ABSTRACT
A study on intestinal parasites and some sexually transmitted infection was conducted to determine the prevalence and the health risk factors of intestinal parasites, Trichomonas vaginalis and HIV infection among the prison inmates in Umuahia, Abia State, Nigeria. About 350 (280 males and 70 females) aged between18-61 years participated in the study. A structured questionnaire was used to obtain socio-demographic and behavioral risk factors. A total of 350 stool, blood and urine sample each and 70 High Vaginal Swab from the female inmates were collected. Samples were screened using saline wet preparation and formol ether concentration, serological and direct wet mount methods respectively. An overall 171(48.8%) for intestinal parasite was recorded. Females were more infected 51(72.8%) than the males 120(42.8%). This was found statistically significant (p<0.05). Five species of intestinal were identified. The most common was hookworm 95 (33.5%) and Trichuris trichuria 33(11.6%) was the least. Among males, age groups 51-60 recorded more infection (63.33%) while 18-20 years recorded least (25.0%). Those in age groups 51-60 recorded 100% infection in females. Of the 171 IP infection recorded, 97(56.7%) were single while 74(43.3%) were mixed infection. Hookworm+E.histolytica were the most 27(36.1%) common mixed infection while E.histolytica+T. trichuris 1(1.4%) were the least. Out of the 350 inmates screened, 152 (43.4%) T.vaginalis infections were recorded. Females were more 58(82.8%) infected than the males 94(33.6%). This was found statistically significant (p< 0.05). Age groups 31-40 recorded highest infection (11.0% and 22.8%) in both male and females respectively. Those in 18-20year age groups in males recorded no infection. A total of 9(2.6%) HIV infections were recorded. Females were more infected 4(5.7%) than males 5(1.7%). This was statistically insignificant (p>0.05). The age groups 31-40 were more infected (0.9%and 0.3%) in both male and females while the least (0.3% and 0.3%) was recorded among the age groups 41-50 years in males and 61> age groups in females respectively. A total of 8(2.3%) for T.vaginalis and HIV co-infection was recorded. Females recorded more 2(2.8%) infection than males 6(2.1%). Age groups 31-40 years recorded highest infection (0.8%) while 41-50 age groups were least (0.3%) infected in both male and females respectively. Those in age groups 18-20 and 61> recorded no infection in both male and females. Questionnaire analysis shows that long-term duration in prison and late deworming at a considerable interval influences intestinal parasite infection. This was statistically significant (p< 0.05). Multiple sexual partners and unprotected sex were among the factors that influences transmission of T.vaginalis and HIV infection but was statistically insignificant (p>0.05). Inmates showed intestinal parasite symptoms like watery stool 50(29.2%) and stool accompanied with blood 11(6.4%). Inmates showed T.vaginalis symptoms like light burning sensation 12(12.8%) and itching/rashes 18(31.0%). Intestinal parasites, T.vaginalis and HIV infection are prevalent among inmates of Umuahia prisons. Adequate and improved healthcare should be provided inside the prisons to enhance their health status especially with regards to parasitic infections. Proper awareness health risk factors for transmission of these infections should be ensured.
TABLE
OF CONTENTS
Title page
i
Declaration
ii
Certification
iii
Dedication
iv
Acknowledgement
v
Table of content
vi
List of figures
vii
List of tables
viii
List of plates
ix
Abstract
x
CHAPTER:
INTRODUCTION
1.1 Background Information
1
1.2 Aims and objectives of the Study
7
1.3 Significance of the Study
8
1.4 Statement of Problem
9
1.5 Justification of the Study
9
1.6 Limitations of the Study
10
1.7 Hypothesis
10
CHAPTER
2: LITERATURE REVIEW
2.1 Intestinal
Parasitic Infections 11
2.1.1 Clinical manifestation of intestinal
parasites
14
2.1.2 Epidemiology of intestinal parasites
15
2.1.3 Pathogenesis of intestinal parasites
15
2.1.4 Classification of intestinal parasites 16
2.1.5 Risk factors of intestinal parasites 17
2.1.6 Modes of transmission of intestinal parasites 18
2.1.6.1 Direct mode of transmission 18
2.1.6.2 Indirect mode of transmission 19
2.1.7 Life cycle of intestinal protozoan parasite
20
2.1.8 Diagnosis of intestinal parasites 22
2.1.9 Treatment and control of intestinal
parasites 22
2.2 Trichomonas
vaginalis infection 24
2.3.1 Clinical manifestation of Trichomonas vaginalis 27
2.2.2 Epidemiology of Trichomonas vaginalis 28
2.2.3 Pathogenesis of Trichomonas vaginalis 29
2.2.4 Classification of Trichomonas vaginalis 30
2.2.5 Risk factors of Trichomonas vaginalis 30
2.2.6
Mode of transmission of Trichomonas
vaginalis 31
2.2.7 Morphology of Trichomonas vaginalis 31
2.2.8 Life cycles of Trichomonas vaginalis 32
2.2.9 Diagnosis of Trichomonas vaginalis 33
2.2.10 Treatment and control of Trichomonas vaginalis 33
2.3 HIV/AIDS infection among prison inmates 34
2.3.1 Clinical manifestation of human immune deficiency virus infection 36
2.3.2 Epidemiology of human immune deficiency virus 37
2.3.3 Risk factors of human immune deficiency virus
transmission 37
2.3.4 Mode of Transmission of human immune deficiency
virus
38
2.3.5 Diagnosis of human immune deficiency virus 39
2.3.6 Treatment and control of human immune deficiency
virus 40
2.4 Co-occurrence of intestinal parasites and hiv
infections 41
2.5 Co-infections of Trichomonas vaginalis and human immune deficiency virus 43
CHAPTER
3: MATERIALS AND METHODS
3.1 Study Area and Study Design 47
3.2 Selection of the Study Site and Population 48
3.3 Ethical Consideration 49
3.4 Specimen Collection for Parasitological and
Serological Analysis 49
3.5 Faecal Analysis
50
3.6 Urine Analysis (wet mount) 52
3.7 Parasitological Examination of T. vaginalis Trophozoites using High
Vaginal Swab
(HVS) 52
3.8 Laboratory Screening for HIV Infection 52
3.9 Data Collection Analysis 53
CHAPTER
4: RESULTS AND DISCUSSION
4.1 Results
54 4.1.1 Overall
prevalence of intestinal parasite among inmates in Umuahia prison,
Abia State
52
4.1.2 Prevalence
and distribution of intestinal parasites species identified among
inmates in Umuahia prison, Abia State 55
4.1.3 Prevalence
of intestinal parasite with respect to single and mixed infections
among inmates in
Umuahia prison, Abia State 57
4.1.4 Overall
prevalence of Trichomonas vaginalis infection
among inmates in
Umuahia prison,
Abia State
60
4.1.5
Overall prevalence of human immune
deficiency virus infection among inmates
in Umuahia prison, Abiia State 62
4.1.6
Prevalence of human immune deficiency
virus infection in relation to gender among
inmates in Umuahia prison, Abia State
63
4.1.7
Prevalence of Trichomonas vaginalis and human immune deficiency virus co-infection
among inmates in Umuahia prison, Abia State 64
4.1.8 Risk factors of intestinal parasites
among inmates in Umuahia prison, Abia State 65
4.1.9 Risk Factors of Trichomonas vaginalis and human immune deficiency virus
Infection among
inmates in Umuahia prison, Abia State
66
4.1.10 Characteristics symptoms associated with
intestinal parasite infection among
inmates in Umuahia prison,
Abia State
67
4.1.11 Characteristic symptoms associated with Trichomonas vaginalis infection among
inmates in Umuahia prison,
Abia State
68
4.1.12 Characteristic symptoms associated with human
immune deficiency virus
infection among inmates
in Umuahia prison, Abia State 69 4.2
Discussion
70
4.2.1 Prevalence
of intestinal parasites infection among inmates in Umuahia prison,
Abia State
70
4.2.2 Prevalence
of Trichomonas vaginalis among
inmates in Umuahia prison, Abia
State 73
4.2.3 Prevalence
of hiv infections among inmates in Umuahia prison, Abia State 76
4.2.4
Prevalence of Trichomonas vaginalis and human immune deficiency virus co-infection
among inmates in Umuahia prison, Abia State 77
4.2.5 Risk
factors of intestinal parasite among inmates in Umuahia prison, Abia State 78
4.2.6
Risk factors of Trichomonas vaginalis and human immune deficiency virus infections among inmates in Umuahia prison,
Abia State 81
4.2.7
Characteristic symptoms associated with intestinal parasite infection among
inmates in Umuahia prison,
Abia State
81
4.2.8
Characteristic symptoms associated with Trichomonas vaginalis infection among
inmates in Umuahia prison, Abia State
82
4.2.9
Characteristic symptoms associated with
human immune deficiency virus infection among inmates in Umuahia prison,
Abia State 83
CHAPTER
5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion
84
5.2 Recommendations
85
References
Appendices
LIST
OF TABLES
4.1: Overall
prevalence of intestinal parasite infection in relation to gender among
inmates in Umuahia Prison, Abia State 54
4.2: Prevalence
of the intestinal parasites infection in relation to sex and age group
among
inmates in Umuahia Prison, Abia State 55
4.3: Prevalence
and distribution of intestinal parasites species identified among
inmates in
Umuahia Prison, Abia State 56
4.4 Overall
distribution of Helminthic and protozoa parasites identified among
inmates in
Umuahia Prison, Abia State
57
4:5:
Prevalence of single and mixed
(multiple) infections of intestinal parasites among
inmates in
Umuahia Prison, Abia State
59
4.6: Overall
prevalence of Trichomonas vaginalis infection
among
inmates in
Umuahia
Prison, Abia State
61
4.7 Prevalence
of Trichomonas vaginalis infection in
relation to age group and
gender
among inmates
in Umuahia Prison, Abia State 61
4.8:
Prevalence of Trichomonas vaginalis infection in relation to the specimen
type
among the female inmate in Umuahia Prison, Abia State 62
4.9 Overall prevalence of HIV infection among
inmates in Umuahia Prison,
Abia State 62
4.10:
Prevalence of HIV infection among the
inmates in relation to age group and
gender among inmates in Umuahia Prison,
Abia State 63
4.11 Prevalence of Trichomonas vaginalis and HIV co-infection among the inmates
in
relation to age group and gender among inmates in Umuahia Prison,
Abia State 64
4.12 Risk
factors of intestinal parasites among inmates in Umuahia Prison, Abia
State 66
4:13 Risk factors of Trichomonas vaginalis and HIV infection among inmates
in
Umuahia
Prison, Abia State 67
4.14
Characteristic symptoms associated
with intestinal parasites infection among
inmates in
Umuahia Prison, Abia State
68
4.15 Characteristic symptoms associated with Trichomonas vaginalis infection among
male
prison inmates in Umuahia Prison, Abia State 69
4.16 Characteristic
symptoms associated Trichomonas vaginalis
infection among
female prison inmates in Umuahia
Prison, Abia State 69
4.17 Characteristic symptoms associated with
HIV infection among inmates in
Umuahia
Prison, Abia State 70
LIST
OF FIGURES
1. Generalized
life cycle of Intestinal protozoan parasites
20
2. Generalize
Life cycles of helminthes
22
3. Morphology
of Trichomonas vaginalis 32
4. Life
cycle of Trichomonas vaginalis
32
5. Map
of Umuahia North Local Government Locating Study Area 48
LIST
OF PLATES
1: Entamoeba
histolytica 99
2: Hookworm 99
3: Ascaris lumbricoides 100
4: Trichuris trichuria 100
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND INFORMATION
Parasitic
infection especially intestinal parasite caused by either protozoa or helminths
or both and are among the most common infectious disease worldwide (Kelly,
1998). Intestinal parasite infections are among the most important persistent
public health problem across the country which has a significant importance in
public health (Brookers et al.,
1999). Majority of the people in the general population are affected by
parasitic infection especially intestinal parasite to which the main species
are Entamoeba histolytica, Ascaris lumbricoides, Trichuris trichuria and hookworms (Mamo,
2014). Intestinal parasite infection can be contacted through ingestion of
contaminated food and drinking water (Kumie and Ali, 2005). It has been estimated that over 60% of the
world's population are infected with intestinal parasite and these may play an
important role in the wide spread of the infection in the general population
(WHO, 1987). The range of infection is also remarkably high in sub-Saharan
Africa, where the majority of Human Immune Deficiency Virus (HIV/AIDS) cases
are concentrated and factors which includes malnutrition and poverty, could
promote transmission of both infection in the region (UNAIDS, 2002). Trichomoniasis
caused by Trichomonas vaginalis is a
sexually transmitted infection widely distributed causing roughly the same
number of sexually transmitted diseases as Chlamydia
(Maybey, 2008) and are also among the major challenge in public health as it
imposes a lot of health threat to the entire population worldwide especially in
the developing countries like Nigeria (Sutton et al., 2007), primarily due to low level of income, poor
environmental and personal hygiene. However, it is sad to know that less
attention has been given to trichomoniasis unlike other sexually transmitted
infections despite occurring in higher prevalence than both chlamydia and gonorrhea (Soper, 2004).
In fact, T. vaginalis infection is
not viewed as an important public health concern compared to other STDs, given
that it has not been a reportable disease hence no federally-funded control
programs exist for it (Soper, 2004).
Intestinal parasites and sexually
transmitted parasites as a public health concern in many countries have been
linked with the co-occurrence of malnutrition and HIV/AIDS. An estimated 80% of
HIV/AIDS patients die of opportunistic and other related infections including
intestinal parasites and sexually transmitted parasites rather than HIV
infection itself which usually occur late in the course of HIV infection especially
when cluster of differentiation (CD4) +T- cell count has been severally
depleted mostly below 200 cells/mm3 (Kam, 1994; Kelly,1998).
Human
Immunodeficiency Virus belongs to Group VI retrovirus which has about four
stages that mature into acquired immunodeficiency syndrome (AIDS). Human
Immunodeficiency virus is a blood borne virus which may be asymptomatic at the
early stage but becomes clinically symptomatic as the infection progresses and
then advance to AIDs. The virus basically attack the immune system by
destroying the CD4 cells and as the infection progresses to AIDS, significantly
increases the risk of life-threatening opportunistic diseases (Espinoza et al., 2007). Human Immunodeficiency
virus infection has claimed more than 25 million lives globally since its first
discovering in December, 1981 (WHO, 1998). In the absence of Anti-Retroviral
Therapy (ART), HIV patients unfortunately may continue to suffer the
consequences of opportunistic parasites if not treated appropriately (Maggi et al., 1994). Patients enrolling into
Anti-Retroviral Therapy programs with low CD4 cell counts have a higher risk of
infection transmission and death may even result before Anti-Retroviral Therapy
(Lawn et al., 2005). There is
evidence that the control of these opportunistic parasitic infections on
HIV-positive patients under anti-retroviral therapy scheme could go a long way
to reduce the morbidity and mortality rate of HIV positive individuals in the
general population (Alfonso, 2011).
Those
parasitic worms found in the intestine of man or animals are known as
intestinal parasites (Arora and Arora 2006). Intestinal parasite infection is
caused by either protozoa or helminthes. Protozoan parasites are one-celled
microscopic organisms belonging to the kingdom protista and can take over the
intestinal tract of their host and then migrate to other organs and tissues
(Arora and Arora, 2006). The most common protozoan encountered is E. histolytica affecting over 50 million
people, G. lamblia affecting over 200
million people and Cryptosporidium species mostly seen in immune-suppressed
individual (Kiani et al., 2016). The
helminths commonly encountered include A.
lumbricoides, hookworms and T. trichuria all of which their adult
stages are found mainly in the intestinal lumen of man (Lawn et al., 2005). Helminthes belong to the
kingdom animalia (Arora and Arora, 2006). All nematodes which include roundworm (Ascaris lumbricoides),
hookworm (Necator Americanus, Ancylostoma duodenale), pinworm (Enterobius vermicularis),
roundworm (Toxocara canis,)
Strongyloides stercoralis are
all examples of helminths (Arora and Arora, 2006). More so trematodes also known as flukes
are mainly flatworm with a leaf-like shape e.g. Fasciolopsis buski (intestinal fluke), Schistosoma
japonicum, Schistosoma mansoni, and Fasciola hepatica (sheep liver fluke). Helminthic infestations are most commonly seen
among school age children and they tend to occur in high intensity in this
group (Albonico, 1999). Helminthic infestation leads to nutritional deficiency
and impaired physical development which will have negative consequences on
cognitive function and learning ability (Norhayati, 1998).
These
intestinal parasitic infections is promoted by several factors such as poor
personal and community hygiene, poor environmental sanitation, ignorance,
climatic condition is easily transmitted through drinking of faecal
contaminated water, eating raw or undercooked contaminated vegetables and
contaminated foods (Lawn et al., 2005). Signs and symptoms of intestinal
parasitic infections can often be unclear and misleading or even asymptomatic
most times. Some of the symptoms however include some common ones like
abdominal pain, bloating, nausea and vomiting. Diarrhoea is also a common
symptom of the infection usually observed at the chronic state. Intestinal
parasites lead to development of mild diarrhoea which may last for several days
or even months. E. histolytica occasionally may invade the
brain, lungs, liver, and other organs forming cysts and giving rise to a
disease called amoebic dysentery. Other symptoms include abdominal cramps and
severe colitis along with development of ulcer.
In addition blood and pus may be seen occasionally in the stool. Intestinal
parasitic infestations do not let the intestines absorb minerals and vitamins
resulting in a pale skin and fatigue (Arora and Arora, 2006).
Human
trichomoniasis caused by T. vaginalis
is a widely distributed sexually transmitted infection, causing roughly the
same number of infection as Chlamydia.
trachomatids which is the most
prevalent transmitted bacteria pathogen (Ginocchio et al., 2012). The parasite resides in human vagina, prostrate and
urinary tract of both male and females (Arora and Arora, 2006). Worldwide, the distribution
of T. vaginalis ranges from 2% to
more than 50% depending on the region, country, gender and environment of the
study populations as well as the procedures used for the diagnosis in various
studies (Ginocchio et al., 2012).
Some
signs of the infection in symptomatic women include greenish or yellowish
vaginal discharge, and strawberry cervix (punctuate hemorrhagic lesions), vulva
irritation and inflammation (Arora and Arora 2006). In males the infection is
usually mild or asymptomatic however, there may be an itching and discomfort
inside the penile urethra mostly during urination (Arora and Arora, 2006).
Other symptoms may include dysuria, pruritis, dyspareunia and pain at the lower
abdominal region (Jonhson and Lewis, 2009). T.
vaginalis infection at its severe stage may lead to serious child bearing
complications such as; premature rupture of the placental membranes, premature
labour and low birth weight in pregnant women (Johnson and Lewis, 2009),
infertility, and as well may enhances predisposition to immunodeficiency virus
(HIV) transmission (Maybe, 2008). Some
researchers have recently provided evidences that Trichomonaisis triggers/predisposes
certain malignant disease like prostrate and cervical cancer (Schwbke and
Donald, 2004). The exact natural history of T.
vaginalis infection in either men or women is not known yet but, appears to
be multifactorial depending on the parasite virulence and the host factor
(Arora and Arora, 2006). Recent studies had suggested that women with Trichomonas infections were 1.4% times
more likely to have a complication during child birth than those who do not
have it (Mavendzenge et al., 2010).
Human
Immunodeficiency Virus belongs to Group VI retrovirus which has about four
stages that mature into acquired immunodeficiency syndrome (AIDS). Human
Immunodeficiency virus is a primary infection which may be clinically
asymptomatic at the initial stage but symptomatic at later stage then advance
to AIDS. Upon transmission, the virus attacks the immune system by destroying
the CD4 cells thereby weakening the immune system of the individual and as such
the infection progresses to AIDS which significantly increases the risk of
opportunistic diseases (Espinoza et al.,
2007). Human Immunodeficiency virus infection has claimed more than 25 million
lives globally since its first discovering in December, 1981 (WHO, 1998). Ninety
percent (90%) cases of HIV infection progresses to AIDS after 10–15 years of infection
(McNaghten et al., 2004). HIV infection
affects all groups (ethnic and racial) and both genders. The infection destroys
T cells, macrophages, and dendritic cells by viral killing of infected cells,
increasing rates of cell multiplication in infected cells and as a result, the
cell-mediated immunity is eventually depreciated (Fleming and Wasserheit,
1999). HIV infection is primarily transmitted through sexual intercourse with
an infected person, sharing of needles/syringes or other sharp objects with an infected
person, or through blood transfusion of HIV-infected blood, although this means
is less common as donated blood is frequently screened for HIV antibodies
before transfusion. It can also be contacted through birth (McKenna and Hu,
2007).
Bacterial,
protozoal, fungal, and viral diseases are among the opportunistic infections
which could result from HIV infection. Some clinical manifestation of HIV
infections includes severe weight loss, respiratory tract infections, herpes
zoster, oral ulcerations, chronic diarrhoea, persistent fever, oral
candidiasis, tuberculosis, and oral hairy leukoplakia (Espinozo et al., 2007). HIV/AIDS produces severe inflammatory disease,
recurrent vaginal yeast infections, and cervical cancer in women (Over and
Piot, 1996).
Around the world, the increasing population
of inmates presents unique characteristics that could increase the transmission
of HIV and other infectious diseases within and outside the prison. In prisons
for instance, the environment is actually relatively open and yet confined
since the movements of individuals (incoming and outgoing) can be monitored in
a given period of time. Many of the
prisoners also leave the prison, and return to the society. Also, many other
persons including the prison staff, volunteers as well as visitors, live and
work among prisoners or visit the prisons on a regular basis (FMOH, 2007). This
condition makes it possible to introduce an infected person in the process to
the prisons where there are many individuals who are susceptible to various
kinds of infection thereby resulting to an increase in the prevalence of
infections if there be any potential contact. Prisons constitute sexually
active males between the ages of 19 and 35, representing a population that is
at high risk of HIV infection transmission before being confined in the prison,
especially in areas where the infection was prevalent already.
Many behavioural factors which are
responsible for the transmission of HIV infections are highly practiced by the
prison inmates which include sexual assault, lesbianism, rape, sex bartering,
prison marriages and so on and has been the major reason why the infection is
high among this group (Mavedzenge et al.,
2010). Homosexual activity which is culturally, religiously, and politically
unacceptable by most societies, is widely practiced and spread in prisons and general
population. This is due to the fact that prisons, being unisexual institutions,
create an ideal environment for various sexual activities between men
(Mavedzenge et al., 2010). However,
these practices could also be linked to some circumstance for instance, in
exchange for food and toiletries probably due to lack of basic sanitary
materials and adequate nutrition in prison, some inmates may be lured into
practicing sex while majority may not have been involved in any kind of sexual behaviour
if not confined. Some studies had reported that very few of the inmates knew
that HIV/AIDS could be contacted mostly through homosexual and lesbianism relationships
(Lazenbye et al., 2014).
1.2
AIMS AND OBJECTIVES
The aim of this study is to determine the
prevalence and some health risk factors associated with the transmission of
intestinal parasites and some sexually transmitted infections among the inmates
in Umuahia prisons.
Specific
objective
Ø To
determine the prevalence of intestinal parasite, T. vaginalis and HIV
infection among the inmates.
Ø Assess
the degree of mixed/multiple infections by intestinal parasites among the
inmates in the study area.
Ø Establish
the prevalence of HIV and T. vaginalis co-infections among the inmates
and
Ø Establish
the association between some risk factors and transmission of intestinal
parasites, T. vaginalis and HIV infection infections in Umuahia prisons.
1.3
SIGNIFICANCE OF THE STUDY
Parasitic
infections especially intestinal parasites and sexually transmitted infections
occur worldwide and are most prevalent in the poorest communities of the
developing countries with more than one million people estimated to be infected
in the world (Adamu, 2013). Prison institutions are especially at risky
environments for transmission of these infections due to poor personal and
environmental practices (Dickson et al., 2016). However, for effective
management of these infections, base line information on the prevalence and activities
that could promote the prevalence is needed.
In
view of this, results from the present study will provide a baseline
information on the prevalence of intestinal parasite and some sexually
transmitted infections among the prison population. The study will also provide
an additional clue on the behavioural practices that could increase the
transmission rate of these infections among the inmates.
Information
gotten from the study will enable the public health authority to channel their
goal regarding the prevention and control of this infection among the prison
inmates and others in the general population.
1.4
STATEMENT OF THE PROBLEMS
Intestinal parasites and sexually
transmitted infections have long been recognized as a major public health
problem. Prisons are especially at risky environments for transmission of
intestinal parasites and sexually transmitted infections because of the behavioural
practices and poor hygiene (Dickson et al., 2016). In some cases, when
infected inmates having served their terms are released into the society may
pose a serious risk to their families and others in the communities as they are
reservoirs for further spread of infections in general population. Moreover, in
Abia State, Nigeria, a literature search on intestinal parasites and sexually
transmitted disease conducted specifically among prison inmates yielded no search
result, therefore the present study was designed to bridge the gap of
knowledge.
1.5
JUSTIFICATION
Although parasitic and sexually
transmitted diseases can infect all members of the population, it is clear that
there are specific groups who are more vulnerable to these infection and its
harmful effects (Hotez et al., 2009). Among this groups are inmates who
have much burden of illness than others in the society. Prisoners in Umuahia
prison live in extremely poor conditions with inadequate facilities hence are
among those vulnerable to the infections. Prisoners are also affected by malnutrition;
lack of portable drinking water and these promotes the infections by parasites.
In parasitic and sexual transmitted diseases prevention and control plans,
inmates are often neglected and overlooked. Prevention program that have been
shown to reduce the transmission of intestinal parasites and sexual transmitted
disease infections are rarely available for inmates.
In many parts of the country, prison
conditions are very bad and far from satisfactory and inmates receive the least
basic health and nutritional requirements. Inmates who have health problems do
not receive proper medical treatment hence may leave the prisons in worse
conditions than their previous life upon release. Based on the foregoing, a
study on the prevalence of intestinal parasites and sexually transmitted
infection among inmates in Umuahia prisons was justified.
1.6
LIMITATIONS OF THE STUDY
The major challenges in this study was getting
a consent letters from the prisons officials and a frequent lead to frequent
interrogation by the staffs on duty. Entering the prison yard daily for sample
collection was a challenge due to the risk of being attacked by the inmates.
Inconsistency of power supply was another major challenge.
1.7
HYPOTHESIS
Hypothesis 1: The inmates do not habor
intestinal parasite, Trichomonas
vaginalis and HIV/AIDS infection.
Hypothesis 2: The inmates are not at the
risk of contacting the infections hence behavioural practices do not expose them
to intestinal parasites, T. vaginalis
and HIV infection in the study area.
Hypothesis
3: Individuals who are infected with T.
vaginalis are not at the risk of getting infected with HIV infection in the
study area.
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