***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Undernutrition is widely perceived to affect the development of an effective immune system . OBJECTIVE We used a mini- analysis system to quantitate antibody titers and evaluate the sera of 200 Kenyan schoolchildren for antibodies to Helicobacter pylori [ isotypes of immunoglobulins A ( IgA ) , G ( IgG ) , and M ( IgM ) ] , hepatitis A virus , rotavirus , tetanus toxoid ( IgG ) , and a panel of recombinant malarial antigens ( MSP1(19 ) , MSP2 , Ag512 , MSP4 , and MSP5 ) . DESIGN Children participated in a school-based feeding intervention with meat , milk , or nonanimal- source foods or in a nonintervention control group . Microvolumes ( 200 mL ) of sera were analyzed at baseline and after 1 y. RESULTS Nearly all children had elevated titers of antibody to H. pylori , hepatitis A virus , rotavirus , and malaria at the outset , despite a high prevalence of apparent biochemical micronutrient deficiencies and stunting , but many had titers of tetanus toxoid IgG antibodies below the protective concentration . Children with low hemoglobin had a greater proportion of elevated H. pylori IgM antibody titers at baseline , which suggests that current infection with H. pylori may be associated with anemia . Compared with the control subjects , only the group eating meat had a significant increase in H. pylori IgM antibodies during the intervention ( P = 0.019 ) . No other group comparisons with the control subjects were statistically significant . The additional finding that the sera of some children showed inadequate tetanus-protective antibodies , despite immunization , suggests that the vaccination program was suboptimal . CONCLUSIONS A large battery of immune assays can be performed on microvolumes of sera . Furthermore , despite evidence of malnutrition , children do develop significant antibody-mediated responses to common pathogens BACKGROUND Iron deficiency ( ID ) is a major cause of anemia , along with other nutritional , parasitic , and genetic factors . Accurate biomarkers are needed to estimate the relative contribution of ID to anemia . Soluble transferrin receptor ( sTfR ) is thought to be unaffected by inflammation . OBJECTIVES The objectives were to determine the difference in sTfR and plasma ferritin ( PF ) concentrations among infants ( 6 - 23 mo of age ) , school-age children ( 6 - 8 y of age ) , and women ( 15 - 25 y of age ) with and without inflammation and with and without Plasmodium falciparum infection and to assess the effect of adjusting sTfR and PF for inflammation or for P. falciparum infection on the estimated prevalence of ID . DESIGN The data were derived from a 14-mo prospect i ve longitudinal survey on anemia , which was conducted in the Taabo area , south- central Côte d'Ivoire . RESULTS At baseline , sTfR concentration was significantly higher in infants and school-age children with either inflammation or P. falciparum infection than in control individuals without inflammation or without P. falciparum infection . Individuals with inflammation had significantly higher PF concentrations than did subjects without inflammation . Adjustments in sTfR concentrations for inflammation or P. falciparum infection in infants and school-age children result ed in significantly lower ID prevalence . Adjustment of PF for inflammation and Plasmodium infection result ed in a higher ID prevalence in infants and women . CONCLUSIONS In Ivorian infants and school-age children , ID prevalence was considerably lower after adjustment of sTfR for inflammation . However , as the prevalence estimates for ID differed widely if based on sTfR or PF , caution is still needed when estimating ID prevalence in areas with a high prevalence of inflammation or malaria . This trial was registered at controlled-trials.com as IS RCT N02181959 BACKGROUND Parasitic diseases ( eg , malaria and helminthiases ) exert enormous burdens on public health and social well-being . Moreover , parasitic infections are important causes of anemia in tropical Africa , exacerbated by lack of a diversified diet and inflammatory and genetic diseases . There is a paucity of longitudinal studies monitoring the dynamics of anemia in relation to the aforementioned parameters . METHODS We design ed a 14-month prospect i ve longitudinal study in 3 cohorts ( ie , infants aged 6 - 23 months , children aged 6 - 8 years , and women aged 15 - 25 years ) in the Taabo health demographic surveillance system located in south- central Côte d'Ivoire .  Parasitological , hematological , and micronutrient data were obtained from repeated cross-sectional surveys , utilizing st and ardized , quality -controlled methods . RESULTS We found that young age , Plasmodium and Schistosoma infections , cellular iron deficiency , and stunting were significantly negatively associated with hemoglobin concentration . Moreover , iron status biomarkers ( ie , ferritin and soluble transferrin receptor ) were significantly associated with inflammatory parameters . CONCLUSIONS Based on our results , effective prevention and control measures that target parasitic diseases and iron deficiency are needed . These measures might include the distribution of long-lasting insecticidal nets , intermittent preventive treatment for malaria , regular anthelmintic drug administration , and improved intake of bioavailable iron , coupled with health and nutritional education and improved hygiene , water , and sanitation BACKGROUND Helicobacter pylori infection treatment was found not to reduce the prevalence of iron deficiency or anemia among Alaska Native children at 14 months after treatment initiation . We hypothesized that 14 months was to early to resolve H. pylori-induced gastric damage . Consequently , we conducted a 40-month follow-up . METHODS We enrolled 219 children 7 - 11 years old who had H. pylori infection ( as diagnosed by (13)C-labeled urea breath test ) and iron deficiency ( serum ferritin level , < 22.47 pmol/L ) in a controlled , household-r and omized trial of the effect of treatment of H. pylori on iron deficiency and anemia ( hemoglobin level , < 115 g/L ) . At 40 months , 176 children were evaluated . RESULTS Forty-four ( 52 % ) of 85 children in the intervention group and 53 ( 58 % ) of 91 in the control group had iron deficiency ( adjusted relative risk [ ARR ] , 0.92 [ 95 % confidence interval { CI } , 0.68 - 1.26 ] ) , versus 4 ( 5 % ) and 17(19 % ) , respectively , with both iron deficiency and anemia ( ARR , 0.25 [ 95 % CI , 0.09 - 0.73 ] ) . Reinfection occurred among 33 ( 52 % ) of 64 children who had cleared their infection . H. pylori-negative children had lower prevalences of iron deficiency ( ARR , 0.62 [ 95 % CI , 0.38 - 1.01 ] ) and iron deficiency and anemia ( ARR , 0.22 [ 95 % CI , 0.03 - 1.50 ] ) , compared with H. pylori -positive children . CONCLUSIONS The resolution of H. pylori infection for > 14 months modestly reduced the prevalence of iron deficiency and substantially reduced the prevalence of iron deficiency and anemia . H. pylori likely plays a casual role in hematological outcomes for some children Background & objectives : Despite routine iron supplementation and promotion of diet modification , iron deficiency anaemia ( IDA ) remains widely prevalent in our antenatal population . Recent studies in pediatric population have highlighted the role of Helicobacter pylori infection in IDA . This study was undertaken to study the effect of eradication therapy in H. pylori infected pregnant women with IDA . Methods : R and omized placebo-controlled double blind clinical trial was done on 40 antenatal women between 14 - 30 wk gestation , with mild to moderate IDA and having H. pylori infection , as detected by stool antigen test . These women were r and omly divided into group I ( n=20 ) : H. pylori treatment group ( amoxicillin , clarithromycin , omeprazole for 2 wk ) and group II ( n=20 ) : placebo group . Both groups received therapeutic doses of iron and folic acid . Outcome measures were improvement in haematological parameters and serum iron profile after 6 wk of oral iron therapy . Results : The prevalence of iron deficiency in pregnant women with mild to moderate anaemia  was 39.8 per cent ( 95 % CI 35.7 , 44.3 ) ; and 62.5 per cent ( 95 % CI 52 , 73 ) of these pregnant women with IDA were infected with H. pylori . After 6 wk of therapeutic oral iron and folic acid supplementation , the rise in haemoglobin , packed cell volume , serum iron and percentage transferrin saturation was significantly ( P<0.05 ) higher in the group given H. pylori eradication therapy as compared to the placebo group . Interpretation & conclusions : Our results showed a high occurrence of H. pylori infection in pregnant women with IDA . Eradication therapy result ed in significantly better response to oral iron supplementation among H. pylori infected pregnant women with IDA St and ard care for men and postmenopausal women with iron deficiency anemia is use of gastrointestinal evaluation to exclude gastrointestinal tract abnormality ( 1 , 2 ) . Nevertheless , even when the gastrointestinal tract is investigated thoroughly , a large proportion of patients ( around 30 % ) remain without a diagnosis ( 2 , 3 ) . Recent epidemiologic studies have suggested an association between Helicobacter pylori infection and iron deficiency ( 4 , 5 ) . Infection with H. pylori is recognized as a major risk factor in peptic ulcer disease and gastric cancer , in which lesions are likely to bleed either overtly or in an occult manner , eventually leading to iron deficiency anemia . However , most people infected with H. pylori only have chronic gastritis that is not associated with gastrointestinal bleeding or with any other specific disease ( 6 ) . It has been suggested that infection with H. pylori may lead to iron deficiency or iron deficiency anemia by impairing iron uptake or increasing iron dem and ( 4 ) . Reversal of iron deficiency anemia after successful eradication of H. pylori was recently observed in children ( 7 , 8) and in a young adult ( 9 ) . We performed a prospect i ve open study to verify the effects of eradication of H. pylori infection on iron deficiency anemia in patients with H. pylori-associated gastritis . Methods Patients Patients were observed from September 1994 to December 1997 . A total of 189 consecutive adult out patients who were older than 20 years of age and had iron deficiency anemia ( 158 women and 31 men ; median age , 47 years [ range , 20 to 79 years ] ) were referred to our gastroenterology department from the hematology department .  Iron-deficiency anemia was defined as a hemoglobin concentration less than 14 g/L for men and less than 12 g/L for women , a mean corpuscular volume less than 80 fL , and a serum ferritin level less than 30 g/L ( 3 ) . Out patients with an obvious cause of blood loss , such as a heavy menstrual period ( cycles>6 days ) , epistaxis , active gastrointestinal hemorrhage , or evidence of fecal occult blood positivity  , were excluded from the study . Other exclusion criteria were gastrointestinal or hematologic cancer at the time of observation , chronic renal failure , severe cardiopulmonary disease , reported or suspected pica , hemolysis , aplastic anemia or thalassemia , alcoholism or liver cirrhosis , and pregnancy . After this selection , patients who were taking nonsteroidal anti-inflammatory drugs ; had had gastric surgery ; or had atrophic body gastritis and celiac disease , as described elsewhere ( 3 ) , were excluded from the study . An iron-poor diet as a cause of iron deficiency anemia was excluded by a hospital dietitian ( 3 ) . A double-contrast barium enema or colonoscopy plus radiographic examination of the small bowel , or Meckel scintigraphy , were also carried out if indicated . Interventions Patients were treated for 2 weeks with omeprazole , 40 mg , in the morning ; amoxicillin , 1 g ; and metronidazole , 250 mg three times daily after meals , for the first week . Patients were also instructed to discontinue any iron replacement therapy , including over-the-counter iron-containing medication . A clinical evaluation was performed 3 months after eradication therapy to check for clinical signs of anemia . Two follow-up visits at 6 and 12 months were planned . At each visit , a complete blood count was done and ferritin levels were measured . Baseline and 12-month transferrin saturation indexes were also calculated . The 6-month follow-up examination included endoscopy with biopsy to evaluate H. p 
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As the subjects grew older , these associations altered .
Second , Muhsen and Cohen emphasize that Helicobacter pylori , a Gram-negative spiral-shaped bacterium that the World Health Organization classifies as a carcinogen of class I , is associated with increased odds of ID anemia ( IDA ) and that anti-H. pylori therapy reduces the risk of IDA .
Hence , these two techniques are not suitable for largescale epidemiologic studies in re sources -constrained setting s. However , a simple  stool antigen assay  and the  [ C ] urea breath test  hold promise for community-based surveys in low-income countries .
The  stool antigen assay  is particularly suitable for studies where fecal sample s are collected for the diagnosis of helminth and intestinal protozoa infections .