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Community and International Nutrition

Nutritional Status Improves after Treatment of Schistosoma japonicum–Infected Children and Adolescents¹

Hannah M. Coutinho^*,2, Luz P. Acosta, Stephen T. McGarvey, Blanca Jarilla, Mario Jiz, Archie Pablo, Li Su^**, Daria L. Manalo, Remigio M. Olveda, Jonathan D. Kurtis and Jennifer F. Friedman^**

^* Center for International Health Research (CIHR), Department of Pathology and Laboratory Medicine, and ^** Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, RI; Research Institute of Tropical Medicine, Manila, the Philippines; International Health Institute and Center for Statistical Sciences, Brown University, Providence, RI

² To whom correspondence should be addressed. E-mail: hannah_coutinho{at}Brown.edu.

ABSTRACT

Studies addressing the relation between chronic schistosomiasis japonica and nutritional status are limited. We conducted a longitudinal treatment-reinfection study in Leyte, the Philippines, among 477 Schistosoma japonicum–infected subjects aged 7–20 y, to evaluate changes in nutritional status after treatment with praziquantel. Stool, Tanner stage, anthropometric indices, and hemoglobin (Hb) were evaluated at baseline, 4 wk post-treatment, and every 3 mo for 18 mo. Height-for-age Z-score (HAZ) and BMI Z-score (BMIZ) were calculated. Change scores relative to baseline were created for all outcome measures. Multilevel repeated-measures analyses were used to adjust for socioeconomic status, sex, either pubertal status or age, and household-level clustering. Z-scores improved modestly but significantly over time. BMIZ in children wasted at baseline improved the most [0.41 (0.26–0.56) Z-score unit] and HAZ improved only in children stunted at baseline [0.17 (0.l2–0.21) Z-score unit]. Hb improvement peaked at 15 mo and occurred only in subjects that were anemic at baseline [peak improvement: 8.3 (6.0–10.6) g/L] and in males [peak improvement 4.7 (2.9–6.6) g/L]. Reinfection, evaluated as egg count over time and egg count 3 mo earlier to assess a delay in effect, was inversely associated with improvement in Hb (P = 0.06 and 0.004, respectively). High-intensity reinfection at 18 mo was associated with significantly less absolute growth from baseline compared with lower-intensity and no reinfection. Based on the peak Hb improvement at 15 mo post-treatment, annual treatment intervals are recommended to reduce schistosomiasis-associated nutritional morbidity.

KEY WORDS: • Schistosoma japonicum • praziquantel • nutritional status • longitudinal

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