Hookworms infect nearly one billion people worldwide, and are a leading cause of anemia and malnutrition in resource-limited countries. Current global strategies to control hookworm and other Soil Transmitted Helminths rely on repeated mass drug administration of albendazole. Recent evidence confirms that deworming drugs are losing effectiveness against hookworm in endemic areas, and the emergence of genetically mediated resistance would have potentially devastating public health implications. The studies in adults and school-age children conducted in the Kintampo North Municipality (KNM), Ghana confirm the overall poor efficacy of albendazole. We hypothesize that treatment responses and reinfections are associated with the nutritional and immune status of the individual, community practices, and parasites' genetics, implying that there is multifactorial mechanism of hookworm treatment failure. In order to test this hypothesis, we propose to conduct research in four specific domains; epidemiology, immunology, parasite population genetics and identification of molecular biomarkers of albendazole resistance for monitoring and surveillance. Over the course of the 5 year study period, this TMRC project will support collaborative research and training to build capacity in parasitic diseases research, building on the longstanding record of the Ghana-Yale Partnership for Global Health and recently, with UMASS.
Overall Narrative The proposed studies that collectively make up NIINE is aimed at conducting multidisciplinary research to identify the major individual, community, environmental and the parasitic risk factors associated with hookworm infections, treatment failures and reinfections. Also in the implementation of NIINE we hope to identify genetic markers of resistance and subsequently use them to map drug responses and monitoring of resistance. It is envisaged that products of NIINE will improve the monitoring and evaluation of existing deworming campaigns. This work will have significant global public health benefit by providing additional tools to enhance the efficacy of mass preventive chemotherapy programs in poor countries.