Cognitive performance and iron status are negatively associated with hookworm infection in Cambodian schoolchildren

Khov Kuong*, Marion Fiorentino, Marlene Perignon, Chhoun Chamnan, Jacques Berger, Muth Sinuon, Vann Molyden, Kurt Burja, Megan Parker, Sou Chheng Ly, Henrik Friis, Nanna Roos, Frank T. Wieringa

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


Soil-transmitted helminth (STH) infection has been associated with lower cognitive performance of schoolchildren. To identify pathways through which STH infection might affect school performance, baseline data from a large rice-fortification trial in Cambodian schoolchildren were used to investigate associations between STH infection, micronutrient status, anemia, and cognitive performance. Complete data on anthropometry, cognitive performance, and micronutrient status were available for 1,760 schoolchildren, 6-16 years of age. STH infection was identified using Kato-Katz, whereas cognitive performance was assessed using Raven's Colored Progressive Matrices (RCPM), block design, and picture completion. STH infection was found in 18% of the children; almost exclusively hookwork infection. After adjusting for age and gender, raw cognitive test scores were significantly lower in hookworminfected children (-0.65; -0.78; -2.03 points for picture completion, RCPM, and block design, respectively; P <0.05 for all). Hookworm infection was associated with iron status (total body iron), but not with vitamin A and zinc status, nor with inflammation or anthropometry. Body iron was negatively associated with increased intensity of hookworm infection (R = 0.22, P <0.001). Hookworm infection in Cambodian schoolchildren was associated with lower cognitive performance, an effect most likely mediated through lower body iron. Interventions that are more effective against hookworm infection are needed to contribute to better health and improvement of cognitive performance.

Original languageEnglish
Pages (from-to)856-863
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number4
Publication statusPublished - 2016

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