1664. Maternal Hookworm Infection and Its Effect on Maternal/Child Health: A Systematic Review and Meta-Analysis

Abstract

Background. Hookworm is an intestinal parasite that infects 500 million people, with another 5.1 billion at risk, especially in poverty-stricken, tropical and subtropical regions. In 2005, an estimated 6.9 million pregnant women living in Sub-Saharan Africa were infected with hookworm, despite efforts for mass drug administration (MDA) being recommended. This study aimed to investigate the health impact of hookworm infection in pregnant women in order to guide public health interventions. Methods. A systematic review and meta-analysis were conducted using Medline OVID for the creation of MeSH terms, with subsequent translation to EMBASE and Cochrane Library. We performed a meta-analysis on the association between maternal hookworm and maternal anemia, as well as maternal hookworm co-infection with malaria. Other effects on maternal/child health were investigated and summarized without a meta-analysis due to the limited study numbers. Results. Our search resulted in 471 studies for the meta-analysis, of which 23 met inclusion criteria. The prevalence of hookworm ranged from 1% to 67% in pregnant women, while malaria prevalence ranged from 11 to 81%. Pregnant women with anemia were more likely to have concurrent hookworm infection (combined odds ratio (cOR) 2.21 [1.94, 2.51], P < 0.001). Additionally, pregnant woman with malaria were more likely to have hookworm infection (cOR 1.71 [1.43, 2.03], P < 0.001). Our investigation also showed an association between maternal hookworm and infant cognitive development (one study), maternal co-infection with HIV (two studies), and infant birth weight (significant in three of four studies). Infant vaccine response did not show an association (four studies). Conclusion. Hookworm infection in pregnant women is an important global health issue associated with significant maternal anemia and concurrent parasitic infections, such as malaria. Despite current MDA strategies in pregnant women, heavy hookworm burden, co-infection with malaria, and subsequent anemia persists. Further investigation on maternal-child outcomes of hookworm infection on maternal anemia, maternal malaria co-infection, and other areas, such as infant cognitive outcomes, will provide potential public health interventional targets to reduce morbidity.