Hookworm together with whip-worm and roundworm, accounts for a disease burden of 576-740 million worldwide.
While it may be tempting to think that problems such as hookworm and roundworm are problems for just the developed world. We’ve been fed this hook, line and sinker. It is worth noting that hookworm was actually a huge problem in the Southeastern region of the US for many years (CDC, 2013). Just because hookworm doesn’t affect us doesn’t mean it isn’t our concern. Yet how can we replicate the success of eradicating and reducing helminth infections in the third world as we did in the US?
The typical appearance of hookworm under microscopy ( Source: CDC)
The Facts first
Hookworm is a soil transmitted helminth with the species Necator americanus and Ancylostoma duodenale is the most common cause of roundworm in humans. As with most NTDs, these nematode parasites are found geographically in moist, warm climates where human waste is used to fertilise soil, or where poor waste management systems are in place (CDC, 2010).
Typically the eggs of the worms are found in human stool and hatch in 1 to 2 days where they can then enter the host via a wound, orally, trans-mammary or trans-pulmonary to infect the blood vessels and alveoli tissue where they eventually attach to the small intestinal wall to cause severe blood loss. These worms typically can be eliminated in one to two years but typically can remain attached for several years following infection (CDC, 2010).
Common signs and symptoms may include:
Once again as with many diseases, those at higher risk of serious disease complications are pregnant women, children and individuals with compromised immune function (CDC, 2010). However with lower intensity hookworm infections it is also likely that adults in particular will display no signs or symptoms of hosting the worms in their GIT. (WHO, 2011).
The costs of hookworm
While anaemia and protein deficiency may sound like mild side effects of unfortunately acquiring hookworm, global estimates place anaemia as the leading cause of years lived with a disability among under 18 year olds, as it affects approximately 619 million children (The Global Burden of Disease Pediatrics Collaboration, 2015). In addition to this alarming statistic, protein energy- malnutrition contributes to 225 906 deaths per year and is particularly prevalent in poorer communities which lack this base sanitation, adequate food supply and lack of medical care.
Since hookworm has low morbidity and a high disability rate, it can often be over-looked as a serious, urgent area of medical research much like many of the other NTDs. However it is this lack of sanitation and lack of food supply, which creates a cycle of poverty and disease. Hookworm is estimated to be responsible for 4,087,803 disability adjusted life years (DALYs), which adds up to a very expensive bill exceeding other highly researched diseases with its costs ranging from $7.5 to $138.9 billion depending on the GNI capital (Bartsch. et al., 2016). In terms of global productivity lost, it is estimated to be $11.1 billion annually lost, which is greater than many other diseases.
Luckily there is medication available for hookworm treatment known as “Anthelminthic medications” called albendazole and mebendazole, which are used for infections over the course of 1-3 days. These drugs are known to be extremely effective and carry very few side effects. In addition to these drugs iron supplements may also be prescribed if the infected person has anaemia (CDC, 2010).
Yet as wonderful as treatment options are, distribution, access and funding are hard in many communities and from both a humanitarian and economical perspective, prevention is superior to treatment. By creating greater sewage disposal, educating people on basic sanitation and wearing shoes (or providing footwear) in these areas, the spread could be reduced significantly.
An example of the common packaging for worm treatment ( Source: CDC)
Why the facts matter
The elimination of hookworm is crucial in breaking poverty cycles. Inadequate access to health, poor sanitation and decreased productivity create an ongoing cycle. There is an urgent need for more education and innovative development to help stop the spread of hookworms and to additionally give equal opportunity to those stuck in a cycle of poverty and disease. Remembering to “love thy neighbor as thyself” may be the only way to come away from our own lavish and selfish perspective to truly empathise and create meaningful change. If this philanthropic approach doesn’t entice you, maybe we need to consider how interconnected our world is becoming, and how we too may become affected. Its certainly cause to pause when we start imaging the impact on ourselves.