Integrated assessment of malaria parasite load, anemia, and associated factors in patients with and without soil-transmitted helminthes coinfection in Southern Ethiopia

Abstract

BACKGROUND: Plasmodium–soil-transmitted helminth (STH) coinfection poses a significant public health burden in sub-Saharan Africa, including Ethiopia. Despite the high prevalence of both infections, limited evidence exists on their interaction, particularly regarding parasitemia and anemia across different age groups. This study aims to fill this knowledge gap and inform integrated control strategies in coendemic settings. METHODOLOGY: A comparative cross-sectional study was conducted among 220 participants attending health facilities in Dilla zuria, Southern Ethiopia with 110 with Plasmodium monoinfection and 110 coinfected with STHs. Stool samples were examined using the Kato-Katz technique for STH identification and egg quantification. Plasmodium parasitemia was determined from Giemsa-stained thick and thin blood films, while hemoglobin concentration was measured using a HemoCue analyzer. Independent t-tests, one-way ANOVA, Post hoc analysis and logistic regression were employed for statistical analysis using SPSS version 25. Anemia classification followed WHO criteria. RESULTS: Coinfected patients exhibited significantly higher mean parasitemia (40,093.54 parasites/µl) compared to monoinfected individuals. Hookworm and Trichuris trichiura infection intensities were positively associated with increased parasitemia, whereas Ascaris lumbricoides showed an inverse relationship. Hemoglobin levels were significantly lower among coinfected individuals and were strongly associated with hookworm (p < 0.001) and Trichuris trichiura (p < 0.038), but not with Ascaris lumbricoides (p < 0.838). Coinfection was also associated with poor hygiene practices, low educational status, raw vegetable consumption, and proximity to stagnant water. CONCLUSION: Malaria–STH coinfection, particularly with hookworm and Trichuris trichiura, exacerbates parasitemia and anemia. Integrating deworming interventions into malaria case management may mitigate anemia and improve health outcomes in coendemic regions. Future studies should employ longitudinal designs to better understand the progression and interaction of malaria and soil-transmitted helminth infections over time. CLINICAL TRIAL NUMBER: Not applicable.