Hrev_master [Healthcare in Low-resource Settings 2014; 2:1891] [page 35] Intestinal parasitic infections in Okada rural community, Edo State, Nigeria: a four year retrospective study Bankole H. Oladeinde, 1 Richard Omoregie,2 Mitsan Olley,3 Ahamdi J. Anunibe,3 Ikponmwosa Odia4 1Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada; 2School of Medical Laboratory Sciences, University of Benin Teaching Hospital, Benin City; 3Department of Pathology, Igbinedion University Teaching Hospital, Okada; 4Institute of Laser Fever Research and Control, Irrua Specialist Hospital, Irrua, Nigeria Abstract Intestinal parasitic infections are associated with morbidity and mortality worldwide. Data on prevalence of intestinal parasitic infection is sparse in rural Nigeria. Against this back- ground, this study aimed at determining the prevalence of intestinal parasitic infections within a four year period in the rural commu- nity of Okada, Edo State, Nigeria. Fecal sam- ples obtained from 1528 patients (consisting of 740 males and 788 females) presenting with signs and symptoms of gastroenteritis at the Igbinedion University Teaching Hospital, Okada were examined for presence of ova, cyst and trophozoites of parasites using standard methods. Patient’s age ranged from 6 months to 73 years. Study was conducted between 2007 and 2010. The prevalence of intestinal para- sitic infections increased significantly (P=0.003) from 14.7% in 2007 to 22.5% in 2010. In the study period, gender did not affect the prevalence of intestinal parasitic infection (P>0.05). Patients within <1-10 years had sig- nificantly higher prevalence of intestinal para- sitic infection. Ascaris lumbricoides was the most predominant parasitic agent, while Schistosoma japonicum was the least preva- lent. With respect to parasite, males were observed to have consistently higher preva- lence of Entamoeba histolytica infection. The prevalence of intestinal parasitic infection was observed to significantly increase from 2007 to 2010. Age was a risk factor for acquiring intes- tinal parasitic infection. Ascaris lumbricoides was the most predominant parasitic agent in all years of study. Control and prevention measures are advocated. Introduction Intestinal parasitic infections are among the most common infections worldwide and about 3.5 billion persons, mostly children, are estimated to be infected.1 Intestinal parasitic infections affect nutritional status, physical development, mental function and alertness, verbal ability, and inhibition control aspects of cognitive behaviour in children.2 Intestinal parasitic infections deprive the poorest of health, contributing to economic instability and social marginalization.3 Death and other serious complications can occur if cases of intestinal parasitosis are left untreated espe- cially in children.1 In Nigeria, intestinal parasitic infection constitutes a major public health challenge.4 Poorly planned housing, improper waste dis- posal, gross environmental pollution and poor environmental situations among others are driving forces for this observation.5 Illiteracy, absence of clean drinking water, and poverty has been shown to promote infection with intestinal parasites3 and these factors are rife in most rural communities in Nigeria.6,7 Although data on prevalence of human intes- tinal parasitic infection in Nigeria is common, there is no published data from Okada commu- nity, Edo State, Nigeria. Monitoring of disease and assessment of effectiveness of interven- tion effort in any community is largely enhanced by the availability of local prevalence statistics over a period of time. This type of data is missing in Okada community, and very sparse in many rural communities of Nigeria. Against this background, this study aimed at determining the prevalence of intestinal para- sitic infection in Okada (a rural community in Edo State, Nigeria) within a 4 year period. Materials and Methods Study area Okada, a rural community, is the headquar- ters of Ovia North East Local Government Area of Edo-state, Nigeria. The Local Government has an estimated population of 155,344 peo- ple.8 Majority of the residents of Okada are farmers with few civil servants, lecturers and students making less than 5% of the communi- ty. The study was carried out at Igbinedion University Teaching Hospital, Okada, Edo State, Nigeria, from January 2007 to December 2010. Some neighboring rural communities (villages) also attend the Hospital. Study population This is a laboratory retrospective study. A total of 1528 patients aged 6 months to 73 years with signs and symptoms of gastroen- teritis were included in this study. They con- sisted of 740 males and 788 females. Informed consent was obtained from all patients or their parents/guardian in case of children prior to specimen collection. The study was approved by the Ethical committee of the Igbinedion University Teaching Hospital, Okada, Edo State, Nigeria. Collection and processing of specimens Stool specimens were collected from each patient in wide mouthed containers and exam- ined microscopically for ova, cysts or protozoa using saline and iodine mount as previously described.9 Statistical analysis The data obtained were analyzed using Chi square (c2) test and odds ratio analysis using the statistical software INSTAT® (Graphpad software Inc., La Jolla, CA, USA). Statistical significance was set at P<0.05. Results A total of 278 (18.2%) of the 1528 patients Healthcare in Low-resource Settings 2014; volume 2:1891 Correspondence: Bankole Henry Oladeinde, Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Nigeria. Tel./Fax: +234.80253096120. E-mail: bamenzy@yahoo.com Key words: intestinal parasite, rural community, Nigeria. Contributions: BHO, MO and AJA took part in study design, generated and analysed data, and substantively drafted the article. RO and IO took part in study design, analysed data and substan- tively drafted the article. Conflict of interests: the authors declare no potential conflict of interests. Acknowledgements: the authors acknowledge all members of the ethical committee of Igbinedion University Teaching Hospital for giving their approval for this study. Received for publication: 18 August 2013. Revision received: 13 September 2013. Accepted for publication: 25 September 2013. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0). ©Copyright B.H. Oladeinde et al., 2014 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2014; 2:1891 doi:10.4081/hls.2014.1891 No n- co mm er cia l u se on ly [page 36] [Healthcare in Low-resource Settings 2014; 2:1891] were infected with at least one intestinal para- site. The prevalence of intestinal parasitic infections was observed to significantly (P=0.003) increase from 2007 to 2010. Among patients with intestinal parasitic infection, 30 (10.8%) had more than one parasite in their stool. No statistically significant difference (P=0.733) was observed over the years with respect to the prevalence of mixed intestinal parasitic infection (Table 1). Gender was not significantly associated with intestinal parasitic infection in all the study period (Table 2). The prevalence of intestinal parasitic infections was significantly higher in the age group <1-10 years from 2007 to 2010. Among participants aged <1-10 years, the prevalence of intestinal parasitic infection was observed to significantly increase from 2006 to 2010 (Table 3). A total of 308 intestinal parasites were identified in 278 patients. Generally, and in all the years of study, Ascaris lumbricoides was the most predominant parasitic agent identified in patients stool, fol- lowed by Entamoeba Histolytica. Schistosama. japonicum was the least prevalent intestinal parasitic agent (Table 4). The prevalence of Entamoeba histolytica infection was observed to be higher among male participants in all years of study (Table 5). Discussion Intestinal parasitic infections are globally endemic and have been described as constitut- ing the greatest single cause of illness and dis- ease worldwide.3 Factors that promote intestin- al parasitic infections, i.e. illiteracy, poverty, absence of clean drinking water,3 are rife in rural communities in Nigeria. Against this background and the paucity of reports on intes- tinal parasitic infections in rural communities of Edo State, Nigeria, this study was conduct- ed. The overall prevalence of intestinal para- sitic infection in this study was 18.2%. This is lower than reported figures in other Nigerian studies.5,10,11 The prevalence of intestinal para- sitic infections varies with different geograph- ical regions.12 The variation could be due to dif- ferences in geographical location: in Ikeh et al.,5 Nduka et al.,10 and Awolaju and Morenikeji,11 studies were conducted in north central, south eastern, and south western Nigeria respectively, in contrast to our study which was conducted in Mid Western Nigeria. The prevalence of intestinal parasitic infec- tion was observed to significantly increase from 14.7% in 2007 to 22.5% in 2010. Igbinedion University, Nigeria’s first private University in Okada, has witnessed an unprecedented influx of persons into the com- munity, without corresponding increases in social amenities, like portable drinking water amongst others. This is likely to result in more people sharing limited social amenities such as portable drinking water, and housing which in turn could precipitate the spread of intestin- al parasitic infections observed over the years in this study. Thirty patients representing 10.8% of the total number of patients with intestinal parasitic infection in this study had more than one parasite recovered from their stool. However, the prevalence of mixed infec- tion did not differ significantly from 2007 to 2010. Irrespective of year of study, gender did not significantly affect the prevalence of intes- tinal parasitic infection. This is consistent with other reports.5,10 Age was found to signifi- cantly affect the prevalence of intestinal para- sitic infection with participants within the age group of <1-10 years consistently observed to have the highest prevalence within each year of study. Similar findings have been reported elsewhere.13 Among patients within the age group of <1-10 years, the prevalence of intes- tinal parasitic infection was observed to signif- icantly (P=0.001) increase from 21.2% in 2007 Article Table 1. Four year prevalence of intestinal parasitic infection in Okada. Year No. of tested No. of infected Mixed infection P patients patients (%) (%) 2007 218 32 (14.7) 5 (15.6) 0.003 2008 454 72 (15.9) 7 (9.7) - 2009 350 60 (17.1) 5 (8.3) - 2010 506 114 (22.5) 13 (11.4) - Total 1528 278 (18.2) 30 (10.8) - Table 2. Effect of gender on prevalence of intestinal parasitic infection in Okada. Year Gender No. of tested No. of infected OR 95% CI P patients patients (%) 2007 Female 113 21 (18.6) 1.951 0.890, 4.273 0.134 Male 105 11 (10.5) 0.513 0.234, 1.123 2008 Female 265 43 (16.2) 1.069 0.639, 1.785 0.902 Male 189 29 (15.3) 0.936 0.560, 1.563 2009 Female 186 33 (17.7) 1.094 0.626, 1.913 0.861 Male 164 27 (16.5) 0.913 0.523, 1.597 2010 Female 282 65 (23.0) 1.070 0.702, 1.630 0.836 Male 224 49 (21.3) 0.935 0.614, 1.424 OR, odds ratio; CI, confidence interval. Table 3. Effect of age on prevalence of intestinal parasitic infection in Okada. Age 2007 2008 2009 2010 P (year) No. of No. of No. of No. of No. of No. of No. of No. of tested infected tested infected tested infected tested infected patients patients (%) patients patients (%) patients patients (%) patients patients (%) ≤1-10 80 17 (21.2) 155 38 (24.5) 115 29 (25.2) 168 68 (40.4) 0.001 11-20 47 8 (17.0) 80 15 (18.8) 58 13 (22.4) 77 18 (23.4) 0.326 21-30 19 2 (10.5) 44 5 (10.6) 30 2 (6.6) 65 6 (24.6) 0.727 31-40 23 1 (4.3) 41 4 (9.7) 39 4 (10.2) 48 5 (10.4) 0.490 41-50 14 1 (7.1) 47 3 (6.3) 41 3 (7.3) 60 4 (6.7) 0.995 51-60 18 0 (0.0) 33 4 (12.1) 25 3 (12.0) 44 6 (13.6) 0.207 ≥60 17 3 (17.6) 54 3 (5.6) 42 6 (14.3) 44 7 (15.9) 0.411 P=0.036 (2007); P<0.0001 (2008); P=0.007 (2009); P<0.0001 (2010). No n- co mm er cia l u se on ly [Healthcare in Low-resource Settings 2014; 2:1891] [page 37] to 40.4% in 2010. This represents increasing risk of acquiring intestinal parasitic infection for children of this age group living in study location. Children within this age group are likely to be involved in domestic chores of get- ting water for household use, and this increas- es exposure to water borne diseases. Also infants may consume food and water of poor hygienic quality, thus increasing their suscep- tibility to infection. These may explain the high prevalence of intestinal parasitic infec- tions in the age group of <1-10 years. However this observation is not consistent with reports elsewhere.5,10 Ascaris lumbricoides was the most predomi- nant parasitic agent generally and in all the years of study, followed by Entamoeba histolyt- ica. This finding agrees with a previous report.14 Poor socio-economic conditions are among the key factors linked with higher prevalence of ascariasis, as are poor defaeca- tion practices, agricultural factors, housing style, and social class.15 Residents of Okada and neighboring villages are mostly farmers, who may engage in agricultural practices that fuel the spread of Ascaris lumbricoides among the population. The finding that Entamoeba histolytica was higher among male partici- pants, have been reported in an earlier study.16 The reason for this however is unclear. Conclusions This study reports a high prevalence of intestinal parasitic infection in Okada rural community, which was observed to increase steadily from 2007 to 2010. Children between 1-10 years had the highest risk of being infect- ed with intestinal parasites. Provision of essential social amenities such as housing and portable drinking water for the teeming popu- lation of Okada community by relevant agen- cies will help in curbing the spate of the dis- ease. Regular screening and treatment of per- sons infected with intestinal parasites by local health authorities and other intervention agencies are also advocated. Increased public enlightenment on the need for the develop- ment of a culture of general environmental cleanliness and personal hygiene among resi- dents of Okada community and environs will also help in stemming intestinal parasitic infections in the bud. References 1. Houmisou RS, Amita EU, Olusi TA. Prevalence of intestinal parasites among primary school children in Makurdi, Benue State, Nigeria. Internet J Infect Dis 2010;8:97-106. 2. Nokes CL, Bundy DAP. Does helminthes infection affect mental processing and educational achievement? Parasitol Today 1994;11:14-8. 3. Mehraj V, Hatcher J, Akhtar S, et al. Prevalence and risk factors associated with intestinal parasitic infections among children in an urban slump of Karachi. PLoS One 2008;3:1-7. 4. Uneke CJ, Nnachi MI, Arua U. Assessment of polyparasitim with intestinal parasitic infections and urinary schistosomiasis among school children in a semi-urban area of south eastern Nigeria. Internet J Health 2009;9:1. 5. Ikeh EJ, Obadofin MO, Brindeiro B, et al. Intestinal parasitism in rural and urban areas of North Central Nigeria: an update. Internet J Microbiol 2006;2:1. 6. Imoh AN, Isaac KJ, Nwanchukwu EO. Comparative analysis of poverty status of community participation in rural develop- ment projects of Akwa-Ibom State, Nigeria. New York Sci J 2009;2:68-75. 7. Aderamo AJ, Magaji SA. Rural transporta- tion and the distribution of public facilities in Nigeria: a case of Edu local government area of Kwara State. J Hum Ecol 2010;29: 171-9. 8. National Population Commission. Population and housing census of the Federal Republic of Nigeria. 2006. Available from: http://www.population.gov. ng/index.php/publications/list-of-publica- tions 9. Akinbo FO, Okaka CE, Omoregie R. Prevalence of intestinal parasitic infec- tions among HIV patients in Benin City, Nigeria. Libyan J Med 2010;5:5506. 10. Nduka FO, Nwango VO, Nwanchukwu NC. Human intestinal parasitic infection in Ishiagu- a lead mining area of Abia State. Anim Res 2006;3:505-7. 11. Awolaju BA, Morenikeji OA. Prevalence and intensity of intestinal parasites in five communities in south-west Nigeria. Afr J Biotechnol 2009;8:5542-6. 12. Ramana KV. Intestinal parasitic infections: an overview. Ann Trop Med Pub Health 2012;5:279-81. 13. Akinbo FO, Omoregie R, Eromwon R, et al. Prevalence of intestinal parasites among patients of a tertiary hospital in Benin city, Nigeria. N Am J Med Sci 2011;3:462-4. 14. Dibua UE, Awagu OJ, Esimone CO. Prevalence of intestinal parasitoses in the Nsukka community of South Eastern Nigeria. Int J Trop Med 2007;2:33-40. 15. O’Lorcain P, Holland CV. The public health importance of Ascaris lumbricoides. Parasitology 2000;121:61-71. 16. Acuna-soko R, Maguire JH, Wirth DF. Gender distribution in asymptomatic and invasive amebiasis. Am J Gastroenterol 2000;95:1277-83. Article Table 4. Yearly distribution of intestinal parasites in Okada. Parasite No. of infected patients (%) 2007 2008 2008 2009 2010 A. lumbricoides 21 (56.7) 46 (58.2) 33 (50.8) 62 (48.8) 162 (52.6) Hookworm 5 (13.5) 10 (12.7) 11 (16.9) 22 (17.3) 48 (15.6) E. vermicularis 2 (5.4) 3 (3.8) 1 (1.5) 3 (2.3) 9 (2.9) S. stercoralis 0 (0.0) 2 (2.5) 1 (1.5) 3 (2.3) 6 (1.9) S. japonicum 0 (0.0) 1 (1.3) 0 (0.0) 1(0.8) 2 (0.6) E. histolytica 8 (21.6) 15 (18.9) 18 (27.7) 34 (26.8) 75 (24.4) G. lamblia 1 (2.7) 2 (2.5) 1 (1.5) 2 (1.5) 6 (1.9) Total 37 (12.0) 79 (25.6) 65 (21.1) 127 (41.2) 308 (0.1) Table 5. Gender distribution of intestinal parasites in Okada. Parasite No. of infected patients (%) 2007 2008 2009 2010 M F M F M F M F A. lumbricoides 7 (58.3) 14 (56.0) 15 (48.4) 31 (64.6) 12 (37.5) 21 (63.6) 35 (49.3) 27 (48.2) Hookworm 1 (8.3) 4 (16.0) 3 (9.6) 7 (14.5) 9 (28.1) 2 (6.1) 10 (14.1) 12 (21.9) E. vermicularis 1 (8.3) 1 (4.0) 2 (6.5) 1 (2.1) 0 (0.0) 2 (6.1) 2 (2.8) 1 (1.8) S. stercoralis 0 (0.0) 0 (0.0) 1 (3.2) 1 (2.1) 1 (3.1) 1 (3.0) 3 (4.2) 0 (0.0) S. japonicum 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.1) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.8) E. histolytica 3 (25.0) 5 (20.0) 8 (25.8) 7 (14.6) 9 (28.1) 9 (27.2) 21 (29.6) 13 (23.2) G. lamblia 0 (0.0) 1 (4.0) 2 (6.5) 0 (0.0) 1 (3.1) 0 (0.0) 0 (0.0) 2 (3.6) M, male; F, female. No n- co mm er cia l u se on ly