by Most Americans see parasitic infections as a problem of the past or a problem that only affects low-income countries. But new research from Washington University in St. Louis finds evidence that the problem is likely widespread in low-resource communities in the southern United States where environmental conditions combined with neglected infrastructure and inadequate access to health care create the perfect breeding ground. reproduction for these infections.
In a small, preliminary study published March 2 in American Journal of Human Biology38% of children sampled from a rural Mississippi Delta community were found to have either parasitic worms or protozoan infections — a single-celled parasitic organism that can negatively affect gut health.
Parasitic infections are a neglected health issue in low-resource communities, according to Theresa Gildner, study co-author and assistant professor of biological anthropology in Arts and Sciences at WashU. School-age children are particularly at risk for these infections due to increased exposure through play, poor hand hygiene and their still-developing immune systems.
If left untreated, infections can lead to nutritional deficiencies and lifelong health consequences. Gildner said many of the community members he worked with during this project expressed frustration with the state and federal governments not listening to their concerns about these issues.
“This is a failure of all levels of government to provide essential services to vulnerable citizens. Health conditions — including parasitic and enteric infections — linked to poor sanitation are likely to worsen in the coming years as climate change and associated extreme weather phenomena further burden already weak infrastructure systems,” said Gildner, an expert on parasitic diseases and health disparities.
According to Gildner, President Biden’s infrastructure bill is a step in the right direction, but more work is needed in the near term to invest in crumbling infrastructure.
“I don’t know if President Biden’s infrastructure bill will directly help the communities where we’ve worked — we haven’t heard anything from our community partners — but I think there could be indirect benefits. For example, bringing more attention to The immediate need to invest in failing infrastructure can lead to more localized projects that benefit those communities,” he said.
However, any efforts to address these infrastructure needs should begin with direct and respectful community involvement by locally elected officials. After all, he said, “The people who live in these communities have the best sense of the problems through their lived experiences and may have ideas about what is most needed to improve conditions in their particular community.”
This is a failure of all levels of government to provide basic services to vulnerable citizens. Health conditions — including parasitic and intestinal infections — linked to poor sanitation are likely to worsen in the coming years as climate change and related extreme weather events further strain already weak infrastructure systems.
About research
Understanding infection patterns in the U.S. — including the current extent of parasitic infections and key sources of exposure — is critical to improving health outcomes, Gildner said. Previous studies in the US have been case-based or focused exclusively on immigrant populations. Very few surveys have been conducted in areas with the most risk factors for exposure.
In the summer of 2019, members of the Rural Embodiment and Community Health (REACH) research group — led by Gildner and Tara J. Cepon-Robins, associate professor of anthropology at the University of Colorado Colorado Springs (UCCS) and including WashU biologist Elizabeth K. Mallott and former UCCS undergraduate Isabella C. Recca — traveled to the rural Mississippi Delta to conduct preliminary community research.
They chose to focus on a small, predominantly black, rural community that is frequently affected by flooding and sewage backups due to community-reported infrastructural neglect.
In total, 24 children — including 12 boys and 12 girls ranging in age from infants to 14 — from 12 households participated in the study. Overall, 38% of children were found to have one or both types of parasitic infections.
Contrary to expectations, they found no significant differences in infection status based on age, gender or household size, although Gildner acknowledges that this could be due to the relatively small sample size. He hopes that continued research with a larger data set will allow the team to better test these patterns in the near future.
Last summer, the team collected additional samples from adults in the same Mississippi community as well as East St. Louis in a community facing similar problems related to infrastructure failure, persistent flooding and sewage backups, Gildner said. The team is also analyzing soil samples collected from various shared community spaces during the 2022 trip to better examine these patterns. And plans are underway to collect additional data in other Mississippi Delta communities this summer.
Education is the key
Lack of education is one of the reasons why parasitic infections often go undetected.
“One interesting thing we noticed during our visit to Mississippi in 2019 is that some of the grandparents we spoke to knew the threat posed by parasite infections locally because they had heard about these issues as children,” Gildner said. “One grandparent told us they remembered public health education programs discussing the dangers of hookworm infection and encouraging community members to wear shoes outdoors to prevent infection.
“However, these messages stopped after early childhood and they always wondered why no one talked about these infections anymore. This kind of messages could be relatively simple to implement, although basic information about key infections would have to be provided from parasites, as many people are no longer aware of these diseases.’
Even health care providers often assume that the risk of parasitic infection is greater for Americans who travel abroad. Educating healthcare providers about the threat parasitic infections pose to the US, how to recognize symptoms and test appropriately is key.
“Without this basic medical knowledge, diagnoses can be missed and treatment delayed,” Gildner said. “For example, one participant last summer was diagnosed with Helicobacter pylori, a bacterium we recently started studying that can cause stomach ulcers and some stomach cancers in severe cases. However, he told us that it took months and visits to multiple doctors to properly test and diagnose, largely because of the assumption that symptomatic cases of this bacterial infection are not a major concern in the US.”
While an option for areas suffering from heavy rates of parasite infestation, prophylactic mass drug administration is not a practical first step in addressing the problem, Gildner explained. There isn’t enough public awareness of the conditions, and safe and effective drugs used to treat infections from common parasites are prohibitively expensive in the U.S., he said.
However, Gildner would like to see more government investment in research in other US locations to clarify the current extent of parasite infections and identify key sources of exposure that could be targeted to improve health outcomes.
