Selective primary health care: strategies for control of disease in the developing world. XVII. Hookworm infection and anemia.

Approximately one-quarter of the world's population is infected with either Ancylostoma duodenale or Necator americanus. Humans transmit the hookworm by fecal contamination of the soil. The eggs hatch and the larvae may survive several months in warm, damp soil. Humans are infected when the larvae penetrate the skin and migrate through the body to the intestines, where the median survival time of the hookworm is one year. The loss of red blood cells into the gut is proportional to the worm load. Symptoms result from iron deficiency anemia and protein loss caused by a heavy worm burden. The peak age-specific prevalence of infection occurs in adult life, but only a small proportion of those infected ever become symptomatic. Possible control measures include chemotherapy to reduce the intensity of infection and the transmission potential and sanitation.