Albonico M, Stoltzfus R J, Savioli L, Tielsch J M, Chwaya H M, Ercole E, Cancrini G
Division of Communicable Diseases, World Health Organization, Geneva, Switzerland.
Int J Epidemiol. 1998 Jun;27(3):530-7. doi: 10.1093/ije/27.3.530.
The hookworms, Ancylostoma duodenale and Necator americanus, cause significant gastrointestinal blood loss. In clinical studies, greater blood losses have been reported with A. duodenale. However, there has been no evidence that endemic A. duodenale infection has greater impact than N. americanus infection on the iron status of populations.
In a sample of 525 school children in Pemba Island, Tanzania, we compared the degree of anaemia and iron deficiency associated with the two hookworm species at the individual and community (i.e. school) levels. Multiple regression was used to control for infection intensities and other child characteristics.
In the 492 children with hookworm positive faecal cultures, haemoglobin and ferritin concentrations decreased with increasing proportions of A. duodenale. Among children with only N. americanus larvae, the prevalence of anaemia was 60.5 % and the prevalence of ferritin <12 microg/l was 33.1%, while in children with > or =50% A. duodenale larvae, the respective prevalences were 80.6% and 58.9%. When children were grouped by the prevalence of A. duodenale at the school level, children from high prevalence (> or =20%) schools had significantly worse iron deficiency and anaemia than children from low prevalence schools.
The species of hookworm being transmitted in a community influences the burden of iron deficiency anaemia in the community, and should be considered in prioritizing and planning programmes for hookworm and anaemia control.
十二指肠钩虫和美洲板口线虫可导致严重的胃肠道失血。在临床研究中，十二指肠钩虫导致的失血量更多。然而，尚无证据表明地方性十二指肠钩虫感染比美洲板口线虫感染对人群铁状态的影响更大。
在坦桑尼亚奔巴岛的525名学童样本中，我们在个体和社区（即学校）层面比较了与这两种钩虫相关的贫血和缺铁程度。采用多元回归来控制感染强度和其他儿童特征。
在492名粪便培养钩虫阳性的儿童中，血红蛋白和铁蛋白浓度随着十二指肠钩虫比例的增加而降低。在仅感染美洲板口线虫幼虫的儿童中，贫血患病率为60.5%，铁蛋白<12μg/l的患病率为33.1%，而在十二指肠钩虫幼虫占比≥50%的儿童中，相应的患病率分别为80.6%和58.9%。当按学校层面十二指肠钩虫的患病率对儿童进行分组时，来自高患病率（≥20%）学校的儿童缺铁和贫血情况明显比来自低患病率学校的儿童更严重。
社区中传播的钩虫种类会影响社区缺铁性贫血的负担，在制定钩虫和贫血控制计划的优先级和规划时应予以考虑。
