Althea Medical Journal. 2016;3(2)
190 AMJ June 2016
Vegetables contamination by Parasitic Helminth Eggs in Malaysia and
Indonesia
Reashnaa Loganathan,1 Ridad Agoes,2 Insi Farisa Desy Arya3
1Faculty of Medicine Universitas Padjadjaran, 2Department of Microbiology and Parasitology
Faculty of Medicine Universitas Padjadjaran, 3Department of Public Health, Faculty of Medicine,
Universitas Padjadjaran
Abstract
Background: Soil-transmitted helminth infection is known to be a serious issue in South East Asia when
the farmers use night soil and contaminated water for their plants. In Indonesia, some of the farmers still
use human feces and sometimes also mixed it with urine from the latrines as fertilizers. On the contrary, in
Malaysia these contamination occured at a lower rate due to strict rules by the authorities.The objective
of this study was to identify the helminth eggs in vegetables from traditional markets in Indonesia and
Malaysia.
Methods: Three traditional markets were selected by non-random sampling, namely Pasar Ampang in
Malaysia and 2 traditional markets in Indonesia, i.e Pasar Tanjungsari and Jatinangor. Cabbages and lettuce
were bought from 15 different vegetable sellers per market. The samples were examined at the laboratory
of the Medical Faculty, Universitas Padjadjaran. The method to obtain the specimen was in accordance with
Khairul Anwar and Ramachandran. This study was carried out from July to October 2014. The collected data
was analyzed by percentage and frequency tabulation.
Result: Most of the samples are contaminated by helminth eggs. In Pasar Ampang, 13.3% in cabbage and
6.7% in lettuce. In Pasar Tanjung Sari, 46.7% in cabbage and 40% in lettuce. Moreover, in Pasar Jatinangor,
33.3% in cabbage and 26.7% in lettuce. Most of the helmint eggs were Ascaris lumbricoides.
Conclusions: The helminthes eggs contamination is higher in Indonesian traditional markets compared to
in Malaysia. [AMJ.2016;3(2):190–4]
Keywords: Ascaris lumbricoides, Brasicca oleracea (cabbage), contamination, Lactuca sativa (lettuce),
traditional markets
Correspondence: Reashnaa Loganathan, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang
Km.21, Jatinangor, Sumedang, Indonesia, Phone: +6283820568730 Email: reash1992@hotmail.com
Introduction
Soil transmitted infection is known to be very
common by consuming food, especially fruits or
vegetables that has not been properly washed.
Contaminated vegetables play a major role in
the transmission of helminths. This is due to
the usage of sewage water for watering the
plants by the farmers and natural fertilizers.1
Different farmers have different ways of
cultivating plants. Some farmers use natural
fertilizers like animal feces however, some
others use synthetic fertilizers. The vegetables
prone to the usage of natural fertilizers are
more likely to be contaminated.2 Furthermore,
the vegetables vendors in some Indonesian
markets claimed that the farmers from whom
they bought the vegetables , used human feces
and sometimes also mixed them with urine
from the latrines as fertilizers.3 These farmers
did not have enough money to buy chemical
fertilizers. On the contrary, in Malaysia these
contamination occured at a lower rate due to
strict rules by the authorities.4
These fecal materials are the object of
parasitic eggs contamination such as Ascaris
lumbricoides, Trichuris trichura, Necator
americanus Ancylostoma duodenale and
others.2 When these eggs are left for a period
of time, the eggs will mature and reach its
infective stages which may cause helminth
infection.5,6 The objective of this study was to
identify the helminth eggs contamination in
vegetables bought in traditional markets in
Indonesia and Malaysia.
Methods
Three respective traditional markets were
selected using the non-random sampling,
Althea Medical Journal. 2016;3(2)
191
namely Pasar Ampang in Malaysia and 2
traditional markets in Indonesia, i.e Pasar
Tanjungsari and Jatinangor. Then, cabbages
and lettuce were bought from these three
respective markets, consisting of 50 grams of
each vegetable from 15 different vegetable
vendors. The locations of vegetable planting
were traced by the vendors. The samples
bought in Pasar Ampang, Malaysia were
packed with zip lock bags then sealed with
a plastic bag. They were then kept in the
refrigerator and examined two days later. The
samples from the other two markets were
immediately brought to the laboratory of the
Faculty of Medicine, Universitas Padjadjaran to
be examined. They were kept in a large basin
and chopped into small pieces then washed
with 500 ml of 0.95% normal saline. The water
used to wash the vegetables was collected in
beakers. Next, the water in both beakers were
mixed and kept aside for 20 minutes to allow
sedimentation. Then, the top layer of the water
was discarded and the suspension was kept. It
was used to fill up 15 centrifuge tubes for each
vegetable and centrifugation was performed.
It was centrifuged at 2,000 rpm for 5 minutes.
Subsequently, the supernatant was discarded
and the residue was used for microscopic
examination. A drop of the residue was placed
on a slide with a glass cover. Microscopic
examination was then carried out. The samples
had been inspected qualitatively to identify if
the samples observed have given a positive or
negative result.7
This study was carried out from July to
October 2014. Ethical clearance was given for
this study. The method used in this study was
similar to the method prescribed by Anwar
and Ramachandran in their previous study.7
Results
Prior to the purchase of vegetables, the
author personally interviewed the vegetable
vendors in all three markets. The vegetables
sold in Tanjung Sari market were grown
by the farmers themselves. When enquired
about how they kept the vegetables fresh, the
farmers claimed that they used ditch -water.
This ditch was flowing in the market itself
and was connected to almost all the stalls in
the market. Thus, there was a possibility that
every stall in the market disposed rubbish
and waste material in the ditch throughout
the buying and selling process in the market.
The water flowing in the ditch also came from
the nearby housing area. The farmers argued
that they only used the water when it looked
clear. They also claimed that there was not a
common tap for the use of everyone. Although
there was a tap at the main entrance, it was
time consuming to collect water with a pail
and walk up to their stall.
Some of the vegetable vendors in Pasar
Jatinangor mentioned that they used well
-water to wash the vegetables at home before
selling them in the market. However, when in
the market, they still used ditch- water to keep
the vegetables fresh. Some of them still used
ditch water throughout the whole process.
One vegetable vendor mentioned that he used
tap water since his stall was near the tap in
front of the market.
In Pasar Ampang, every vegetable stall
where the samples were bought had their
own tap. This was one of the steps taken by the
Dewan Bandaraya Kuala Lumpur of the state
government of Wilayah Persekutuan state.
They play an important role in maintaining
cleanliness in the market. A few workers were
in charge of cleaning the markets every day
after they were close, and for this service each
stall will have to pay a particular sum of money
at the end of each month.
Based on the results of this study, it can
be deduced that from the respective selected
traditional markets, all of thevegetables were
contaminated by helminth eggs. Moreover,
the cabbage (Brasicca oleracea) had a higher
contamination of soil -transmitted helminths
compared to the lettuce (Lactuca sativa).
The different species of soil -transmitted
helminths eggs which had been found: in
cabbage and lettuce were Brasicca oleracea,
Ascaris lumbricoides, Hookworm, Trichuris
trichura and other (in cabbage), and Brasicca
oleracea, Ascaris lumbricoides, Trichuris
Table 1 Percentage of contamination of helminth eggs in 15 samples of cabbage
(Brasicca oleracea) and Lettuce (Lactuca sativa)
Type of Vegetables Pasar Ampang Pasar Tanjung Sari Pasar Jatinangor
Cabbage (Brasicca oleracea) 13.3% 46.7% 33.3%
Lettuce (Lactuca sativa) 6.7% 40% 26.7%
Reashnaa Loganathan, Ridad Agoes, Insi Farisa Desy Arya: Vegetables contamination by Parasitic Helminth
Eggs in Malaysia and Indonesia
Althea Medical Journal. 2016;3(2)
192 AMJ June 2016
trichura and other (in lettuce) (Table 2, 3).
The most helminths eggs detected were
Ascaris lumbricoides, followed by Trichuris
trichiura and hookworm (Table 2).
Discussion
Although Malaysia is a developing country,
soil -transmitted helminth infections still
exist. This can be deduced based on the study
conducted by Anwar and Ramachandran,7
which identified the prevalence of soil
-transmitted helminths among lettuce leaves
sold in local markets in Penang, Malaysia. The
study has been carried out in 12 different
markets in Penang, Malaysia. All of these
markets showed a high contamination
with Ascaris lumbricoides. However, there
were also contamination with hook worms,
Trichuris trichura and other species of soil
-transmitted helminths. The similarity to this
study was the high number of contamination
with Ascaris lumbricoides which was detected
in both kinds of vegetables.
Another study was carried out in Barru,
Sulawesi, Indonesia to identify the intestinal
helminth infections. This study showed that
people were highly infected with Trichuris
trichuria8 and Ascariasis lumbricoides.
Infection reduces with people who are highly
educated, and the farmers were people who
were not educated properly. Hence, they were
unaware of the infection which can be caused
by night soil.9
In Pasar Ampang, helminth eggs
contamination was low compared to the
2 traditional market in Indonesia. This is
probably due to the strict action of the Dewan
Bandaraya state government in keeping the
markets clean during and after the operational
hours. The presence of a tap in each stall
enhances the cleanliness of the vegetables
as it can be washed more often with a clean
source of water. However, there is still a slight
contamination due to the carelessness of the
stall keeper in not cleaning the vegetables
thoroughly under the running water as the
vegetables are washed in bulk and not one by
one. Therefore, there is a possibility that the
eggs do not fall off the vegetables. Moreover,
the District Health Department plays an
important role in checking on the fertilizers
used for cultivating the vegetables in Malaysia.
The results show that not all farmers are
competent in using fertilizers free of fecal
material throughout the whole process. The
watering system of plants in the whole of
Malaysia is controlled by Indah Water. This
company is responsible in only providing
water that has gone through the processes
in the water plant to produce clean water for
consumption. The farmers have been given a
subsidy so that they can use it to water their
plants at a lower price.
The government of Malaysia has taken
many steps to increase the cleanliness level
of the vegetables sold in the market and
to reduce the parasitic helminth infection.
However, there were some black dots which
caused the continuous presence of infection
with parasitic helminths.
Based on the study of Anuar and Salleh the
two main risk factors found to be associated
with hookworm infection was consuming raw
vegetables and eating contaminated fresh
food. Infections with Ascaris lumbricoides and
Table 2 Distribution of soil -transmitted helminths eggs in Cabbage (Brasicca oleracea) and
Lettuce (Lactuca sativa)
Species Pasar Ampang Pasar Tanjung Sari Pasar Jatinangor
Cabbage (Brasicca oleracea)
Ascaris lumbricoides 2 4 5
Hookworm - 1 -
Trichuris trichiura - 1 -
Others - 1 -
Lettuce (Lactuca sativa)
Ascaris lumbricoides 1 5 3
Hookworm - - -
Trichuris trichiura - 1 -
Others - - 1
Althea Medical Journal. 2016;3(2)
193
Trichuris trichura are age dependent and the
infections are mostly seen in communitiesaged
lesser than 15 years old, belonging to a large
household members and of low socioeconomic
background.10
Furthermore, the vegetables sold in
both markets in Indonesia, Pasar Tanjung
Sari and Pasar Jatinangor, showed a higher
contamination of parasitic helminths eggs
compared to Pasar Ampang. When comparing
both Pasar Tanjung Sari and Pasar Jatinangor,
Pasar Tanjung Sari showed a higher number of
positive results. Pasar Tanjung Sari is known to
be one of the biggest markets in Sumedang area.
The presences of only one tap at the entrance
of the market hascaused more farmers to use
the ditch water to keep the vegetables fresh.
The ditch water may contain fecal material
which will increase the contamination with
the soil -transmitted parasitic helminth. On
the other hand, Pasar Jatinangor is a smaller
market compared to Pasar Tanjung Sari. Here,
the distance from the main tap at the entrance
is not too far. Therefore, more farmers from
Pasar Jatinangor use clean water from the tap
to keep the vegetables fresh. Only those who
have their stalls at a further distance from the
main tap may use ditch water. Thus, this might
explain why Pasar Tanjung Sari had a higher
contamination with soil -transmitted parasitic
helminthes compared to Pasar Jatinangor.
Some of the vendors in Pasar Jatinangor
claimed that they purchased their vegetables
in Pasar Tanjung Sari. However, these
vegetables were washed again before being
sold in Pasar Jatinangor. Most of the vendors
used the existing tap water for washing the
already contaminated vegetables. Although
the vegetables were washed and cleaned again,
they have a lesser number of positive results.
The vendors claimed that the officials
from the Health Ministry occasionally carried
out their rounds. This enabled the farmers to
use human excreta and other animal excretes
as manure for their plants since this was the
cheapest and most convenient way to obtain
fertilizers. The farmers also came from low
socioeconomic background, so that, they
could not afford to buy expensive fertilizers. To
water the plants they used water from the river
which was also dirty. The vendors claimed that
the river water was known to be clean since it
originated from the hills. However they failed
to understand that many people uses the river
water for domestic purposes. People use it
for cleaning, washing and people also openly
defecate in the river. This causes the water to
be highly contaminated.
In this study, the limitation is the difficulty
in identifying of the eggs since the Ascaris
lumbricoides eggs looked similar to the
Dicrocoelium dendriticum eggs at a glance.
It can be concluded that soil -transmitted
helminths exist in both vegetables. The
cabbage is more contaminated with soil
-transmitted helminths than the lettuce.
Ascaris lumbricoides, Trichuris trichura,
hookworms and others have been found in the
samples.
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