Abstract
BackgroundThe distribution of and factors associated with intestinal parasitic infections are poorly defined in high risk vulnerable populations such as urban slums in tropical sub-Saharan Africa.MethodsIn a cross sectional study, children aged 5 years and below who presented with diarrhoea were recruited from selected outpatient clinics in Mukuru informal settlement, and from Mbagathi District hospital, Nairobi, over a period of two years (2010–2011). Stool samples were examined for the presence of parasites using direct, formal-ether concentration method and the Modified Ziehl Neelsen staining technique.ResultsOverall, 541/2112 (25.6%) were positive for at least one intestinal parasite, with the common parasites being; Entamoeba histolytica, 225 (36.7%),Cryptosporidium spp. 187, (30.5%), Giardia lamblia, 98 (16%).The prevalence of intestinal parasites infection was higher among children from outpatient clinics 432/1577(27.4%) than among those admitted in hospital 109/535 (20.1%) p < 0.001. Infections with E. histolytica, and G. lamblia were higher among outpatients than inpatients (13.8% vs 1.3% p < 0.001 and 5.8% vs 1.3% p < 0.049) respectively, while infection with Cryptosporidium spp. was higher among inpatients than outpatients (15.3% vs 6.7%) respectively p < 0.001. Other parasites isolated among outpatients included Isospora belli, 19 (1.2%), Ascaris lumbricoides, 26 (1.6%), and Hymenolepis nana 12 (0.8%), with the remainder detected in less than ten samples each. HIV-infected participants were more likely to be infected with any parasite than uninfected participants, Adjusted Odds Ratio (AOR), 2.04, 95% CI, 1.55-2.67, p < 0.001), and with Cryptosporidium spp. (AOR, 2.96, 95% CI 2.07-4.21, p < 0.001).The inpatients were less likely to be infected with E. histolytica than outpatients (AOR, 0.11, 95% CI, 0.51- 0.24, p < 0.001), but more likely for inpatients to be infected with Cryptosporidium spp. than outpatients (AOR, 1.91, 95% CI, 1.33-2.73, p < 0.001). Mixed parasitic infections were seen in 65 (12.0%) of the 541 infected stool samples.ConclusionIntestinal parasitic infections are common in urban informal settlements’ environment. Routine examinations of stool samples and treatment could benefit both the HIV infected and uninfected children in outpatient and inpatient settings.
Highlights
The distribution of and factors associated with intestinal parasitic infections are poorly defined in high risk vulnerable populations such as urban slums in tropical sub-Saharan Africa
In this study we examined the prevalence of intestinal parasitic infections among children aged 5 years and below, both HIV positive and HIV negative, living in Mukuru urban informal settlement, and either presenting at outpatient clinics, or admitted to the Mbagathi District hospital in Nairobi
Study site and patients This was a prospective cross sectional study of children aged 5 years and below who presented with diarrhoea to selected outpatient clinics (Reuben Centre, Lea toto and Medical Missionaries of Mary) which, are the only public dispensaries located in Mukuru informal settlement, as well as those admitted to the paediatric wards at Mbagathi District hospital from January 2010 to December 2011
Summary
Intestinal parasitic infections have enormous consequences on the health of HIV infected patients [18], and sub-Saharan Africa is already over burdened by HIV infection These patients often suffer from frequent diarrhoeal episodes coupled with weight loss resulting from intestinal parasites, some of which can be fatal [19,20,21,22]. Polyparasitism was frequently observed in all these studies.To the best of our knowledge, there is no published data on the prevalence of intestinal parasitic infections in the informal settlements in Nairobi. Such data underlie decisions on the need for early diagnosis and management in order to prevent the health complications among vulnerable groups such as children, some of who could be HIV positive. In this study we examined the prevalence of intestinal parasitic infections among children aged 5 years and below, both HIV positive and HIV negative, living in Mukuru urban informal settlement, and either presenting at outpatient clinics, or admitted to the Mbagathi District hospital in Nairobi
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