ABSTRACT
Intestinal infections caused by protozoans and helminths are globally endemic and have been described as constituting the greatest worldwide cause of illness and disease, with more severe cases in children. The prevalence and risk factors of gastro-intestinal parasitic infections of protozoans and helminths in children in seventeen (17) schools (daycare and nursery sections), in Sabon-Gari Local Government Area of Zaria, Kaduna State, were investigated. The study was carried out between January and March, 2015 (dry season), and between May and July, 2015 (wet season). Questionnaires were administered and a total of 772 stool samples were collected from the children and examined for parasite cysts and eggs. The stool samples were examined using formol- ether concentration technique and data obtained were analysed using Microsoft Excel and Epi-info software packages. The overall prevalence of the protozoa plus helminths was 9.33%. The cysts of two intestinal protozoans, Balantidium coli Malmsten, 1857 (0.26%) and Entamoeba histolytica Lesh, 1873 (0.26%), and eggs of six intestinal helminths: Hookworm (4.92%); Ascaris lumbricoides Linnaeus, 1758 (3.50%); Dipylidium caninum Linnaeus, 1758 (0.52%); Diphyllobothrium latum Linnaeus, 1758 (0.39%); Strongyloides stercoralis Normand, 1876 (1.04%) and Hymenolepis nana Grassi, 1887 (0.26%) were identified. The protozoan cysts were only observed in the stool samples of nursery school children. There was a higher and statistically significant difference in prevalence of intestinal protozoans and helminths in girls (12.04%) than in boys (6.67%) (P = 0.007). Increase in age was found to be positively and significantly associated with the intestinal protozoan and helminth infections (P = 0.000695), with the lowest prevalence in children aged between 0 and 2 years (5.00% and 4.76%) and highest prevalence in the 6year-olds (12.26%). The prevalence of intestinal parasitic protozoan and helminth infections among children in the day care and nursery schools was associated with risk factors such as improper hand-washing, drinking of tap water, possession of domestic animals, use of pit latrines and sharing of toilets between staff and children, and the dry season (OR≥1). This study has identified that intestinal parasites are prevalent among children in day care centres and nursery schools in Sabon-Gari Local Government Area of Zaria, there is therefore the need for an intervention programme for sustainable elimination of these intestinal parasitic infections.
TABLE OF CONTENTS
Contents Page
Title page i
Declaration… iii
Certification… iv
Dedication… v
Acknowledgements… vi
Abstract… vii
Table of Contents… viii
List of Tables… xi
List of Figures… xii
List of Plates… xiii
List of Appendices… xiv
CHAPTER ONE
1.0 INTRODUCTION 1
1.1 BACKGROUND OF THE STUDY 1
1.2 STATEMENT OF THE RESEARCH PROBLEM 2
1.3 JUSTIFICATION 3
1.4 AIM 3
1.5 OBJECTIVES 4
1.6 HYPOTHESES 4
CHAPTER TWO
2.0 LITERATURE REVIEW 6
2.1 Intestinal parasites 6
2.2 Intestinal protozoans 6
2.2.1 Global distribution and prevalence of intestinal protozoans 7
2.2.2 Distribution and prevalence of intestinal protozoan in Nigeria 8
2.2.3 Transmission and pathogenesis of some intestinal protozoans… 9
2.2.4 General Life-cycle of intestinal protozoans… 10
2.3 Intestinal helminths 11
2.3.1 Global distribution and prevalence of intestinal helminths… 11
2.3.2 Distribution and prevalence of intestinal helminths in Nigeria 12
2.3.3 Transmission of intestinal helminths 13
2.3.4 Pathogenesis of some intestinal helminths… 14
2.3.5 General life-cycle of intestinal helminths… 15
CHAPTER THREE
3.0 MATERIALS AND METHODS 16
3.1 Study Area 16
3.2 Study population 16
3.3 Ethical clearance 16
3.4 Sample Size 16
3.5 Tools for data collection 19
3.6 Laboratory examination of stool samples 21
3.7 Data Analysis 21
CHAPTER FOUR
4.0 RESULTS 23
4.1 Prevalence of species of intestinal protozoans and
helminths in children of the daycare centres and nursery schools 23
4.2 The prevalence of intestinal protozoans
and helminths in the nursery schools children 23
4.3 The prevalence intestinal helminths in children of the daycare centres 33
4.4 Prevalence of intestinal helminths among the children according to age 33
4.5 Prevalence of intestinal protozoans and
helminths among children according to gender 33
4.6 Prevalence of intestinal helminths in children of
the nursery schools during the dry and wet seasons 37
4.7 Prevalence of intestinal helminths in children of
the day care centres during the dry and wet seasons 37
4.8 Relationship between some risk factors and the prevalence of intestinal protozoans and helminths
in children of the daycare centres and nursery schools 40
CHAPTER FIVE
5.0 DISCUSSION 42
CHAPTER SIX
6.0 CONCLUSIONS AND RECOMMENDATIONS 48
6.1 Conclusions 48
6.2 Recommendations 49
REFERENCES 50
APPENDICES 55
LIST OF TABLES
4.1 Summary of infestation data of species of intestinal protozoans and helminths in children of daycare centres and nursery schools 31
4.2 The prevalence of intestinal protozoans and helminths in children of the nursery schools 32
4.3 The prevalence of intestinal helminths in children from daycare centres 34
4.4 Prevalence of intestinal protozoans and helminths in children
according to age 35
4.5 Prevalence of intestinal protozoans and helminths in children according to gender 36
4.6 Prevalence of the intestinal helminths in children of the nursery schools during the dry and wet seasons 38
4.7 Prevalence of intestinal helminths in children of the daycare centres during the dry and wet seasons 39
4.8 Relationship between some risk factors and the prevalence of intestinal protozoans and helminths among children in the daycare centres and nursery schools 41
LIST OF FIGURES
3.1 Map of Nigeria showing the 36 states and the Federal Capital Territory and map of Kaduna State showing the Local Government Areas… 17
3.2 Map of Sabon Gari Local Government area showing locations of the schools sampled 18
LIST OF PLATES
I Cysts of Entamoeba histolytica 24
II Egg of Dipylidium caninum 25
III Egg of Diphyllobothrium latum 26
IV Egg of Hymenolepis nana 27
V Egg of Ascaris lumbricoides 28
VI Hookworm egg 29
VII Strongyloides stercoralis egg 30
LIST OF APPENDICES
Appendix I: Questionnaire 55
Appendix II: Prevalence of intestinal parasites among children and nannies in daycare and nursery schools in the dry season… 56
Appendix III: Intestinal parasites common to children and the nannies from some sampled daycare centres and nursery schools 57
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the study
Intestinal parasitic infections caused by protozoans and helminths are globally endemic and have been described as constituting the greatest worldwide cause of illness and disease (Chan, 1997; Pillai and Kain, 2003). It has been estimated that 3.5 billion people worldwide are infected with intestinal parasites and the most affected population with highest morbidity are children (Lawn et al., 2005; Chirdan et al., 2010). Also, over 270 million preschool children and over 600 million school-age children live in areas where these parasites are intensively transmitted (WHO, 2015). Intestinal parasitic infections in children have been attributed to their exposure to contaminated meals at onset of weaning when the child’s immune system and personal hygiene are still poor, and when the child is beginning to explore the environment through crawling and other activities (Yilgwan and Okolo, 2012).
Although infections with intestinal protozoans and helminths are said to cause problems to their hosts, parasites are seen to live for long periods in the bowel without causing symptoms or requiring treatment (Haque, 2007). Certain risk factors have been associated with the proliferation of these intestinal parasitic infections among which are low socio- economic status and poor living conditions as well as people in over-crowded areas with poor environmental sanitation, poor garbage disposal, unsafe water supply and unhygienic personal habits (Adamu et al., 2006).
Most intestinal protozoans and helminths are easily transmitted from person to person by direct contact or through contaminated food, water and environments. Over 70 species of parasitic protozoans and helminths infect humans (Odu et al., 2013); this leads to dysenteric and diarrhoeic conditions, intestinal obstruction, malnutrition, iron deficiency, anaemia, malabsorption and other such conditions (Buchini et al., 2007). Most common protozoan parasites infecting humans include Giardia duodenalis Leeuwenhoek, 1681; Cryptosporidium spp. Tyzzer , 1912; Entamoeba histolytica and Balantidium coli, while Trichuris trichiura Morgani, 1740; Strongyloides stercoralis, Ascaris lumbricoides, Necator americanus Stiles, 1898 and Ancylostoma duodenale Dubini, 1834 are some common helminths that affect children (Cox, 2002; Cheesebrough, 2009; Okpala et al., 2014; Abera et al., 2014).
Day care centres and nursery schools are environments where children are more likely to acquire intestinal parasites and pre-school children have been reported to harbour the greatest number of intestinal parasites, especially worms (Crompton and Nesheim, 2002; Gonçalves et al., 2011). Childcare-acquired infections within these institutions may occur due to contact among children, poor toilet facilities, poor sanitary conditions and contaminated playgrounds in the nursery schools (Odoba et al., 2012). Transmission of intestinal parasites among the children can be attributed to the children’s ignorance on the occurrence and mode of transmission of such parasites as well as poor hygienic and sanitary habits. Children have been reported to be at the greatest risk of helminthiasis and other intestinal parasitic infections which are often associated with poor growth, reduced physical activity and impaired learning ability. Also, due to the global endemicity of these intestinal parasites, they greatly affect the health, growth and development of children worldwide (Wakelin, 1996; Matthys et al., 2011; Okpala et al., 2014).
1.2 Statement of Research Problem
It is an established fact that diarrhoea is an important cause of morbidity and death among children, especially children under 5years in developing countries. This leads to about 9% of all deaths among children under age 5 worldwide in 2015 (UNICEF, 2016). The prevalence of parasitic protozoa and helminths among children, especially those in the day care centres and nursery schools is poorly reported and therefore not known to permit formulation of intervention strategies by relevant authorities, especially in Sabon-Gari Local Government Area.
1.3 Justification
Over 270 million pre-school children and over 600 million school-age children live in areas where intestinal protozoans and helminths are intensely transmitted, and are in need of treatment and preventive interventions (WHO, 2015). Studies around the globe and some parts of Nigeria reported various protozoans and helminths to be prevalent among day care, pre-school (mostly under 5years) and school-age children (Chirdan et al., 2010; Obadiah et al., 2011; Okpala et al., 2014; Umeh et al., 2015); some of the studies have associated these parasitic infections to diarrhoeic and dysenteric conditions, anaemia, retarded growth among other illnesses. In most of these studies, the prevalence of these intestinal parasites was associated to parent’s occupations, family background, housing conditions and feeding habits. Hence, there is a need to assess the health risk associated with attendance of day care centres and nursery school within Sabon Gari Local Government Area towards proffering an intervention programme by relevant authorities.
1.4 Aim
The aim of this study is to evaluate the occurrence of gastro-intestinal helminths and parasitic protozoans in children attending day care centres and nursery schools within Sabon-Gari Local Government Area of Zaria, Kaduna State, Nigeria.
1.5 Objectives
The objectives of this study are:
1. To determine the prevalence of gastro-intestinal protozoan parasites and helminths infecting children in day care centres and nursery schools in Sabon-Gari Local Government Area of Zaria, Kaduna State.
2. To identify the risk factors associated with the prevalence of gastro-intestinal protozoans and helminths infection in children of the day care centres and nursery schools.
3. To determine the association of gender and age with the prevalence of gastro- intestinal protozoans and helminths infecting children in the day care centres and nursery schools.
4. To assess the effect of seasons on the prevalence of gastro-intestinal protozoan and helminth infections in children of the day care centres and nursery schools in the study area.
1.6 Hypotheses
1. Gastro-intestinal protozoans and helminths are not prevalent in children of day care centres and nursery schools in Sabon-Gari Local Government Area of Zaria, Kaduna State.
2. There are no risk factors that significantly affect the prevalence of gastro-intestinal protozoans and helminths infection among children in the day care centres and nursery schools.
3. Gender and age are not associated with the prevalence of gastro-intestinal protozoans and helminths in children of the day care centres and nursery schools.
4. Seasons does not influence the prevalence of gastro-intestinal protozoans and helminths in children of the day care centres and nursery schools in the study area.
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