Hookworm anemia in the adult population of Jagapati village, Bali, Indonesia.

A cross sectional study was conducted in Jagapati Village, Bali to assess some characteristics of hookworm anemia among the adult population. Hookworm anemia was defined as an iron deficiency anemia in heavily infected individuals (EPG > 2,000). WHO criteria for anemia and criteria of Hercberg for iron deficiency were used. In this study, 15 cases of hookworm anemia were found among 454 total samples (3.3%), or among 123 cases of iron deficiency anemia (12.2%). The age varied between 16-69 years with male to female ratio of 1:2.8. Twelve cases were found with symptoms and signs of anemia, 1 case with full blown hookworm anemia, and 2 cases were asymptomatic. The hemoglobin level was found to be 4.5-12.9 g/dl, with 12 cases (80.0%) being classified as mild anemia, 2 cases (13.3%) as moderate anemia, and 1 case as severe anemia. The mean serum iron level was 39.6 mg/dl, mean transferrin saturation was 11.1%, and mean serum ferritin level was 9.6 ng/dl. Hypoalbuminemia was found in 9 cases (60.0%), eosinophilia in 8 cases (53.3%), and low serum folic acid level in 5 cases (38.5%). High total serum IgE level was found in all but one case, with mean total serum IgE level of 3,739 U/ml. The intensity of hookworm infection was moderate in 11 cases (73.3%) and severe in 4 cases (26.7%). It could be concluded that hookworm anemia was characterized by iron deficiency anemia with eosinophilia, high serum total IgE level, hypoalbuminemia and moderate to severe hookworm infection.

Hookworm infection and iron stores: a survey in a rural community in Bali, Indonesia.

A study of the rural population of the village of Belumbang, Province of Bali, Indonesia, has been conducted to assess the relationship between intensity of hookworm infection (hookworm egg count) and iron stores, hemoglobin level or hematocrit. There was a significant negative correlation between serum ferritin level and hookworm egg count. However no correlation was found between hookworm egg count and hemoglobin level or hematocrit. In a separate analysis the above correlation could be shown in male hosts but not in female hosts. It is concluded that hookworm infection, even in light infection, can interfere with iron stores, but in female hosts this effect might be masked by other factors.

Some epidemiological aspects of hookworm infection among the rural population of Bali, Indonesia.

Stool examination using direct smear method, Kato-Katz thick smear technique and modified Harada Mori test tube cultivation method were done on 2,331 people among the rural population of Bali. The serum ferritin was examined by ELISA technique and hemoglobin concentration by cyanmethemoglobin technique. Overall prevalence of hookworm infection was 24.02% with heterogeneity in local prevalences. The highest prevalence was found in wet highland area (46.3%), followed by wet lowland (27.7%), dry highland (14.2%) and dry lowland (10.9%). The majority of hookworm infection cases were associated with Ascaris and Trichuris infections. Most of the hookworm infections (73.3%) were light/very light in intensity with a mean EPG of 619. The prevalence and intensity of infection were increasing with age, and the age-prevalence and age-intensity curves were slightly convex. There was no significant difference of prevalence or intensity of infection between males and females. The condition and humidity of soil found to be an important determinant for prevalence of hook-worm infection. The frequency distribution of the intensity of hookworm infection showed an over-dispersed distribution pattern with 10% of people harboring more than 63% of parasite burden as measured by EPG. The prevalence of anemia was higher, but not statistically significant, in hookworm infected persons compared with people without infection. But this study failed to show a significant correlation between intensity of infection with hemoglobin level. There was a significant correlation between serum ferritin level with intensity of infection.