Translational studies of hookworm infection in Ghana, 2022

Abstract

Hookworm infection is endemic in sub-Saharan Africa, including rural communities in Ghana. A cross-sectional study of hookworm infection was conducted in Beposo, Ghana (Bono East Region). We enrolled 1,047 participants, including men and women across the age spectrum (3-100 years). Following IRB review and subject consent, fecal and serum samples were collected, and household questionnaires were administered to capture demographic, socioeconomic, and water, sanitation, and hygiene practices within the community. Hookworm prevalence was 28.6% (285/996 individuals) as determined by Kato-Katz (KK) fecal microscopy. Of these, 92% (262/285) were classified as light intensity according to WHO standards. The highest prevalence was observed among children aged 11-16 years (33.5%, 52/155). Regular use of borehole water was associated with a higher incidence of hookworm compared to piped water (p<0.05). Screening fecal samples for hookworm DNA using qPCR yielded a cohort prevalence of 41% (404/992). Hookworm-infected subjects defined by either KK or qPCR exhibited higher levels of serum antibody (IgG) directed at Necator americanus soluble larval protein extracts (NaLEX) and adult worm excretory/secretory (NaES) proteins compared to those who were uninfected (p<0.001). The predictive utility of anti-NaES IgG levels was further demonstrated by Receiver Operating Characteristic curve analysis, which yielded an Area Under the Curve of 0.74 (p<0.0001) as a gauge of diagnostic validity. This study defines host demographic and behavioral factors associated with hookworm infection in Beposo and demonstrates the potential value of serologic testing as a tool for disease surveillance and monitoring the impact of control efforts in endemic communities.