Prevalence of Intestinal Parasites among Patients in the Abha Region

Abstract

Original ArticlesPrevalence of Intestinal Parasites among Patients in the Abha Region Moslem Uddin Khan, MB, BS, DPH, FACTM, PhD, MFCM Serag El-Dine Amir, MB, BCh, MSc Osama M. Eid, and MB, BCh, MSc Shashi AggerwalBSc(Gen), BSc(MLT) Moslem Uddin Khan Address reprint requests and correspondence to Dr. Khan: Department of Family and Community Medicine, College of Medicine, King Saud University-Abha Branch, P.O. Box 641, Abha, Saudi Arabia. From the Department of Family and Community Medicine, College of Medicine, King Saud University-Abha Branch, Abha Search for more papers by this author , Serag El-Dine Amir From the Shamasan Primary Health Centre, Abha Search for more papers by this author , Osama M. Eid From the Department of Family and Community Medicine, College of Medicine, King Saud University-Abha Branch, Abha Search for more papers by this author , and Shashi Aggerwal From the Shamasan Primary Health Centre, Abha Search for more papers by this author Published Online:1 Sep 1989https://doi.org/10.5144/0256-4947.1989.471SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutABSTRACTABSTRACTA retrospective study was conducted among the patients of the Shamasan Primary Health Centre to find the prevalence rates of intestinal parasites by age, sex, and seasonality. All patients whose stool samples were examined and properly recorded during the years 1406H and 1407H (1985-87) were included in the study. Results showed that about 2% of the 283,622 patients were advised stool analysis. The overall parasite prevalence rate was 29.4%. All ages and sexes were affected, with higher prevalence rates in children less than 10 years of age and in females aged 20 to 49 years. There were some seasonal variations in the parasite prevalence rates. The prevalence rate for Giardia lamblia was 15.5%, Entamoeba histolytica 7.5%,E.coli 6.2%, Ascaris lumbricoides 1%, and Hymenolepis nana and Schistosoma less than 1%. Hookworm was not seen. Although a lower prevalence rate of G. lamblia was expected, its prevalence rate in the dry atmosphere and high altitude (2500 to 3000 meters) of the Ahba region appears to be higher than or similar to that in other parts of the Kingdom.IntroductionMost intestinal parasites have been associated With ill health for centuries. The prevalence of almost all parasites depends on climatic and socioenvironmental conditions. In a Bangladesh slum, over 80% of the population have one or more parasites.1 In some parts of India, Ascaris infection has been reported to vary from 80% to 95%.2 In Pakistan, the prevalence of parasites in diarrheal patients was found to be 71%, with a high rate of Giardia lamblia.3 In one community of Canada, the A. lumbricoides prevalence rate was over 28%.4 In Yemen, a neighboring country of Saudi Arabia, 53% of the stool specimens were positive for intestinal parasites.5 At the same time, only 7.56% of the food handlers working in restaurants of Saudi Arabia were infested with parasites, and a very low percent of them had Entamoeba histolytica (3.17%) and G. lamblia (3.10%) infection.6 But the prevalence rates were different in expatriates working in Riyadh. Among them, 55.7% were infested with parasites.7 In another hospital-based study in Riyadh, 22.9% of the patients had pathogenic parasites and many more commensals.8It thus appears that the parasite rate varies from country to country, and even among different parts and different populations of the same country. The parasite prevalence rates of Abha, which is situated at a high altitude (2500 to 3000 meters), have not been adequately documented. We, therefore, conducted a retrospective study to examine the pattern of parasites and their prevalence rate in patients attending the Shamasan Primary Health Centre of Abha City. Our aim was to understand the age and sex distribution of patients and the topographic and climatic influence on parasite prevalence rates.MATERIALS AND METHODSShamasan Primary Health Centre is one of the three health centers in Abha City. Patients are treated irrespective of their religion and nationality. Patients having complaints suggestive of association with parasitic infection were referred by all physicians of the center to the clinical pathology laboratory for stool examination. Plastic stool cups with tight lids were supplied to patients, and fresh stool samples were received on the subsequent mornings for examination. Specimens underwent microscopic examination quickly using a saline and iodine stained wet-mount preparation, according to the standard method recommended by the WHO.9 Both cysts and vegetative forms of G. lamblia and E. histolytica were considered as positive findings.Analysis has been done with consideration to age, sex, and seasonality. Each month represents 2 months' data of the Hejira years 1406 and 1407 (1985-87). All results of stool examination (5398) were included in the analysis, except some cases where age and sex were ill defined. Official holidays and leave days of the examiner were not covered. Significance was tested by using the chi-square test where necessary.RESULTSDuring the 2-year period, 283,622 patients attended the Shamasan Primary Health Centre for treatment, and 5398 patients' stool specimens (1.9%) were examined. On the whole, approximately 10 stool samples were tested per clinic-day in addition to urine, blood, and other samples. Of 5398 stool specimens examined, 1586 (29.4%) were positive for parasites.The age and sex distribution of the patients contracting parasites is shown in Table 1. The distribution was not uniform for all ages. The rates were lower in patients 15 to 19 years old for both sexes compared to the other age groups. This difference was statistically significant (P < 0.05). The prevalence rates in patients up to 10 years old and in females between the ages of 20 and 49 years were higher than in other age groups. These differences were also significant statistically (P < 0.01 and < 0.05, respectively). The overall rates between males (29.3%) and females (29.5%) were not different. In patients age 50 and over, females had a lower rate (22.3%) than males (32.6%), though this difference was not statistically significant.Table 1. Prevalence of Lamblia, E. histolytica and E. coli by age and sex of patients.Table 1. Prevalence of Lamblia, E. histolytica and E. coli by age and sex of patients.Prevalence of Ascaris, Schistosoma mansoni, and Hymenolepis nana was equal to or less than 1% (Table 2). No hookworm was isolated from 5398 stool samples. The overall prevalence rate of G. lamblia was higher (15.5%) than any other pathogens. Its prevalence rate in children less than 10 years of age was higher than any other age groups in both sexes (P < 0.001). The prevalence of E. histolytica (7.7%) and E.coli (6.2%) was almost uniform in all age groups. The rates were not significantly different between males and females.There was no significant seasonal variation in the prevalence of G. lamblia, but the prevalence rate of E. histolytica during December and January was significantly higher than the prevalence rate for February and March (P < 0.05). The overall rate for G. lamblia (15.5%) was twice the rate of E. histolytica (7.7%).Table 2. Prevalence of parasites among 3171 males and 2227 females tested.Table 2. Prevalence of parasites among 3171 males and 2227 females tested.DISCUSSIONAbout 2% of patients are usually referred for stool testing. The reasons for high and low rates of stool microscopy during Safar (September-October) and Jumada Al-Awal (December-January) in this study are not evident. Diarrheal diseases, however, increase from the month of Safar (October) in Southeast Asian countries. The exact seasonal trend in Saudi Arabia, especially in Abha, is not known. The higher or lower percent of stool testing does not coincide with the higher or lower percent of stool positivity. Therefore, to find out all agents associated with intestinal symptoms, further investigation by doing both stool microscopy and stool culture is necessary.The rate of isolation of parasites in children under 10 years old is significantly higher than those over 10. The higher rates of isolation in females than males 20 to 49 years old may be due to their physical exposure to ill children and their excreta. The low rate in the group 15 to 19 years old may be due to better personal hygiene and less exposure to child care before reaching the parental stage.Giardia is more often found in fecally contaminated water.10 In Abha, people use bottled and jar water for drinking and dug well water for washing and bathing. Although transmission through dug well water and contaminated vegetables cannot be ruled out, there is a greater possibility of transmission from person to person. Recently, zoonotic transmission has been suggested for giardiasis,10 but its possibility in Abha is remote for its low animal population and absence of beavers. From the almost uniform seasonal prevalence of both G. lamblia and E. histolytica, it appears that there are no major seasonal factors which might increase or decrease transmission in this community.During the same period (1987), Madani and associates isolated 3.5% of G. lamblia from 722 apparently healthy individuals of the same city (personal communication). Our isolation rate of G. lamblia in the primary health center patients was much higher (15.5%), and this difference is highly significant statistically (P < 0.001). It may, therefore, be inferred that, although there may be some inapparent infections like many other intestinal pathogens, G. lamblia is primarily associated with abdominal symptoms. No such difference has been observed in these two samples in the isolation rates of E.coli (6.2% vs 7.6%). In about 5% of cases, however, mixed infection was noticed.The total absence of hookworm in this population is interesting. Since the people do not walk barefooted, the endemicity is unlikely. The environment may be detrimental even for sporadic occurrence of hookworm. The low prevalence (1%) of A. lumbricoides is remarkable. In other areas of the Kingdom8 and other Arab countries,5 the rates were higher. Lack of surface water, use of latrines, and presence of dry weather may be detrimental to these parasites' existence. Selection of samples may also influence the prevalence rate. Further research is needed to determine the modes of transmission of G. lamblia among these patients living in this dry place situated at a high altitude.ARTICLE REFERENCES:1. Khan MU, Shahidullah M, Barua DK, Begum T. "Efficacy of periodic deworming in an urban slum population for parasite control" . Ind J Med Res. 1986; 83: 82–8. Google Scholar2. Elkins DB, Haswell-Elkins M, Anderson RM. "The epidemiology and control of intestinal helminths in the Pulicat Lake region of Southern India: I. Study design and pre-and post-treatment observations of Ascaris lumbricoides infection" . Trans R Soc Trop Med Hyg. 1986; 80 (5): 774–92. Google Scholar3. Baqai R, Zuberi SJ. "Prevalence of intestinal parasites in diarrhoeal patients" . J Pak Med Assoc. 1986; 36: 7–11. Google Scholar4. White FM, Pereira LH, Embil JA, Manuel FR. "Ascaris lumbricoides in Nova Scotia" . Can J Public Health. 1986; 77 (3): 201–4. Google Scholar5. Farag HF. "Intestinal parasitosis in the population of the Yemen Arab Republic" . Trop Geogr Med. 1985; 37 (1): 29–31. Google Scholar6. Khan ZA, Al-Jama AA, Madan I. "Parasitic infections among food handlers in Dammam and Al-Khobar, Saudi Arabia" . Ann Saudi Med. 1987; 7 (1): 47–50. Google Scholar7. Abdel-Hafez MA, El-Kady N, Noah MS, et al. "Parasitic infestation in expatriates in Riyadh, Saudi Arabia" . Ann Saudi Med. 1987; 7 (3): 202–6. Google Scholar8. Qadri SMH, Khalil SH. "Intestinal parasites: incidence and etiology in over 1, 000 patients at King Faisal Specialist Hospital in Riyadh" . Ann Saudi Med. 1987; 7 (3): 207–11. Google Scholar9. Willis. Manual of basic techniques for a health laboratory. Geneva: WHO, 1980;163. Google Scholar10. Bemrick WJ, Erlandsen SL. "Giardiasis: is it really a zoonosis?" Parasitol Today. 1988; 4 (3): 69–71. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byAl-Ballaa S, Al-Sekeit M, Al-Balla S, Al-Rashed R, Al-Hedaithy M and Al-Mazrou A (1993) Prevalence of Pathogenic Intestinal Parasites Among Preschool Children in Al-Medina District, Saudi Arabia, Annals of Saudi Medicine, 13:3, (259-263), Online publication date: 1-May-1993.Ibrahim O, Bener A and Shalabi A (1993) Prevalence of Intestinal Parasites among Expatriate Workers in Al-Ain, United Arab Emirates, Annals of Saudi Medicine, 13:2, (126-129), Online publication date: 1-Mar-1993. Volume 9, Issue 5September 1989 Metrics History Accepted5 November 1988Published online1 September 1989 ACKNOWLEDGMENTThe authors acknowledge the cooperation of Mr. Hussain Abdur Rahman Faya, Director of the Shamasan Primary Health Centre, for allowing them to do this study and publish the results. They thank the staff of this center for their assistance and Mr. Mike dela Paz of the College of Medicine for secretarial assistance.InformationCopyright © 1989, Annals of Saudi MedicinePDF download