Prevalence of Gastrointestinal Helminths Among Primary School Children in Unyeada Community Andoni LGA
Chapter One
Aim
The aim of this study is to evaluate the occurrence of gastro-intestinal helminths in children attending primary schools within Uyeada community in Andoni Local Government Area, Rivers state, Nigeria.
Objectives
The objectives of this study are:
- To determine the prevalence of gastro-intestinal protozoan parasites and helminths infecting children in primary schools in Uyeada community in Andoni Local Government Area, Rivers state.
- To identify the risk factors associated with the prevalence of gastro-intestinal protozoans and helminths infection in children of the primary schools.
- To determine the association of gender and age with the prevalence of gastrointestinal protozoans and helminths infecting children in the primary schools.
- To assess the effect of seasons on the prevalence of gastro-intestinal protozoan and helminth infections in children of the primary schools in the study area.
CHAPTER TWO
LITERATURE REVIEW
Intestinal parasites
Intestinal parasitic infections cause a tremendous burden of disease in the tropics and subtropics as well as temperate climates due to its wide global distribution (CDC, 2014a). Prevalence of intestinal parasites has been reported from all over the world of which an estimated 3.5 billion people are affected, most of whom are children residing in developing countries (WHO, 2000). Parasitic infections can occur in children of all ages such as infants, toddlers, and very young children. Toddlers, preschoolers and young school children in day care centres and school settings are at risk for parasitic diseases caused by both parasitic protozoans and helminths which are mostly spread by person-toperson contact as is common during childhood play (Obadiah et al., 2011). Pets and other animals are also potential sources of infection with intestinal parasites such as Toxoplasma gondii Nicolle and Manceaux, 1908; Toxocara Spp. Wilder, 1950; Dipylidium caninum, among others that can affect children of all ages (WHO, 2015; O’Donoghue, 2010). The major intestinal parasitic infections of global public health concern, of the protozoan species are Entamoeba histolytica and Giardia lamblia and soil transmitted helminths Ascaris lumbricoides, Trichuris trichiura and hookworm (WHO, 2000; Haque, 2007).
Intestinal Protozoans
Intestinal protozoan parasites can be said to have contributed immensely in undermining the health of children as they are commonly known to cause gastrointestinal infections compared to helminths (Haque, 2007). Several epidemiological studies within and outside Nigeria have indicated that a high prevalence of intestinal parasitic infections, including protozoan, as a contributing factor affecting approximately one-quarter of the world’s population, especially children, mostly due to their poor hygienic and sanitary habits coupled with voracious eating habits (Uguoma et al., 2008). Also, recent estimate indicates that more than 880 million children are in need of treatment for intestinal protozoan parasites and helminths (WHO, 2016).
Pathogenic intestinal protozoa infections are common in school-age children in the developing world and they are frequently associated with malabsorption syndromes and gastrointestinal morbidity (Speich et al., 2013). Although several protozoan parasites affect humans, not all of them are pathogenic. The most pathogenic intestinal protozoans are Entamoeba histolytica, Cryptosporidium parvum and Giardia lamblia. Others may include Isospora spp., Trichomonas vaginalis and Entamoeba coli among others (Amin, 2002; Harhay et al., 2010). In developed countries, protozoan parasites more commonly cause gastrointestinal infections compared to helminths because the former multiply within the host.
Global Distribution and Prevalence of Intestinal Protozoans
Diarrhoea, at a global level, is a major contributor to childhood mortality and morbidity in the developing world and is estimated to cause 2.5million deaths each year (Kosek et al., 2003).
In a study carried out by Jayarani et al. (2014) on intestinal parasitic infections in preschool and school going children from rural area of Puducherry, India, a prevalence of 15% was reported. Giardia lamblia was the most prevalent parasite (44%) and it was more prevalent in school going children (10%) than in preschool children (13.33%).
In Ghana, a high prevalence of 89.5% with Giardia lamblia was reported by Nkrumah and Nguah (2011) in their study to associate diarrhoea with prevalence of G. lamblia in children. The prevalence of G. lamblia was associated with childhood diarrhoea.
Al-hindi and El-Kichaoi (2008) reported the prevalence of intestinal parasites in prescholars in Gaza where the protozoans E. histolytica, G. lamblia and Entamoeba coli were identified. G. lamblia was the highest prevalent parasite with a prevalence of 10.3% and it is also seen to be more associated with diarrhoea in children. E. histolytica/dispar was found to be more prevalent in children of 0-10month (63.6%) than other age groups. This was found to be influenced by milk bottles contamination or breast feeders and creeping of those children on contaminated grounds.
CHAPTER THREE
MATERIALS AND METHODS
Study area
Uyeada community in Andoni Local Government Area is located within longitude 11°05′0″N to 11°15′30″N and latitude 07°34′E to 7°47′E. The Obolo (Andoni) people, part of the Obolo state, of Rivers,Abia,and Akwa Ibom States, of Nigeria, are an Ijaw sub-ethnic group with strong historical relations with Oron people of Niger Delta in Nigeria. The Andoni people refer to God as Awaji or Owaji. It has the population of 286,871 people as at 2006 census.
Study population
The study population comprised children in primary schools within Uyeada community in Andoni Local Government Area, Rivers state which were randomly selected. Prior visit was made to schools informing them about the research after which consent was sought from the school authorities and the children’s parents and guardians through the school, to carry out the study.
CHAPTER FOUR
RESULTS
Prevalence data of the species of intestinal protozoans and helminths in children of the primary schools
Cysts and eggs of eight (8) intestinal parasites were recovered from stool samples examined in this study. They include the cysts of two protozoans (Entamoeba histolytica (Plate I) and Balantidium coli) and the eggs of six helminths (Dipylidium caninum, Diphyllobothrium latum, Hymenolepis nana, Ascaris lumbricoides, Hookworm and Strongyloides stercoralis) (Plates II, III, IV, V, VI and VII respectively). Parasite with the highest prevalence was Hookworm (4.92%) followed by A. lumbricoides (3.50%) then S. stercoralis (1.04%), which are all soil transmitted helminths. The intestinal parasites with the lowest prevalence were the protozoans, E. histolytica (0.26%) and Balantidium coli (0.26%); and H. nana (0.26%) (Table 4.1).
CHAPTER FIVE
DISCUSSION
The cysts and eggs of eight intestinal protozoans and helminths of medical importance were identified in the stools of children in primary schools in Uyeada community in Andoni Local Government Area. They include the cysts of Entamoeba histolytica and Balantidium coli; and eggs of Hookworm, Ascaris lumbricoides, Strongyloides stercoralis, Hymenolepis nana, Dipylidium caninum and Diphyllobothrium latum. The results obtained here support the fact that in developing countries, including Nigeria, intestinal helminths have prevailed due to poor living standards, poor environmental sanitation and ignorance of health-promoting behaviours as stated by Odoba et al. (2012). Ascaris lumbricoides, Strongyloides stercoralis and hookworm were the predominant parasites identified and are soil transmitted helminths. The presence of these soil transmitted helminths in the children can be associated to their play habits; most of these children are in their oral stage and they play a lot with soil and soiled objects which serves as factors that predisposes them to these intestinal parasites when they put these objects in their mouths. Also, the prevalence of these soil transmitted helminths may have occurred among children who licked/ sucked their fingers which might have been soiled or contaminated. Some of the parasites identified in this study had been reported to occur among children in primary schools by Chirdan et al. (2010); in nursery schools, Sabon Tasha, Chikun by Kuboye (2013) and among primary school pupils and their playgrounds in Zaria by Odoba et al. (2012).
CHAPTER SIX
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
Intestinal protozoans and helminths are prevalent in primary school children in Uyeada community in Andoni Local Government Area (9.33%). Intestinal helminths are more prevalent in the sampled nursery schools than intestinal protozoan parasites and only helminths parasites were recorded in children of the sampled primary schools. This means the first null hypothesis that “gastro-intestinal protozoans and helminths are not prevalent in children of primary schools in Uyeada community in Andoni Local Government Area”, is rejected.
There is significant association between some risk factors such as hand washing with only water (OR=2.35) and not washing hands after play (OR=2.05), use of pit latrines (OR=1.72), sharing of toilets between staff and students (OR=1.70) and non-use of disinfectants in cleaning (OR=1.72) (CI≥1); with the prevalence of intestinal protozoan and helminth infections in the study area. The second hypothesis is also rejected.
Age and gender significantly correlates with the prevalence of intestinal protozoans and helminths primary schools in Uyeada community in Andoni L.G.A. rejecting the third hypothesis which states that “age and gender are not associated with the prevalence gastro-intestinal protozoans and helminths infecting children in primary schools in Uyeada community in Andoni Local Government Area, Rivers state”.
Seasons affect the prevalence of intestinal protozoans and helminths which is more in the dry season than the wet season. The fourth hypothesis, “Seasons does not affect the prevalence of gastro-intestinal protozoan parasites and helminths infecting children in primary schools in Uyeada community in Andoni Local Government Area, Rivers state,” is also rejected.
Recommendations
Based on the results of this study, it is recommended that the management of the schools should provide appropriate hand washing facilities (such as clean running water with liquid soap and possibly hand sanitizer) and the teachers and nannies/caregivers should ensure that the children practice appropriate hand washing/ use the facilities properly.
Good hygiene practices should be introduced into the schools’ syllabuses by the Ministry of Education and any other relevant authority, especially with regards to proper hand washing with soap and water.
School management should make sure that toilets are cleaned properly and ensure adequate water supply.
Parents should also be advised/sensitized through health personnel and the media on the need to deworm their children regularly as recommended by WHO (2017).
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