From soil to stomach: How worms worsen nutritional deficits: A systematic review

Pooja Shokeen; Kul Pooja; Neeraj Neeraj

doi:10.53730/ijhs.v9nS1.15798

Authors

Pooja Shokeen
poojashokeen2000@gmail.com
SGT University, Gurugram, Haryana, India
Kul Pooja SGT University, Gurugram, Haryana, India
Neeraj SGT University, Gurugram, Haryana, India

Keywords:

Soil-transmitted helminths, malnutrition, anaemia, micronutrient deficiency, stunting, deworming, child health, hookworm, WASH interventions, global health

Abstract

Background: Soil-transmitted helminth (STH) infections—caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms—affect over 1.5 billion people worldwide. These infections exacerbate undernutrition through blood loss, nutrient malabsorption, and impaired appetite. Objectives: To evaluate the relationship between STH infections and nutritional deficits, including anaemia, micronutrient deficiencies, growth impairments, and cognitive outcomes, and assess the effectiveness of deworming interventions. Methods: Literature search in PubMed, Scopus, Web of Science, and EMBASE (2007–2023). Data synthesized narratively; a meta-analysis performed for haemoglobin outcomes. Results: 19 studies included. Hookworm infection strongly associated with iron-deficiency anaemia (pooled mean difference: −0.78 g/dL). Other helminths contributed to reduced micronutrient levels, stunting, and poor cognitive outcomes. Nutritional recovery observed when deworming combined with supplementation and sanitation. Conclusion: STH infections significantly contribute to nutritional deficits, particularly among children. Sustainable control requires integrated deworming, nutrition, sanitation, and education.

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References

World Health Organization. Soil-transmitted helminth infections [Internet]. 2023 [cited 2025 May 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections

Degarege A, Erko B, Negash Y, Animut A. Intestinal Helminth Infection, Anemia, Undernutrition and Academic Performance among School Children in Northwestern Ethiopia. Microorganisms. 2022;10(7):1353. DOI: https://doi.org/10.3390/microorganisms10071353

Yap P, Utzinger J, Hattendorf J, Steinmann P. Influence of nutrition on infection and re-infection with soil-transmitted helminths: a systematic review. Parasit Vectors. 2014 May 19;7:229. DOI: https://doi.org/10.1186/1756-3305-7-229

Crompton DWT, Nesheim MC. Nutritional impact of intestinal helminthiasis during the human life cycle. Annu Rev Nutr. 2002;22:35–59. DOI: https://doi.org/10.1146/annurev.nutr.22.120501.134539

Lo NC, Heft-Neal S, Coulibaly JT, et al. State of deworming coverage and equity in low-income and middle-income countries using household health surveys: a spatiotemporal cross-sectional study. Lancet Glob Health. 2019;7(11):e1511–20. DOI: https://doi.org/10.1016/S2214-109X(19)30413-9

Hotez PJ, Brooker S, Bethony JM, Bottazzi ME, Loukas A, Xiao SH. Hookworm infection. N Engl J Med. 2004;351(8):799–807. DOI: https://doi.org/10.1056/NEJMra032492

Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, Hotez P. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521–32. DOI: https://doi.org/10.1016/S0140-6736(06)68653-4

Stephenson LS, Latham MC, Ottesen EA. Malnutrition and parasitic helminth infections. Parasitology. 2000;121(Suppl):S23–38. DOI: https://doi.org/10.1017/S0031182000006491

Muslim A, Lim YA, Mohd Sofian S, Shaari SA, Mohd Zain Z. Nutritional status, hemoglobin level and their associations with soil-transmitted helminth infections between Negritos (indigenous) from the inland jungle village and resettlement at town peripheries. PLoS One. 2021 Jan 13;16(1):e0245377. DOI: https://doi.org/10.1371/journal.pone.0245377

Hall A, Hewitt G, Tuffrey V, de Silva N. A review and meta-analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr. 2008;4(s1):118–236. DOI: https://doi.org/10.1111/j.1740-8709.2007.00127.x

Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance. Cochrane Database Syst Rev. 2015;2015(7):CD000371. DOI: https://doi.org/10.1002/14651858.CD000371.pub6

Alderman H, Behrman JR, Lavy V, Menon R. Child nutrition, child health, and school enrollment: a longitudinal analysis. J Hum Resour. 2001;36(1):185–205. DOI: https://doi.org/10.2307/3069675

Humphrey JH. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet. 2009;374(9694):1032–35. DOI: https://doi.org/10.1016/S0140-6736(09)60950-8

Ziegelbauer K, Speich B, Mäusezahl D, et al. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med. 2012;9(1):e1001162. DOI: https://doi.org/10.1371/journal.pmed.1001162

Campbell SJ, Savage GB, Gray DJ, et al. Water, sanitation, and hygiene (WASH): a critical component for sustainable soil-transmitted helminth and schistosomiasis control. PLoS Negl Trop Dis. 2014;8(4):e2651. DOI: https://doi.org/10.1371/journal.pntd.0002651

Strunz EC, Addiss DG, Stocks ME, et al. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med. 2014;11(3):e1001620. DOI: https://doi.org/10.1371/journal.pmed.1001620

Keiser J, Utzinger J. Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA. 2008;299(16):1937–48. DOI: https://doi.org/10.1001/jama.299.16.1937

Vercruysse J, Albonico M, Behnke JM, et al. Is anthelmintic resistance a concern for the control of human soil-transmitted helminths? Int J Parasitol Drugs Drug Resist. 2011;1(1):14–27. DOI: https://doi.org/10.1016/j.ijpddr.2011.09.002

Freeman MC, Akoko DO, Rheingans R, et al. The impact of a school-based water, sanitation and hygiene program on knowledge and practices of students and their parents: Nyanza Province, Kenya, 2007. Epidemiol Infect. 2012;140(4):616–26.