# Interplay of Gastrointestinal Parasites, Micronutrient Deficiencies, and Anemia in Children from the Bolivian Highlands

## TL;DR

This study finds that children in the Bolivian highlands suffer from high rates of parasitic infections, micronutrient deficiencies, and anemia, highlighting the need for better nutrition and sanitation.

## Contribution

The study identifies specific associations between intestinal parasites and micronutrient deficiencies in children from a highland region.

## Key findings

- Giardia lamblia and Blastocystis spp. infections are strongly linked to vitamin A and D deficiencies.
- Zinc deficiency is significantly more common in older children and is a risk factor for anemia.
- Moderate-to-severe anemia affects over half of the children, regardless of sex or age.

## Abstract

Children living in resource-limited regions with inadequate environmental sanitation, such as the Bolivian highlands, are affected by parasitic infections that may compromise nutritional status. Objective: This study aimed to assess the prevalence of intestinal parasitic infections and their associations with nutritional status, micronutrient deficiencies, and anemia in school-aged children from La Paz, Bolivia. Methods: A cross-sectional study was conducted among 212 schoolchildren aged 5–13 years in the municipality of La Paz, in highland areas characterized by high poverty levels. Parasitological examination, anthropometric measurements, and biochemical assessment of micronutrients (vitamins A and D, zinc, iron) were performed to evaluate children’s health status. Results: Mild malnutrition was more prevalent than moderate-to-severe forms. Micronutrient analysis revealed substantial deficiencies in vitamin A (39%), zinc (25%), and vitamin D (18%). Zinc deficiency was significantly more common in children aged 11–13 years compared to younger age groups (p = 0.034). Intestinal protozoan infections showed significant associations with micronutrient deficiencies. Giardia lamblia infection was associated with both vitamin A (30.9%, p = 0.042) and vitamin D (78.9%, p = 0.001) deficiencies. Blastocystis spp. infection was similarly linked to higher prevalence of vitamin A (35.8%, p = 0.025) and vitamin D (69.7%, p = 0.004) deficiencies. Entamoeba coli infection was significantly associated with vitamin D deficiency (p = 0.021), while Iodamoeba bütschlii infection showed a significant association with zinc status (p = 0.027), with notably lower zinc deficiency prevalence in infected children (7.7%) compared to non-infected children. Among helminth infections, Ascaris lumbricoides was significantly associated with vitamin D deficiency (37%, p = 0.018). Moderate-to-severe anemia was highly prevalent, affecting over half of the children regardless of sex. Wasting (BAZ) was significantly associated with age (p = 0.030), with moderate-to-severe cases most prevalent in children aged 5–7 years and absent in older groups, while mild wasting increased with age. In univariate logistic regression analysis, zinc deficiency emerged as a significant risk factor for anemia (OR = 2.51, 95% CI: 1.19–5.29, p = 0.016). No significant associations were observed between anemia and sex, age group, vitamin A or D status, or anthropometric indicators including underweight, stunting, or wasting. Conclusions: These findings highlight the substantial burden of micronutrient deficiencies, parasitic infections, and anemia among children in this impoverished region, underscoring the urgent need for targeted public health interventions addressing nutritional supplementation, parasite control, and improved sanitation.