Hookworm infection is largely connected with Iron deficiency anaemia and the effects that this can have on the sufferer. This parasitic infection causes anaemia in the host through feeding activities and prolonged intestinal blood loss. The longer the host is infected with the worm, the harder it is for them to replace the

iron that is lost through the feeding and development of the hookworm. Also affected is protein levels in the host, which can be excreted rapidly through the urine. This can cause depletion in the body’s stores which may result in protein energy malnutrition.
Stunting and poor cognitive growth can also occur in children because of the chronic malnourishment associated with hookworm infection.

(Bethony et al., 2006)

Iron deficiency anaemia and hookworm

The development of hookworm associated anaemia is firstly related to the iron status of the host before infection. If the host has iron levels that are already low, there is a higher risk of developing IDA during infection. Heavily infected hosts are most at risk of hookworm associated anaemia as one A. duodenale worm can cause more than 0.05ml of blood loss per day.
In a study conducted in Tanzania, 3595 schoolchildren were assessed for the connection between iron deficiency anaemia and parasitic infections. It was found that 82.7% suffered from iron deficiency anaemia and that 73% of severe anaemia found was caused by hookworm infection.
Due to children being at higher risk of contracting hookworm, control methods are even more important to prevent against the risk of iron deficiency anaemia.
Another group at high risk of contracting iron deficiency anaemia is pregnant women. It is thought that 44 million pregnant women in east Africa are anaemic. By hookworms creating blood loss in the mother through their feeding habits, they are not only putting the mother at risk of suffering from IDA. If the mother is malnourished, the foetus may not be getting adequate nutrients in the womb and this may cause intrauterine growth retardation and potential cognitive and growth problems.
Anthelminthic treatments are of high importance to this high risk group, as well as iron supplements where possible. Changes in the diet of pregnant mothers that live in areas where hookworm is endemic should also be looked at to ensure that they are providing enough nutrients to prevent against deficiencies that could protect them at times of infection.
To combat against hookworm infections a diet rich in iron should be consumed. Foods such as meat, fish, green leafy vegetables, legumes and pulses are all recommended to protect against iron depletion that is caused by blood loss in hookworm infection.

(Loukas et al., 2005; Brooker et al., 2007; Stoltzfuz et al., 1997; Hotez et al., 2003; Torlesse & Hodges, 2000)

Protein losses and hookworm

Hookworm infection has also been linked to causing protein losses in the hosts’ body, worsening levels of malnutrition and severely affecting energy levels of the sufferer.
A study of two groups of Malaysian and Indian school aged children (a total of 1,203 subjects) assessed the connection between hookworm infection and weight, height and haemoglobin levels in children suffering from hookworm infection. It was found that those suffering chronic infection were also suffering from protein energy malnutrition as well as anaemia. The effects of protein energy malnutrition can be a factor affecting stunting and wasting in children that are infected, therefore it is crucial to raise levels of protein in those that are at risk of contracting hookworm infection.

To increase levels of protein through the diet it is recommended to increase consumption of protein rich foods. These can include foods such as meat, fish, eggs, legumes and pulses.

(Foo, 1990; Al-Mekhalfi et al., 2005)

Stunting and poor cognitive development and hookworm.

Another serious issue connected with hookworm infection is stunting caused by undernutrition from the parasite.

A recent study investigated the connection between the nutritional statuses of 1113 individuals aged from 6 months to 83 years in connection with helminth infections. 69.8% of subjects were found to have hookworm infection and low body mass due to nutritional deficiencies caused by hookworm. This may result in eventual growth stunting and short stature.

Hookworm infection has also been linked to poor cognitive function in children. This connection is thought to be caused by iron deficiency anaemia. Intestinal blood loss caused by the adult hookworm causes less haemoglobin in the red blood cells, which is crucial to carry oxygen around the body. If there is a lack of haemoglobin, oxygen cannot be carried to the brain which can result in poor cognitive function.

To combat growth stunting and poor cognitive function malnourishment levels must be dealt with. Levels of iron and protein must be improved as well as ensuring at risk groups have enough nutrients in their diet to fight malnourishment.

(Jardim-Botelho et al., 2008)