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We conducted a two-year longitudinal cohort study of hookworm infection with a random selection of 274 school-age children (4\u201316 yrs) in rural Ghana to identify nutritional and environmental exposures impacting hookworm infection and response to treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Every six months (baseline Jan 2013) we collected anthropometric measurements, pre- and post-treatment fecal samples, and blood samples. Household surveys and multiple-pass twenty-four-hour recalls were conducted at baseline and 18 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-eight participants (28.5%) were absent from at least 1 time point. Of the 196 that were screened at all five time points, 87 (44.4%) were hookworm-infected&gt;1 time. Assessment of albendazole treatment response was conducted on 83 participants. Sixty (72.3%) were cleared of hookworm infections while 23 (27.5%) remained infected post-treatment (ERR: 0\u201399%). Treatment efficacy was more likely among children aged over 9.66 years (HR: 1.55; 95% CI: 1.18, 2.04) and those from food-insecure households (HR: 2.26; 95% CI: 1.06, 4.81). Hookworm infection status and albendazole treatment outcome at baseline and 18 months were the dominant influences on infections at 6 and 24 months, respectively. Future risk of infection at both 6 and 24 months had significant environmental and nutritional predictors, although the variables differed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Global school-based deworming has been associated with reduced rates of hookworm infection among schoolchildren in Africa; however, additional strategies will be necessary for long-term, sustainable control. This study reports on an innovative two-year longitudinal study of school age children with repeated cycles of testing and treatment. We modelled hookworm infection as a function of predictors that were measured six months prior, thereby strengthening the assessment of causal relationships between environmental, infection and nutritional risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014492","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:33:26Z","timestamp":1785519206000},"page":"e0014492","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A 24 month longitudinal cohort study of hookworm infection among school-age children in Ghana: Predictors of persistent and repeated infection"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5979-3717","authenticated-orcid":true,"given":"Debbie L.","family":"Humphries","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene A.","family":"Larbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Maldonado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Otchere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Quagraine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hibbah Araba","family":"Osei-Kwasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sena","family":"Seddoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George E.","family":"Mensah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dickson","family":"Osabutey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector Nobiya L.","family":"Samani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwadwo Ansah","family":"Koram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cappello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"issue":"10100","key":"pntd.0014492.ref001","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S0140-6736(17)32154-2","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"Global Burden of Disease Injury Incidence and Prevalence Collaborators","year":"2017","journal-title":"Lancet"},{"key":"pntd.0014492.ref002","doi-asserted-by":"crossref","first-page":"16088","DOI":"10.1038\/nrdp.2016.88","article-title":"Hookworm infection","volume":"2","author":"A Loukas","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"pntd.0014492.ref003","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1196\/annals.1425.000","article-title":"Hookworm and poverty","volume":"1136","author":"P Hotez","year":"2008","journal-title":"Ann N Y Acad Sci"},{"issue":"1","key":"pntd.0014492.ref004","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1365-3156.2005.01541.x","article-title":"Synergistic associations between hookworm and other helminth species in a rural community in Brazil","volume":"11","author":"FM Fleming","year":"2006","journal-title":"Trop Med Int Health"},{"key":"pntd.0014492.ref005","unstructured":"World Health Organization. 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