by Most Americans consider parasitic infections a problem of the past or one that only affects low-income countries. However, new research from Washington University in St. Louis finds evidence that the problem is likely widespread in resource-poor communities in the southern United States, where environmental conditions combined with neglected infrastructure and inadequate access to health care create the perfect breeding ground for these infections.
In a small, preliminary study published on Feb American Journal of Human Biologyfound that 38% of children taken from a rural community in the Mississippi Delta had either parasitic worms or protist infections — a single-celled parasitic organism that can negatively impact gut health.
According to Theresa Gildner, co-author of the study and assistant professor of biological anthropology in Arts & Sciences at WashU, parasitic infections are a neglected health problem in resource-poor communities. School-age children are particularly at risk for these infections due to increased exposure during play, poor hand hygiene, and their developing immune systems.
Left untreated, the infections can lead to malnutrition and lifelong health consequences. Gildner said many of the community members they worked with during this project have expressed frustration that the state and federal governments are not listening to their concerns about these issues.
“This is a failure of all levels of government to provide basic services to vulnerable citizens. Health conditions — including parasitic and intestinal infections — associated with poor sanitation are likely to worsen in the coming years as climate change and associated extreme weather events already continue to stress weak infrastructure systems,” said Gildner, an expert on parasitic diseases and health disparities .
Gildner said President Biden’s infrastructure bill is a step in the right direction, but more work is needed in the near future to invest in the crumbling infrastructure.
“I don’t know if President Biden’s infrastructure bill will directly help the communities we’ve worked in — we haven’t heard from our community partners — but I think there could be indirect benefits. For example, more attention to the immediate need for investment in failing infrastructure can lead to more localized projects that will benefit these communities,” she said.
But any effort to meet these infrastructure needs should begin with direct and respectful community engagement through locally elected officials. Finally she said: “The people who live in these communities have the best sense of what the problems are through their lived experiences and may have ideas as to what is most needed to improve conditions in their specific community .”
This is a failure of all levels of government to provide basic services to vulnerable citizens. Health conditions – including parasitic and intestinal infections – associated with poor sanitation are likely to worsen in the years to come as climate change and associated extreme weather events put further strain on already fragile infrastructure systems.
About the research
Understanding U.S. infection patterns — including current levels of parasitic infections and key exposure sources — is critical to improving health outcomes, Gildner said. Previous studies in the US have been case-based or focused solely on immigrant populations. Very few surveys have been conducted in regions with the most risk factors for exposure.
In the summer of 2019, members of the Rural Embodiment and Community Health (REACH) research team led by Gildner and Tara J. Cepon-Robins, associate professor of anthropology at the University of Colorado Colorado Springs (UCCS), including WashU biologist Elizabeth K. Mallott and former UCCS student Isabella C. Recca – traveled to the rural Mississippi Delta to conduct preliminary community research.
They chose to focus their attention on a small, predominantly black, rural community that is often affected by flooding and sewage backlogs, as the community reports that it is neglecting infrastructure.
A total of 24 children – including 12 boys and 12 girls aged infants to 14 years – from 12 households took part in the study. Overall, 38% of the children had one or both types of parasitic infections.
Contrary to expectations, they found no significant differences in infection status by age, gender, or household size, although Gildner concedes that this may be due to the relatively small sample size. She hopes ongoing research with a larger dataset will allow the team to better test these patterns in the near future.
Last summer, the team collected additional samples from adults and in the same community in Mississippi as well as East St. Louis in a community facing similar problems related to failing infrastructure, ongoing flooding and sewer backlogs, Gildner said. The team is also analyzing soil samples collected from various shared common spaces during the 2022 trip to better study these patterns. And it plans to collect more data in other Mississippi Delta communities this summer.
Education is the key
A lack of education is one of the reasons why parasitic infections often go undetected.
“One interesting thing that struck us during our 2019 visit to Mississippi is that some of the grandparents we spoke to were aware of the threat of parasitic infections locally because they had heard about these problems as children,” said Gildner. “A grandparent told us they remembered public health education programs that discussed the risks of hookworm infection and encouraged community members to wear shoes outdoors to help prevent infection.
“However, these messages stopped after their early childhood and they had always wondered why no one spoke about these infections anymore. This type of messaging could be relatively easy to implement, although basic information about important parasitic infections would need to be provided since many people are no longer aware of these diseases.”
Even healthcare providers often assume that Americans traveling abroad are at greatest risk of parasitic infection. Educating healthcare providers about the threat of parasitic infections in the US, recognizing symptoms, and testing appropriately is critical.
“Without this basic medical knowledge, diagnoses can be missed and treatments delayed,” Gildner said. “For example, one participant was diagnosed last summer Helicobacter pylori, a bacterium that we recently studied that, in severe cases, can cause stomach ulcers and certain types of stomach cancer. However, she told us it took months and visits to multiple doctors before she was properly tested and diagnosed, in large part due to the belief that symptomatic cases of this bacterial infection are not a big problem in the US.
While it’s an option for regions suffering from high rates of parasite infection, preventive mass drug administration isn’t a practical first step to address the problem, Gildner explained. There’s not enough public awareness about the condition, and the safe, effective drugs used to treat common parasitic infections are incredibly expensive in the US, she said.
However, Gildner would like more government investment in research elsewhere in the US to help clarify the current levels of parasitic infections and identify important sources of exposure that could be addressed to improve health outcomes.
