Effects of chronic parasitosis on women's health.

Parasitic diseases are closely related to the lack of sanitation (unavailability of potable water, inadequate disposal of human waste, lack of latrines) or the absence of personal hygiene. They are also closely linked to warm and humid climates, and are therefore considered tropical diseases. This chapter addresses chronic hookworm parasitosis and malaria, and their effect on women's health. Of all Helminthes, hookworms cause the most severe anemia because of iron deficiency due to chronic blood loss. Worldwide, an estimated 51% of pregnant women suffer from anemia-almost twice as many as non-pregnant women. In severe cases (Hb < 70 g/l) the risk of perinatal maternal and child death increases up to 500-fold. Anemia due to maternal deficiency affects the fetus, causes retarded intrauterine growth, and reduces fetal ability to absorb iron provided by the mother. Hookworms are nematodes that infect roughly 1 billion people. Their preferred habitat is the jejunum, where they attach to the mucous tissue to feed, and secrete an anticoagulant causing bleeding. Hookworm infections often begin in childhood. The worm enters the body through the skin and reaches the highest number at the end of adolescence and young adulthood. Little attention has been given to the treatment of pregnant women because of unavailability of safe antiparasitic drugs and fear of teratogenesis. However, there are new treatments, and the anthelminthic drugs may be administered in schools and organized women's groups in communities. During pregnancy anthelminthic treatment can improve maternal, fetal and infant health. Treatment given every 4 months has been shown to interrupt the transmission cycle of the parasite and help to improve the iron status of all women. Therapeutic strategies should be linked to other measures, such as promoting the use of shoes, introduction of potable water, education and treatment of the population at large, especially the school-age population. An estimated 267 million people are annually infected by malaria, a parasitic disease caused by Protozoa of the genus Plasmodium. Malaria is transmitted by the Anopheles mosquito and is highly prevalent in tropical and subtropical regions located between 40 degrees latitude North and 30 degrees latitude South. It causes acute attacks that leave the human body in such a poor state that health problems resulting from these attacks become chronic. Due to the high mortality and morbidity associated with it, malaria is considered the most serious of tropical diseases and a major public-health dilemma. Pregnant women are at high risk of becoming infected, as well as children in their first years of life. In pregnant women, malaria can cause anemia which can be the major cause of maternal mortality, especially during the first pregnancy. Malaria can also cause fetal anemia which frequently results in retarded intrauterine growth and low birth weight. Prophylactic treatment with antimalarial drugs during pregnancy is recommended in areas where the disease is endemic. The prophylactic treatment should focus primarily on primiparous women who are most susceptible. Chloroquine is safe and effective for antimalarial prophylaxis, and is not teratogenic. Proguanil is also safe for prophylactic use during pregnancy, particularly in areas where P. falciparum is resistant to chloroquine. Mefloquine may be used during the third trimester of pregnancy, only if other antimalarial drugs are unavailable or ineffective.