmitted helminth infections.

These figures, when compared with studies conducted in other parts of the world, show

that Kashmir valley is one of the most hyper-endemic regions for intestinal helminthiasis.

For example, studies conducted on the frequency distribution of gastrointestinal helminths

by Bundy et al. (1988) showed high overall prevalence of 62 % among the urban slum

children of Malaysia. Rodriguez et al. (2000) reported high prevalence of 72 % among

the school children studying in a public institution in Maracaibo, Venezuela. Legesse and

Erko (2004) also noted the high prevalence of 88.2 % among the school children in rural

Ethopia, while Kabatereine et al. (2001) reported an overall prevalence of 56 % among the

school children of south Uganda.

The high prevalence of soil-transmitted helminth infections is probably a consequence

of a low standard of living, poor sanitation, lack of personal hygiene, traditional methods of

agriculture, indiscriminate defecation, the use of night soil as fertilizers and other occupational

work.

Malnutrition was found to be prevalent in the children of Kashmir valley, but it was found

to be more prevalent in children infected by gastrointestinal helminths than in uninfected

children. Further, it was also observed that mixed type infection was responsible for causing

more malnutrition than single type infection. These figures, when compared to other parts

of India (Table 3), show that in Kashmir valley malnutrition is highly prevalent (Ghosh,

Shah, 2004) and needs early attention of medical practitioners, social scientists, economists,

governmental and non-governmental organizations. The reasons behind malnutrition are

200

many, but from present study, it was clear that helminthiasis was one important factor

responsible for malnutrition in already nutritionally compromised children. Sivakumar and

Reddy (1975) showed that ascariasis causes malabsorption of vitamin A; abnormal fat and

increased intestinal transit time, which ultimately leads to malnutrition. Cooper and Bundy

(1988) estimated that approximately 10 % of young children living in conditions appropriate

for hyperendemic geohelminthic transmission could have growth retardation. Gupta (1990)

showed that ascariasis contributes significantly to malnutrition in communities where these

conditions coexist.

Table 3. Prevalence of malnutrition in different Indian Cities (Source: Ghosh, Shah, 2004)

City (Year)

Number

Classification

Prevalence, %

Vadodra (2002)

3157

IAP

Grade I - 41

Grade II - 20

Grade III - 2

Delhi (2001)

150

IAP

Grade I - 11

Grade II - 9

Grade III - 6

Chronic Energy Deficiency - 51

Varanasi (2001)

WHO

Stunt - 10

Chandigarh (2000)

1400

IAP

Under weight - 58

Delhi (1997)

630

WHO

Stunted - 53

Wasted - 23

Under weight - 68

Luckhnow

1061

WHO

Stunt - 63

Wasted - 26

Srinagar (1997)

584

IAP

Grade I - 33

Grade II - 21

Grade III - 6

Calcutta (1994)

1280

IAP

Grade I - 28

Grade II - 17

Grade III - 7

Bhopal (1992)

1000

IAP

Grade I - 41

Grade II - 15

Grade III - 2

Calcutta (1989)

601

Gomez and WHO

Grade I - 40

Grade II - 44

Grade III - 9

Stunt - 81

Wasted - 9

202

Oberhelman et al. (1998) revealed a correlation between intestinal parasitosis and

malnutrition: he found intestinal parasites among children with low WFA (weight for age)

(48.5 %) versus those with normal WFA (38.5 %). The presence of Ascaris or Trichuris in

the stool was associated with low WFA in the overall group. Differences in the prevalence of

Trichuris by nutritional status were especially striking, with Trichuris eggs present in 9.9 %

of all children with low WFA and in 2.8% of all children with a normal WFA (P=0.00008).

Sugunam et al. (1996) also showed that intestinal parasitic infestations contribute significantly

to poor growth and malnutrition in children. Stephenson (1999) established that the high

prevalence of infections, mostly gut helminth infections among children living in poor areas,

impairs linear growth by affecting nutritional status. Hughes et al. (2004) showed that children

with helminthiasis and anaemia were found to be 8.7 times more likely to be stunted and

4.3 times more likely to be underweight than non anaemic and non-infected children. Other

studies have described how even mild and moderate chronic helminth infection and anaemia

impair the physical and mental development in children (Nokes et al., 1992; Hutchinson et

al., 1997; Dickson et al., 2000). Reduced food intake, impaired digestion, malabsorption and

poor growth are frequently observed in children suffering from ascariasis and trichuriasis

(Crompton, Nesheim, 2002).

From the above discussion it is clear that children in communities with rampant intestinal

helminth infections are at more risk of becoming malnourished than in those where prevalence

of helminth infections is low.

Acknowledgements

I am thankful to all the children, their parents and teachers for their cooperation.

References

Bundy D.A.P., Kan S.P., Rose R. 1988. Age related prevalence, intensity and frequency distribution of gastrointestinal

helminth infections in urban slum children from Kaulalumpur Malaysia. Transactions of the Royal Society

of Tropical Medicine and Hygiene 82 (2): 289-294.

Cooper E.S., Bundy D.A.P. 1988. Trichuris is not trivial. Parasitology Today 4 (11): 301-306.

Crompton D.W.T., Nesheim M.C. 2002. Nutritional impact of intestinal helminthiasis during the human life cycle.

Annual Review of Nutrition 22: 35-59.

De Silva N.R., De Silva H.J., Jayapani V.P.P. 1994. Intestinal parasitosis in Kandy area, Sri Lanka. Southeast Asian

Journal of Tropical Medicine and Public Health 25 (3): 439-473.

Dickson R., Awasthi S., Williamson P., Demellweek C., Garner P. 2000. Effect of treatment for intestinal helminth

infections on growth and cognitive performance in children: systemic review of randomized triala. BMJ

320: 1697-1701.

Ghosh S., Shah D. 2004. Nutritional problems in urban slum children. Indian Pediatrics 41 (1): 682-696.

Gupta M.C. 1990. Effect of Ascariasis upon nutritional status of children. Journal of Tropical Pediatrics 36 (4):

189-191.

Hall A. 1993. Intestinal parasitic worms and the growth of children. Transactions of Royal Society of Tropical

Medicine and Hygiene 87 (3): 241-242.

Hughes R.G., Sharp D.S., Hughes M.C., Akoula S., Heinsbroek P., Schulz D., Palmer K., Cavelli-sforza T., Galea

G. 2004. Environmental influences on helminthiasis and nutritional status among pacific school children.

International Journal of Environmental Health Research 14 (3): 163-177.

Hutchinson S.E., Powell C.A., Walker S.P., Chang S.M., Grantham-McGregor S.M. 1997. Nutrition, anemia,

geohelminth infection and school achievement in rural Jamaican primary school children. European Journal

of Clinical Nutrition 51: 729-735.

203

Kabatereine N.B., Tukahebwa E.M., Brooker S., Alderman H., Hall A. 2001. Epidemiology of intestinal helminth

infestations among school going children in southern Uganda. East African Medical Journal 78 (6): 283-286.

Legesse M., Erko B. 2004. Prevalence of intestinal parasites among school children in a rural area close to the

South east of Lake Langano, Ethiopia. The Ethiopian Journal of Health Development 18 (2): 116-120.

Nokes C., Grantham-McGregor S.M., Sawyer A.W., Robinson B.A., Bundy D.A.P. 1992. Moderate to heavy

infections of Trichuris trichiura affect cognitive functions in Jamaican school children. Parasitology 104

(3): 539-547.

Oberhelman R.A., Guerrero E.S., Fernandez M.L., Silio M., Mercado D., Comisky N., Ihenacho G., Mera R. 1998.

Correlations between intestinal parasitism, physical growth and psychomotor development among infants and

children from rural Nicaragua. The American Journal of Tropical Medicine and Hygiene 58 (4): 470-475.

Rodriguez Z.R., Lozano C.G., Diaz I., Cheng R., Rucson G. 2000. Intestinal parasites in school children at a public

institution in Maracaibo municipality, Venezuela. Investigacion Clinica 41 (1): 37-57.

Sivakumar B., Reddy V. 1975. Absorption of Vitamin A in children with Ascariasis. The Journal of Tropical

Medicine and Hygiene 78 (5): 114-115.

Stephensen C.B. 1999. Burden of infection on growth failure. The Journal of Nutrition 129 (2): S534-S538.

Sugunam A.P., Mushekar M.V., Sehgal S.C. 1996. Intestinal parasitic infestations among different population groups

of Andaman and Nicobar islands. The Journal of Communicable Diseases 28 (4): 253-259.

Waterlow J.C., Buzina R., Keller W., Lane J.M., Nichaman M.Z. 1977. The presentation and use of height and

weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin

of the World Health Organization 55 (4): 489-498.

Геогельминты и их влияние

на нутритивный статус детей в Кашмире

Showkat Ahmad Wani

Ключевые слова: дети, питание, гельминты, нематоды, Кашмир

РЕЗЮМЕ

Высокая распространенность инфекций кишечными гельминтами среди детей, проживающих

в развивающихся странах, препятствует там росту населения. Целью настоящего исследования

было сравнение нутритивного статуса детей, инфицированных геогельминтами, с таковым

у неинфицированных детей. У 382 детей были взяты пробы кала и выполнены антропометри-

ческие измерения. Для определения зараженности гельминтами применяли стандартные методы

копроскопии - нативный мазок кала и флотационный метод обогащения с использованием

сульфата цинка. Нутритивный статус оценивался по классификации Ватерлоу (Waterlow et al.,

1977). Из 382 обследованных детей 78.27 % были инфицированы либо Ascaris lumbricoides,

либо Trichuris trichiura, либо обоими этими паразитами. Согласно проведенным исследованиям,

дети, инфицированные геогельминтами, в большей степени страдают от недоедания, чем не-

инфицированные. Среди школьников Кашмирской долины широко распространено заражение

геогельминтами, что негативно сказывается на их нутритивном статусе.

204