Hookworm Infestations among Pregnant Teenagers in Bungoma County, Kenya

Abstract

Hookworm infection (Ancylostomiasis) and its association with hematopoietic micronutrient deficiency, contributes significantly to anaemia in poor countries. In these countries, teenage pregnancy is a major health problem characterized by high prevalence of anemia, exacerbating physiological distress due to increased oxygen demand. In spite of the high prevalence of this problem, no study has been undertaken in Kenya. This is resultant from the combined metabolic needs of a rapidly growing girl and her developing fetus. Anemia increases risks of feto-maternal and child mortality and morbidity, if preventive interventions are not part of antenatal care for prospective teenage mothers. Hookworm infection therefore significantly endangers the health of the teenage antenatal mothers in Kenya. The literature revealed no previous study on the problem in the target population.

Objectives: The objective of this study was to explore the necessity for including treatment for worms in the antenatal care programme for the target population. The study, therefore, aimed at determining the prevalence of anemia, Hookworm infection and the possible etiological role of the latter among teenage antenatal mothers in Kenya.

Methods: A descriptive and cross-sectional survey conducted in 2009 at Bungoma County Hospital and Bumula Health Centre antenatal clinics in West Kenya whose sample population comprised 384 pregnant teenage girls. Diagnosis for anemia was made from hemoglobin concentration (estimated by cyanmethemoglobin spectrophotometry). Hookworm infection was diagnosed based on the presence of ova in stool using Ritchie’s Formol Concentration and Direct stool microscopy. Statistical Package for Social Sciences (SPSS) version 12 was used to analyze data and inference was based on 5% significance level.

Results: The prevalence of Ancylostomiasis was 28% and that of anemia was 61% (Hb<100g/L). Severe anemia (Hb<60g/L) constituted 20%, moderate (Hb≤90g/L) 31.2% and mild (Hb>90<110g/L) constituted 48.3% of the teenage antenatal mothers. There was a significant association between Ancyclostomiasis and anaemia (Chi sq 32.238, p<0.001). Logistic regression (p<0.05) showed that Hookworm infection was a significant predictor of anemia. The teenage antenatal mothers infested with Hookworm were four (4) times more likely to be anemic (OR: 95% CI: 3.703; df 2.287-5.995).

Conclusions: Anemia in pregnancy in the rural Kenya settings is high and that hookworm infections have significant impact on the prevalence, health of teenage mothers and pregnancy outcomes. Based on this evidence and other studies, we suggest that during antenatal acre (ANC) period, there should be routine screening for Ancylostomiasis infections, followed by a single dose of Albendazole after the first trimester along with iron and folic acid supplements. This can cause significant elevation of hemoglobin and serum ferritin levels thereby reducing maternal and perinatal morbidity and mortalities, prematurity and low birth weights in our poor communities.