ABSTRACT
Parasitic infections abound worldwide. The environment, the climate, the social behaviour and economic factors make developing countries more vulnerable to parasitic infections compared to developed countries. A cross-sectional study was conducted between the months of December 2017-May 2018 to determine the prevalence of parasitic infections in Obizi Amakama Olokoro, rural settlement in Umuahia South Local Government Area of Abia state. Three different sample types (blood, urine and stool) were collected and analyzed following standard laboratory procedures. Faecal samples were analyzed using the Formol-Ether Concentration technique, urine samples were analyzed using Centrifugal Sedimentation method and blood samples were analyzed using Rapid Diagnostic Test (RDT) and microscopy (gold standard). Sociodemographic data was collected using structured questionnaire. Statistical analysis was done using the Pearson’s Chi-square, using the PAST Statistical package. The results of this study recorded an overall blood parasitic prevalence of (32.4%), with Plasmodium falciparum recording the highest prevalence of (28.2%) by RDT and (30.6%) by microscopy and Tyrpanosoma brucei gambiense occurring as mixed infection, having the lowest prevalence (1.8%).Schistosoma haematobiumhad a prevalence of (3.9%). The following intestinal parasites occurred, with Ascaris lumbricoides, recording the highest prevalence (14.4%), Hookworm (2.1%), Taenia saginata (0.7%), Schistosoma mansoni (3.5%), Enterobius vermicularis (1.1%), Trichuris trichura (1.4%), Chilomastixmensnili (1.8%), Entamoebacoli (0.4%). Mixed infections occurred, the combination of Hookworm and Taenia saginataoccurred most as mixed infection (1.8%), the combination of Ascarislumbricoides occurred as mixed infection with Taeniasaginata (1.1%), Fasciola hepatica and Schistosoma mansoni recorded a prevalence of (0.7%), Balatidium hominis and Enterobius vermicularis recorded a prevalence of (0.7%). Parasites distribution was found to be statistically significant with respect to age, occupation and the use of ITNs. The prevalence of blood parasites with respect to gender and age was statistically insignificant P = 0.16 and P = 0.2, and statistically insignificant with respect to occupation 0.00 with (P ≥ 0.05) indicating significance. Plasmodium falciparum was statistically significant with respect to the use of ITNs 0.01. Urinary parasites were found to be statistically significant with respect to gender 0.01, age 0.00 and occupation 0.00. Intestinal parasites were not statistically significant with respect to gender 0.20, but were statistically significant with respect to age 0.00 and occupation 0.00. Fever, fatigue, blood in urine and stool, diarrhoea were the signs of ill health reported. The participants gave reasons for their non-use of ITNs, some of which were cost and availability of purchase and discomfort during night rest. The results from this work have shown that Plasmodium falciparum is still a thriving issue in terms of parasitic diseases recording the highest prevalence of blood parasitic infections and parasitic infections in general (32.4%). Parasitic infections are endemic in the study area.
TABLE
OF CONTENTS
Cover page i
Title page ii
Declaration iii
Dedication iv
Certification v
Acknowledgements vi
Table of Contents vii
List of Tables xi
List of Figures xii
List of Plates xiii
Abstract xiv
CHAPTER 1:
INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problem 3
1.3 Aim and Objectives of the Study 4
1.4 Justification of the Study 4
CHAPTER 2:
LITERATURE REVIEW
2.1 Measures for Controlling
Parasitic Diseases 7
2.2 Burden of Parasitic Diseases 8
2.3
Previous Studies on the Prevalence of Parasitic Infection 11
2.4 Blood Parasites (Malaria) 18
2.4.1
Transmission of malaria 18
2.4.2
Symptoms 19
2.4.3 Life cycle of Plasmodium species 20
2.4.4
Malaria diagnosis 21
2.4.5
Prevention and control 25
2.4.6 Insecticide-treated mosquito nets 25
2.4.7 Indoor spraying with residual insecticides 25
2.4.8 Antimalarial drugs 25
2.5
Human African Trypanosomiasis (HAT) 26
2.5.1
Life cycle 27
2.5.2 Transmission and symptoms 29
2.6 Schistosomiasis (Urinary and Intestinal) 29
2.6.1 Life cycle of Schistosoma 30
2.6.2 Transmission 32
2.6.3 Symptoms 32
2.6.4 Prevention 32
2.7 Intestinal Parasites (Helminths) 33
2.7.1 Transmission 33
2.7.2 Symptoms 34
2.7.3 Life cycle of Ascaris lumbricoides 34
2.7.4 Prevention and control 37
2.8 Trichinella
spiralis 37
2.8.1 Life cycle of Trichinella spiralis 37
2.8.2 Symptoms 40
2.8.3 Transmission 40
2.8.4 Prevention and control 41
2.9 Intestinal protozoa: Entamoeba histolytica 41
2.9.1 Transmission 41
2.9.2 Life cycle of Entamoeba histolytica 42
2.9.3 Signs and symptoms 45
2.9.4 Pathogenicity of Entamoeba histolytica 45
2.10 Trichuris trichiura 46
2.10.1 Life cycle and transmission 46
2.10.2 Symptoms 48
2.10.3 Prevention and control 49
2.11 Chilomastix mensnili 49
2.11.1 Life cycle and transmission 49
2.12 Taenia saginata 52
2.12.1 Transmission 52
2.12.2 Symptoms 52
2.12.3 Prevention and control 54
2.13 Balantidium
coli 55
2.13.1 Transmission 55
2.13.2 Symptoms 56
2.13.3 Prevention and control 59
2.14 Enterobius vermicularis 59
2.14.1 Life cycle Enterobius vermicularis 59
2.14.2 Prevention and control 62
CHAPTER 3:
METHODOLOGY
3.1 Study Area 63
3.2 Ethical Approval 65
3.3 Study Design and Duration of
Study 65
3.4 Sample Collection 65
3.5 Collection of Blood Samples 65
3.6 Collection of Urine and Faecal
Samples 66
3.7 Sample Analysis 66
3.7.1 Blood sample analysis and
examination for parasites 66
3.7.2 Thin smear 66
3.7.3 Thick smear 66
3.7.4 Rapid diagnostic test 67
3.7.5 Urine analysis 67
3.7.6 Faecal analysis 67
3.8 Statistical Analysis 67
CHAPTER
4: RESULTS AND DISCUSSION
CHAPTER
5: CONCLUSIONS AND RECOMMENDATIONS
5.1 Conclusions 99
5.2 Recommendation 99
References
Appendix
LIST
OF TABLES
4.1: Socio-Demographic
Characteristics of the Respondents 69
4.2a:
Prevalence of Malaria Parasite by RDT 70
4.2b. Overall Prevalence of Blood Parasites by Microscopy 71
4.3: Overall
Prevalence of Blood Parasites 72
4.4: Prevalence
of Urinary Tract Parasite 73
4.5: Overall
Prevalence of Intestinal Parasites 75
4.6: Prevalence of Blood Parasites with Respect to Gender 76
4.7: Prevalence of Urinary Parasite with
Respect to Gender 77
4.8:
Gender-related Prevalence of Intestinal Parasites 78
4.9 Prevalence of Blood Parasites with
respect to Age 79
4.10: Prevalence
of Urinary Tract Parasite (Schistosoma
haematobium)
with Respect to Age 80
4.11: Prevalence of Intestinal
Parasites with Respect to Age 81
4.12: Prevalence of Blood Parasites with
Respect to Occupation 82
4.13: Prevalence
of Urinary Tract Parasites with Respect to Occupation 83
4.14: Prevalence of Intestinal Parasites with Respect to Occupation 84
4.15: Signs and
Symptoms Reported 85
4.16: Prevalence
of Malaria Infection with Respect to ITNs 86
4.17: Reasons
for Non-use of ITNs 87
LIST
OF FIGURES
2.1: Life
cycle of Plasmodium species 24
2.2: Life cycle Trypanaosoma species 28
2.3: Life cycle of Schistosoma species 31
2.4: Life cycle of Ascaris lumbricoides 36
2.5: Life cycle diagram of Trichinella spiralis 39
2.6: Life cycle of Entamoeba histolytica 44
2.7: Diagram showing the life cycle of Trichuris trichiura 48
2.8 Life cycle of Chilomastix
mensnili 51
2.9 Life cycle of Taenia. saginata 53
2.10 Life cycle of Balantidium infection
in humans 58
2.11: Life cycle of Balantidium coli 61
3.1: Map showing the Location of Obizi
Hall in Umuahia South LGA,
Abia State 64
LIST
OF PLATES
Trichuris
trichuria 117
Entamoeba histolytica 118
Ascaris
lumbricoides 119
Trophozoites of Plasmodium species in thick
film 119
Wounded red blood cells by Plasmodium species 120
Hookworm species 121
Picture of the research work 122
Picture of the Research work showing sample
collection 123
CHAPTER
1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Health is a very important aspect of
development because healthy people are economically more effective. Any
strategic development therefore must see the necessity to appreciate the
inextricable relationship between health and development (Galadima, 2009).
Parasitic diseases influence every aspect of human life, from childhood to
adolescence and adulthood. If they do not kill outright, as in malaria, they
debilitate, as in sleeping sickness, thereby preventing the affected
individuals from vigorously pursuing their chosen source of livelihood. This
also, escalates the amount of effort required to stay alive.
Parasitic infections abound
worldwide. The environment, the climate, the social behavior and economic poverty
make developing countries more susceptible to parasitic infections compared to
developed countries. Consequently, parasitic infections are more endemic in the
rural areas compared to the urban settlements. Some factors are responsible for
the wide spread of parasitic infections in developing countries. These include
inadequate water supply and sanitation, crowded living conditions, lack of
access to health care, low level of education, poor personal hygiene, poor
environment and lack of toilet facilities amongst others (Galadinma, 2009;
Ukpai and Ugwu, 2007).
Some
of the parasites that cause parasitic infection are: Toxoplasma gondii, Ascaris lumbricoides, Entamoeba histolytica,
Schistosoma masoni, Trypanosoma species,
Loa loa, Leishmania species, Trichomonas vaginalis, Trichuris trichiura,
Hookworm, Wuchereria bancrofti, Trypanosoma species, Plasmodium falciparum and many others.
Parasitic infections can be transmitted by man to man or from animals to man
(zoonosis) through several ways.
Modes
of Transmission
Per
cutis: This mode of transmission involves the
parasites’s infective stages (cercariae, filariform larvae) which would
normally pierce the skin of victims who walk with bare foot or swim in infected
water bodies. Parasites that use this mode includeNecator americanus, Ancylostoma duodenale, Schistosoma mansoni,
Schistosoma haematobium and other Schistosomes
(Galadinma, 2009).
Insect vectors:
Insects can serve both as intermediate hosts and vectors of human parasites.
The infective stages usually develop in the insects, then move to the mouth
parts and are inoculated into the susceptible human host through insect bites
during blood meals. Such parasites include;
Onchocerca volvulus by the Simulium
damnosum complex malaria parasites through the Anopheles mosquitoe, African
Trypanosomes through the Glossina flies, Loa Loa through theTabanid flies, Wuchereria bancrofti byCulex,
Aedes mosquitoes, Leishmania parasites through the Bhlebotomine sandflies, Trypanosoma cruz by the Triatomine bugs (Galadinma, 2009; Ukpai,
2010).
Sexual
intercourse: A parasites that uses this route of
transmission isTrichomonas vaginalis
Congenital
transmission: Examples of parasites that can be
transmitted through this route are: Plasmodium
species, Babesia canis and Toxoplasma gondii.
Blood
transfusion:
Examples of parasites that can be transmitted through this mode are: Plasmodium species and Babesia canis (Galadima, 2009).
1.2 STATEMENT OF THE PROBLEM
Parasites have become the leading causes of
morbidity and mortality in the world. Statistics has that there are estimated
100 million malaria casesin Nigeria with over 300,000 deaths per year (WHO,
2009). 60 million people have been estimated to live in areas where Human
African Trypanosomiasis (HAT) is endemic resulting in 300 000-500 000 new cases
of HAT (WHO, 2006). The greatest number
of Schistosomiasis cases worldwide has been recorded in Nigeria with about 29
million infected cases and 101 million people are at risk of infection (Hotez,
2009).
Poor sanitary conditions, climate,
poverty, ignorance, eating habits, cultural beliefs and practices work together
to provide an optimum environment for proliferation and infection of parasitic
diseases in Africa. These poor unhygienic conditions prevalent in most cities
of the developing countries are ideally-suitable for the transmission of
parasitic infections through air, food, water, human waste and insect-vectors
(Houmsou et al., 2010). Apart from
inflicting sickness and death on mankind, parasites make life miserable for man
through poverty, sapping of energy, and loss of animal protein. The economy suffers due to loss of useful man
hours. Absenteeism from school and work a have been greatly attributed to parasitic
infections. Many of these parasitic infections may be asymptomatic and due to
negligence on the part of individuals and government, these parasites are
allowed to increase in the body and before any serious help would be sought
for, much damage has been done. This goes to say that individuals would always
go about living their lives as long as they can, without routine check-up and
therefore become reservoir hosts, from where these parasites could spread to
more people. With the increase in
insurgency and security issues in the country, citizens have moved from
parasite-endemic regions to places with low parasite endemicity. Some of these
people could have the potential to transfer these parasites to their new
location. It was therefore, necessary to investigate Obizi, a rural settlement
in Umuahia
South local government area of Abia
State. Rural settlements are mostly the
cheapest places where migrants settle
in.
1.3 AIM AND OBJECTIVES OF THE STUDY
(a)
The aim of this study was to determine the prevailing parasitic infections in
the study areathrough the following objectives:
(b) Objective: The objectives of this this study
are:
1. Determine
the prevalence of blood parasites in the study area.
2. Determine
the prevalence of urinary parasites in the study area.
3. Determine
the prevalence of intestinal parasites in the study area.
4. Assess
the rate of different parasitic infections in relation to age, sex and
occupation.
1.4 JUSTIFICATION OF THE STUDY
Globally, millions of people suffer
from parasitic infections, in tropical countries, especially in Africa.
Parasitic infections remain one of the principal factors contributing to human
morbidity and mortality (Nmor, et al.,
2009). Malaria affects 3.3 billion people or half the world’s population, in
106 countries (U.S Embassy, 2011). WHO estimates 216 million cases of malaria
occurred in 2010 with 81% in the Africa region (WHO, 2019). The climate and the
abundance of Anopheline mosquitoes
have combined to stabilize the disease in the country. Only 10% of global
health research spending is directed towards the “neglected diseases of the
poor”, even though these diseases, including parasitic infections account for
roughly 90% of global disease burden. Human activities, insurgency and movement
of people from parasitic endemic areas to the city have created a need for
regular monitoring of prevalence status of parasitic diseases. Recent and
accurate data is always needed to help prevent spread the and re-occurrence of
these diseases (Onyebiguwa et al.,
2010).
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