Childhood stunting in Northeast Brazil:: the role of Schistosoma mansoni infection and inadequate dietary intake

Objective: To evaluate the relationship between stunting, Schistosoma mansoni infection and dietary intake in schoolchildren. Design: This is a cross-sectional study. Two stool samples were obtained from each child and examined quantitatively for the presence of S. mansoni, Ascaris lumbricoides and Trichuris trichiuria eggs. Information on dietary intake, and demographic, biologic and socioeconomic variables was elicited during the in-home survey. Logistic regression was used to evaluate the association between stunting (height for age <-2s.d.), parasitic infection and food consumption. Setting: The study was carried out in the city of Nazare, located in the Reconcavo region of the State of Bahia, northeastern Brazil. Subjects: The sample consisted of 461 children 7-14 y old, 228 boys and 233 girls, recruited from public schools. Results: Of the children studied, 55.1% presented with S. mansoni infection and 22.1% were stunted. The median protein, lipid and carbohydrates intake were 47.8, 36.0 and 248.2 g/day, respectively. The median caloric consumption was 1527.0 kcal (6388.97 kJ/day). The analysis indicated that children heavily infected (>= 400 eggs/g of stool) with S. mansoni had a 2.74-fold (95% CI: 1.32-5.67) higher risk of stunting than uninfected children, and those with inadequate intake of lipid (<36 g/day) had a 1.83-fold (95% CI:1.05-3.20) increased risk of stunting compared to those with adequate diets. Conclusion: Heavy S. mansoni infection and inadequate dietary intake of fat in schoolchildren play a significant and independent role in the development of stunting. This meaning that nutritional interventions in this age group in S. mansoni endemic areas must include the diagnosis and treatment of the infection associated with dietary measures.