The prevalence of hookworm infection, iron deficiency and anaemia in an Aboriginal community in north-west Australia

Objective: To determine the prevalence of hookworm infections, iron deficiency and anaemia in an Aboriginal community in the north of Western Australia. Design and setting: A cross-sectional survey conducted in 1992, examining faecal specimens and blood samples from Aboriginals and non-Aboriginals in a remote coastal community in the north of Western Australia. Participants: All those living in the community at the time of the survey. Main outcome measures: Parasite status and haematological values for haemoglobin, serum iron, ferritin, transferrin and mean red cell volume. Results: Infections with hookworm were present throughout the Aboriginal population (77%; n=243), with the highest prevalence in children aged 5-14 years (93%; n=74). Hookworm was not detected in non-Aboriginals (n=24). Iron deficiency was common throughout the Aboriginal population, especially in children aged 5-14 years (79%; n=68) and women aged over 14 years (72%; n=65). Anaemia was highly prevalent among Aboriginal children aged 5-14 years (84% in hookworm-positive children, 75% in hookworm-negative) and women aged over 14 years (63% in hookworm-positive women, 31% in hookworm-negative). Aboriginals over 14 years of age who had hookworm (n=82) had significantly lower levels of haemoglobin, serum iron and serum ferritin, a lower mean red cell volume and significantly higher transferrin levels than uninfected Aboriginals (n=38) and non-Aboriginals (n=19) in the same age group. Hookworm infections were associated with anaemia (P<0.01) and iron deficiency (P<0.01) in people over 14 years of age. The species of hookworm, determined after examining 13 larval cultures and two adult worms, was found to be Ancylostoma duodenale. Conclusion: Infections with A. duodenale are endemic in Aboriginals in this community, and are likely to contribute to the high prevalence of iron deficiency and anaemia observed in the Aboriginal population, particularly in children and women.