INTESTINAL PARASITES AMONG UNITY PRIMARY SCHOOL PUPILS, IN ORAIFITE, EKWUSIGO L.G.A. ANAMBRA STATE, SOUTHEASTERN NIGERIA.
CHAPTER ONE
1.0. INTRODUCTION
Intestinal parasites are parasites that populate the gastro-intestinal tract. They are larger than bacteria and viruses but some of them are so small that one cannot see them without a microscope. Intestinal parasitic infections have been described as constituting the greatest single worldwide cause of illness and disease. Numerous studies have shown that the incidence of intestinal parasites may approach 99% in developing countries (Ambrose, 2001).
CHAPTER TWO
LITERATURE REVIEW
2.1. Epidemiology
The distribution of parasitic infections is determined by several factors, such as environment, food- habit, cultural tradition, social status, economic situations and others. Each parasite has its own natural and social habitat, and favourable environment is a prerequisite for its transmission. For example, Soil-transmitted helminthes (STHs) or Geohelminthes are highly prevalent in poor agricultural societies, where human faeces are used as a fertilizer (Crompton, 1999; Horton, 2003). Fish-transmitted flukes are prevalent among raw-fish-eating communities along river basins and seaside areas (Chai et al., 2005), and schistosomiasis is transmitted to people residing along endemic rivers or water reservoirs. In a word, the prevalence of a parasitic infection is a consequence of both natural and cultural factors, but its control is a product of social consent and change of behavior.
Of the world’s 218 countries, Ascaris is known to be distributed in 153 countries; no data are available on its distribution in the remainder. In 1947, globally 650 million people were estimated to be infected with Ascaris, but this scored to 1,472 million in 1990 (Crompton, 1999).
Moreover, these estimates suggest that the overall prevalence of ascariasis has remained almost unchanged over the last 50 years. Most of the infected are believed to live in Asia, Africa, and Central or South America. However, in Asia, Ascaris has been almost completely eradicated from Japan, the Republic of Korea, and Taiwan. China is currently showing a rapid decrease of its prevalence in urban and developed areas (Tang, 2002). Therefore, the estimates in Asia need to be revised.
More than one billion of the world’s populations, including at least 400 million school children, are chronically infected with Ascaris lumbricoides, Trichuris trichiura, Hookworms, Enterobius vermicularis and Taenia sp. (Adeyeba and Akinlabi, 2002; Braide, 2004). Parasitic diseases of blood and gastro-intestine of human are rampant in the tropics because there are favourable climatic, environmental and socio- cultural factors which permit transmission of these parasitic diseases, whether water-borne, vector-borne, soil transmitted or those that result from some poor sanitary or social habits provide some of the many public health problems in the tropics (Woodrouff, 1965; Oduntan, 1974). Few studies had also indicated a direct correlation between the intensity of infection with hookworms and with Ascaris lumbricoides and non- deficiency anaemia and intestinal obstruction (Salimon, 1980).
Since hookworm larval stages have limited motility, their rate of development and survival are dependent on the surrounding environmental humidity, temperature and ultra-violet light, such that geographical differences in transmission will be influenced by these factors and related factors such as rainfall, soil type and altitude. The influence of climate on hookworm transmission was reviewed by Chandler (1929). Chandler concluded that 20-30OC was optimal for transmission with larvae reaching maturity in five days, with the lower limit lying between 8-10OC and the upper limit 40-45OC. available experimental data indicate that above temperatures of 35-40OC development of eggs arrests and death occurs (Nwosu, 1978; Udonsi and Atata, 1987) showed that at temperature of 35OC larvae of Necator amerianus were all dead, with the highest cumulative hatching rates obtained at 30OC. The apparent difference between these experimental findings and Chandler’s observation can be explained by the ability of hookworm larvae to migrate downwards in the soil and to areas of shade. Thus, although the ambient temperature may exceed 35OC hookworm larvae can still find refuge in cooler microhabitats.
In the developing world, amoebiasis causes some 450 million infections per annum, about 50 million incidents and about 100,000 deaths (Mirelman, 1987). Invasive amoebiasis is prevalent in certain areas of the world including West and South East Africa, China, the whole of S.E. Asia, Mexico, and the West portion of South America, and the Indian subcontinents (Mirelman, 1987). Giardia lamblia infection is endemic throughout the world and epidemics of it occur sporadically. It has been estimated that about 200 million infections occur per year in Africa, Asia, and Latin America (WHO, 1987).
In Nigeria, high prevalence of intestinal parasites ranging between 14 and 42%, especially in the communities without toilets, has been reported (Nwosu and Anya, 1980). Intestinal nematodes, amoebae and few other protozoa have not been identified as opportunistic in Acquired Immune Deficiency Syndrome (AIDS) patients.
Etim et al., (2002) obtained prevalence values of 53.2, 31.0, 27.0 and 5.5% for Ascaris sp., Ancylostoma sp., Trichuris sp., and Schistosoma mansoni respectively, from primary school children aged 5- 13 years in Calabar, Nigeria. The prevalence of these helminthes varies with respect to sex, age-groups, standard of sanitation as well as socio- economic status of patients. For instance, children of parents in the low income group, showed the highest prevalence of infection, just as males showed more infection than females.
Of the 1,177 randomly surveyed children in Lagos, Nigeria, 46.8% had parasitic infections with four types of helminthes, Ascaris lumbricoides (29.7), Trichuris trichiura (18.4), hookworm (0.7), and Strongloides stercoralis (0.3%) as well as malarial trophozoites (43.3) and gametocytes (2.0%) (Adeoye et al., 2007). Parasitic diseases in association with nutritional imbalance were known to cause about 20.7% mortality in Lagos (Ejezie, 1983).
The prevalence of intestinal protozoan parasites in Owerri Metropolis, in the studied health facilities and resident homes, respectively was: E. histolytica/dispar (36.5% and 31.4%), E. coli (33.6% and 45.7%), G. lamblia (25.5% and 22.9%) and C. parvum (4.4% and 0.0%) (Oguoma et al., 2008).They also showed that the Month of July had the highest prevalence rate (31.4%).
2.2. Public Health Consequences of Intestinal Parasites
The morbidity associated with intestinal parasitic infections is varied and ranges from mild, transient clinical signs and symptoms to severe clinical disease, as well as chronic and insidious effects on the growth, learning and productivity of individuals. In areas of high transmission, repeated waves of N. americanus and A. duodenale L3 larvae entry through the skin can result in a cutaneous syndrome known as ground itch. This comprises a puritic erythematous papulovesicular rash. Ground itch appears most commonly on the hands and feet. In contrast to infection by the anthropophilic hookworm, zoonotic infection with A. braziliensis L3 results in cutaenous larva migrans (CLM) (Blackwell and Vega-Lopez, 2001). This is characterized by serpiginous burrows appearing most frequently on the feet, buttocks, and abdomen (Blackwell and Vega-Lopez, 2001). CLM has been reported with increased frequency among travelers returning from the Caribbean resorts and among residents along the Atlantic and Gulf Coasts of the United States (Yosipovitch et al., 2002).
Intestinal blood loss is the major clinical manifestation of human hookworm infection (Crompton and Stephenson, 1990). Heavy hookworm infections or moderate infections in patiences wioth underlying iron and protein nutritional deficiencies results in hookworm disease, the clinical entity that specifically refers to the resulting iron deficiency and microcytic, hypochromic anaemia (Beaver et al., 1984).
Guyatt (2000) highlights the way in which intestinal parasitic infection can affect productivity and wage-earning capacity in adults, either directly or indirectly through an effect of early ill-health in childhood. Nevertheless, she noted that there is little or no direct evidence that helminth infections lower the productivity of adults, in part due to the lack of well-designed studies. However, some of the health consequences of hookworm, especially anaemia and under-nutrition, are known to affect productivity. Several field studies show a strong impact of iron deficiency anaemia (IDA) on decreased aerobic work capacity and to a lesser extent on economic productivity (Haas and Brownlie, 2001). A recent study among Bangladesh tea pluckers found a negative association between intensity of major nematode species (A. lumbricoides, T. trichiura, and hookworm) and both haemoglobin and measures of labor productivity (Gilgen et al., 2001). They however observe that haemoglobin and productivity were positively associated. In a four-way trial design both anthelminthic treatment and iron supplementation increased haemoglobin but did not have a measurable effect on labour productivity, although this was suggested to reflect seasonal nutritional stress which occurred in the latter part of the trial (Gilgen and Mascie-Taylor, 2001). Even where IDA does not result in reduced productivity, the higher energetic cost of undertaking work may reduce non-economic activities such as childcare and leisure.
In addition to clinical effects, severe and chronic infection, intestinal parasitic infection also has consequences on cognitive performance, and educational achievement of school children during their development. Recent studies conducted throughout the developing world have provided evidence that school children infected with intestinal parasites perform poorly in tests of cognitive function (Watkins and Pollitt, 1997; Drake et al., 2000). For example, Sakti et al. (1999) studying 432 children from 42 primary schools in Indonesia found that children infected with hookworm performed significantly worse in tests associated with working memory than children without hookworm infection, even after controlling for nutritional status and socio-economic status.
Pathogenesis of Enterobius species have two aspects: damage caused by worms within the intestine and damage resulting from egg deposition around the anus. Minute ulcerations of adults may lead to mild inflammation and secondary bacterial infection (Shubenko- Gabuzova, 1965). Very rarely, pinworms will penetrate into the submucosa with fatal results. Movements of females out of the anus to deposit eggs, especially when the patient is asleep, lead to a tickling sensation of the perianus, causing the patient to scratch. The subsequent vicious circle of bleeding, bacterial infection, and intensified itching can lead to a nightmare of discomfort.
Wandering of adult Capillaria hepatica through the host liver causes loss of liver cells and thereby loss of normal function. Large areas of parenchyma may be replaced by masses of eggs. Rarely, eggs will be carried to the lungs or other organs by the blood stream. Hepatomegaly can become severe, and eggs become encased in granulomatous tissue, with heavy infiltration of eosinophils and other leukocytes (Choe et al., 1993).
The first obvious clinical sign of S. haematobium infection is blood in the urine; for intestinal schistosomiasis, it is blood in stool. A consequence of the deposition of schistosome eggs in mucosa and tissues. The clinical and life-threatening complications of schistosomiasis include bladder cancer or serious kidney malfunction, in S. haematobium infection, and severe complications of the liver and spleen, in intestinal schistosomiasis. In addition to these clinical complications it is becoming increasingly appreciated that the effects of infection are worse than previously thought and that schistosomiasis, as well as soil-transmitted helminthes, exert subtle, yet significant, insults on the growth, education and productivity of individuals. For example, intense schistosome infection in children may result in poorer short-term memory and slower reaction times. Heavy burdens of schistosome infection can be associated with reduced growth.
Many cases of diphyllobothriasis are apparently asymptomatic or have poorly defined symptoms associated with other tapeworms, such as vague abdominal discomfort, diarrhea, nausea, and weakness.
Almost a fourth of the population of Finland may be infected with Diphyllobothrium latum, and about 1000 of these people have pernicious anaemia (Bondorff, 1956).
Cyclospora cayetanensis is capable of causing prolonged gastro- intestinal disorder. Globally, this is characterised by persistent and intermittent watery diarrhea accompanied by weight loss and other symptoms, in both immunocompetent and immunocompromised individuals irrespective of sex and age (Fryauff et al., 1999). The disease process which emanates may be the consequences of the reactions of human host to the parasites invading the host’s tissue, causing destruction and damage to the tissue, or the result of the parasites depriving the human host of some essential nutrients (Woodrouff, 1965).
Many parasitic infections, especially those of helminthic origin are asymptomatic, could produce mild or, in a typical case, confusing symptoms. These are often neglected until bizarre, serious or chronic clinical pictures are present. Infection with Balantidium coli can be without symptoms unless the ciliates invade the intestinal wall. Invasion can cause inflammation and ulceration, leading to dysentery with blood and mucus being passed in the faeces (Chessbrough, 2000). About one in five infections are symptomatic as usually reported. Usually the course is chronic with recurrent episodes of diarrhea of varying severity (Ikeh, 1999). The course can be culminative and fatal in debilitated patients. Bowel movements can number from 5 to 24 and are moisty or watery, contains mucus and sometimes blood, and have a pigeon odour (Ikeh, 1999).
Very occasionally, severe intestinal amoebiasis causes overwhelming amoebic colitis which can be fatal. Other rare complications of invasive amoebiasis cause appendicitis and inflammatory masses in the bowel referred to as amoebomas (Chessbrough, 1999). Amoeba may enter the blood stream and be carried to the liver and other parts of the body where they can form an abscess. This is ten times more common in adults than in children, with a higher frequency in men (Chessbrough, 1999).
Attachment of trophozoites of Giardia lamblia to the brush border could produce a mechanical irritation and obstruct absorption. Giardia infection leads to a derangement of the normal villus architecture in some patients. This derangement includes shortening of the villi, crypt cell hypertrophy, and increased inflammatory cell infiltration in the lamina propia (Wiser, 2000). Giardia also interfere with the ability of the intestine to absorb nutrients and secret digestive enzymes when they entirely cover the epithelial surface and some even migrate up to the bile duct to the gall bladder and cause crampy pain or jaundice (Nester et al., 1998).
2.3. STRATEGIES FOR CONTROL
In the past, the objective of intestinal parasite control was to eradicate the infection. However, helminthes are extremely difficult to eradicate in communities where poverty and inadequate water and sanitation prevail, due to the high transmission potential of these parasites (Anderson and May, 1991). As a consequence, the current control strategies for intestinal parasites have shifted from eradication to controlling morbidity, using chemotherapy, supported by health education and improved water, feeding and sanitation. The design and implementation of chemotherapy programmes have greatly benefited from an improved understanting of the dynamics of helminthes. Mathematical models have been used to explore the consequences of control (Anderson and May, 1991).
2.3.1. Sanitation and Hygiene
Undoubtedly improved sanitation and hygiene are essential for the long-term control of parasitic diseases. The availability of latrine facilities is associated with lower helminth and protozoan intensities. However, the impact of introducing sanitation on infection levels may only be evident after decades (Esrey et al., 1991) and may not be completely effective. For example, in one study, hookworm prevalence declined by only 4% after the introduction of latrines (Huttly, 1990). Despite associations between hookworm infection and use of footwear to protect from exposure to infective larvae, there is debate as to whether promotion of footwear is an effective control strategy (Albonico et al., 1999). Furthermore, the impact of footwear on interrupting hookworm transmission has probably been overestimated, given that N. amerianus infective larvae penetrate all aspects of the skin and A. duodenale larvae are orally infective. The long time required for improved sanitation and behavior change to occur necessitates a need for a quick acting, medium-term measure to control helminth infections, namely chemotherapy (Albonico et al., 1999).
2.3.2. Chemotherapy
Their broad spectrum of activity, low cost, high efficacy and ease of administration mean benzimidazole anthelminthics are the current cornerstone of helminth control (Savioli et al., 2002). This is particularly true for resource-poor nations that cannot afford expensive sanitation measures. Four anthelminthics are available for the treatment of hookworm: albendazole, levamisole, mebendazole and pyrantel pamoate. Previously, the use of benzimidazole drugs was contraindicated in pregnancy because of uncertainty over possible teratogenicity. However, a recent WHO consulation have reviewed the evidence and concluded that pregnant and lactating women should be considered a high-risk group and included in treatment campaigns (Allen et al., 2002).
CHAPTER THREE
MATERIALS AND METHODS
3.1. Study area
The study was undertaken in Oraifite Community, Ekwusigo Local Government Area (LGA) Anambra State, Southeastern Nigeria. It has a tropical continental climate with distinct wet and dry seasons. The average relative humidity is about 80% reaching 90% during rains. There are wide divergences in the composition of the soil from rich loamy soil to sandy soil with immense agricultural potentialities. The inhabitants are predominantly farmers and traders. Rain water stored in tanks and boreholes are their sources of drinking water. Method of faecal disposal in the primary school includes pit latrine and defecation in buhes surrounding the school premises. Only one public health centre offer health services to the host community.
3.2. Subjects
The subjects were pupils of Unity Primary School in Oraifite Community. The consents of their parents, guardians and school authority were sought and obtained after they were briefed on the importance and significance of the study by the researcher.
CHAPTER FOUR
4.0. RESULTS
The data obtained from stool samples were analysed statistically using chi-square (X2) test. The level of significance was p< 0.05.
An overall prevalence rate of 47.6% was observed. Seven parasites, namely Ascaris lumbricoides (12.8%), Trichuris trichiura (1.9%), Hookworm (7.6%), Strongyloides stercoralis (4.8%), Entamoeba
histolytica (11.0%), Entamoeba coli (6.7%), and Giardia lamblia (2.8%) were isolated (Table 1). Thus, Ascaris lumbricoides was the most prevalent intestinal parasite (figure 1).
Infection was higher among females than in males, though it was not statistically significance (p > 0.05). Children in age group 10-14 years had the highest prevalence rate (61.4%) while those in age group 5-9 (24.1%) had the lowest prevalence rate. The difference in the prevalence rate with respect to age was statistically significance (p < 0.05). Children whose parents were farmers and those whose parents combine farming with other occupations (Others) had the highest prevalence rate of 66.7% each. Children whose parents were traders and civil servants had the prevalence rate of 41.0% and 20.4% respectively.
CHAPTER FIVE
5.0. DISCUSSION
Prevalence of intestinal parasites
5.1.1 Overall prevalence
The result of the investigation demonstrates very clearly a high prevalence of intestinal parasites among school pupils in UNICEF primary school, Isingwu, Oraifite, Ekwusigo L.G.A., Anambra State, Southeastern Nigeria. An overall prevalence of 47.6% recorded by this study appears high when compared with some reported results of previous studies in other parts of the country. For instance, Alakija (1986) reported a value of 25.6% in rural areas of Nigeria. Okeniyi et al. (2005) recorded a value of 33.1% among semi-urban Nigerian children. Opara et al. (2007) reported a value of 21.1% among primary school children in Owerri municipality, Imo State. Anosike et al. (2005) reported a value of 37.3% in a central Nigerian rural community. However the prevalence is almost similar with 48.7% prevalence rate reported by Mba and Amadi (2001). Several other reports from other parts of tropical Africa have shown very high (>70%) infection rates of intestinal helminthes (Dada et al., 1993).
Variations in prevalence rate of intestinal parasitosis from different rural communities could be related to several factors including people’s level of education, standard of personal/environmental hygiene and perhaps social habits (Anosike et al., 2006). More so, some ecological factors such as temperature, relative humidity, rainfall (Onwuliri et al., 1993), different diagnostic techniques employed by various workers could be responsible for observed differences in prevalence between schools. This calls for a uniform standard diagnostic technique for any National Control program on intestinal parasitiasis.
The high prevalence observed in this study could be due to the fact that a great number of pupils prefer to defaecate in the nearby bush and farm around their school, because their pit latrines were always soiled. It could also be as a result of infection from their homes, in line with the studies by Mba and Amadi (2001), as well as Okon and Oku (2001), who reported high prevalence of parasitic infections in the rural setting, pri-urban and urban- slum. Crompton (1999) reported that the high prevalence observed in his study was attributed to poor environment and personal hygiene, shortage of good water supply and indiscriminate defaecation.
5.1.2. Helminths
Ascaris lumbricoides was the most common intestinal parasite in this study, as in other studies, because the worm is remarkably infectious and usually versatile (WHO, 2002; Bello et al., 1992). The well-protected eggs of Ascaris can withstand drying and can survive for very lengthy periods (Mordi and Ngwodo, 2007). Ascaris lumbricoides had the highest prevalence of 12.8% in this study (figure 1). The prevalence appears low when compared with results obtained in other areas by different workers. For instance, Obiamiwe (1977) reported a prevalence value of 19.3%. Obiamiwe and Nmorsi (1992) reported a value of 46.7% in the defunct Bendel State of Nigeria. Eguwunyenga et al. (2004) reported a prevalence of 55%, in Eku, Delta State of Nigeria. Shitta and Akogun (2004) reported a prevalence of 48% among the nomadic Fulanis of Northen Nigeria. Odikamnoro and Ikeh (2004) reported a prevalence of 51.5% among the Kpirikpiri Community of Abakaliki of Ebonyi State. However, the prevalence is almost in line with 15.2% and 10.4% prevalence rate reported by Oyerinde (1978), and Elekwa and Ikeh (1996) respectively.
The presence of Trichuris trichiura infection is predictable, however low, since such unhealthy environmental conditions generally influence its endemicity (Ukoli, 1984). Trichuris trichiura had a prevalence value of 1.9% in this study. This value appears low when compared with the reports of both past and current studies in other parts of the country and in the world. For instance, Ramsay (1934) reported a value of 2.8%. Cowper and Woodward (1961) reported 18.5%. Alakija (1986) reported 1.7%. Anosike et al. (2002) reported 14.0%. Oyindo et (2002) reported 5.3% and Egwuyenga et al. (2004) reported 20.8%. Ogwurike and Rangna’an (2006) reported a value of 2.4% while Adeoye et al. (2007) reported 18.4% and Ngele (2008) reported 5.42%.
Hookworm was relatively the third most common parasite species identified in the study. The prevalence value was 7.6%. This value appears low when compared with the value from other studies in various part of the country. Egwuyenga et al. (2004) reported infection rate of 22.5%. Ogwurike and Rangna’an reported a value of 3.8%. Ijagbone and Olagunji (2006) recorded the value of 20.5% while Ngele (2008) recorded 58.33% and Obiukwu et al. (2008) recorded 31.1%. Nwosu (1981) had reported that hookworm transmission occurs more during the rainy season in Nigeria. This probably accounts for the low prevalence observed in this study as it was conducted during the dry season (from January to March). The higher prevalence of A. lumbricoides (12.8%) compared to that of Hookworm (7.6%) agreed with some previous reports (Opara et al., 2007), but different from others (Nwaorgu et al.1998).
The low prevalence of Strongyloides stercoralis in faeces agreed with previous studies (Ijagbone and Olagunji, 2006; Adeboye et al., 2007). Reason for low prevalence observed in most studies may not be unconnected to its vulnerability to adverse environmental conditions hence its alternate mode of infection, autoinfection.
5.1.3. Protozoans
In this study, Entamoeba histolytica/dispar showed a prevalence of 11.0%. Studies done elsewhere in Nigeria had lower prevalence values. For instance, Obiamiwe and Nmorsi (1990), reported a value of 3.9 %, Ogunbi (1971) reported a value of 5.7%, while Cowper and Woodward (1961) reported a value of 4.2%. Anosike et al. (2002) reported a value 4.0%. The high prevalence of Entamoeba histolytica/dispar could be as a result person to person transfer through food or water among the school pupils, which the study observed.
Other protozoa that were observed in this study were Entamoeba coli (6.7%) and Giardia lamblia (2.8%). The prevalence of the two protozoa appear low, when compared with the findings of Oguoma et al. (2008) which recorded prevalence of 36.0 and 25.0%, for Entamoeba coli and Giardia lamblia respectively. Nzeako (1992) posited that the highest incidence of infection with intestinal protozoan parasites was peaked between July and August (peak of rainy season). This may probably account for the low prevalence observed in this study as it was conducted during the dry season (dry season).
5.1.4. Prevalence with respect to Sex
The prevalence of parasites by sex showed no significant difference (p > 0.05), implying that the difference in males and females only occurred by chance. This corroborates other reports (Obiukwu et al. 2008; Egwunyenga and Atakiru, 2005). They reported that both males and females have the same chances of being infected by these parasites.
5.1.5. Prevalence with respect to Age groups
Age group 10 – 14 years, recorded highest prevalence value of 61.4%. Pupils under this age-group play a lot in the sand. Besides, little or no care is given to them; they are allowed to do things on their own (Obiukwu et al., 2008) unlike their counterparts in age-group of 5 – 9 years in which the prevalence dropped to 24.1%.
5.1.6. Prevalence with respect to Occupation of Parents
In many tropical countries, geohelminth is an occupational disease of the farming community (Adams and Meaggraith, 1976; Onaedeko and Oladipo, 1989). It is therefore not surprising that in this study, pupils whose parents are farmers habour more parasites than those whose parents are traders and civil servants (Table 2).
5.1.7. Prevalence with respect to class of pupils
Nursery school pupils showed highest prevalence (54.9%) amongst the class of pupils examined. There was no statistically difference between the prevalence of intestinal parasites by class (p > 0.05). Therefore, it could be inferred that the observed differences in these classes occurred by chance. Also, the attitude of staying under the Mango tree in front of the school compound, by these nursery school pupils (as observed in this study) where they made contact with the soil might be the reason for the highest prevalence seen in them.
Generally, transmission of infection can be during outdoor play with no slippers or shoes on soil contaminated with faeces (Adeoye et al., 2007). Some of the children might have contacted infection through ingestion of helminth eggs and protozoan cysts in contaminated food,
drinking infected water, eating with or licking unwashed contaminated hands and fingers, clothing or air, especially during outdoor play in the soil (Adeoye et al., 2007). Combination of defeacating in open spaces, playing in soil and the geophagus habit of the children could be a good source of high helminth infection (Etim and Akpan, 1999).
5.2. Conclusion and recommendation
The delibilitating effects of intestinal parasitic infections on school children are many and include among others, malnutrition, kwashiorkor, emaciation, abdominal pain, and mental backwardness (Ijagbone and Olagunji, 2006). Some of these features were observed physically among the children sampled. Some pupils complained of symptoms associated with intestinal parasitic diseases and absenteeism from school due to illness caused by these parasites. Also school teachers made similar observations on their pupils. In order to control the condition, local health officers should visit the school for routine deworming of the school children. Sanitary improvement such as regular washing of the toilets and effective use of water for hand washing after playing should be adopted. Adequate health education and provision of basic amenities should also help to provide some level of good living in the school.
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INTESTINAL PARASITES AMONG UNITY PRIMARY SCHOOL PUPILS, IN ORAIFITE, EKWUSIGO L.G.A. ANAMBRA STATE, SOUTHEASTERN NIGERIA.
