Parasitic infections such as malaria, hookworm, whipworm, and schistosomiasis can cause or exacerbate anemia, especially when the infection is moderate to heavy, and when women are coinfected with multiple parasites . Helminthes attach to the intestines and/or bladder and feed on blood, causing regular host blood loss due to blood loss at the site of helminth attachment, and the blood consumed by the parasite. Parasitic infections can lead to, among other symptoms, anorexia, malabsorption of nutrients, nutrient loss through fecal or urinary blood loss, nausea, diarrhea, and vomiting, which can result in depletion of iron stores and iron-deficiency anemia [65, 66]. Efforts to control and prevent parasitic infections such as the use of bed nets, routine deworming using chemother-apeutic agents, malaria prevention and control, and improved sanitation can help combat anemia (Table 22.6). Specific to pregnant women, it is likely safe to provide deworming therapy after the first trimester of pregnancy, and one study showed that pregnant women infected with hookworm who were given antihelminthic chemotherapy at the end of their first trimester had higher hemoglobin concentrations than did the controls [62, 66].
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