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Intestinal parasitic infection-intensity, prevalence and associated risk factors, a study in the general population from the Uttarakhand hills

Authors:
  • Karwar Institute of Medical Sciences, Karwar
  • V.C.S.G.G.M.C.& R.I., srinagar, uttarakhand
  • Government Doon Medical College

Abstract and Figures

Background: Intestinal parasitic infection is an important public health problem in developing countries. Low socioeconomic conditions, lack of access to potable drinking water, poor personal hygiene and environmental sanitation are the factors associated with intestinal parasitic infection. Aim: The aim of this study was to estimate the prevalence of intestinal parasitic infections and identify the associated risk factors. Materials and Methods: Study was performed on 327 stool specimens of all age groups from August 2012 to May 2013. Specimen collected and examined with direct wet mount, formal ether sedimentation and salt fl otation methods. Results: Out of the total 327 participants prevalence of intestinal infections was 11.62%. Among the Protozoa, Giardia lamblia (3.06%) was the most common, followed by Entamoeba histolytica (0.92%). Hookworm (2.75%) and Hymenolepis nana (2.14%) were the most common helminthes found. Parasitosis was seen more in female (17.07%) than male (8.33%) and highest between 51 and 60 years (22.22%) age group with risk factors like open defecation (22.69%), untreated river water (17.91%) and among people living in rural areas (15.17%). Conclusion: There is a need to create awareness about safe drinking water, personal hygiene and environmental sanitation and to take urgent remedial steps to prevent and control intestinal parasitic infections.
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422
International Journal of Medicine and Public Health | Oct-Dec 2014 | Vol 4 | Issue 4
Swapna Kotian,
Munesh Sharma,
Deepak Juyal,
Neelam Sharma
Department of Microbiology
and Immunology, Veer Chandra
Singh Garhwali Government
Medical Sciences and Research
Institute, Srinagar Garhwal,
Uttarakhand, India
Address for the Correspondence:
Ms. Swapna Kotian,
Department of Microbiology
and Immunology, Veer Chandra
Singh Garhwali Government
Medical Sciences and Research
Institute,
Srinagar Garhwal - 246 174,
Uttarakhand, India.
E-mail: kotian.swapna@gmail.com
Intestinal parasitic infection-intensity,
prevalence and associated risk factors,
a study in the general population from
the Uttarakhand hills
Background: Intestinal parasitic infection is an important public health problem in
developing countries. Low socioeconomic conditions, lack of access to potable drinking
water, poor personal hygiene and environmental sanitation are the factors associated
with intestinal parasitic infection. Aim: The aim of this study was to estimate the
prevalence of intestinal parasitic infections and identify the associated risk factors.
Materials and Methods: Study was performed on 327 stool specimens of all age groups
from August 2012 to May 2013. Specimen collected and examined with direct wet
mount, formal ether sedimentation and salt otation methods. Results: Out of the total
327 participants prevalence of intestinal infections was 11.62%. Among the
Protozoa,
Giardia lamblia
(3.06%) was the most common, followed by
Entamoeba histolytica
(0.92%). Hookworm (2.75%) and
Hymenolepis nana
(2.14%) were the most common
helminthes found. Parasitosis was seen more in female (17.07%) than male (8.33%)
and highest between 51 and 60 years (22.22%) age group with risk factors like open
defecation (22.69%), untreated river water (17.91%) and among people living in rural
areas (15.17%). Conclusion: There is a need to create awareness about safe drinking
water, personal hygiene and environmental sanitation and to take urgent remedial
steps to prevent and control intestinal parasitic infections.
Key words: Ascaris lumbricoides, Giardia lamblia, India, parasitosis
Original Article
INTRODUCTION
Intestinal parasitic infection is endemic worldwide, and it represents a large and serious medical health
problem in the developing countries with high prevalence rate in many regions. It is estimated that
3.5 billion people are affected, and 450 million are ill as a result of these infections, the majority being
children. These infections cause morbidity and mortality along with other manifestations like iron
de ciency anemia, growth retardation in children and other physical and health problems.[1] Helminthic
infection is also related to protein energy malnutrition, low pregnancy weight and intra uterine weight
gain. The most common parasite causing infections globally are Ascaris lumbricoides (20%), hookworm
(18%), Trichuris trichiura (10%) and Entamoeba histolytica (10%).[2] Most of these are transmitted through
soil, there route of transmission being faecally contaminated ngers or sometimes migrate through
skin to intestine.[3] Poor sanitation, scarcity of potable drinking water and substandard personal hygiene
practices may contribute to the rapid spread of such infections.[4] With increasing population, poor
socioeconomic conditions, continuous urbanization and industrialization with unplanned reforestation
and the climatic changes may be the various reasons for the emergence of previously unrecognized
diseases. Ethenic food habits and tourism to exotic places have led to exposure of food borne parasitic
infections.[5] In India, the overall prevalence rate ranges from 12.5% to 66% with the prevalence rate
for individual parasite varying from region to region.[9-12]
It has become important to know the disease burden of parasitic infestation in the general
population residing in this area. One of the major drawbacks in the ght against the parasitic
disease is the inability to prevent them by immunization as no effective vaccine is available
Abstract
Access this article online
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DOI: 10.4103/2230-8598.144119
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Kotian,
et al
.: Intestinal parasitosis in Uttarakhand hills
423 International Journal of Medicine and Public Health | Oct-Dec 2014 | Vol 4 | Issue 4
currently against any parasitic disease. Thus, the present study
aimed to evaluate the incidence and prevalence of intestinal
parasitic infection in the general population in and around
Srinagar Garhwal, Uttarakhand.
MATERIALS AND METHODS
This study was undertaken in the Department of Microbiology
from August 2012 to May 2013 of all age groups and includes
stool samples of the patients admitted to the wards as well as those
attending the outpatient department of our tertiary care hospital
with a total sample size of 327. After the approval from Institutional
Ethical Committee and obtaining written informed consent from
the patient, stool samples were collected in wide mouthed sterile
screw capped labeled containers without preservative. At the time
of collection date of sampling, name of the patient, education,
occupation, housing status, toilet facility, behavioral habits like hand
washing practice after defecation and source of drinking water was
also taken down in a performa.
The sample received were subjected to complete examination
both gross and microscopy within 1-2 h of its collection. In gross
examination consistency of the stool sample, presence of mucus,
blood, intestinal worm and segments of the tapeworm was noted.
Microscopic examination included saline and iodine wet mount,
which was observed under 10× and 40× magni cations. Negative
samples were re-examined by concentration technique like formal
ether sedimentation (Allen-Ridley) and salt otation technique. The
wet mount was screened for the presence of ova and cyst of the
parasite. Protozoa and helminthes were identi ed according to their
morphological details (Garcia, 1998).
RESULT
A total of 327 stool samples were examined out of which 38 were
found to have intestinal parasitic infection with a prevalence rate
of 11.62%. Various parasites identi ed among the study population
were protozoans and helminthes. Among the parasites identi ed
Giardia lamblia 10 (3.06%), hookworm 9 (2.75%) and Hymenolepis
nana 7 (2.14%) were the most common followed by, A. lumbricoides
5 (1.53%), Strongyloides spp. 4 (1.22%) and E. histolytica 3 (0.92%).
Figure 1 depicts the characterization of the various parasites
identi ed.
It was noted that out of 38 positive samples, parasitosis was seen
more in female patients (17.07%) when compared to males (8.33%).
It was also noted that people who used open defecation (22.69%),
untreated river water (17.91%), people living in rural areas (15.97%)
and those who were agriculturist by profession showed more
prevalence of parasitic infection as depicted in Table 1. Parasitic
infection was seen more in people belonging to age group between
51 and 60 years (22.22%), followed by 11-20 years (18.75%), 41-
50 years (11.43%), 31-40 years (11.36%), 0-10 years (10.61%),
61-70 years (9.09%), and 21-30 years (6.98%) as shown in Table
2. Figure 2 depicts the parasite distribution in various age groups.
It was seen that in India the prevalence rate of intestinal infection
ranges from 6.63% to 55.5% from the year 2002 to 2013 being
depicted in Table 3.
Figure 1: Characterization of the various parasites identi ed Figure 2: Parasite distribution in various age groups
Table 1: Distribution based on gender, sanitation,
water source and residence
Positive (%) Negative Total
Sex
Male 17 (8.33) 187 204
Female 21 (17.07) 102 123
Total 38 289 327
Sanitation
Closed 11 (5.29) 197 208
Open 27 (22.69) 92 119
Total 38 289 327
Water treatment
Treated 14 (7.25) 179 193
Untreated 24 (17.91) 110 134
Total 38 289 327
Residence
Urban 15 (8.20) 168 183
Rural 23 (15.97) 121 144
Total 38 289 327
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Kotian,
et al
.: Intestinal parasitosis in Uttarakhand hills
424
International Journal of Medicine and Public Health | Oct-Dec 2014 | Vol 4 | Issue 4
DISCUSSION AND CONCLUSION
Human parasitic infection is a global problem of enormous
proportion with wide variation in intestinal parasite from region
to region; different geographic areas, communities and ethnic
groups even seasonal variation are also known.[7] Knowledge of
the distribution and extent of Intestinal parasitic infection in a
given community is a prerequisite for planning and evaluating
intervention program. The primary aim of this study was to identify
the high-risk communities and formulate appropriate intervention
measures. In the developing world intestinal parasitic infection is
still an important cause of morbidity and mortality.[8] The present
study results showed the occurrence of several intestinal parasites
of public health importance in people residing in this area. The
prevalence was found to be 11.62% which is in agreement with
the studies from Puducherry by Ragunathan et al. and from Lathur
by Davane et al. but low when we compare it with the study from
Vellore by Kang et al., showing a prevalence rate of 97.4%. Various
studies have shown that prevalence rate in India ranges from 12.5%
to 66% with varying prevalence for individual parasites.[9-12] The
wide variation in the prevalence of intestinal parasites may be
due to variations in factors like quality of drinking water supply,
sanitation and other environmental conditions.
Srinagar Garhwal is situated on the bank of river Alaknanda
originating from Himalayas, and serves as the main source of water
for all purposes. However, being contaminated by organic and
inorganic components which includes fecal waste which is own
into the river. There is no de ned protocol for garbage disposal
in the habitating areas along the river. Studies have shown that
crowding and technical problems in disposal of sewage as the main
factors determining parasitosis in water.[13] Only 60% households
have toilets, 10% use public toilets and rest 30% defecate in the
backyard of their house or in the open elds. The feces is exposed
to scavenging animals, drying effects of sun and wind and during
the rains being washed away contaminating the river water.[14] High
prevalence was seen in the population using untreated river water
in comparison with those using ltered or boiled water this in
accordance with the report of other authors.[15]
In the present study, it was observed that prevalence of intestinal
parasitic infection was seen more among females (17.07%) then
the males (8.33%). This can be better explained as, in addition to
household work women in this region are also engaged in handling
of livestock and in eld work too and thus are comparatively more
exposed to contaminated soil and water, a major predisposing
factor for infection.
Giardia was the most common Protozoa identi ed in our study
accounting for 3.06% and mostly seen in children which is in
accordance with many studies conducted previously[16,22,28] it gets
transmitted by feco-oral route by drinking contaminated water as
it is a common environmental contaminant of water supply. The
water supply is really an important risk factor for the Giardiasis,
and several large outbreak of Giardiasis have resulted from the
contamination of drinking water supply with the human waste.
Giardia cysts have been isolated from water supplies in different
parts of the world.[17-21]
Table 3: Prevalence of potentially pathogenic parasites reported between 2002 and 2013 from India
Year Sample Percentage of sample positive for
nPercentage +ve G. lamblia A. lumbricoides Hookworm E. histolytica H. nana Strongyloides
2002
Kaur et al., (New Delhi) 127 46.5 11.8 11
2010
Ragunathan et al.
(Puducherry)
1172 34.56 7 43.21 28.89 — 7.66
Singh et al. (Kashmir) 514 42.41 28
2011
Aher and Kulkarni
(Ahmednagar)
624 30.4 13.5 1.9 0.9 3.9 4.5 0.6
Rashid et al. (Bareilly) 320 22.81 6.25 9.68 2.5 2.18
2012
Davane et al. (Lathur) 211 6.63 33.3 45.4 27.2 66.6 36.3
Panda et al. (Bangalore) 124 55.65 37.3 24.2 8.7 37.3 11.6
Bisht et al. (Gaziabadh) 335 38 40.4 3.12 55.3 24.2
2013
Present study (Uttarakhand) 327 11.62 3.06 1.53 2.75 0.92 2.14 1.22
H. nana = Hymenolepis nana, E. histolytica = Entamoeba histolytica, A. lumbricoides = Ascaris lumbricoides, G. lamblia = Giardia lamblia
Table 2: Parasitic distribution in varying age group
Age group Positive (%) Negative Total
0-10 14 (10.61) 118 132
11-20 6 (18.75) 26 32
21-30 3 (6.98) 40 43
31-40 5 (11.36) 39 44
41-50 4 (11.43) 31 35
51-60 4 (22.22) 14 18
61-70 2 (9.09) 20 22
>70 0 1 1
Total 38 289 327
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Kotian,
et al
.: Intestinal parasitosis in Uttarakhand hills
425 International Journal of Medicine and Public Health | Oct-Dec 2014 | Vol 4 | Issue 4
The most common helminths infestation seen in our study was
hookworm 2.75% followed by H. nana 2.14%, A. lumbricoides 1.53%,
Strongyloides 1.22% and E. histolytica 0.92%. This is in contrast to other
studies in which Ascaris was the most common helminth.[6,23,24,26,27,29,30]
Prevalence of hookworm infection can be attributed to walking
barefoot in the elds as the infection results from penetration of
the skin by lariform larva.[25]
This study showed that intestinal parasitic infection is a major public
health problem and is directly related to poor personal hygiene,
poor socioeconomic conditions and other factors. It has been
shown that most endemic transmission of enteric infections among
communities in developing countries is not primarily via water, but
instead through other routes such as contaminated food, hands,
and clothing. Among the interventional measures health education
of school going children, maintenance of proper hand hygiene,
provision of safe drinking water, proper waste disposal, identifying
and treating infected as well as asymptomatic individuals are most
important. The knowledge of prevalence will even strengthen or
justify the prophylactic use of a broad spectrum anti-parasitic drugs
particularly in children.
The study was limited to single sample observation. Perhaps, larger
sample size and longitudinal studies with more parameters must be
necessary for the continuation of this surveillance study to obtain
an accurate understanding and cause of the parasitic burden of
this area.
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How to cite this article: Kotian S, Sharma M, Juyal D, Sharma N.
Intestinal parasitic infection-intensity, prevalence and associated
risk factors, a study in the general population from the Uttarakhand
hills. Int J Med Public Health 2014;4:422-5.
Source of Support: Nil, Con ict of Interest: None declared.
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... A quite similar prevalence of 6.68% was observed in a study from Rohtak [7], while a study from south India showed a very higher prevalence rate of 97.4% [8]. A slight higher prevalence of 11.2% has been reported from the neighboring state of Uttarakhand in 2014 [9]. On the other hand, prevalence of intestinal parasitic infections in neighboring countries Nepal and Sri Lanka has been reported as 29.4-34.56%, ...
... The positivity of intestinal parasites was more 5.62% in females as compared to males 4.19%, which is in accordance with the study by Kotian et al. [9]. Some studies showed male predominance [11,12]. ...
... G. lamblia was the most common intestinal protozoan detected in our study accounting for 26.09% followed by E. histolytica, which were 17.39% which is in agreement with many past studies [7,9,16,17]. The route of transmission is through feco-oral route by ingestion of contaminated water and food as it a frequent environmental contaminant of water supply. ...
Article
Full-text available
Objective: Intestinal parasitic infection is a burgeoning health issue, especially in developing countries owing to low socioeconomic conditions, poor sanitation, poor personal hygiene, and lack of access to potable drinking water. This study aims to determine the prevalence of different intestinal parasites among the patients. Methods: This cross-sectional study was conducted among 470 patients attending our hospital from October 2018 to September 2019. Specimens were collected and examined macroscopically and microscopically using concentration methods and modified Ziehl-Neelsen staining for coccidian parasites. Results: Out of the 470 patients, prevalence of intestinal infections was 4.89%. The helminthic infections were more common (52.17%), which was topped by Hookworm infection (26.09%) followed by Ascariasis (13.04%). Among the protozoa, Giardia lamblia (26.09%) was the most common, followed by Entamoeba histolytica (17.39%). The parasitic infections were more in female (5.62%) than male (4.19%) and highest in the pediatric age group and between 51 and 60 years. Conclusion: The prevalence of intestinal parasitic infections is decreasing due to increasing awareness about sanitation, effects of open defecation, safe drinking water, and personal hygiene. However, the need of intervallic monitoring of intestinal parasitic infections is necessary.
... A quite similar prevalence of 6.68% was observed in a study from Rohtak [7], while a study from south India showed a very higher prevalence rate of 97.4% [8]. A slight higher prevalence of 11.2% has been reported from the neighboring state of Uttarakhand in 2014 [9]. On the other hand, prevalence of intestinal parasitic infections in neighboring countries Nepal and Sri Lanka has been reported as 29.4-34.56%, ...
... The positivity of intestinal parasites was more 5.62% in females as compared to males 4.19%, which is in accordance with the study by Kotian et al. [9]. Some studies showed male predominance [11,12]. ...
... G. lamblia was the most common intestinal protozoan detected in our study accounting for 26.09% followed by E. histolytica, which were 17.39% which is in agreement with many past studies [7,9,16,17]. The route of transmission is through feco-oral route by ingestion of contaminated water and food as it a frequent environmental contaminant of water supply. ...
Article
Full-text available
Objective: Intestinal parasitic infection is a burgeoning health issue, especially in developing countries owing to low socioeconomic conditions, poor sanitation, poor personal hygiene, and lack of access to potable drinking water. This study aims to determine the prevalence of different intestinal parasites among the patients. Methods: This cross-sectional study was conducted among 470 patients attending our hospital from October 2018 to September 2019. Specimens were collected and examined macroscopically and microscopically using concentration methods and modified Ziehl–Neelsen staining for coccidian parasites. Results: Out of the 470 patients, prevalence of intestinal infections was 4.89%. The helminthic infections were more common (52.17%), which was topped by Hookworm infection (26.09%) followed by Ascariasis (13.04%). Among the protozoa, Giardia lamblia (26.09%) was the most common, followed by Entamoeba histolytica (17.39%). The parasitic infections were more in female (5.62%) than male (4.19%) and highest in the pediatric age group and between 51 and 60 years. Conclusion: The prevalence of intestinal parasitic infections is decreasing due to increasing awareness about sanitation, effects of open defecation, safe drinking water, and personal hygiene. However, the need of intervallic monitoring of intestinal parasitic infections is necessary.
... The prevalence of intestinal worm infestation in this study was lower than a similar study reported in India by Gopalakrishnan [10], Kumar [11], Khanal [12], but comparatively higher than a report from Kotien [13], Misra [14]. Various study shows the prevalence rate in India ranges from 12.5% to 66% [16][17][18][19]. ...
... Recovery and concentration of (oo)cysts in water and wastewater is usually achieved through centrifugation and filtration (Moreno et al., 2018;Galvani et al., 2019). However, other less commonly used methods include immunomagnetic separation (De Jong, 2017), salt flotation (Kotian et al., 2014;Wells et al., 2016), glucose flotation (Norris et al., 2018), and formol-ether concentration (Parameshwarappa et al., 2012). Most of these methods are not specific for concentration of (oo)cysts, except the immunomagnetic separation method, therefore, it is possible to concentrate a large amount of foreign material of the same size, as the (oo)cysts, which could subsequently interfere with downstream molecular analysis. ...
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Infections caused by protozoan parasites are a major public health concern globally. These infections are commonly diagnosed during water-borne outbreaks, necessitating accurate and highly sensitive detection procedures to assure public health protection. Current molecular techniques are challenged by several factors, such as low parasite concentration, inefficient DNA extraction methods, and inhibitors in environmental samples. This study has focused on the development and validation of a molecular protocol for DNA extraction and efficient protozoan (oo)cyst recovery and quantification of protozoan parasites from wastewater using droplet digital PCR (ddPCR). Five DNA extraction methods, including commercial kits, custom phenol-chloroform, and in-house modified methods, were evaluated. The efficiency of each method was assessed via spectrophotometric analysis and ddPCR amplification using specific primers. Lastly, the developed protocol was evaluated to detect and quantify Cryptosporidium parvum in wastewater from different geographical regions in South Africa. The conventional phenol-chloroform extraction method yielded the highest DNA concentration of 223 (±0.71) ng/μl and detected the highest number of Cryptosporidium parvum (1807 (±0.30) copies/ddPCR reaction) using ddPCR compared to other methods evaluated in this study. Additionally, the phenol-chloroform method demonstrated high sensitivity in extracting DNA from as few as one cyst/L of Cryptosporidium parvum, corresponding to 5.93 copies/ddPCR reaction. It was also observed that analysis of both the filtered supernatant and pellets after centrifugation improves the recovery efficiency of oocysts from wastewater by 10.5%, resulting in a total recovery of 64.1%. In addition, ddPCR platform as an efficient PCR method to detect and quantify oocysts from diluted samples such as wastewater has been proposed. This optimized protocol was successfully applied to measure protozoan concentration in wastewater from different regions in South Africa. The improved DNA extraction and quantification method proposed in this study would be effective in monitoring protozoan concentration in the environment, which will help in instituting mitigation measures to reduce water-borne infections.
... The overall prevalence of 29.1% obtained in this study is similar to earlier studies from Tonga (26.4%) [5] and 28% in Nigeria [10]. However, the prevalence was higher when compared with studies from Douala (15.2%) and Uttarakhand in India (11.6%) [13,14]. ...
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... This may be attributed to the equal involvement of females in outdoor activities. Some studies have reported a male preponderance, (Bisht et al., 2011;Fatima and Shubha, 2011) while in some females were found to have a predominant infection (Kotian et al., 2014). The isolation of helminths was higher (60.8%) as compared to protozoa (39.1%). ...
... This may be attributed to the equal involvement of females in outdoor activities. Some studies have reported a male preponderance, (Bisht et al., 2011;Fatima and Shubha, 2011) while in some females were found to have a predominant infection (Kotian et al., 2014). The isolation of helminths was higher (60.8%) as compared to protozoa (39.1%). ...
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