Researchers Find Hookworm Infection Linked to Extreme Poverty in Rural Alabama


EJI’s Rural Development Manager Catherine Coleman-Flowers worked with scientists to survey Lowndes County residents who have been exposed to raw sewage.

A new study found that residents of Lowndes County, Alabama, are suffering from high rates of hookworm infection, a poverty-related disease typically found only in developing countries and long thought to have been eradicated in the United States.

Scientists at the National School of Tropical Medicine at Baylor College of Medicine worked with EJI’s Catherine Coleman-Flowers, who has been documenting raw sewage and inadequate wastewater management in Lowndes County, to test residents. More than one in three people (34 percent) tested positive for traces of hookworm, a gastrointestinal parasite that causes anemia in all ages and iron deficiency, cognitive delays, and stunted growth in children.

“It’s shocking that we continue to have these infections of poverty in the United States,” said researcher Dr. Rojelio Mejia, assistant professor of pediatrics at the National School of Tropical Medicine at Baylor and director of the Laboratory of Clinical Parasitology and Diagnostics at the Texas Children’s Hospital Center for Vaccine Development.

The peer-reviewed study published in the American Journal of Tropical Medicine and Hygiene shows how poor sanitation is linked to extreme poverty and the endemic prevalence of hookworm infections. “Hookworm is a 19th century disease that should by now have been addressed,” Ms. Coleman-Flowers told the Guardian, “yet we are still struggling with it in the United States in the 21st century.”

Lowndes County has a long history of racial discrimination and inequality; white residents’ violent opposition to civil rights there earned it the nickname “Bloody Lowndes.” Today, the average annual income is $18,046, and almost a third of the population live below the poverty line. Of the county’s 11,000 residents, 74 percent are African American.

Ms. Coleman-Flowers estimates that 80 percent of the county has no municipal sewer system. The high clay content of the area’s fertile black soil prevents wastewater from filtering efficiently. Traditional underground septic systems cannot function properly under these conditions, which require installation of much more expensive above-ground septic tanks that cost up to $15,000.

In wealthier, more populated areas, government spending ensures good sewer systems, but in remote, majority African American counties throughout Alabama’s Black Belt, the poor are neglected by elected officials who not only fail to provide financial assistance for low-income households to obtain mandated septic systems, but also have criminally prosecuted poor families because they lacked the money to install new septic systems.

Nearly three-quarters of the residents in the Baylor survey reported that they had been exposed to raw sewage washing back into their homes from faulty septic tanks or waste pipes becoming overwhelmed in heavy rains. “They are disgusted about it, they’re sick and tired of living like this but there’s no public help for them here and if you’re earning $700 a month there’s no way you can afford your own private sanitation,” Aaron Thigpen, a community activist who assisted with the hookworm study, told the Guardian.

Dr. Peter Hotez, dean of the National School of Tropical Medicine, who led the research team, along with Dr. Mejia, said the results were a wake-up call for the nation. “This is the inconvenient truth that nobody in America wants to talk about,” he said. “These people live in the southern United States, and nobody seems to care; they are poor, and nobody seems to care; and more often than not they are people of color, and nobody seems to care.”