Intestinal parasitic worms and the growth of children

The Prevalence of Intestinal Parasites and Their Associated Factors among Diabetes Mellitus Patients at the University of Gondar Referral Hospital, Northwest Ethiopia

BACKGROUND

Worldwide, more than one-sixth of the population is infected by intestinal parasites, of which the majority live in developing countries. On the other hand, the prevalence of diabetes mellitus has been increasing over recent decades in developing countries. Patients with diabetes mellitus encountered impaired immunity and suffer from the consequences of infection particularly intestinal parasitic infection.

OBJECTIVE

This study is aimed at assessing the prevalence of intestinal parasites and associated factors among diabetes mellitus patients at the University of Gondar Referral Hospital, Northwest Ethiopia.

METHODS AND MATERIALS

An institutional-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Referral Hospital from February 15 to March 30, 2018. A total of 234 diabetes mellitus patients were enrolled. A systematic random sampling technique was used to select study participants. Sociodemographic and clinical data were collected using a semistructured questionnaire. A 5-gram stool sample was collected to identify parasitic infection using a direct wet mount and formal-ether concentration technique. Data was entered and analyzed by using SPSS version 20. A p value of ≤0.05 was considered as statistically significant.

RESULT

In the current study, the overall prevalence of intestinal parasite infection among diabetics was 45 (19.2%). The parasites identified in this study were Ascaris lumbricoides 15 (6.41%), Entamoeba histolytica/dispar 9 (3.85%), Hookworm 9 (3.85%), Schistosoma mansoni 7 (3%), Enterobius vermicularis 3 (1.3%), and Giardia lamblia 2 (0.9%). Poor educational background (AOR = 3.62; 95% CI (1.038, 12.65); p = 0.043), poor hygiene and sanitation (AOR = 4.67; 95% CI (1.82, 12.07); p = 0.001), and inappropriate latrine usage (AOR = 5.41; 95% CI (1.43, 20.56); p = 0.013) were significantly associated with the prevalence of intestinal parasitic infection among diabetes mellitus patients.

CONCLUSION

The overall prevalence of intestinal parasitic infection among diabetes mellitus patients was relatively high. There should be continued prevention, control, and management of intestinal parasitic infection in such a study population.

Malnutrition and intestinal helminth infections in schoolchildren from Dibanda, Cameroon

Intestinal helminth infections and malnutrition constitute a major health burden in developing countries, with infants and children being the most vulnerable groups. The extent of the burden of intestinal helminth infections and malnutrition was investigated in a cross-sectional study involving 265 children aged between 4 and 14 years residing in Dibanda, a semi-rural area located in Buea, South West Region, Cameroon. The prevalence of intestinal helminth infections was determined microscopically after faecal samples were prepared by the formol-ether sedimentation concentration technique of stool analysis. Nutritional status was determined using age and the anthropometric parameters of weight and height. Standard deviation (SD) or Z scores of height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) were computed based on the World Health Organization 2006 growth reference curves. Anaemia was assessed by packed cell volume (PCV). The prevalence of intestinal helminth infection in the study population was 47.2% (125/265). All infections were of low intensity, with Ascaris recording the highest geometric mean egg count (GMEC) ± SEM of 363.51 ± 60.35 (egg count range: 76-3000 eggs/gram of stool). Overall, 42.3% of children had PCV < 31%. Also, 47.2% of those with intestinal helminth infections also had PCV < 31%. The prevalence of malnutrition was 30.2% (80/265). Of 80 malnourished children, 5.3% were wasted ( < - 2SD weight-for-height Z-score), 7.2% underweight ( < - 2SD weight-for-age Z score) and 24.2% stunted ( < - 2SD height-for-age Z score). The mean values of all the anthropometric indices were lower in helminth-infected children. Findings from this study are strongly suggestive that intestinal helminth infections and malnutrition exist in children residing in Dibanda and constitute a major health problem that needs to be addressed immediately to reduce morbidity and mortality.

Intestinal parasitic infections among children in central Albania

Although intestinal parasitic infections (IPI) among children remain a global issue, the current information on such infections in Albanian children is very limited. A cross-sectional study of the IPI in 321 children living in the Albanian counties of Tirana (152) and Elbasan (169) was therefore conducted in 2008, with a pre-tested standard questionnaire employed to gather the relevant personal and clinical data. Using formalin-ether concentration and permanent stains, stool samples were examined microscopically for the ova, cysts and oocysts of any parasites. The overall prevalence of IPI was 19% (61 of 321), with protozoan infections (11·5%) apparently more common than infections with soil-transmitted helminths (STH; 8·1%). Giardia duodenalis was the parasite most frequently detected (10·9%), followed by hookworm (5·6%), Ascaris lumbricoides (1·9%), Trichuris trichiura (0·6%), Cryptosporidium (0·3%) and Entamoeba histolytica/dispar (0·3%). The results of a univariate analysis indicated that the children from Tirana county were significantly more likely to be found infected with STH compared with the children from Elbasan county (12·5% v. 4·1%; P=0·006). Children sampled in the community were also more likely to be found STH-positive than the children sampled as they attended hospitals and health clinics (10·5% v. 6·0%) but this difference did not reach statistical significance. The children found STH-positive were five times more likely to be suffering from diarrhoea than the other children checked in clinical settings (P=0·004) and were also more likely to be suffering from abdominal pain (P=0·054) and/or diminished appetite (P=0·016).

The epidemiology of soil-transmitted helminth and protozoan infections in south-west Cameroon

A cross-sectional study of the prevalence, intensity and effects of soil-transmitted helminth and protozoan infections was undertaken among patients at the Buea Hospital Annex located in Buea sub-division of Cameroon. Stool samples from 356 subjects (174 males and 182 females) were collected and processed using standard concentration methods. Our results showed that 31.0% of subjects were infected with intestinal helminths and the prevalence was higher in females (32.4%) than in males (30.5%). A significantly higher prevalence was observed in rural (47.2%) than in urban areas (21.0%); significance < 0.1%. Prevalence was highest among those aged between 6 and 12 years (41.4%). The total prevalence of intestinal helminth infections were 19.3% for Ascaris lumbricoides, 14.0% for hookworm and 11.8% for Trichuris trichiura. The intensity of infection was unevenly distributed, with very heavy loads concentrated in a few individuals. Data also showed that 28.1% (100/356) of the subjects were infected with protozoans. Females showed a higher prevalence (28.6%; 52/182) than males (20.7%; 36/174). Also, there was a significantly higher prevalence in rural (34.0%; 49/144) than urban areas (18.4%; 39/212); significance < 0.1%. The age group 6–12 years again had a higher prevalence (37.1%; 26/70). The total prevalence of intestinal protozoans was: Entamoeba histolytica (24.4%), Entamoeba coli (11.2%) and Giardia lamblia (0.6%). These relatively heavy prevalences in patients may be reduced by appropriate medication and maintaining strict personal hygiene. Health education, clean water supply, good sewage management and a congenial environment will all help to minimize infection.

Association between geohelminth infections and physical growth in schoolchildren

OBJECTIVE: This study aims to assess the association between geohelminth infections and the physical growth of schoolchildren. METHODS: This is a cross-sectional study with the participation of 1861 children aging from 7 to 14 years who live in a municipality in the Southern region (Recôncavo) of the State of Bahia. The participants were submitted to anthropometric assessment and stool tests. Multiple logistic regression analysis was used as the statistical means to determine the association of interest. RESULTS: The risks of stunting were greater among boys with Ascaris lumbricoides (Odds ratio=1.79; confidence interval 95%: 1.07-3.01), Trichuris trichiura (Odds ratio=2.26; confidence interval 95%: 1.33-3.84) and ancylostomiasis (Odds ratio=2.18; confidence interval 95%: 1.28-3.73) when compared with non-infected children. These results remained unchanged after adjustments for the location of the school, children's ages and other geohelminth infections. CONCLUSION: These infections did not compromise girls´ growth. These results emphasize the association between geohelminth infection and linear physical growth, indicating the need to implement preventive and curative measures that allow the quality of life of the children to improve since the repercussion that these parasites have on the nutritional status and health of this population is severe.

Micronutrient supplements for children after deworming

The availability of a few inexpensive, single-dose drugs to treat soil-transmitted helminths and schistosomiasis offers the potential to reduce a considerable burden of acute disease, especially among children in sub-Saharan Africa. These treatments are being promoted as "rapid impact interventions". However, if helminth infections cause underweight, stunting, anaemia, and impaired mental development in children, how will removing worms alone lead to recovery without treating the underlying deficits that have been caused or made worse by helminth disease? Energy, protein, and micronutrients are required by children who are underweight or who have stunted growth; children who are anaemic will require iron and other micronutrients for haemopoiesis; and children who have lost education will need remedial teaching. Treating neglected worm diseases is an essential first step to good health, but anthelmintic drugs need to be integrated with simple and inexpensive nutritional interventions such as micronutrient supplements to promote recovery and have a rapid effect.

An evaluation of the impact of a school nutrition programme in Vietnam

OBJECTIVE

To evaluate the effectiveness of a school nutrition programme on the weight gain and growth of Vietnamese schoolchildren.

DESIGN

A proximate cluster evaluation of children in seven schools, in which fortified milk and biscuits supplying 300 kcal of energy were being given on school days, compared with children in 14 nearby schools with no feeding. All children were dewormed.

SETTING

Twenty-one primary schools in Dong Thap Province, Vietnam.

SUBJECTS

A cohort of 1080 children in grade 1 of 21 primary schools, and a cross-sectional interview of 400 children in grade 3.

RESULTS

The programme gave children the equivalent of 90 kcal day- 1 over 17 months. t-Tests showed a small but statistically significant difference between groups in their average gain in weight and height: 3.19 versus 2.95 kg (P < 0.001) and 8.15 versus 7.88 cm (P = 0.008). A multiple-level model showed that the programme was statistically significant after controlling for clustering of children in schools, sex, age and initial underweight (P = 0.024). A significant impact on height was also seen in a regression model, but not when controlling for school. The most undernourished children tended to gain the least weight. There was no evidence of substitution.

CONCLUSION

The programme had a small but significant effect on weight gain, but the most undernourished children benefited the least. Methods need to be developed to target them. This design may offer a means of estimating the impact of school feeding on growth in other programme settings.

Parasites of the small intestine

This paper discusses the most important parasites that inhabit the human small intestine. Beginning with the protozoa and proceeding through the various species of cestodes, nematodes, and trematodes that inhabit the human small bowel, the most important organisms are presented. Possible future developments are discussed along with pathophysiology and treatment in this phylogenic approach. Zoonotic illnesses, those diseases that by their rarity are of little import, and diseases without significant clinical or social implications are beyond the scope of this article and are not discussed.

Parasites of the small intestine

This paper discusses the most important parasites that inhabit the human small intestine. Beginning with the protozoa and proceeding through the various species of cestodes, nematodes, and trematodes that inhabit the human small bowel, the most important organisms are presented. Possible future developments are discussed along with pathophysiology and treatment in this phylogenic approach. Zoonotic illnesses, those diseases that by their rarity are of little import, and diseases without significant clinical or social implications are beyond the scope of this article and are not discussed.

Diarréia por parasitas

A diarréia é uma causa importante de morbimortalidade nos países em desenvolvimento. Os agentes etiológicos mais comuns são os vírus e as bactérias. Este artigo tem o objetivo de analisar a ocorrência de diarréia como manifestação clínica de parasitose. Discute-se quais os protozoários e os helmintos que podem causar diarréia, as bases científicas atuais que explicam os mecanismos fisiopatológicos que desencadeiam a diarréia, bem como os exames complementares e o tratamento adequado para cada parasita implicado.

Relationship between protein-energy malnutrition, vitamin A, and parasitoses in living in Brasília

It is still controversial whether intestinal parasitic infections can influence the nutritional status of children. The relationship between protein-energy malnutrition, vitamin A and parasitic infections was evaluated in 124 children. The food intake estimated by recall method was generally low and poor. Seventy five percent of the children were infected with intestinal parasites. The mean+/-SD weight-for-age and height-for-age Z-score were skewed one standard deviation to the left, when compared to normal standards. An association was found between protein-energy malnutrition and Giardia lamblia, but not with Ascaris lumbricoides or Hymenolepis nana infection. Only Giardia-infected children had a decreased weight-for-age and weight-for-height Z-score. Hypovitaminosis A was a major nutritional problem, but no relationship between this deficiency and parasitic infection was found. Our data indicate that low and poor food intake were the major cause of protein-energy malnutrition among the children, and except for Giardia, this was not influenced by parasitic infections.

A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children

Single interventions for helminthic infections and micronutrient deficiencies are effective, but it is not clear whether combined interventions will provide equal, additive or synergistic effects to improve children's health. The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children. A double-blind, randomized, placebo-controlled trial in 11 rural South African primary school randomly allocated 579 children aged between 8 and 10 years into six study groups, half of whom received antihelminthic treatment at baseline. The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits, either unfortified or fortified with vitamin A and iron or with vitamin A only, given daily for 16 weeks. The outcome measures were anthropometric, micronutrient and parasite status, and scholastic and cognitive test scores. There was a significant treatment effect of vitamin A on serum retinol (p < 0.01), and the suggestion of an additive effect between vitamin A fortification and de-worming. Fortified biscuits improved micronutrient status in rural primary school children; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection. The burden of micronutrient deficiency (anaemia, iron and vitamin A) and stunting in this study population was low and, coupled with the restricted duration of the intervention (16 weeks), might have limited the impact of the interventions.

Anthelmintic treatment of rural Bangladeshi children: effect on host physiology, growth, and biochemical status

BACKGROUND

The effect of helminth infestation on the nutrition, growth, and physiology of the host is still poorly understood. Anthelmintic treatment of children in developing countries has had varying success in terms of growth improvements.

OBJECTIVE

The objective of this study was to assess the effect of regular deworming on child growth, physiology, and biochemical status.

DESIGN

The study was a 12-mo longitudinal intervention in 123 Bangladeshi children aged 2-5 y. Treatment (mebendazole) or placebo tablets were administered every 2 mo for 8 mo and again at 12 mo. Weight, height, midupper arm circumference, intestinal permeability, plasma albumin, alpha(1)-antichymotrypsin, and total protein concentration were assessed every 2 mo.

RESULTS

Treatment with mebendazole reduced the prevalence of Ascaris lumbricoides from 78% to 8%, of Trichuris trichiura from 65% to 9%, and of hookworm from 4% to 0%. There was no significant difference in the growth of treated children compared with those given placebo tablets. No changes in intestinal permeability or plasma albumin were observed after deworming. Significant decreases in total protein (P<0.001) and alpha(1)-antichymotrypsin (P<0.001) were observed in the treatment group, indicating possible reductions in inflammation and immunoglobulin concentration after deworming. A significant increase in the prevalence of Giardia intestinalis (from 4% to 49%) in the treatment group was associated with a short-term reduction in weight (P = 0.02) and higher intestinal permeability (P <0.001) in infected subjects. No long-term effects of G. intestinalis on growth were observed.

CONCLUSION

Low-intensity helminth infections, predominantly of A. lumbricoides and T. trichiura, do not contribute significantly to the poor growth and biochemical status of rural Bangladeshi children.

Ascaris-Trichuris association and malnutrition in Brazilian children

This work was designed to evaluate the role of intestinal parasites on nutritional status in three rural areas of Brazil. A total of 520 children aged 1-12 years were studied through a questionnaire concerning housing, socio-economic conditions and a 24-h food intake recall. Measurements of weight and height were also performed, and three stool samples were collected on consecutive days for parasitological analysis. Scores of the standard deviation (z-scores) for the weight-for-height and height-for-age were used to characterise the growth profile. A high prevalence of intestinal parasites was detected, with Giardia lamblia (44%), Endolimax nana (43%), Ascaris lumbricoides (41%) and Trichuris trichiura (40%) being the most prevalent. Eleven per cent of the children were classified as showing stunting. Inadequate daily caloric intake was observed in 78% of the population and the proportion of those with inadequate protein intake was 34%. Logistic regression analysis was employed for the multivariate study. Stunting was significantly associated with estimators of low economic income, inadequate protein intake and polyparasitism, especially the association between Ascaris lumbricoides and Trichuris trichiura.

Relationships between soil-transmitted helminthiases and growth in urban slum schoolchildren in Ujung Pandang, Indonesia

This study examined the relationship between intestinal helminthiases and growth in urban slum schoolchildren. Children (n = 330) who received single doses of either pyrantel, albendazole, or placebo at baseline and again at 6 months were followed and examined fully at 0, 3, 6, and 12 months for helminth infections and anthropometry. Results of treatments indicated that all groups reduced their prevalence and intensity toward the period of the study. Reductions in intensity of both infections in the treatment groups were observed large in 3 and 12 months, whereas at 6 months reached mostly the initial level of infection. There was no significant difference in growth changes between the dewormed (once and twice) and the placebo groups. However, after controlling for some potential confounding factors, there was a significant relationship between reduction of A. lumbricoides infection and height gain at 3 and 12 months (both P < 0.05). In addition, there was a significant association between reduction in T. trichiura infection and increased midarm circumference at 3 and 12 months (P < 0.002 and P < 0.08, respectively). We conclude that treatment of helminth infections in school-age children may improve growth in areas where malnutrition and helminth infections are prevalent.

A healthy body and a healthy mind?: the relationship between ill-health and cognitive function in school-age children

Health of school age children and the Partnership for Child Development

Until recently, health programmes in developing countries have focused on infant survival and on the health of adolescents and, consequently, the health concerns of children of school age, falling between the ages of infancy and adolescence, have been neglected. The World Bank Development Report of 1993, stated a need to move beyond the focus on survival and to capture the concept that community health depends on the quality of life and opportunities for development. In response, the Partnership for Child Development was set up in 1992 to address the problem of ill-health among school-age children in the developing world.

Parasitic infection in malnourished school children: effects on behaviour and EEG

This paper describes a study of 194 children (aged 9-13) from a mountain village in Ecuador who were infected with one or more species of intestinal helminth or protozoan parasite. In addition to parasite load, the assessment consisted of a battery of psychological and neuropsychological tests, an EEG examination, measures of iodine level, presence of goitre and level of nutrition. We found that, in general, parasite infection, as measured at the baseline level, was not associated with cognitive impairment. The intensity of infection with A. lumbricoides, however, was correlated with the level of verbal ability and with inhibition-control aspects of cognitive behaviour. Multivariate analysis with level of nutrition, EEG status and parasite burden showed a consistent main effect of the degree of nutrition on neuropsychological performance, particularly the language, problem solving and inhibition-control dimensions.

Perceptions and treatment of intestinal worms in rural Bangladesh: local differences in knowledge and behaviour

A survey was conducted on 131 mothers in rural Bangladesh to examine knowledge and perceptions of helminth infection in relation to use of health facilities and treatment-seeking behaviour. Almost all respondents considered worms to be a cause of bad health and a high percentage of mothers had obtained deworming treatment for their children. However, marked differences were found in mothers' descriptions of the causes and prevention of helminth infection in two adjacent areas; Pullakandi and Shekpara. The discrepancies in biomedical knowledge corresponded with differences in treatment-seeking behaviour in the two areas. All households in the area had access to free deworming treatment provided by a health clinic, but this facility was predominantly used by women living nearby in Pullakandi. Because of the cultural and social constraints on female activities, women living further from the clinic, in Shekpara, preferred to send their husbands to a pharmacy in the nearby town to buy deworming treatment. As a consequence, these households were at a relative disadvantage in respect of the low exposure of women to health education and the greater financial cost of deworming treatment. The study highlights the influences of social and cultural factors on treatment-seeking behaviour, which in turn affect women's exposure to health education and biomedical knowledge of helminths. Further questions are raised, however, on the ability of women to implement preventive measures and the impact of health education on rates of parasitic infection.

An 18-month study of the effect of periodic anthelminthic treatment on the growth and nutritional status of pre-school children in Bangladesh

An 18-month study was conducted from February 1989 to August 1990 to examine the effect of regular deworming on child growth and nutritional status. A sample of 1402 children, from 2 to 6 years old, were divided into a treatment group and a control group. The 688 children in the treatment group received a 500 mg single dose of mebendazole, while the 714 children in the control group were given a placebo. Height, weight and mid-upper arm circumference (MUAC) were measured on monthly household visits. Growth was measured in terms of the change in height-for-age, weight-for-age, weight-for-height and MUAC over 18 months. The initial prevalence of infection was estimated from a random sample of 96 children (49 treated, 47 control). The initial overall prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm was 71, 44 and 10% respectively. The final prevalence of infection, estimated from a random sample of 265 children, was A. lumbricoides 6%, T. trichiura 6% and hookworm 2% in the mebendazole group compared with 64, 18 and 19% respectively in the placebo group. Despite the successful treatment of helminths, there was no significant improvement in the growth of treated children compared with their untreated counterparts in terms of the change in z-scores of height-for-age, weight-for-age, weight-for-height and MUAC. The factors which may have contributed to this outcome are discussed.