Report of the WHO informal consultation on hookworm infection and anaemia in girls and women

Overview

Iron deficiency and anaemia affect a significant part, and usually a majority, of the population in many countries. Most of those affected are women of childbearing age. Women in developing countries spend up to half of their reproductive lives pregnant or lactating. Iron deficiency in childbearing women increases maternal mortality, prenatal and perinatal infant loss and prematurity. Forty percent of all maternal perinatal deaths are linked with anaemia. Favourable pregnancy outcomes are 30% to 45% less likely in anaemic mothers and their infants have less than one-half of the normal iron reserves.

Hookworm infection is a recognized major contributor to iron deficiency anaemia in women of childbearing age in most developing countries and is known to be associated with high maternal mortality and morbidity. However reliable estimates of hookworm infection in women of childbearing age are not available and strategies for the prevention and control of hookworm anaemia in pregnancy are not clearly defined. In spite of recent recommendations for promoting the use of anthelminthics in pregnancy by a WHO meeting in Brazzaville in 1989 and the United Nations ACC/SCN in 1991, there is still no general consensus on the possible impact that control measures may have on maternal and child health and the risks and benefits of the use of anthelminthic drugs associated with iron supplementation in pregnant women.

Blanket exclusion of pregnant or lactating women from treatment against hookworms has been the result, not of clear evidence of possible untoward effects, but of reluctance and fear to carry out appropriate trials on hookworm infection in pregnancy. There is an urgent need to evaluate appropriate treatment against hookworm infection for women of childbearing age so that health services in endemic countries can offer them better treatment according to scientific evidence.