© 1998 Oxford University Press
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Epidemiological evidence for a differential effect of hookworm species, Ancylostoma duodenale or Necator americanus, on iron status of children
aDivision of Communicable Diseases, World Health Organization Geneva, Switzerland
bCenter for Human Nutntion, School of Hygiene and Public Health, The Johns Hopkins University 615 N Wolle St. Baltunore, MD 21205, USA
cDivision of Control of Tropical Diseases, World Health Organization Geneva, Switzerland
dDepartment of International Health, The Johns Hopkins School of Public Health, Baltimore, USA
eMinistry of Health Zanzibar, United Republic of Tanzania
fPemba Helminth Control Programme Zanzsbar, United Republic of Tanzania
gDepartment of Parasitology, University ‘La Sapienza’ Rome, Italy
Reprint requests to Rebecca J Stoltzfus
BACKGROUND: The hookworms, Ancylostomo duodenale and Necator americanus, cause significant gastrointestinal blood loss. In clinical studies, greater blood losses have been reported with A. duodenale. However, there has been no evidence that endemic A. duodenale infection has greater impact than N. americanus infection on the iron status of populations.
METHODS: In a sample of 525 school children in Pemba Island, Tanzania, we compared the degree of anaemia and iron deficiency associated with the two hookworm species at the individual and community (i.e. school) levels. Multiple regression was used to control for infection intensities and other child characteristics.
RESULTS: In the 492 children with hookworm positive faecal cultures, haemoglobin and ferritin concentrations decreased with increasing proportions of A. duodenale. Among children with only N. americanus larvae, the prevalence of anaemia was 60.5% and the prevalence of ferritin <12 .µ/l was 33.1%, while in children with 
50% A. duodenale larvae, the respective prevalences were 80.6% and 58.9%. When children were grouped by the prevalence of A. duodenale at the school level, children from high prevalence (20%) schools had signficantly worse iron deficiency and anaemia than children from low prevalence schools.
CONCLUSIONS: The species of hookworm being transmitted in a community influences the burden of iron deficiency anaemia in the community, and should be considered in prioritizing and planning programmes for hookworm and anaemia control.
Keywords Hookworms, Ancylostoma duodenale, Necator americanus, school children, iron deficiency, anaemia
Accepted 7 October 1997
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