The occurrence of helminths and coccidia in zebu calves among pastoralists in Isiolo County Kenya

In Kenya, helminthosis and coccidia infections in cattle, are the second highest cause of death in zebu calves up to 12 months old, estimated at 12% mortality rate. The aim of our study was to investigate the factors associated with helminth and coccidia infection among zebu beef calves in Isiolo County Kenya. A cross-sectional study was conducted between November and December on 2020 in Isiolo North and South Constituencies. Garbatulla and Burat wards in Isiolo North and Kinna in Isiolo South were purposively selected due to high number of large cattle herds compared to other areas. A total of 411 calves from 34 herds aged between 3 weeks and 12 months were randomly selected for the study. Calf level and management and environmental data were collected through semi-structured questionnaires, observations and physically. Faecal samples were obtained from the rectum or immediately after defaecation for laboratory analysis located in Kinna Ward in Isiolo South Constituency. In the laboratory, faecal egg counts were estimated using the McMaster faecal floatation technique. Descriptive, univariate and multivariable logistic regression analyses were carried out with outcome as parasites eggs or oocysts per gram of faecal sample. The factors associated with coccidia infections in the final multivariable logistic regression analysis for coccidia were: Location (Constituencies), availability of drinking water, lush pasture, floor condition, availability of extension services and herd size. In the multivariable logistic regression final model for strongyle infection, age of the calf, herd size, co-infestation with other parasites, and availability of extension services were significant. The results of this study indicated that prevalence of helminth and coccidia infections in calves is high and the calf, environmental and management factors were associated with such infections.

To identify demographic, behavioural and environmental determinants of intestinal parasitic infection, evaluate the impact of a variety of dry sanitation systems on intestinal parasitic infection, and evaluate the safety of using stored biosolids in agriculture in order to guide future sanitation interventions in rural areas of El Salvador. Interviews were conducted with 109 households in eight communities where double-vaulted and solar urine-diverting desiccating latrines, pit latrines or no latrines were used. Faecal samples from 499 individuals were tested for enteric helminths and protozoa. Users of solar desiccating latrines had the lowest prevalence of enteric parasite infection. Double-vault, urine-diverting desiccating latrines effectively reduced the transmission of some pathogens, but may not achieve the conditions sufficient for the complete destruction of the more environmentally persistent pathogens, Ascaris lumbricoides and Trichuris trichiura. Contact with inadequately treated latrine biosolids was associated with an increased risk of Ascaris infection. Solar latrines were associated with the overall lowest prevalence of enteric parasitic infections. Members of households where latrine biosolids were used in agriculture had a higher prevalence of infection than those where biosolids were buried. We therefore recommend the promotion of solar latrines in rural areas of El Salvador over other dry sanitation systems, and recommend that stored biosolids not be used in agriculture.

Aim:Gastrointestinal (GI) helminth parasitism is one of the major constraints for profitable sheep production. Due to variations in the prevalence of GI helminths from region to region, it becomes important to map out accurately the parasitic fauna of a particular region for development of suitable control measures.Materials and Methods:An extensive study of GI helminths was carried out in Budgam district of Kashmir Valley over a period of 1 year. A total of 1200 fresh ovine faecal samples from both sexes of young ones and adults were collected in sterilized plastic bags and examined by standard sedimentation and floatation techniques. Positive faecal samples (15-20%) in each season were examined by Stoll’s dilution method to determine the parasitic load. A total of 120 faecal samples (30 samples in each season) positive for strongyle eggs were subjected to coproculture using Petridish method and the third stage larvae were harvested to find out prevalence of different genera of strongyle worms.Results:The overall prevalence of GI helminths was found to be 77% with platyhelminths and nemathelminthes in 26.58 and 60.92% animals, respectively. The overall prevalence of mixed GI helminths was found to be 8.67%. Eggs of various helminths encountered in the present study were those of Fasciola spp. (3.58%), Dicrocoelium spp. (11.58%), paramphistomes (4.83%), Moniezia spp. (7.92%), strongyle worms including Nematodirus spp. (57.75%), Strongyloides spp. (1.67%), and Trichuris spp. (1.5%). On coprocultural examination Haemonchus spp. (55%) was found to be most predominant strongyle worm followed by Trichostrongylus spp. (17.5%), Ostertagia spp. (11.67%), Oesophagostomum spp. (9.17%), and Chabertia spp. (6.67%). On seasonal basis, highest prevalence of GI helminths was recorded in summer (83.00%) followed by spring (78.67%), winter (76.33%), and autumn (70.00%), the difference being statistically non-significant (p>0.05). The prevalence of platyhelminths (Fasciola spp., Dicrocoelium spp. and Moniezia spp.) was found to be non-significantly higher in winter, but paramphistomes showed the highest prevalence in the summer season. Nemathelminth infection was found highest in summer season and lowest during the winter season. Eggs per gram (EPG) ranged from 0 to 1800, and an average EPG count was found to be 454.35±27.85. EPG was found to be highest in summer (684.00±69.83) and lowest in winter (202.38±18.82). The overall prevalence of GI helminths was found more in adult sheep (83.00%) compared to young ones (53.11%), the difference being statistically significant (p<0.05). Similarly, the prevalence of helminths was found to be higher in females (78.32%) as compared to males (72.97%), the variation being statistically non-significant (p>0.05).Conclusion:Seasonal variation plays an important role in the prevalence of GI helminths in addition to age and sex of the animal.

BackgroundHelminth and coccidian infections are among potential parasitic infections in the livestock production. The present study aimed to determine the prevalence and intensity of gastrointestinal helminths as well as Eimeia species in domestic goats.ResultsThe overall prevalence of parasitic infections was 50.24% (206/410). Twenty two species of helminth eggs/Eimeria spp. oocysts were revealed. The prevalence of helminths was 21.95% (90/410) and that of Eimeria spp. was 39.27% (161/410). Mixed infection was reported in 10.98% (45/410). The highest prevalence was found in young animals (75.0%; 60/80) followed by yearlings (58.46%; 76/130) and the lowest one was in adults (35.0%; 70/200). The infection rate was higher in females (59.02%; 180/305) than males (24.76%; 26/105). The prevalence was mostly highest in summer (63.85%; 83/130) followed by winter (57.78%; 52/90), autumn (40.0%; 28/70) and the lowest one was in spring (35.83%; 43/120). Age, sex and seasonal variations revealed significant (P ≤ 0.05) differences among examined goats. The infection with both nematodes and Eimeria spp. were detected in 7.32% (30/410). The co-infection with Eimeria spp. and tapeworms were found in 2.93% (12/410). Both trematodes and Eimeria spp. were seen in 0.73% (3/410) of examined specimens. Nine Eimeria species were recorded; Eimeria ninakohlyakim-ovae, E. hirci, E. caprinova, E. caprina, E. christenseni, E. jolchijevi, E. arloingi, E. apsheronica and E. alijevi. The most predominant Eimeria species was E. arloingi (23.17%; 95/410) and the least abundant one was E. apsheronica (0.73%; 3/410). The revealed trematodes were Fasciola spp. (0.49%) and Paramphistomum spp. (0.24%). Among cestodes, tapeworms belonged to Anoplocephalids included Moniezia spp. (7.31%) and Avitellina sp. (0.49%) were detected. Meanwhile, coproculture revealed that the prevalence of nematodes infection was 13.41% (55/410) including nine species; Chabertia ovina, Ostertagia ostertagi, Haemonchus contortus, Trichostrongylus axei, T. colubriformis, Bunostomum sp., Cooperia oncophora, Cooperia curticei and Strongyloides spp.ConclusionIn the present study, the prevalence of helminths was 21.95% and that of Eimeria spp. was 39.27%, which is considered a high infection rate. Accordingly Strict hygienic measures as well as regular deworming are highly recommended to avoid wide spread of both helminth and coccidial infections.

A survey of gastrointestinal parasite infections of young (< 6 months old), immature (6-12 months old) and adult (> 12 months old) dairy cattle on 16 farms in Kiambu District, Kenya was conducted during a dry season (September 1991 to January 1992) and during a wet season (March to July 1992). The survey was based on monthly coproparasitological examination of cohorts and worm counts in tracer calves. The effects of age, sex, farm and season on the prevalence and intensity of helminth and coccidial infections were determined. Faecal egg and oocyst counts revealed that the overall prevalences were: strongyles (including trichostrongyles) (85.5%), liver flukes (Fasciola gigantica) (34.0%), coccidia (30.9%) and tapeworms (9.6%). Eight species of the protozoan Eimeria were identified, the most prevalent species being E. bovis and E. zuernii. The most prevalent nematode genera were Haemonchus, Cooperia, Oesophagostomum and Trichostrongylus. Season, farm and age of the animals had a significant (p<0.05) influence on the intensity of infection with strongyles, liver flukes and coccidia, whereas the sex of the animals had no significant (p>0.05) effect on the prevalence or intensity of infections. A higher intensity of infection with strongyles and coccidia was found in the wet season than in the dry season (p<0.05). The age-specific intensity was in the following order: for strongyles, immature animals of 6-12 months of age had the highest egg counts, followed by young calves and adults. Calves had significantly (p<0.05) higher oocyst counts than immatures or adults. Liver fluke egg counts did not differ significant (p>0.05) between immatures and adult cattle.

Intestinal parasitic infections remains a public health problem in rural areas of low-income and middle-income settings of tropical and subtropical zones however epidemiological evidence is scarce in urban areas. This study aimed to assess the extent of intestinal helminths and protozoa infections among residents of Douala city in Cameroon, and to identify risk factors of their transmission. A community-based cross-sectional study was carried out in 2013 on 428 residents from two quarters of Douala city by microscopic examination of a stool sample from each participant simultaneously as fresh wet mounts, Kato-Katz thick smear and smear from formol-ether concentration technique. All participants from the selected quarters were invited to provide a stool sample, and interviewed about demographic and socioeconomic characteristics, sanitary situation, hygiene behaviors, antihelminthic chemotherapy. The overall prevalence of intestinal helminths and protozoa infection was 15,2%. The infection rate was significantly different between quarters (p=0.003). Dwellers harbored helminths, protozoa or both infections. The prevalence of pathogenic intestinal protozoa, namely E.histolytica/E.dispar and G.intestinalis was 8.9% and 0.7% respectively. The prevalence of the non pathogenic protozoa E.coli was 1,6%. Prevalences of helminth namely A.lumbricoides, T.trichiura, S.stercoralis, H.nana and S.mansoni were below 5%. Polyparasitic infections occurred in 2.1% of the participants. The prevalence of intestinal parasites carriage were influenced by age, educational level, dwelling area, household clustering for all parasitic infections taken together, poor sanitation and hygiene behaviors. Intestinal helminth and protozoa infections were hypoendemic in Douala urban area. Amoebiasis, giardiasis, ascaridiasis, trichuriasis, strongyloidiasis hymenolepiasis, and mansoni schistosomiasis were the main infections identified mostly at low prevalent rates. All helminth infections recorded were of low intensity. Provision of health education, improving personal hygiene, potable drinking water supply as well as school based deworming should be the major focus area of all institutions in Douala.

BackgroundStudies have shown that households using sludge from human excreta for agriculture are at an increased risk of soil transmitted helminths. However, while use of ecological sanitation (EcoSan) latrines is increasing in most African countries including Malawi, few studies have been done to check whether use of such sludge could potentially increase the prevalence of helminthic infections among household members as a results of exposure to faecal sludge/compared to use of traditional latrines.MethodsA cross sectional study was done targeting households using EcoSan and traditional pit latrines. Samples were collected from both types of latrines in Chikwawa (rural) and Blantyre (urban) districts. These two districts have a high number of EcoSan latrines in southern region of Malawi. 156 latrines were sampled (n = 95 traditional; n = 61 EcoSan), and processed following standard guidelines using modified triple floatation method. Identification of helminth ova (Ascaris lumbricoides, hookworms, Trichuris trichiura, Taenia spp. and Diphyllobothrium latum) was done using standard microscopy methods. The difference between the prevalence and mean concentration of helminths between the two types of latrines was tested using Chi Square and t test respectively.ResultsOf the total latrines tested, 85.9% (n = 134) had at least one species of helminth while 84.6% (n = 132) had at least a STH, with 82.0% (n = 50) in EcoSan and 86.3% (n = 82) in traditional pit latrines. There was no significant difference between the prevalence of helminths in EcoSan and traditional pit latrines [χ2 = 0.43 (1), P = 0.5]. The prevalence of Ascaris lumbricoides was significantly higher in EcoSan than in traditional pit latrines [χ2 = 5.44 (1) p = 0.02] while prevalence of hookworms was significantly higher in traditional pit latrines than in EcoSan latrines [χ2 = 13.98 (1) p < 0.001]. The highest concentration of helminths per gram of faecal sludge was in traditional pit latrines [31.2 (95% CI 19.1–43.2)] than in EcoSan latrines [26.4 (95% CI 16.5–36.3)].ConclusionThere was no significant difference between overall prevalence of helminths between households using EcoSan and those using traditional pit latrines. However, Ascaris lumbricoides was significantly higher in households using EcoSan latrines. EcoSan users need awareness on safe ways of handling faecal sludge in order to reduce chances of reinfection from Ascaris lumbricoides. Further research should be undertaken on household members to identify those infected and potential routes of infection to enable preventive targeting.

BackgroundProtozoa and helminths cause significant morbidity and mortality, particularly in tropical and subtropical regions where an accurate understanding of their epidemiological profile is needed to improve their control. In Gabon, a country endemic for a diverse range of both helminths and protozoa, epidemiological data for protozoa are lacking, whereas updated data for helminths are needed. This study aimed to describe the distribution of helminth and protozoan infections in the Moyen-Ogooué province of Gabon.MethodsThis cross-sectional study included individuals aged one year and older living in the study areas for at least one year. The participants were selected via a stratified sampling procedure. Blood, urine, and stool samples, along with sociodemographic data, were collected. Soil-transmitted helminths (STHs) were diagnosed using the Kato-Katz, coproculture and Harada-Mori techniques. Urogenital schistosomiasis was diagnosed using the urine filtration technique. Intestinal protozoa were diagnosed using the mercurothiolate-iodine-formol technique. Plasmodium spp. and filarial infections were diagnosed by thick blood smear microscopy, and, in addition for filaria, by leucoconcentration technique.ResultsA total of 1,084 participants were included, with a mean age of 31.6 years (SD: 23.6) and a female-to-male sex ratio of 1.15. The overall prevalence of helminth infections was 36% (95%IC: 33–39), with STHs being most common (21%; 95%CI: 18–23), followed by schistosomiasis (11%; 95%CI: 8 – 13) and filariasis (9%; 95%CI: 7–10). The most prevalent STH species were Trichuris trichiura (11%; 95%CI: 10–14), followed by hookworm (9%; 95%CI: 8–11). The prevalence of Plasmodium spp. was 13% (95%CI: 11–15), and the overall prevalence of intestinal protozoa was 28% (95%CI: 25–31), with Blastocystis hominis (11%; 95%CI: 9–13) and Entamoeba coli (8%; 95%CI: 7–10) being the most common intestinal protozoan species. Coinfections with multiple parasite species were observed in 42% of the infected participants, predominantly involving T. trichiura, Schistosoma haematobium, and Plasmodium spp. infection prevalence varied with age, gender, location, and occupation.ConclusionThis study reveals a moderate prevalence of helminths and protozoa in our community, with age, gender, and location playing a significant role in their distribution, as do common coinfections between helminths and protozoa. These findings call for further research to provide valuable insights for controlling helminth transmission in the region.

Protozoa and helminths cause significant morbidity and mortality, particularly in tropical and subtropical regions where an accurate understanding of their epidemiological profile is needed to improve their control. In Gabon, a country endemic for a diverse range of both helminths and protozoa, epidemiological data for protozoa are lacking, whereas updated data for helminths are needed. This study aimed to describe the distribution of helminth and protozoan infections in the Moyen-Ogooué province of Gabon. This cross-sectional study included individuals aged one year and older living in the study areas for at least one year. The participants were selected via a stratified sampling procedure. Blood, urine, and stool samples, along with sociodemographic data, were collected. Soil-transmitted helminths (STHs) were diagnosed using the Kato-Katz, coproculture and Harada-Mori techniques. Urogenital schistosomiasis was diagnosed using the urine filtration technique. Intestinal protozoa were diagnosed using the mercurothiolate-iodine-formol technique. Plasmodium spp. and filarial infections were diagnosed by thick blood smear microscopy, and, in addition for filaria, by leucoconcentration technique. A total of 1,084 participants were included, with a mean age of 31.6 years (SD: 23.6) and a female-to-male sex ratio of 1.15. The overall prevalence of helminth infections was 36% (95%IC: 33-39), with STHs being most common (21%; 95%CI: 18-23), followed by schistosomiasis (11%; 95%CI: 8 - 13) and filariasis (9%; 95%CI: 7-10). The most prevalent STH species were Trichuris trichiura (11%; 95%CI: 10-14), followed by hookworm (9%; 95%CI: 8-11). The prevalence of Plasmodium spp. was 13% (95%CI: 11-15), and the overall prevalence of intestinal protozoa was 28% (95%CI: 25-31), with Blastocystis hominis (11%; 95%CI: 9-13) and Entamoeba coli (8%; 95%CI: 7-10) being the most common intestinal protozoan species. Coinfections with multiple parasite species were observed in 42% of the infected participants, predominantly involving T. trichiura, Schistosoma haematobium, and Plasmodium spp. infection prevalence varied with age, gender, location, and occupation. This study reveals a moderate prevalence of helminths and protozoa in our community, with age, gender, and location playing a significant role in their distribution, as do common coinfections between helminths and protozoa. These findings call for further research to provide valuable insights for controlling helminth transmission in the region.

ObjectiveThe purpose of this study was to determine the prevalence of intestinal parasitic infections among patients who had attended Hawassa University students’ clinic, Southern Ethiopia.ResultOver the 10 years period, a total of 13,679 patients visiting Hawassa University students’ clinic were included in the study. A total of 6553 (47.9%) patients were positive for at least one intestinal parasite. The overall prevalence of intestinal helminth and protozoan infections was 20.3% and 27.6% respectively. There were four dual infections and one triple infection. E. histolytica/E. dispar trophozoite was the most common identified parasite, which was seen in 18% of the patients while Enterobius vermicularis (0.1%) was the least reported parasite. Other parasites identified were Ascaris lumbricoides (15.0%), Hookworm species (2.0%), Taenia species (1.8%), Hymenolepis nana (0.7%), Strongyloides stercoralis (0.3%), Trichuris trichuria (0.2%), and Shistosoma mansoni (0.2%). The prevalence of helminthes was higher in females (23.3%) than in males (19.5%) (P < 0.00001) while that of protozoan infections was 28.5% in males than females (23.8%) (574/2414) (P < 0.00001).

Although the prevalence of helminths infection among schoolchildren is known, there has been little progress in the application of count model for modelling the risk factors of helminths egg. Only a few studies applied multilevel analysis to explore the variation in helminths prevalence across schools and classes. This study aimed to assess the prevalence, intensity of helminths infection, and identify risk factors at the individual-, household-, and school-level among schoolchildren in Southern Ethiopia. Using multistage random sampling, we recruited 864 students in the Wonago District. We applied multilevel-logistic and zero-inflated negative binomial regression models (ZINB). Risk factors were concentrated at the individual level; school-level and class-level variables explained less than 5% of the variance. The overall helminths prevalence was 56% (479/850); Trichuris trichiura prevalence was 42.4% (360/850); and Ascaris lumbricoides prevalence was 18.7% (159/850). The rate of any helminths increased among thin children (AOR: 1.73 [95% CI: (1.04, 2.90]), anemic (AOR: 1.45 [95% CI: 1.04, 2.03]), mothers who had no formal education (AOR: 2.08 [95% CI: 1.25, 3.47]), and those in households using open containers for water storage (AOR: 2.06 [95% CI: 1.07, 3.99]). In the ZINB model, A. lumbricoides infection intensity increased with increasing age (AOR: 1.08 [95% CI: 1.01, 1.16]) and unclean fingernails (AOR: 1.47 [95% CI: 1.07, 2.03]). Handwashing with soap (AOR: 0.68 [95% CI: 0.48, 0.95]), de-worming treatment [AOR: 0.57 (95% CI: 0.33, 0.98)], and using water from protected sources [AOR: 0.46 (95% CI: 0.28, 0.77)] were found to be protective against helminths infection. After controlling for clustering effects at the school and class levels and accounting for excess zeros in fecal egg counts, we found an association between helminths infection and the following variables: age, thinness, anemia, unclean fingernails, handwashing, de-worming treatment, mother’s education, household water source, and water storage protection. Improving hygiene behavior, providing safe water at school and home, and strengthening de-worming programs is required to improve the health of schoolchildren in rural Gedeo.

A total of 632 faecal samples of goats of Jabalpur district of Madhya Pradesh state were examined during three years of the study period (November 2012-October 2015), out of which 82.75% sampleswere positive for helminthic infections. Among various helminths, maximum prevalence was of strongyles (32.59%) followed by amphistomes (14.40%), Moniezia spp. (12.50%), Strongyloides spp. (0.79%), Trichuris spp. (0.47%) and Fasciolagigantica (0.32%). Year wise prevalence revealed a highly significant (p<0.01) decrease in prevalence of helminths. Except Trichuris and Moniezia spp., the effect of year was significant for prevalence of all other gastro-intestinal helminths observed during the study. Significantly higher (p<0.05) helminth infections were observed in monsoon (87.97%) as compared tothat of winter (81.48%) or summer (79.03%) season. The seasonal difference in prevalence was found significant for strongyles, Strongyloides spp., amphistomes and Moniezia spp. There was no significant variation in Trichuris spp. and Fasciola gigantica infections in relation to season. Age wise prevalence of helminths was non-significantly higher in kids (83.13%) than in adults (82.62%). Except Moniezia spp., age wise observations did not reveal any significant difference (p>0.05) in prevalence of other gastrointestinal helminths.

HIV and helminths: time for a new direction

The prevalence of helminths in pigs was investigated in five rural communities situated on the embankment of Dongting Lake in Zhiyang County, Hunan Province, People's Republic of China, in an area known to be endemic for Schistosoma japonicum. The helminth prevalences identified on the basis of faecal egg count analysis were: Oesophagostomum spp. (86.7%), Ascaris suum (36.7%), Metastrongylus spp. (25.8%), Strongyloides spp. (25.8%), Trichuris suis (15.8%), Globocephalus spp. (6.7%), Gnathostoma spp. (4.2%), Schistosoma japonicum (5.0%) and Fasciola spp. (1.3%). Post mortem examinations of a small number of pigs depositing eggs of different helminth species revealed the presence of Oesophagostomum dentatum, O. quadrispinulatum, A. suum, Metastrongylus apri, M. pudendotectus, T. suis, G. hispidum and Ascarops dentata. Prevalences of all helminths, with the exception of Oesophagostomum spp., were higher in young pigs (< 8 months old) compared with adult pigs. Prevalences of trematodes were very low, especially for S. japonicum which had decreased dramatically compared with previous reports from this area of P.R. China, whereas prevalences of nematodes were generally in agreement with those reported from other Yangtze River Provinces. Results from helminth prevalence studies in pigs, conducted in other provinces of P.R. China between 1987 and 1997, are presented and discussed. It was concluded that a government helminth control programme, implemented in 1995 to control S. japonicum infection in pigs in Hunan Province, may have resulted in a greatly reduced prevalence of S. japonicum in pigs in this region.

The prevalence of helminths in pigs was investigated in five rural communities situated on the embankment of Dongting Lake in Zhiyang County, Hunan Province, People's Republic of China, in an area known to be endemic for Schistosoma japonicum. The helminth prevalences identified on the basis of faecal egg count analysis were: Oesophagostomum spp. (86.7%), Ascaris suum (36.7%), Metastrongylus spp. (25.8%), Strongyloides spp. (25.8%), Trichuris suis (15.8%), Globocephalus spp. (6.7%), Gnathostoma spp. (4.2%), Schistosoma japonicum (5.0%) and Fasciola spp. (1.3%). Post mortem examinations of a small number of pigs depositing eggs of different helminth species revealed the presence of Oesophagostomum dentatum, O. quadrispinulatum, A. suum, Metastrongylus apri, M. pudendotectus, T. suis, G. hispidum and Ascarops dentata. Prevalences of all helminths, with the exception of Oesophagostomum spp., were higher in young pigs (&lt; 8 months old) compared with adult pigs. Prevalences of trematodes were very low, especially for S. japonicum which had decreased dramatically compared with previous reports from this area of P.R. China, whereas prevalences of nematodes were generally in agreement with those reported from other Yangtze River Provinces. Results from helminth prevalence studies in pigs, conducted in other provinces of P.R. China between 1987 and 1997, are presented and discussed. It was concluded that a government helminth control programme, implemented in 1995 to control S. japonicum infection in pigs in Hunan Province, may have resulted in a greatly reduced prevalence of S. japonicum in pigs in this region.