Summary:
The world today is characterized by inequity in terms of the distribution of resources and socio-economic growth. Many places in the world are extremely poor. These places lack adequate development in terms of health care, social empowerment, and economic stability. One of the areas that exhibit the characteristics above is the Wallo Rural area (WalloRA), which is located in Sub- Saharan Africa. This area has a population of about is 30,000 people. The high levels of poverty in this area make the Wallo Rural Area a closed society in terms of access to information and basic amenities. Due to this phenomenon, there was no information available regarding the prevalence of parasitic diseases in this area. One thing that is important to note is that parasitic diseases are the major causes of high morbidity and child mortality in this area. This study aims at accomplishing two important objectives. First of all, this study aims at explaining the prevalence of different types of parasitic infections. Second, this study also aims to define the factors that expose the WalloRA to parasitic infections and their impacts on health of the population of WalloRA.
This study assumes an analytical design in conducting research. The two facets of the WalloRA that were fundamental for this study were children under the age of 15 and their parents or guardians. This study conducted the research on 375 children under the age 15 years for 10 days in October 2011. The reasons why this research focuses on this age group of children are that children under the age of 15 years old are the most vulnerable group to the infection of these parasites and also due to the fact that this age group is that children under the age of 15 constitute about half of the population of WalloRA. This research also interviewed parents using questionnaire conducted in the local language in order to enhance their understanding of the questions.
Focusing on the methodology of the research, there were three important methods that were employed. The first methods that was the testing of stool samples for the presence of eggs using the standard Kato-Katz technique for soil-transmitted helminthes and intestinal schistosomiasis.The second method of study that was conducted was, the research included taking urine samples and then testing for the presence of Schistosoma haemotobium using filtration technique. Third, this research involved conducting blood samples on slides for thick and thin blood films for malaria.
Looking at the method of data analysis, this research used Epi-Info software and statistical analysis software Minitab. The results obtained from the questionnaire conducted on parents showed that parents had low economic standards, poor access to health care, and low educational levels. Some of the risk factors related to the parasitic infections in WalloRA were the lack of sleeping bed nets, infested water sources, poor environmental sanitation, swimming and fishing in infested water. The study also showed that the prevalence of hookworm was the highest with a 58.4 % (219), followed by Plasmodium falciparum about 47.5 % (178). Ascariasis trichuriasis, P. malariae and S. haematobium were 33.2 % (125), 20.0 % (75), 12.8 % (48) and 5.3 % (20) respectively. No cases of intestinal Schistosomiasis species were found. Most people had contracted parasite infection due to interaction with infected persons. There was no significant difference between the presence of parasites and gender, but the difference was observed statistically significant by age. Finally, highlights on the prevalence of these parasites in their native habitats in order open up more research on better control of diseases caused by these parasites with an attempt to protect humans from parasitic infections as well as reduce the spread of these parasites around the world.
Method
Stool and urine samples collection and examination:
As part of the research, children under the age of 15 years were given the necessary tools and equpment for the collection of urine and stool samples. The equipment that was used in the collection of these samples was labeled plastic containers and waterproof papers. The children were asked bring their urine and stool samples in the plastic containers and waterproof paper that were supplied to them. [4]. the collected samples were stored in boxes that were stored in cool dry place during their transfer process into the laboratory. It was prescribed that the collected samples be stored under low temperatures for at least 24 hours before being processed.
The Kato-Katz technique, which is considered as being the standard method, was used to test for the presence of eggs as well as soil-transmitted helminthes and intestinal schistosomiasis [15]. The total data obtained was used in the calculation the mean. The units used in the recording of the final were in terms of the mean derived from the data collected. (Number of eggs per gram of stool or egg count). The samples of Urine samples that were collected were tested for the presence of Schistosoma haemotobium. In order to achieve this, a filtration technique was employed [1 and 3]. In addition, this research also used Reagent strips (Uristix) that were approximately 10 parameters, Cypress Diagnostics) to test for micro-haematuria immediately after samples of urine were collected. Any samples that tested positive for micro-haematuria were tested for S. haematobium ova.
Blood sample collection and examination:
Blood samples were conducted using a finger pricking technique. The collected samples were put in slides so as to test for thick and thin blood films. In order to increase visibility the slides were stained with Giemsa's stain [1]. Each child used his or her own sterile lancet to avoid contamination. Because the area where the study was conducted was endemic for malaria it was important to collect for thick blood films to test for the presence of plasmodium that causes malaria.
Ethical consideration:
This study enhanced the ethicality of the research by consulting with to the head of household/guardian of children at the time of specimen collection in order to obtain consent of participation. In addition this research opened up the treatment for individuals who tested positive for intestinal helminthes, schistosomiasis and malaria using a local [2].
Data analysis
In the initial stage of data collection, questionnaire forms were double-checked in order to ascertain that they were of high quality before computer entry. In the second stage, the results obtained from the laboratory tests was recorded on well prepared format carefully and finally was attached with the questionnaire. The intestinal helminthes and protozoa species that were not dominant with the region were not studied sufficiently which leaves a leeway for more research on these species. The analyses were created using Epi-Info software and statistical analysis software Minitab [1].
Co-infection of Plasmodium spp., Schistosomiasis and (STH):
Ashford et al (1992) indicates that that most individuals had contracted parasitic infections through interactions with one another. Some of the species that exhibited these characteristics were Plasmodium spp., S. haematobium and STH. 14 % of the population studied had no frequency of infection of these parasites. About 28 % of the population had infections from a single parasite. Approximately 31 % of the population had a double infection while 18 % cases of triple infection to six infections. The modal number of the population had double infections. The mean of people studied in terms of the kind of infection 1.83 (Figure 3). Figure 4 shows the co-infections in different age-groups of the children population. According to the statistics shown of figure 4 children less than five years are the most vulnerable to these parasitic infections. Thus, the mean number of infections per person by age is between 0.7 and 2.5.
Prevalence of parasites by age and gender:
This research used analyzed the prevalence curves of parasites that were common in this area. Fig 1 and 2 illustrates the distinctiveness of the prevalence curves. However, there is some level of commonality in that both curves rise from zero during birth and reaches at the climax at about late childhood, after which the curve flattens. For example, P. falciparum, P. malariae, A. lumbricooides and T. trichiura, continued to lower after the flattening of the curve, a trend that was maintained throughout adult life. A slight rise was only evident among oldest people which can be speculated as being caused by their low immunity. In hookworm and S. slercoralis the prevalence did not reduce in adults but the rate of increase slowed down. The trend exhibited by S. haematobium is also shown in the curves, but the numbers are significantly small for them to be represented on the curves.
Conclusion and recommendation
In areas that are highly infested with parasitic infections, the prevalence of malaria infections is high among children who are under five years. By the age of fifteen the prevalence reduces significantly. This indicates that the immunity of children becomes stronger as they grow older [2]. Ashford et al (1992) explains that the prevalence of the two common Plasmodium spp., A. lumbricooides and T. trichiura in children under the age of 5 years in Kenya, a country on East Africa, were significantly high. However, the prevalence continued to decrease as children approached the age of 15. This shows uniformity of data in terms of this study and Ashford et al research in Kenya
The children population size that was surveyed was about 375 children. The children were tested for Plasmodium spp., Schistosomiasis and STH. Most children contracted infections from each other due to interaction. The Prevalence of hookworm was the highest at about 58.4 % (219), Plasmodium falciparum followed at approximately 47.5 % (178), Ascariasis, Trichuriasis, P. malariae and S. haematobium were 33.2 % (125), 20.0 % (75), 12.8 % (48) and 5.3 % (20) respectively . There was no species of intestinal Schistosomiasis that were found among the children surveyed. This study found connections between the two Plasmodium spp., and also between hookworm infection and S. slercoralis [1].In addition, there were statistically differences between the prevalence of parasites and age of individuals, but no statistical differences were indicated in terms of gender.
This study was the first to determine the prevalence of parasitic infections of inhabitants in WalloRA. Our results attribute the lack of a national control program, lack of clean water supply, poor sanitation, poverty, poor access to healthcare, and low levels of education in this area, which have led to favorable conditions for a high prevalence of these parasites. In addition, other important risk factors, which affect the prevalence of parasitic infections, lack of sleeping bed net, and swimming and fishing in infested water.
We therefore recommend that more emphasis and public funding be directed to conduct civic education among the locals about parasitic infections. The government of WalloRA should also step up in terms of establishing control measures to reduce the spread of these parasitic infections. Other important steps that the government of WalloRA need to take includes free and regular screening and treatment for parasitic infections The government should also provide clean water and articulate for a higher sense of personal and environmental hygienic among the locals.. These measures also should focus on reducing poverty. In order to maximize the output of these steps, health education should be made available both to children and adults within the area.
We also recommend that the community solicits for funds so as to build additional clinic and health centers in order to treat patients in this remote area as well as save lives. In addition, we recommend the government of WalloRA to join the WHO education program so that it can sensitize its people on the best way to fight malaria. Bed nets and sprays should also be availed to the members of the public bearing in mind that some of the locals cannot afford these products.
Finally, this study opens up more research on the prevalence of these parasites in their native habitats and better control methods to contain these parasites. If these recommendations are adhered to then the protection of humans and reducing the spread of these parasites throughout the world is something that is achievable. Health care agencies across the world should also take these recommendations in order to safeguard other populations that may be in the same situation as the WalloRa area. In addition, I we would recommend that international organizations and health agencies consider going to this area and helping the locals either financially or morally as they struggle to fight these parasitic infections.
Acknowledgements:
I would like to thank the support staff health centre in WalloRA in that without them this research would not be possible. I would also like all lecturers from our college who gave us the technical knowhow about how to approach this project.
