FREQUENCY OF INTESTINAL PARASITIC INFECTIONS AMONG SCHOOLCHILDREN IN IBB CITY-YEMEN

Objectives: Intestinal parasitic infections are widely distributed and remain one of the most health problems in Yemen. This is a cross-sectional study aimed to determine the prevalence of intestinal parasitic infection and associated factors among schoolchildren in Ibb City, Yemen. Methods: A total of 300 stool samples were collected from schoolchildren between January to April 2018 and examined by direct smear and formalin ether concentration techniques. Results: The result showed that 62.7% were positive for intestinal parasites, with a higher frequency of single than multiple infections (85.1 vs. 14.36%, respectively). Also, 85.64% were infected by protozoa whereas 14.36% infected by helminths. The prevalence of infection was 61.70% for Entameba histolytica, 23.94% for Giardia lamblia, 7.45% for Ascaris lumbricoides, 4.3% for Hymenolepis nana, and 2.61% for Enterobius vermicularis. Moreover, the highest prevalence of E. histolytica, G. lamblia, and A. lumbricoides was within group aged 9-12 years. H. nana was between age groups of 9-12 and 13-16 years while E. vermicularis was found among 5-8 and 9-12 years. In addition, females were 69% infected significantly higher than males 54.55%. Besides, the various signs and symptoms associated with intestinal infections have been documented. Conclusion: High prevalence of intestinal infection was documented among schoolchildren drinking from cistern water, poor hygiene practices, poor food sanitation, non-swimming, and non-previously treated for Schistosoma parasite. High frequency of intestinal parasitic infection between schoolchildren in the study area requires more effort to implement the appropriate programmers that warrant to control and prevention the prevalence of intestinal parasitosis.


INTRODUCTION
Intestinal parasitic infection, caused by protozoa and helminths, is one of the world's largest health problems and is responsible for affecting nearly 3.5 billion people and about 450 million illnesses caused by intestinal parasites 1 . The highest prevalence of parasitosisis concentrated in developing countries with up to 50% 2 . Many factors play an important role in developing countries for transmission of the intestinal parasites the representing the unavailability of potable water, reduced hygienic environments, fast population growth, and, low economic status 3, 4 . Intestinal parasitic infections are the most threats that challenge the healthy living in developing countries mainly affecting school children 5 . The young children are found to be too much affected within intestinal parasites compared to adults because of their increased requirements of nutrition and weak immune systems. The presence of intestinal parasites in this age group have been accompanied with significantly risk problems such as slowly in growth, lack of protein-energy malnutrition, iron deficiency, decrease in physical activity, and impaired mental function and learning ability 6 . It was estimated that around 12% of the world wide illness burdens resulting from intestinal parasites are reported amongst children aged 5-14 years old in developing countries 7 . Also, nearly 270 million pre-school and 600 million schoolchildren are living in a zone where the parasites are extensively transmitted 8 14 . This study is small and not enough to show the occurrence of intestinal parasitic among schoolchildren and related factors. Therefore, the aim of the current work was to determine the prevalence of intestinal parasitic infections and risk factors for parasite infection among schoolchildren in Ibb, Yemen.

SUBJECTS AND METHODS Study Design and Area
A cross-sectional study was carried out at medical laboratory department, Ibb University which located in Ibb city, Yemen, during the period from January to April 2018. There were seven districts subjected for present work that are Al-Dehar, Al-Maeen, Al-Mashanh, Al-Sabal, Harathah, Mafrg-Jeblah, and Shaban that located in Ibb city. From each district, one school was selected randomly.

Ethical statement
The study protocol was permitted by the University of Ibb, Yemen, and authorization to start collection of data was granted by the Education Office of the City of Ibb. Before the start of data collection and samples, the goals and methods of study were explained to the school principals and children to agree to their inclusion in this study.

Data Collection
A designed questionnaire was subjected to each participant such as age, gender, the clinical information like diarrhea, blood in the stool, and abdominal pain as well as environmental factors like; source of drinking water, personal hygiene, food sanitation, parents occupation, swimming, and previous Schistosoma treatment.

Sample Collection and Examination
A total of 300 stool samples were chosen of schoolchildren, aged between 6-16 years old, attending governmental schools. A dry, clean, leak proof container (labeled faecal) was given to each child and was instructed on how to introduce specimens (stool) into the bottles and transmitted to a laboratory, as soon as possible, for parasitological examination 15 . The specimens were prepared and tested by using three methods of routine examination of stool: wet preparation, saline sedimentation centrifuged, and formalin/ether concentration 15 .

RESULTS
Three hundred (300) specimens were chosen of school children presenting to seven governmental schools in Ibb city. Of these samples, 168(56%) were females and 132 (44%) were males. The distribution of collected samples according to age was listed in Table 1 Figure 2. Furthermore, multiple infections were obviously identified and documented that 160(85.1%) of the positive samples were infected with one type of parasite species, while 28 (14.9%) were infected by double types of parasites (Table 2). prevalence of E. histolytica was reported among the age group of 9-12 years (41.4%) followed by the age of13-16 years (37.9%). The high rate infections were 51.1% and 57.1% recorded between 9-12 years by G. lamblia and A. lumbricoides, respectively. Also, the similar results of H. nana infection were (50%) reported between groups aged 9-12 and 13-16 years while infection E. vermicularis infection was found among 5-8 years and 9-12 years as listed in Table 4.Moreover, the overall rates of intestinal parasitic infection were recorded 69.1% and 54.55%, respectively, in females and males Table 4. Table 5 summarizes the common signs and symptoms among infected schoolchildren. It was revealed that the high rate was 49.3% recorded with an abdominal pain followed by 46.7% for diarrhea. While the low rate was with 8% with bloody in the stool. The results based on factors were found that the frequency of intestinal parasitic infection among schoolchildren drinking from the cistern with 76.6%, poor hygiene with 76.1%, poor food sanitation with 57.4%, no swimming practice 68.1%, not previously treated for Schistosoma 68.1%as listed in Table 6.

Figure 1: The collected samples according to districts DISCUSSION
Recently, the high rate of intestinal parasites prevalence among children in Yemen is well-known. The major factors associated with the incidence of intestinal parasitic diseases refer to the low hygienic practices, environment contamination with fecal, lack of safe water, and health education resulting from the high level of poverty 13 . The present study was revealed that 300 samples (168 females and 132 males) were collected from schoolchildren from Ibb city.

Figure 3: Type of intestinal infection among schoolchildren
In the current investigation, the intestinal protozoa were 85.64% the most predominant infections observed among schoolchildren, while the intestinal helminthes infections were (14.36%). A similar result was reported by Al-Mekhlafi et al., 16 24 . In the present study, the prevalent intestinal parasites in females with 69% was significantly higher than males (54.55%).Conversely, the previous study by Alwabr and Al-Moayed 13 reported that the infection rates between males (46.5%) were higher than females (43.5%). The present result showed that the majority of clinical signs and symptoms sufferings are associated with the main parasites in Yemen such as E. histolytica and Giardia. Also, blood in the stool, cough, muscle aches, skin itch and weight loss were shared with all parasitic infections and another illness. This result was supported by Al-Haddad and Baswaid 10 who found that different symptoms as diarrhea, abdominal pain, abdominal distention, constipation, nausea and vomiting, and fever were presented between participated. The effect of intestinal parasites on children weight was investigated in Yemen. Alwabr and Al-Moayed 13 showed that more than 67% of the infected schoolchildren were found to be underweight and 22% stunting. High prevalence of intestinal infection in this work was recorded among schoolchildren drinking from cistern water, poor hygiene practices, poor food sanitation, nonswimming, and non-previously treated for Schistosoma parasite. The environmental and behavioral factors could be played a major role in prevailing of intestinal parasitic infections with high rate in the study area.

CONCLUSION
It can be concluded that the high frequency of protozoa and helminthes infections reported in the present investigation indicated poor hygiene and environmental pollution as a problem of public health among schoolchildren in the area. Therefore, there are more efforts to implement the appropriate programmers that warrant to control and prevention the prevalence of intestinal parasitosis among schoolchildren.