Hookworm Transmission Dynamics in Beposo, Ghana: Insights from a 4-Year Longitudinal Cohort Study

Abstract Background Soil-transmitted helminth (STH) infections affect around 1.5 billion people worldwide, with hookworm alone infecting up to 500 million. While current control efforts focus on school-aged children, hookworm infection remains a significant concern across the age spectrum in regions of rural poverty. In 2022, a longitudinal study was initiated in Beposo, Ghana, to assess the transmission dynamics of hookworm infection and the impact of deworming over time. Methods A baseline cohort of 1,047 individuals was enrolled and consented, with fecal samples collected from 996 subjects (ages 3-100 yrs) and screened using Kato-Katz microscopy. The baseline hookworm prevalence was 28.6% (285/996), and all infected subjects were treated with a single oral dose of albendazole (400mg). A subset of hookworm-infected subjects (n=285) was selected for further study, along with an age-matched group of uninfected subjects (n=370). Baseline demographic surveys were initiated in 2022, and household-level water, sanitation, and hygiene (WASH) questionnaires were conducted in 2024 to assess key factors that mediate hookworm infection. Given the gaps in understanding the dynamics of immune responses following exposure, an ELISA assay was developed using serum samples collected from the longitudinal cohort to quantify total IgG responses to hookworm (Necator americanus) excretory/secretory proteins. Results Among participants with complete follow-up across all four years, hookworm prevalence decreased over the study period, falling from 42.7% (200/468) at baseline to 29.3% (137/468) in 2023, 24.4% (114/468) in 2024, and finally 11.8% (55/468) in 2025. Deworming resulted in post-treatment cure rates of 58.4% in 2023, 49% in 2024, and 72.3% in 2025. Geospatial analyses of hookworm burden also indicate a progressive decline in infection intensity across the study area. Serological analysis of baseline serum revealed clear antibody reactivity to hookworm antigens (AUC of 0.75), suggesting reliable discrimination between hookworm-positive and negative individuals. Based on the epidemiological analyses, there is a heightened risk of hookworm infection among those using a borehole (OR: 1.66; CI:1.15-2.39). Furthermore, the study identified three distinct groups: (1) Chronic infection: persistently positive, likely from treatment failure; (2) Clearance: initially positive but cleared post-treatment; (3) Never infected: consistently negative. Conclusion By integrating longitudinal epidemiological, geospatial, and serological data, this study sheds light on hookworm transmission dynamics in rural Ghana. Given the significant clinical sequelae of hookworm infection, particularly in children, it is likely that novel approaches to deworming and targeted control efforts, supported by strengthened WASH interventions, are necessary to reduce morbidity and transmission in endemic communities.