A tale of two communities: intestinal polyparasitism among Orang Asli and Malay communities in rural Terengganu, Malaysia.

Fatin Nur Elyana,Yee Ling Lau,Hesham M Al-Mekhlafi,Mona A Al-Areeqi,Mohamad Hafiz Abd-Basher,Salwa Dawaki,Norhayati Moktar,Nabil A Nasr,Awatif M Abdulsalam,Wahib M Atroosh,Hany Sady,Lahvanya R Subramaniam,Johari Surin,Init Ithoi,Tengku Shahrul Anuar

doi:10.1186/s13071-016-1678-z

Abstract

BackgroundIntestinal parasitic infections (IPIs) are still major health problems in many developing countries including Malaysia, particularly in the poor and socioeconomically deprived rural and remote communities in Peninsular Malaysia. This study was conducted to determine the prevalence of IPIs and to identify the key factors associated with intestinal polyparasitism as well as to evaluate the knowledge, attitude and practices (KAP) on IPIs among rural Orang Asli and Malay communities in Terengganu, Malaysia.MethodsA cross-sectional study was conducted among 340 participants (165 Orang Asli and 175 Malay) aged ≤ 15 years from the Hulu Terengganu and Kemaman districts of Terengganu. Faecal samples were examined for the presence of intestinal parasites by using direct smear, formalin-ether sedimentation, trichrome stain, modified Ziehl Neelsen stain, in vitro cultivation in Jones’ medium, Kato Katz and Harada Mori techniques. Demographic, socioeconomic, environmental and behavioural information of the participants and their KAP for IPIs were collected by using a pre-tested questionnaire.ResultsOverall, 149 (90.3 %) Orang Asli and 43 (24.6 %) Malay children were infected by at least one parasite species. The overall prevalences of intestinal polyparasitism among the Orang Asli and Malay were 68.5 % (113/165) and 14.3 % (25/175), respectively. Multiple logistic regression analysis showed that using unsafe water supply as a source for drinking water, the presence of domestic animals, not wearing shoes when outside, not washing vegetables before consumption, not washing hands after playing with soil, indiscriminate defecation and the low level of mother’s education were the key risk factors for intestinal polyparasitism among the Orang Asli, while working mothers and the presence of domestic animals were the risk factors among the Malay children. Almost all the Malays were well aware about the IPIs while Orang Asli respondents had a poor level of related awareness.ConclusionsThis study demonstrates that IPIs are highly prevalent in rural Terengganu, Malaysia. Community awareness about IPIs was found to be imperative in protecting Malay children from these infections. An integrated control programme for the prevention and control of IPIs is highly recommended for these communities, with a special emphasis on the Orang Asli population.

Highlights

Intestinal parasitic infections (IPIs) are still major health problems in many developing countries including Malaysia, in the poor and socioeconomically deprived rural and remote communities in Peninsular Malaysia
Numerous studies reported that IPIs (mainly soil-transmitted helminths (STH) and giardiasis) during childhood are significantly associated with protein-energy malnutrition, iron deficiency anaemia (IDA), vitamin A deficiency (VAD), intellectual retardation and educational deficits that lead to poor school attendance and poor educational achievement [8,9,10,11,12,13]
Poverty prevails in the Orang Asli communities in which about two-thirds of the participants belonged to families with low household monthly income (< RM500)

Summary

Introduction

Intestinal parasitic infections (IPIs) are still major health problems in many developing countries including Malaysia, in the poor and socioeconomically deprived rural and remote communities in Peninsular Malaysia. Intestinal parasitic infections (IPIs) are still major public health problems worldwide, among children in poor and rural communities of most countries in tropical regions. It is well documented that IPIs are associated with a complex web of causation that involves poverty (which is, in general, the root of these problems), inadequate sanitation, poor hygienic practices, illiteracy, ecosystem differences and overcrowding [5, 6]. It was found that polyparasitism (the concurrent infection with multiple parasite species) is associated with higher mortality rates and may increase the sufferers’ susceptibility to other infections [15, 16]. The adverse consequences of these infections may continue into the adulthood with effects on the economic productivity and trapped the endemic populations in a cycle of poverty, underdevelopment and disease [17]

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Results

Discussion

Conclusion