Document Type

Capstone Experience

Graduation Date

5-2024

Degree Name

Master of Public Health

Department

Epidemiology

First Committee Member

Joseph Fauver, PhD

Second Committee Member

David Brett-Major, MD MPH

Third Committee Member

Abraham D Mengist, PhD

Abstract

Hookworms are soil-transmitted helminths that infect over 500 million people worldwide, primarily those in low-income countries. Infection with hookworm can cause anemia, malnutrition, and stunted physical and cognitive development. Deworming campaigns have attempted to combat hookworm infections in endemic areas for decades. However, there is growing variability in the effectiveness of deworming drugs, and post-treatment reinfections are abundant. There are significant gaps in our understanding of critical host-parasite factors that mediate hookworm infection, reinfection, and response to deworming treatment in endemic communities. A five-year prospective study was undertaken to better understand drivers of hookworm infection in rural Ghana and thus improve future intervention strategies. Here, we present the year 2 cross-sectional assessment of the human behavioral, demographic, and social factors influencing community infection levels and response to treatment in Beposo, Ghana. Among 588 participants >3 years old recruited in year 1 (2022) of the community-wide survey, we collected information on demographic data, social behaviors, and sanitation infrastructure. In June-July 2023, we collected anthropometric measurements and outcomes of interest, including hookworm infection status, eggs per gram of stool (EPG). Additionally, treatment success following administration of 400 mg of albendazole, including cure rate (CR) and egg reduction rate (ERR) were measured. Univariate analysis was performed to describe participant characteristics and potential risk factors. Multivariable logistic regression was used to assess the relationship between exposures, infection risk, and treatment outcomes and was adjusted for potential confounders. The prevalence of hookworm was 31.9%, and the CR was 58.5%. The baseline mean EPG was 343.6 (+/- 405.9), and the post-treatment EPG was 49.6 (+/- 98.2). The overall ERR was 80.40%. Analysis revealed that education, malaria co-infection, using boreholes as water sources, and lacking electricity were factors significantly associated with increased odds of hookworm infection. Subjects with a higher pre-treatment EPG were significantly less likely to be cured following albendazole administration, suggesting that 400 mg of albendazole may be insufficient to treat heavy parasite burdens. In addition, participants who were hookworm-positive in 2022 were less likely to be cured at the first follow up timepoint in 2023, an association we intend to investigate further as the study progresses.

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Available for download on Wednesday, April 29, 2026

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