TABLE OF CONTENTS
Title page ……………………………………………………………. i
Certification page ……………………………………………………. ii
Dedication ……………………………………………………………. iii
Acknowledgements ………………………………………………….. iv
Table of Contents ……………………………………………………. v
List of tables ………………………………………………………….. viii
List of figure …………………………………………………………… ix
Abstract ……………………………………………………………….. x
CHAPTER ONE
1.0. INTRODUCTION ………………………………………………. 1
CHAPTER TWO
2.0. LITERATURE REVIEW ……………………………………….. 6
2.1. Epidemiology …………………………………………………… 6
2.2. Public health consequences of intestinal parasites ………… 10
2.3. Strategies for control ………………………………………….. 17
7
2.3.1. Sanitation and hygiene ……………………………………….. 17
2.3.2. Chemotherapy …………………………………………………. 18
2.3.3. Phytotherapy …………………………………………………… 24
2.4. Diagnostic methods ……………………………………………… 26
CHAPTER THREE
3.0. MATERIALS AND METHODS ………………………………… 30
3.1. Study area ………………………………………………………. 30
3.2. Subjects …………………………………………………………. 30
3.3. Collection of stool samples ……………………………………. 31
3.4. Laboratory investigation ……………………………………….. 31
3.5. Parasitological methods ……………………………………….. 32
3.5.1. Direct saline and iodine mounts ……………………………… 32
3.5.2. Egg floatation method …………………………………………. 33
3.5.3. Formal-ether concentration technique ………………………. 34
CHAPTER FOUR
4.0. RESULTS ………………………………………………………. 36
8
CHAPTER FIVE
5.0. DISCUSSION …………………………………………………… 42
5.1. Prevalence of intestinal parasites …………………………….. 42
5.1.1. Overall prevalence ……………………………………………… 42
5.1.2. Helminths ………………………………………………………… 44
5.1.3. Protozoans ………………………………………………………. 46
5.1.4. Prevalence with respect to Sex ………………………………… 47
5.1.5. Prevalence with respect to Age groups ……………………….. 47
5.1.6. Prevalence with respect to Occupation of parents …………… 48
5.1.7. Prevalence with respect to class of pupils …………………….. 48
5.2. Conclusion and recommendation ………………………………… 49
REFERENCES ………………………………………………………….. 50
APPENDIX ………………………………………………………………. 66
9
LIST OF TABLES
1. Overall prevalence of intestinal parasites found in the stool
specimens from pupils of Unity primary school, Oraifite,
Ekwusigo L.G.A., Anambra State, Southeastern Nigeria.
2. Prevalence of intestinal parasites with respect to sex, age groups
and occupation of parents of pupils of Unity primary school,
Oraifite, Ekwusigo L.G.A., Anambra State, Southeastern
Nigeria.
3. Prevalence of intestinal parasites with respect to class of pupils of
Unity primary school, Oraifite, Ekwusigo L.G.A.,
Anambra State, Southeastern Nigeria.
10
LIST OF FIGURE
1. Prevalence of parasites detected in the stool samples from pupils of
Unity primary school, Oraifite, Ekwusigo L.G.A.,
Anambra State, Southeastern Nigeria.
11
ABSTRACT
A study was conducted to determine the prevalence of intestinal
parasites among pupils in Unity primary school in Oraifite, Ekwusigo
Local Government Area, Anambra State, Southeastern Nigeria. Of the
462 surveyed pupils, 47.6% had parasitic infection. Seven intestinal
parasites were isolated; Ascaris lumbricoides (12.8%), Hookworm
(7.6%), Strongyloides stercoralis (4.8%), Trichuris trichiura (1.9%),
Entamoeba histolytica (11.0%), Entamoeba coli (6.7%), Giardia lamblia
(2.8%). Prevalence rate was higher among (p > 0.5) males than females
though not statistically significance. Pupils in the age-group 10-14 years
had the highest prevalence value (61.4%) while those in age-group 5-9
years had the lowest prevalence value (24.1%). Infection was higher
among those whose parents were farmers and traders than those of civil
servants. Prevalence was also higher among nursery school pupils.
Health education, sanitation and mass chemotherapy should be
encouraged in order to control intestinal parasitic disease in the school.
12
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).
Intestinal parasitic infections are among the most prevalent of
human parasitic infections worldwide (Jeliffe, 1966; Toriole, 1990; WHO,
1966). They had been long recognized as an important health problem
especially among Nigerian children (Kow and Balasurbrama, 1986;
Janes, 1974; Oduntan, 1974; Ajayi and Akinyinka, 1999; Olusi et al.,
1975; Salimon 1980). Several epidemiological studies had indicated a
high prevalence of intestinal parasitic infections among Nigeria children
(Salimon and Akinyemi, 1988; WHO, 1978, 1987; Graitcher, 1988).
The involvement of protozoan agents in humans can be traced
back to the 19th century and these protozoa group constitute the highest
group of parasites known to be associated with diarrheal condition.
13
Originally, the Coccidia parasites are known to be pathogenic mainly to
some species among lower animals, insects, birds and non-human
primates (Beneson, 1995; Marshall et al., 1997; Fryauff et al., 1999).
Today, a newer Coccidian, C. cayetanensis has now been added to the
list of protozoan agents that can induce diarrhea. Prior to 1979, when the
first human case of cyclosporiasis was reported (Ashford, 1979), only
four genera of the coccidian were known to infect humans and these are
Cryptosporidium, Isospora, Toxoplasma and Sarcocystis (Clarke and
McIntyre, 1996). In the developed countries like the United State of
America (USA) and the United Kingdom (UK), where a lot of
documentation exists, there is a fair idea of the profile of parasitic
pathogens. In USA, it is now a common practice for stool samples
submitted to the laboratory, to be first screened for the presence
commonest pathogenic parasites and when these are absent, the
screening for newer agents like C. cayetanensis is done (Garcia-Lopez
et al., 2000).
Soil-transmitted helminthes (STH) or Geohelminthes are one of the
most important groups of infectious agents and are causing world’s
major human health problems until now. Four species of helminthes,
namely, Hookworms (Ancylostoma duodenale and Necator
americanus), Ascaris lumbricoides, and Trichuris trichiura are primary
14
agents of STH, and estimated infected populations are 1.3 billion, 1.5
billion, and 1.0 billion people, respectively (Crompton, 1999).
Geohelminthes are more important among children and in poor or
malnourished populations in morbidity and mortality. It was speculated
that 15% of host population harbored 70% of STH worm burdens (Bundy
and de Silva, 1998). Inadequate hygiene, poor health care systems and
facilities, social indifference, social instability, civil wars, and natural
disasters make situations worse. Geohelminthes and poverty are
intimately linked in a vicious cycle in most developing countries. The
DALY (Disability-Adjusted Life Years) score of STH is around 4.65
million over the world (Horton, 2003). However, priority of STH control is
often neglected even in wormy countries.
Four major groups of intestinal parasite exist; they include single
celled parasites (Protozoa), flukes (Trematoda), tapeworms (Cestoda)
and roundworms (Nematoda). Each of these groups of parasites can
infect the digestive tract, and sometimes two or more can cause
infections at the same time. Parasites get into the intestine through the
mouth from uncooked, improperly cooked, unwashed food,
contaminated water and hands or by skin contact with larvae infested
soil. Infection with intestinal parasite could also be through oral sex.
15
When the infective stages of the parasites are swallowed, they move into
the intestine where they can develop and cause disease (Endris, 2001).
Infection with parasitic helminthes is often recognized as one of
the important public health problems in tropical inhabitants. Here, there
exist over 2,000 million helminthic infections, with about 15 million
Nigerians suffering from ascariasis alone, while there are several
thousands with strongyloidiasis, trichuriasis, enterobiasis, hookworm,
tapeworm infections among others (Edungbola and Obi, 1992). This
indicates that the prevalence of and morbidity from intestinal
helminthiasis are enormous. Many parasitic infections, especially those
with helminthic origins are asymptomatic, could only produce mild or, in
a typical case, confusing symptoms (Anosike et al., 2006). Thus they are
often neglected until bizarre, serious or chronic clinical pictures are
present. In most rural communities, low standard of sanitation and poor
socio-economic conditions are obvious predisposing factors to high
prevalence of human intestinal helminthiasis (Gundiri and Akogun,
2000). Although several reports exist in Nigeria on the mortality and
morbidity of most intestinal helminth parasites (Ogbe and Odudu, 1990;
Dada et al., 1993), the much needed baseline data on the level of
endemicity of human intestinal helminthiasis especially on the rural
sectors are not easily recorded and do not exist (Ukoli, 1990).
16
Considering the impact of parasitic infection among children;
coupled with the fact that there is no information on gastro-intestinal
studies in Oraifite Community, from which the present study is
conceived. This study aims at the identification of various intestinal
parasites, which infect primary school children, to determine the overall
prevalence of infection and the pattern of infestation in relation to age,
sex, occupation of parents, and class- of the pupils, and reports the
results of the investigation on intestinal parasites in school pupils in Unity
Primary School, Oraifite, Anambra State, Southeastern Nigeria.
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