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Impact of parasitic infections on nutritional status and micronutrients in Saudi children


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Background: Micronutrients deficiency is a great problem that is augmented by infection and poor nutrition. Copper, zinc, and iron are trace elements needed for human growth. Objective: To investigate the impact of parasitic infections on nutritional status and serum copper, iron, and zinc in western Saudi children. Subjects and methods: A case-control study included 110 parasitic infected children and 90 age and sex matched controls. Anthropometric measures were evaluated using specific Saudi Arabian growth charts. Parasites were detected in stool specimens using standard microscopic methods. Atomic Absorption Spectrophotometer was used for detection of serum zinc, iron, and copper. Data were analyzed statistically using SPSS version 20. Results: Parasitic infected children showed a statistically significant low weight for age, weight for height, and BMI. Serum zinc, iron, and copper were significantly lower in parasitic infected children than control. Serum zinc has the most significant positive correlation with weight for age, weight for height and BMI for age (r=0.6, 0.6, 0.7), respectively, followed by iron. Malnutrition existed in 34.5% of children with parasitic infections with a significant impact on serum zinc. Multiple linear regression models showed a highly negative effect of parasitic infection and a less negative effect to underweight on serum zinc, copper and iron levels. Conclusion: Studied serum micronutrients especially zinc and iron and anthropometric indices were significantly lower in parasitically infected children.
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Curr Pediatr Res 2017; 21 (1): 1-7 ISSN 0971-9032
Curr Pediatr Res 2017 Volume 21 Issue 1
In developing countries, there are many health drawbacks
of which the micronutrient deciencies are considered a
great problem that is augmented by infectious diseases
and poor dieting creating a complex cycle in children,
which is difcult to be controlled, especially in pre-
schoolchildren due to their rapid growth rate and needs
[1-3]. Inappropriate ingestion of micronutrients, as well
as hindering its adequate absorption, which is augmented
by illnesses as infections with various parasites eventually
lead to a shortage of valuable trace elements [4,5].
For adequate development and growth, children need vital
micronutrients, the most common of which are copper,
zinc, and iron. They are needed for maintaining a healthy
child with intact immunity as they participate in a lot
of enzymatic and biological processes [6,7]. WHO has
highlighted upon the prevalence of both zinc, and iron in
developing countries, and has estimated that the highest
incidence is among children [8,9].
Parasitic infections, especially that affecting intestines are
widely distributed all over the world and comprise great
health concerns, especially for children in poor regions
in Latin America, Africa, and Asia [10,11]. The link of
poor nutrition and intestinal helminthes infection has been
well recognized by many researchers who settled several
conclusions regarding age groups at greatest risk and the
effect of such infections on growth parameters especially
Impact of parasitic infections on nutritional status and micronutrients in
Saudi children.
Naglaa M Shalaby1,2, Nehad M Shalaby3, Ashraf O Sayed4
1Department of Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
2Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi
3Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
4Department of pediatrics, Children and Women's University Hospital, Minia University, Egypt.
Background: Micronutrients deciency is a great problem that is augmented by infection
and poor nutrition. Copper, zinc, and iron are trace elements needed for human growth.
Objective: To investigate the impact of parasitic infections on nutritional status and serum
copper, iron, and zinc in western Saudi children.
Subjects and methods: A case-control study included 110 parasitic infected children and
90 age and sex matched controls. Anthropometric measures were evaluated using specic
Saudi Arabian growth charts. Parasites were detected in stool specimens using standard
microscopic methods. Atomic Absorption Spectrophotometer was used for detection of
serum zinc, iron, and copper. Data were analyzed statistically using SPSS version 20.
Results: Parasitic infected children showed a statistically signicant low weight for age,
weight for height, and BMI. Serum zinc, iron, and copper were signicantly lower in parasitic
infected children than control. Serum zinc has the most signicant positive correlation with
weight for age, weight for height and BMI for age (r=0.6, 0.6, 0.7), respectively, followed by
iron. Malnutrition existed in 34.5% of children with parasitic infections with a signicant
impact on serum zinc. Multiple linear regression models showed a highly negative effect of
parasitic infection and a less negative effect to underweight on serum zinc, copper and iron
Conclusion: Studied serum micronutrients especially zinc and iron and anthropometric
indices were signicantly lower in parasitically infected children.
Keywords: Parasites, Zinc, Iron, Copper.
Accepted November 02, 2016
Impact of parasitic infections on nutritional status and micronutrients in Saudi children.
Curr Pediatr Res 2017 Volume 21 Issue 1 2
weight and height [12,13]. The intensity and type of
parasitic infection contribute to its effect on nutrition [14].
To check how adequate nutrition the children have, one
should apply anthropometric indexes which highlight the
nutritional status of children; they are benecial because
they are considered a non-invasive, accurate, convenient
and simple tool to quantify the degree of under-nutrition
or over-nutrition [15].
The targets of this research were to check the inuence
of parasitic infections on nutritional condition and serum
zinc, iron, and copper in preschool and school children in
the Kingdom of Saudi Arabia.
Subjects and Methods
Study Area
This research was performed in the western area of Saudi
Arabia. The nature of its climate is cool in winter, hot in
summer. The annual least and the highest temperature is
(20°C) and (48°C), respectively.
Study Design
A case-control study was undertaken over one year from
August 2014 to September 2015 after obtaining ethical
approval from the Research and Ethic Committee of
Faculty of Applied Medical Sciences, King Abdul-Aziz
University, Jeddah, Saudi Arabia. Also, an informed
consent was taken from the parents of those children
joined the study.
Subject Sampling
This research work was done on 110 children infected
with different parasites known by their positive stool
analysis. Their ages were from 2-15.5 years. The studied
groups were 60 males and 50 females. A control group
was included with 90 parasite free healthy children 52
were males and 38 were females with matched age and
sex. They were enrolled from children, attending different
clinics for a regular check-up. The following inclusion and
exclusion criteria were applied:
Inclusion criteria
Children of both sexes.
Ages were from 2 up to 15 years.
Underweight or normal weights were only
No history of vitamins or mineral received by
participant children for 6 months preceding the study.
Exclusion criteria
Overweight, obesity.
Underweight due to chronic diseases as congenital
heart problems, endocrine disorders, tumors.
Children received mineral-vitamin supplements in
the last 6 months. All exclusion criteria were set
to rule out any confounders that could affect our
Both groups were submitted to the following:
A) Nutritional assessment: The children were nearly
naked wearing no shoes while measuring of weight to
the nearest 100 gram using a digital electronic scale and
of height with a portable anthropometric stadiometer
(Seca) to the nearest 0.1 cm. All measurements were
undertaken by the same person and recorded as the mean
of three consecutive readings. Anthropometric indices
were used to estimate the children's nutritional status
as follows: The Body Mass Index (BMI) was calculated
from a child's weight in kilograms and height in meters
(kg/m2) for school-aged children, Weight-for-Height
(WFH) for preschool children, Weight-for-Age (WFA)
and Height-for-Age (HFA).They were plotted on age-
sex specic Saudi growth charts [16]. Underweight,
stunting, and wasting was dened by values below
the 5th centile line for WFA, HFA, and WFH or BMI,
B) Detection of parasites in stool: Standard steps were
used in collecting stool specimens in a clean leak proof
stool cups. All data of participating children including
name, age, sex serial number, and date of sample
collection was recorded obviously on the stool cups. Just
after collection, direct wet smear using iodine, saline, and
lacto-phenol cotton blue, was performed. Subsequently,
formalin-ethyl acetate sedimentation was done in the
stool sample and examined by direct wet smear (as
previous) and modied Ziehl-Neelsen stain [17]. The
parasitological examination was performed by two senior
clinical laboratory technicians, independently at the
laboratory of Parasitology, King Abdul-Aziz University
Hospital. According to their parasitological stool results,
parasitically infected children were classied into protozoa
and helminthes types.
C) Biochemical estimation: For estimating serum
micronutrient levels, zinc, iron and copper, blood
specimens were taken by phlebotomists with minimal
veno-stasis after overnight fasting to determine the levels
of micronutrients. Five milliliters of cubital venous blood
samples were collected in sterile tubes and centrifuged for
15 min. Sera were separated and stored in Eppendorfs at
−20°C until analysis was done at the Analytical Chemistry
Unit, Faculty of Applied Medical Sciences, King Abdul-
Aziz University. The concentrations of Zinc, Iron, and
Copper of serum samples were determined by Contr
AA 700 High-Resolution Continuum Source Atomic
Absorption Spectrophotometer [18].
Statistical Analysis
IBM SPSS software package (Statistical Package for Social
Sciences, version 20 for Windows) was used to analyze
data. Continuous variables were presented as median
(interquartile ranges); categorical variables as numbers and
percentages. A one-sample Kolmogorov-Smirnov test was
used to assess whether the data were normally distributed.
The majority of the variables does not follow a normal
distribution (P<0.05), they were non parametric variables,
thus the results are presented as median (interquartile
Curr Pediatr Res 2017 Volume 21 Issue 1
ranges). Categorical data were analyzed for comparison
using chi-square tests or Fisher’s exact test, if chi-squared
test is not suitable when the expected values in any of the
cells of a contingency table are below 5; Continuous data
which not normally distributed were compared using the
Mann-Whitney test. Spearman correlation analysis was
used to assess the correlation between anthropometric
measurements and serum iron, zinc and copper in children
with parasitic infections.
A stepwise multiple linear regression analyses were
calculated to assess the effects of parasitic infections, BMI
for age, weight for age, height for age and age and sex on
the serum levels of zinc, iron and copper.
At 5% level of signicance, P-value less than 0.05 were
considered signicant in all analysis. Cut-off value for,
iron, copper, zinc, was dened at their serum levels of 60
μg/dl, 75 μg/dl, 75 μg/dl, respectively [19].
Table 1 show that a hundred and ten children with parasitic
infections 93 protozoa and 17 helminthes infections and 90
healthy controls were included in the study. Patients with
parasitic infections revealed a statistically signicant low
Weight-for-Age (WFA), Weight-for-Height (WFH) and
Body Mass Index (BMI) p<0.001; based on a cutoff value
(<5th percentile). A statistically signicant low levels of
zinc, iron, and copper, were also identied, compared to
healthy control group p<0.01.
A Box plot distribution illustrated for the median, 25th-
75th interquartile ranges of serum Zinc, Iron, and copper,
62, (54-68); 22 (20-35); 83 (78-88) (µg/dl), respectively,
in children with parasitic infections (Figure 1).
Table 2 shows how the parasitic infections were prevalent
in the 110 studied children. Five types of a single protozoan
infection were identied in 75% of children: Giardia lamblia
was the most prevalent protozoa (n=34), followed by
Entamoeba hisotolytica (n=21), Cryptosporidium parvum
Table 1. Comparison between parasitic infections and
controls participating in the study
Age, years 9 (5.5-12.6) 8 (5-12) 0.5
60 (55.5%)
50 (45.5%)
52 (58%)
38 (42%) 0.7a
Weight, kg 24 (17.2-
37.9) 26 (18.8-39.1) 0.25
Height, cm 126(108-
146) 126 (104-144) 0.9
BMI for age 15.8 (13.9-
17.9 (16.3-
19.9) 0.1
BMI centile 25(2.9-50) 50 (50-50) 0.001*
Weight for age 10 (2.9-25) 50 (25-50) 0.001*
Height for age 25 (10-50) 25 (25-50) 0.1
Weight for height 50 (8.8-50) 75 (50-90) 0.01*
Serum Zinc,
µmol 62 (54-68) 78 (73-83) 0.001*
Serum Iron, µmol 22 (20-35) 33 (30-35) 0.001*
Serum Copper,
µmol 83 (78-88) 89 (83-93) 0.001*
93 (85%)
17 (15%)
Notes: Continuous variables are presented as median
(interquartile ranges); Categorical variables are numbers
with percentages
Abbreviations: BMI, Body Mass Index. aChi-square test;
others are Mann-Whitney Test
*P is signicant
Figure 1. Box plot distribution of serum levels of Zinc, Iron and Copper (µg/dl) in children with parasitic infections: upper
horizontal line of box=75th percentile; lower horizontal line of box=25th percentile; horizontal bar within box=median;
square within box=mean; vertical lines out of the box=minimum and maximum
Impact of parasitic infections on nutritional status and micronutrients in Saudi children.
Curr Pediatr Res 2017 Volume 21 Issue 1 4
(n=12), Entamoeba coli (n=9), and Isospora (n=4). Two
protozoan infection was identied in each patient in 12%
of children: Giardia lamblia and Entamoeba hisotolytica
(n=7), Giardia lamblia and Cryptosporidium parvum (n=6).
Two helminthes were identied in 15% of infected children:
Ascaris (n=10) and Hymenolepis nana (n=7).
No statistically signicant difference was noted
between protozoa and helminthes infections, concerning
anthropometric measurements and micronutrients in
serum (zinc, Iron, and copper) (Table 3).
Correlations between serum micronutrients and
anthropometric measurements in children with parasitic
infections are shown in Table 4, serum zinc has the
most signicantly positive correlation with weight for
age, weight for height and BMI for age (r=0.6, 0.6, 0.7;
respectively, p<0.001). While serum iron, has a less
signicant positive correlation with weight for age, weight
for height and BMI for age (r=0.3) for all anthropometric
measures (p<0.003). Serum copper has also a weak but
signicant positive correlation shown only with weight
for age, otherwise, no signicant correlations with other
anthropometric indices.
The most parameters affecting serum zinc negatively in
stepwise multiple linear regression model were parasitic
infection and underweight (B1=-12.95 and B2=-0.18, with
a p<0.001 and 0.01, respectively), while BMI for age had
a signicant positive effect on serum zinc level (B3=2.18,
p<0.001), with an R2 of the model of 0.63.Also, parasitic
infection showed a large negative effect (B1=-3.64, p<0.01)
and a small negative effect of underweight (B2=-0.18,
p<0.03) on serum copper level. In serum copper, parasitic
infection had a negative effect (B1=-3.65, p<0.001), a
weak negative effect to underweight, had on serum copper
(B2=-0.18, p<0.03) with R2 of 0.19.Similarly, parasitic
infection and underweight, had a negative effect on iron
serum level, (B1=-8.9, and B2=-0.13, with a p<0.001 and
0.003, respectively).
Table 5 shows that 34.5% of children with parasitic
index Serum Iron Serum Zinc Serum
Weight-for-age 0.4
Height-for-age 0.3
(p<0.05)* 0.1 (p>0.5) 0.08
Weight-for-height 0.3
(p<0.001)* 0.1 (p>0.3)
BMI for age 0.3
0.1 (p>0.
*P is signicant
Table 4. Correlations between anthropometric measurements
and serum iron, zinc and copper in children with parasitic
infections (n=110).
Parasite species No %
Giardia lamblia 34 31
Entamoeba hisotolytica 21 19
Cryptosporidium parvum 12 11
Entamoeba coli 98.2
Isospora 4 3.5
Giardia lamblia & Cryptosporidium
parvum 65.5
Giardia lamblia & Entamoeba
hisotolytica 76.4
Ascaris 10 9
Hymenolepis nana 76.4
Table 2. Prevalence and type of protozoa and helminthes
infections in studying children (n=110)
Table 3. Comparison of protozoa and helminthes infections
regarding some anthropometric measurements, serum
Zinc, Iron, and Copper (n=110)
Variable Protozoa
(n=17) p
Weight for age
≥ 5th centile
<5th centile
51 (69%)
13 (94%)
4 (6%)
X2 =2.8a
Height for age
≥ 5th centile
<5th centile (stunted)
80 (86%)
13 (14%)
16 (94%)
1 (6%)
X2 =0.7
Weight for height
≥ 5th centile
<5th centile (wasted)
68 (77%)
25 (23%)
15 (88%)
2 (12%)
BMI centile
≥ 5th centile
<5th centile (wasted)
59 (69%)
34 (31%)
14 (94%)
3 (6%)
Serum zinc
52 (56%)
41 (44%)
11 (65%)
6 (35%)
Serum Iron
88 (95%)
5 (5%)
15 (88%)
2 (12%)
0.6 b
Serum Copper
4 (4%)
89 (96%)
1 (6%)
16 (94%)
aChi-square test; bFisher’s test
(n=72) p
Serum Zinc
32 (84%)
6 (16%)
15 (21%)
57 (79%)
Serum Iron
36 (95%)
69 (96%)
3 (4%)
Serum Copper
3 (8%)
35 (92%)
1 (1%)
71 (99%)
*P is signicant
Table 5. Serum micronutrients in infected children
according to their nutritional status (n=110)
Curr Pediatr Res 2017 Volume 21 Issue 1
infections had malnutrition and there was a statistically
signicant difference of serum zinc between the
malnourished and nourished children with parasitic
infections (p<0.001). However, in the two studied groups,
they were not statistically different as regard the serum
iron and copper.
Trace elements deciencies and poor nutrition dramatically
hinder adequate human health and socio-economic
development. Both developed and developing countries
are interested in the burden of trace elements deciency
disorders, the highest prevalence is found in Sub-Saharan
Africa and South Asia [20].
In the present study, zinc, iron and copper serum levels
were signicantly lower in parasitic patients compared to
controls. The path physiology is not clearly understood;
however, micronutrients deciencies may be linked to
malabsorption due to mucous affection. Patients with
Giardiasis, in particular, may have intestinal lesions
caused by Giardia trophozoites may impair intestinal zinc
absorption to a great extent. Additionally, infection by
various parasites affects obviously the level of serum zinc
due to its shifting to the liver [21]. Besides, the intestinal
parasites use carbohydrates, lipids, minerals, vitamin and
other food sources of the host in order to gain essential
energy of the life cycle [22].
The results of the present study are comparable with those
reported recently by Arbabi et al. [23] they found that
serum levels of trace elements such as magnesium, zinc,
and copper were reduced with infection by Giardia lamblia
and in enterobiasis. These ndings were supported by
many other researches which claried the poor absorption
of several micronutrients caused by intestinal parasites
[24,25]. Some studies not only showed that patients with
parasitic infections had micronutrients deciencies, but
also their treatment with anti-parasitic medications had
improved their serum levels [26,27]. For example, Olivares
et al. [28] reported that serum copper, zinc, and magnesium
deciencies have signicantly improved three months after
treatment of patients with Enterobius vermicularis and
Giardia lamblia infections. Similarly, another study from
Mexico reported that eradication of Giardia lamblia led to
a marvelous increase in the mean serum zinc levels after
treatment for six months in Mexican schoolchildren [29].
In the present study, serum iron was signicantly lower
in patients with parasitic infections than children of the
healthy group; the observed results are similar to earlier
researches which stated that there was a decient status of
iron in the sera of parasite infected children [30,31].
In contrast to the results of the present study, some other
studies reported a controversial association between
parasitic infections and micronutrients. Results of a study
from Turkey revealed that children with giardiasis had
increased serum levels of copper, whilst zinc and iron
levels were low [26]. Similar ndings were reported by
other researchers [32-35]. Such controversial results of
several studies could be explained by the inability of the
body to store zinc causing a decrease in its level to a great
extent. Conversely, the storage of copper is mainly in its
binding form to ceruloplasmin which is considered one of
the important acute phase reactant that increases in various
infections explaining why serum level of copper increases
during such conditions. In the present study, low serum
copper could be explained also that many children are
underweight or stunted and have inadequate ingesting of
foods with high bioavailability of copper such as meat,
poultry, and sh that is evidently found with poor nutrition.
In this study, serum iron levels were remarkably lower
(p<0.0001) in children having parasitic infections than
the control group. The outcomes of the current study were
also similar to those reported by other studies [26,32].
In the current research, 35% of parasites infected children
were malnourished (wasted and or stunted) versus 65%
nourished. It was demonstrated that serum zinc was the
only micronutrient signicantly lower in malnourished
than the nourished ones (p<0.001). Correlation analysis
between serum micronutrients and the anthropometric
measurements shown positive signicant correlations
of serum iron and zinc with most of anthropometric
measurements (weight-for-age, weight- for-height and
BMI-for-age). On the contrary, serum copper did not
have a signicant correlation with all anthropometric
measurements, except with weight for age (r=0.2). Many
researchers observed the same as well [1,36]. Furthermore,
multiple linear regression model shown a highly negative
effect of parasitic infection (B1=-12.95, B1=-3.64, -8.9,
respectively) and a less negative effect to underweight
(B2=-0.18, -0.13) on serum zinc, copper and iron levels.
Some reasons may be responsible for the low iron
deciency in this study, such as a combination of reduced
intake, decient absorption. It cannot be ignored that the
parasitic infection has a systemic effect and parasites
utilize iron, which is essential for their growth and
multiplication [37]. Iron deciency anemia is estimated
by WHO at approximately half of children whose ages
ranged from 4 to 15 years old in developing countries
[38]. As mentioned before, zinc cannot be stored in the
body so its serum level could be easily dropped, especially
in susceptible pre-schoolchildren because of their higher
growth demands. The zinc deciency prevalence was
estimated by WHO. It was 31%, ranging from 4 to 73%
across various areas all over the world [39]. In the present
study, anthropometric measurements indicated that 84%
of children with malnutrition who are short, and or wasted
have a signicant lower zinc concentration versus 21%
in normally nourished children. Many reporters dened
that short stature and decreased height-for-age was mainly
affected by decient levels of serum zinc as it is considered
one crucial factor in the metabolism of nucleic acids and
hence the protein synthesis, consequently impeding the
whole process of growth in children [4,40].
One of the striking observations of the present study is no
signicant difference of serum iron and copper between
the malnourished and normally nourished groups in
Impact of parasitic infections on nutritional status and micronutrients in Saudi children.
Curr Pediatr Res 2017 Volume 21 Issue 1 6
children with parasitic infections. The explanations for this
result could be related to other factors, not investigated,
such as heavy parasitic infections, small number of study
children or some dietetic factors, for example, decreased
bioavailability of most minerals and increased levels of
phytate in the food due to the consumption of a diet based
mainly on plants [41].
The present study is not without limitations; rst, the
dietary intake of the children have not been monitored,
nor calculated, since the ingestion of low bioavailability
food of most of the micronutrients may contribute to
deciencies of serum zinc and iron especially in children
living in low socioeconomic status, this occurs because
of inhibition of absorption by phytates, polyphenols
and oxalates, which are found in diets mainly based on
plants [41]. The main inhibitor is phytate; it can bind
divalent minerals such as Zn2+ and Fe2+, thus hindering
their body absorption [42]. Another limitation is
the study did not involve developmental milestones
assessment, other studies, recently, have focused on
the relationship between intestinal parasitic infection,
malnutrition, and child development. Investigators from
Jamaica demonstrated improved academic performance
in children who had been dewormed with anthelmintic
drugs [43,44].
Serum micronutrients: zinc, iron and copper and
anthropometric indices were signicantly lower in
children with parasitic infections than controlled
children group. Multiple regression analysis showed
that parasitic infection and underweight had a negative
effect on all micronutrients studied. However, they were
no signicant differences of micronutrients between
protozoa and helminthes infections. Serum zinc andiron
correlated positively with most of the anthropometric
indices; however, serum copper only had a weak positive
correlation with weight for age. Further large studies
are recommended to clarify more the relations between
parasitic infections, micronutrients, development and
cognition in children.
Many thanks to laboratory technicians for their valuable
help in carrying out this work.
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Correspondence to:
Nehad MS,
Pediatric Department,
Faculty of Medicine,
Mansoura University,
Mansoura, 35516,
Tel: 00201093988813
... We interpret these results since zinc cannot be stored in the body and therefore it can be easily decreased in the serum. The study conducted by (Shalaby et al., 2017). The physiology of the pathway is not clearly understood however, micronutrient deficiency may be associated with malabsorption due to mucous substances. ...
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Not Available Keywords To cite this article: Al-Abadi F, H, A, and Alawadi H, M. (2021). Study of levels of some trace elements vitamins and different blood indicators in the patients with giardiasis and amoebic dysentery in Al-Najaf Al-Ashraf province.
... [6] This is not in accordance with Shalaby's et al study in Saudi Arabia where the results showed that children infected with the parasite had statistically significant low weight for age, weight for height, and BMI (p = 0.001) which means that there were a significant relationship between infection and the nutritional status of children. [14] In this study, there was no high incidence of Giardia lamblia infection in Sei Glugur village, Pancur Batu District. This might be influenced by other risk factors such as endemic areas for giardiasis, clean drinking water and water sources, children's play areas, and risk of contact with infected animals. ...
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Background. Giardia lamblia is a protozoan that causes an intestinal infection called giardiasis. This infection can cause the process of absorption of nutrients is not optimal. Giardiasis can result in a decrease in nutritional status. The aim of study is to determain the relationship between giardiasis and nutritional status at the age of elementary school children. Method. This is cross-sectional study of 114 students at SD INPRES 104222 and 101828 in Sei Glugur Village in Pancur Batu District. Primary data collection was carried out by anthropometric examination and examination of stool samples using the formol ether concentration technique at the Parasitology Laboratory of the Faculty of Medicine, Universitas Sumatra Utara. Results. From 114 children who met the inclusion criteria, the incidence of Giardia lamblia infection was 7%. Based on the weight for height index, 8 (7%) people had poor nutritional status, 61 (53.5%) people with underweight nutritional status 27 (23.7%) people with moderate nutrition and 12 (10,5%) people with good nutrition. Overweight by 1 (0.9%) person and obese 5 (4.4%) people. There is no correlation between giardiasis infection with weight for height (p>0.05). Conclusion. The incidence of Giardia lamblia infection was low and there was no correlation between giardiasis with nutritional status in primary school-age children.
Attention deficit hyperactivity disorder (ADHD) represents a mysterious neuropsychiatric alarming concern due to indefinite etiopathogenesis among children. Notably, the studies which investigated the correlation between ADHD and parasitic infections are insufficient. Therefore, this research aimed to assess the correlation between ADHD and some tissue dwelling and intestinal parasitic infections in children. The study was conducted on 200 children, including 100 children suffering from ADHD (Group I) and 100 healthy children as a control group (Group II). All caregivers fulfilled predesigned sociodemographic form and Conners parent rating scale (CPRS-48) questionnaire. Blood samples were collected to determine hemoglobin level as well as relative eosinophilic count. The presence of anti-Toxoplasma IgG and anti-Toxocara IgG in serum by Enzyme-Linked Immunosorbent Assay (ELISA) was further investigated. Also, micronutrients as zinc, iron, and copper levels were measured. Schistosoma antigen was investigated in urine samples. Stool samples were subjected to direct wet smear, concentration technique and modified Ziehl–Neelsen (MZN) staining for coccidian parasites detection. Cryptosporidium parvum, Giardia lamblia and Entamoeba histolytica antigens were investigated in stool samples. Group I expressed more liability to sociodemographic risk factors, decreased levels of Hb, iron, zinc, and copper with statistically significant difference (P < 0.001). Comparison between Group I and Group II regarding the detected parasitic infections exhibited statistically significant difference except Schistosoma antigen positivity which expressed no statistical significance. The present study concluded that the parasitic infections with their consequences are potential risk factors in children with ADHD indicating that their early diagnosis and treatment may help in ADHD prevention.
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Severe acute malnutrition (SAM) and sepsis is a serious combination. In a recent unpublished study of acute presentation at the EMD, 33% of all children under age of 5 were seen with severe acute malnutrition and these had 8.8 % mortality within first 48 hours. Mostly due to septic shock, with a poor Glasgow coma scale and tachycardia (signs of septic shock). Likewise, a study done in 2006 among hospitalized children with SAM showed 28% mortality among the inpatients. This acute- on- chronic situation is not uncommon and even among the survivors of the first 48 hours, dealing with severe acute Malnutrition and sepsis is: a double-edged sword”. Sepsis in children with Severe Acute Malnutrition presents a challenging problem and this is discussed in this booklet. Diarrhea, Pneumonia, TB, HIV , Helminthiasis and Nosocomial infections. This is a lecture series at University.
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Background: There are scant evidences between giardiasis and enterobiasis with human mal-absorption of micronutrient. Objectives: The aim of the present study was to found out the changes in the serum zinc, copper, magnesium and vitamin B12 levels in schoolchildren infected with Giardia intestinalis and Enterobius vermicularis. Patients and Methods: This case-control study was carried out among 359 children from aged 6 - 12 years old at 8 suburban public schools. Three stool examinations were done using standard techniques for identification parasitic infection. Fifty E. vermicularis and 37 G. lamblia infected individuals were enrolled as study groups. Serum levels of copper, zinc, magnesium were assessed by autoanalyzer and vitamin B12 levels were measured using gamma counter. ANOVA and paired t-test analyses were used to determine the association between infections and trace elements changes. Results: The prevalence of G. intestinalis and E. vermicularis infections were 10.3% and 13.9%, respectively. The serum zinc, copper and magnesium levels showed a significant decrease in individuals infected with G. intestinalis and E. vermicularis (P < 0.05). Mean values of Giardia positive and negative groups for copper 143.65 ± 16.51 and 176.26 ± 17.6 μg/dL, zinc 62.26 ± 16.06 and 80.66 ± 23.58 μg/dL, and magnesium 1.82 ± 0.23 and 2.01 ± 0.16 mg/dL, respectively. Mean values of Enterobius positive and negative groups for copper 145.55 ± 26.84 and 176.26 ± 17.6 μg/dL, zinc 72.7 ± 17.92 and 80.66 ± 23.58 μg/dL and magnesium 1.93 ± 0.11 and 2.01 ± 0.16 mg/dL, respectively. Conclusions: The results showed that giardiasis and enterobiasis decreased serum levels of copper, zinc and magnesium. Further studies are needed to clarify the actual mechanism governing the zinc, copper, magnesium and vitamin B12 giardiasis/enterobiasis interaction.
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Malnutrition and parasitic diseases are within the major issues in rural areas in developing countries. In this study, the nutritional status, dietary intake including mineral absorption inhibitor (phytate), hematological indicators and trace element status (zinc, iron) were evaluated and associated to the presence of intestinal parasites in a group of children from a rural area of Bolivia. The results showed that 96% of the children had intestinal parasites; 7 types of parasites (Ascaris lumbricoides, Giardia lamblia, Ancylostoma duodenale, Entamoeba histolytica, Entamoeba coli, Tri-churis trichiura, Strongyloides stercolaris) were identified. Anthropometric measurements indicated that 37% of the children were stunted and 17% were underweight. Iron and zinc intake showed that 34% and 30% of children had inadequate intake of these nutrients respectively. Phytate: zinc molar ratios were between 6.5 and 21, and from 6.2 to 15 for phytate: iron, indicating that the absorption of zinc and iron might be compromised by the level of phytate in the diet. The serum zinc was below the lower cutoff in 87% of the children, indicating zinc deficiency. Moreover, a multiple regression model showed the significant effect of the presence of the parasite Giardia lamblia and phytate intake on the serum zinc levels. Regarding the iron status, 30% of the children presented with anemia and about 66% had iron deficiency; a simple linear regression model showed the significant negative effect of the presence of the parasite Ancylostoma duode-nale on iron status. In conclusion, the levels of zinc and iron, which were low in this child population , were greatly affected by the presence of intestinal parasites; in addition, the consumption of plant-based diets with high levels of phytate also impaired the zinc absorption.
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Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate-including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding-is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.
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Giardia lamblia is one of the most important intestinal parasites. The aim of this study was to measure serum levels of IgA, IgE, zinc, copper, vitamin B12 and folate in individuals with giardiasis in comparison to normal subjects. The study was carried out among 49 Giardia positive and 39 age and sex matched healthy volunteers. Examination of stool samples was done by direct wet smear and formol-ether concentration method. Serum samples were obtained for further laboratory examination. IgA levels were measured by Single Radial Immune Diffusion (SRID). IgE levels were measured by ELISA kit. Zinc and copper levels was measured by Ziestchem Diagnostics Kit and colorimetric endpoint-method respectively. Vitamin B12 and folate levels were measured by DRG Diagnostics Kit and Enzyme Immunoassay method respectively. All data were analyzed using SPSS version 17. There was a statistically significant difference in IgA, IgE, copper and zinc levels between positive and negative groups (P<0.05). There was no significant difference between vitamin B12 and folate levels between the two groups. Mean values of Giardia positive and negative groups for IgA were 309.26 and 216.89 mg/dl, IgE 167.34 and 35.49 IU/ml, copper 309.74 and 253.61 μg/dl and zinc 69.41 and 144.75 μg/dl respectively. The results showed levels of IgA may correlate more closely with giardiasis than IgE. Regarding trace elements, giardiasis elevated serum copper levels, while it decreased serum zinc. Finally, there was no significant difference in serum levels of vitamin B12 and folic acid between the two groups.
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Epidemiological information on the prevalence of intestinal parasitic infections in different regions is a prerequisite to develop appropriate control strategies. Therefore, this present study was conducted to assess the magnitude and pattern of intestinal parasitism in highland and lowland dwellers in Gamo area, South Ethiopia. Community-based cross-sectional study was conducted between September 2010 and July 2011 at Lante, Kolla Shelle, Dorze and Geressie kebeles of Gamo Gofa Zone, South Ethiopia. The study sites and study participants were selected using multistage sampling method. Data were gathered through house-to-house survey. A total of 858 stool specimens were collected and processed using direct wet mount and formol-ether concentration techniques for the presence of parasite. Out of the total examined subjects, 342(39.9%) were found positive for at least one intestinal parasite. The prevalence of Entamoeba histolytica/dispar was the highest 98(11.4%), followed by Giardia lamblia 91(10.6%), Ascaris lumbricoides 67(7.8%), Strongyloides stercoralis 51(5.9%), hookworm 42(4.9%), Trichuris trichiura 24(2.8%), Taenia species 18(2.1%), Hymenolepis nana 7(0.6%) and Schistosoma mansoni 1(0.12%). No statistically significant difference was observed in the prevalence of intestinal parasitic infections among lowland (37.9%) and highland dwellers (42.3%) (P = 0.185). The prevalence of intestinal parasitic infection was not significantly different among the study sites but it was relatively higher in Geressie (42.8%) than other kebeles. Sex was not associated with parasitic infections (P = 0.481). No statistically significant difference of infection was observed among the age groups (P = 0.228) but it was higher in reproductive age group. The high prevalence of intestinal parasitic infections among the lowland and highland dwellers in Gamo area indicated that parasitic infections are important public health problems. Thus, infection control measures and the development of awareness strategies to improve sanitation and health education should be considered.
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Background Several micronutrients are essential for adequate growth of children. However, little information is available on multiple micronutrient status of school children in Ethiopia. The present study was designed to evaluate the relationship between multiple micronutrient levels and nutritional status among school children. Method In this cross-sectional study, anthropometric data, blood and stool samples were collected from 100 children at Meseret Elementary School in Gondar town, Northwest Ethiopia. Serum concentration of magnesium, calcium, iron, copper, zinc, selenium and molybdenum were measured by inductively coupled plasma mass spectrometer. Anthropometric indices of weight-for-age, height-for-age and BMI-for-age were used to estimate the children's nutritional status. Stool samples were examined by standard microscopic methods for intestinal parasites. Results The prevalence of stunting, underweight, wasting and intestinal parasitoses among school children was 23%, 21%, 11% and18%, respectively. The mean serum levels of magnesium, calcium, iron, copper, zinc, selenium and molybdenum were 2.42±0.32 (mg/dl), 15.31±2.14 (mg/dl), 328.19±148.91 (μg/dl), 191.30±50.17 (μg/dl), 86.40±42.40 (μg/dl), 6.32±2.59 (μg/dl), and 0.23±0.15 (μg/dl), respectively. Selenium deficiency, zinc deficiency and magnesium deficiency occurred in 62%, 47%, and 2% of the school children, respectively. Height-for-age showed significant positive correlation with the levels of copper and molybdenum (p = 0.01) and with the levels of magnesium (p = 0.05). Conclusion Deficiencies of selenium and zinc were high among the school children although the deficiencies were not significantly related with their nutritional status. The prevalence of both malnutrition and intestinal parasitism was not negligible. These calls for the need to undertake multicentre studies in various parts of the country to substantiate the data obtained in the present study so that appropriate and beneficial strategies for micronutrient supplementation and interventions on nutritional deficiencies can be planned.
Malnutrition including vitamin A and iron deficiency and parasitic diseases have a strikingly similar geographical distribution with the same people experiencing both insults together for much of their lives. Parasitic infections are thought to contribute to child malnutrition and micronutrient deficiency through subtle reduction in digestion and absorption, chronic inflammation and loss of nutrients. Parasites may affect the intake of food; it’s subsequent digestion and absorption, metabolism and the maintenance of nutrient pools. The most important parasites related to nutritional status are intestinal parasites especially soil transmitted helminthes, Giardia duodenalis, Entamoeba histolytica followed by other parasites such as the coccidia, Schistosoma sp. and malarial parasites.
Parasitic infections are highly prevalent in the general population. A relation between a parasitic infection and absorption of minerals is not an easy task. Serum levels of copper, zinc and magnesium were prospectively measured in 64 children with intestinal parasitic infection. Thirty-nine children with Enterobius vermicularis were treated with pyrantel pamoate and 25 children with Giardia lamblia with tinidazole and metronidazole. Three months after treatment, significant differences in serum copper, zinc and magnesium were seen in patients with E. vermicularis infection, and in serum magnesium levels in patients with G. lamblia. Although the pathogenic mechanism is not clear, these findings could reflect a deficiency related to malabsorption due to mucous affection. Early detection and treatment of intestinal parasitosis could avoid these serum mineral deficiencies.
Summary Studies in animals and human subjects have shown that diets high in phytic acid can cause zinc deficiency, and that the phytate content is negatively correlated to zinc absorption. Suboptimal zinc status has been shown to cause increased morbidity, poor pregnancy outcome, impaired growth, immune competence and cognitive function, emphasizing the need to optimize zinc bioavailability. Reducing the content of phytate in the diet is one way of improving zinc absorption and this can be achieved by novel precipitation methods during processing, food preparation methods that activate endogenous phytase (e.g. baking, fermentation, malting and hydrothermal processing), or addition of exogenous phytase. During the action of phytase on phytic acid, the hexaphosphate is hydrolysed into inositol phosphates with lower degrees of phosphorylation. Because only the penta- and hexaphosphates have been shown to inhibit zinc absorption, it is often essential to analyze the individual forms of phytate in the diet when evaluating zinc bioavailability. Phytic acid does not inhibit copper absorption, but has a modest inhibitory effect on manganese absorption.