Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Michael Cappello

Second Advisor

Debbie Humphries

Abstract

INTRODUCTION: Parasitic helminth infections have persisted in resource-limited settings around the world, leading to greater numbers of people experiencing sequelae including malnutrition, anemia, and impaired growth and cognitive function among children. Despite periodic deworming efforts, a high burden of disease remains in sub-Saharan Africa. Establishing baseline prevalence of these infections can inform local and national deworming campaign objectives as well as tailor additional interventions accordingly. Here we describe our efforts to determine baseline prevalence and analyze potential risk factors for infection in Ashanti Region, Ghana.

OBJECTIVES: The primary objective of this study was to characterize the molecular epidemiology of hookworm and schistosomiasis co-infections among communities surrounding Lake Bosumtwe in Ashanti Region, Ghana.

METHODS: This was a cross-sectional epidemiological analysis in which participants (n= 907) were recruited from four rural communities. Qualitative demographic surveys were issued to identify possible risk-factors for infection along with quantitative collection of fecal samples and urine samples for helminth analysis. A single community, Abono (n= 406), was used for post-hoc analyses.

RESULTS: Total hookworm prevalence was 5.6% and varied by community (3.1-7.3%). Age (AOR= 1.05, p=0.0004), wealth (AOR= 5.94, p= 0.02), and daily shoe use (AOR=0.13, p=0.01) were independently and significantly associated hookworm status. In comparison to hookworm infection, incidence of the whipworm, Trichuris trichiura, infection was observed in two communities. There was a total of two schistosomiasis infections across all communities.

CONCLUSION: Hookworm prevalence in each community was lower than previously reported findings. This suggests either a penetrance of mass drug administration campaigns or a strong mechanism of protective immunity. The independently associated risk factors of age, wealth, and daily shoe use are consistent with other studies. Interestingly, age had a positive correlation with hookworm infection, indicating that previously established patterns of immunity in Sub-Saharan Africa may not exist in these communities. Significant association with the poorest wealth quartile suggests a celling effect of wealth for protection against hookworm infection. Our findings highlight need for more robust community-based monitoring of MDA programs in order to detect local variability in performance as well as lay the framework for investigating diagnostic sensitivity and treatment response.

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This is an Open Access Thesis.

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