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Examining the Co-Infection Effects of Helminths and Malaria in an Indonesian Community

Abstract
Malaria is one of the most prevalent vector-borne infectious diseases with major morbidity and mortality in sub-Saharan Africa and Southeast Asia. Recent epidemiological studies have shown that co-occurrence of soil-transmitted helminth (STH) infections, or infection caused by parasitic worms, are associated with increased risk of malaria infection. However, studies of the association between STH and malaria, and the effect of antihelminth (deworming) treatments that are more commonly used in areas with high STH infection rates, are sparse. Therefore, we explored the relationship between STH and malaria infection in an Indonesian community (N=1997) with high prevalence of both STH and malaria while controlling for covariates and evaluating the role of deworming treatment as a covariate. Participants with STH infection and/or malaria infection were categorized as either infected or uninfected using PCR testing (cycle threshold count) at both baseline and end of study. Self-report, blood, and stool samples were used to assess overall STH and malaria infection from September 2008 to July 2010. Descriptive statistics were used to assess the impact of STH infection on malaria outcomes. To quantify these associations, robust Poisson regression models were used to assess the impact of baseline infections including STH infection on malaria while adjusting for age, sex, and the use of deworming treatment. Approximately 39.5% and 19.1% of all participants were infected with Plasmodium vivax and P. falciparum, respectively, at the start, while 18.0% and 9.96%, respectively, were infected at the end. A positive association was observed between Ascaris lumbricoides and P. vivax, and between Necator americanus and P. falciparum (PR = 1.04, 95% CI = 0.53 to 2.04; PR = 2.07, 95% CI = 1.00 to 4.29, respectively). While a negative association was observed between N. americanus and P. vivax, and between A. lumbricoides and P. falciparum (PR = 0.91, 95% CI = 0.44 to 1.89; PR = 0.66, 95% CI = 0.27 to 1.65, respectively). Overall, two of these models were significant (p = 0.062; p = 0.008; p = 0.030; p = 0.062, respectively). Similarly, there was a positive association observed between the use of albendazole treatment and STH and malaria outcomes.
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