Co‐infections with Plasmodium, Ascaris and Giardia among Rwandan schoolchildren

Objectives Co‐infections with Plasmodium, Ascaris and Giardia are common in sub‐Saharan Africa but epidemiological and clinical data are rare. We examined factors associated with co‐infections and their clinical manifestation among Rwandan schoolchildren. Methods Schoolchildren aged 6–10 years attending 12 schools in Huye district, Rwanda, were recruited preceding routine deworming. Data on socioeconomic status (SES) and children′s histories were obtained, and children were clinically and anthropometrically examined. Blood and stool samples were collected, and infections with Plasmodium, Ascaris and Giardia were determined by microscopy and PCR assays. Results Among 878 schoolchildren, Plasmodium, Ascaris and Giardia were present in 22%, 35% and 36%, respectively. Co‐infections with two or more parasites were found in 24%; only one‐third of the children did not harbour any of the parasites examined. Factors associated with parasite (co‐)infections largely overlapped and reflected low SES, in addition to a few specific risk factors. Clinically, most children were asymptomatic but anaemia (38%), underweight (17%), and reported signs and symptoms in the preceding 2 weeks (46%) were common. Many of the reported and assessed signs and symptoms were associated with Plasmodium infection, and co‐infection with Ascaris and/or Giardia did basically not modify the clinical picture. One exception was malnutrition, which was pronounced in Ascaris–Giardia co‐infection vs. individual mono‐infections. Conclusions Parasitic co‐infections are common in Rwandan schoolchildren, and are associated with a rather silent clinical manifestation that nevertheless may affect school performance and long‐term development. School‐based health interventions should target such co‐infections in an integrated manner. Objectifs Les coinfections par Plasmodium, Ascaris et Giardia sont courantes en Afrique subsaharienne, mais les données épidémiologiques et cliniques sont rares. Nous avons examiné les facteurs associés aux coinfections et leurs manifestations cliniques chez les écoliers rwandais. Méthodes Des écoliers âgés de 6 à 10 ans fréquentant 12 écoles du district de Huye au Rwanda ont été recrutés avant le déparasitage de routine. Les données sur le statut socioéconomique (SSE) et les antécédents des enfants ont été obtenues et les enfants ont été examinés cliniquement et anthropométriquement. Des échantillons de sang et de selles ont été recueillis et les infections à Plasmodium, Asca