CONTACT : QUEEN OZIOMA LAWRENCE queenlawrence8@gmail.com 126 Abstract Human intestinal parasites are among the most common infectious disease s worldwide. This st udy wa s conducted to determine intestinal parasites prevalence and risk factors in the study area. A total of 350 c onsented inmates aged 18->60 years participated in the study. Stool samples were scree ned using wet preparation and formol ether c oncentration method. An overall prevalence of 48.8% was recorded for intestinal parasite, which wa s significantly (p< 0.05) high among females. Five species of inte stinal parasite were ide ntifie d. The most common identified was hookworm (95, 33.5%), while the least was Trichuris trichiuria (33, 11.6%). Age group 51-60 years recorded the highest infection (63.33%) among the male s, while age group 18-20 years had the least (25.0%). Age groups 51-60 and >60 years recorded 100% infections among the females. Of the 171 infections recorde d, 97(56.7%) had single infection, while 74(43.3%) had multiple infections. Questionnaire analysis showe d that inmates who have been in the prison for years were more parasitized. Inmates who dew orm monthly, yearly and not at all accounted for 64.2%, 78.7% and 39.2% infections respectively whic h was significant (p< 0.05). The study revealed the prevalence of intestinal parasitic infections in the inmates. Improved healthcare a nd awareness is highly recommended inside the facility. ISSN : 2580-2410 eISSN : 2580-2119 Intestinal Parasites and Risk Factors Among Inmates in Umuahia Abia State, Nigeria. Queen Ozioma Lawrence 1*, Anthonia Nnenna Chuks Amadi 1, Chinenye Okosa 1, Eberejah Juliet John 2, Nsikakabasi Charles Ukpong 3, Prisca Chimerebere Aririguzo 4 1 Department of Zoology and Environmental Biology, College Of Natural Sciences, Michael Okpara University of Agriculture Umudike, Nigeria 2 Department of Microbiology, Faculty of Biological Sciences, Abia State University Uturu, Nigeria 3 Department of Ani mal and Environmental Biology, Faculty of Sciences, University of Uyo, Nigeria 4 Department of Public Health, School of Health Technology, Federal University of Technology Owerri, Nigeria Introduction The parasitic worms found in the intestine of man or animals are known as intestinal parasites (Arora, and Arora, 2006) Intestinal parasite infections are among the most persistent public health problems and are of public health importance (Brookers et al., 1999). Either protozoa or helminthes can cause intestinal parasite infection. Protozoan parasites are one-celled microscopic organisms belonging to the kingdom protista ( Arora, OPEN ACCESS International Journal of Applied Biology Keyword parasites; hookworm; infection; factors; inmates Article History Received June 25, 2022 Accepted December 14, 2022 International Journal of Applied Biology is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly c ited. International Journal of Applied Biology, 6(2), 2022 127 and Arora, 2006). They can take over the intestinal tract of thei r host and then migrate to other organs and tissues (Arora, and Arora, 2006), while helminthes are worms usually with elongated, flat, or round bodies (Castro, 1996). Among these helminthes are soil - transmitted hel minthes; the roundworms, whipworm and hookworm, classified as neglected tropical diseases. Neglected tropical diseases (NTDs are diverse group of 20 health condi tions that are mainly prevalent in tropical areas, where they mostly affect the impoverished communities and disproportionately affects women and childre n (WHO, 2002; WHO, 2022). They are widely distributed in tropical and subtropical areas, with the most significant numbers occurring in sub-Saharan Africa, the Americas, China, and East Asia (WHO, 2002). Theses disease causes devastating health, social and economic consequences to more than 1 billion people (Al Amin and Wadhwa, 2022). Its study has received less than 1% of the global research budget (Al Amin and Wadhwa, 2022). Approxi mately more than 2 billion people are infected by soil-transmithiasis (Samuel et al., 2017) The majority of the people in the general population are affected by intestinal parasites to which the main species are Entamoeba histolytica, Ascaris lumbricoides (roundworm), Trichiuris trichiuria (whipworm) and hookworms species (Lorainne et al., 2015). Intestinal parasite infections can be contracted through faecal-oral rout (eg; eggs or larvae T. trichiuria and A. lumbricoides) transdermal (e.g; larval of hookworm) and vector-borne transmission (eggs of the flukes) (Schabussova, 2014; Kiani et al., 2016; Kumie and Ali, 2005). These parasitic intestinal infections are promoted by several factors such as poor personal and community hygiene, poor environmental sanitation, ignorance, and climatic condition (Al Amin and Wadhwa, 2022). Other factors tied to the prevalence of the infection are; untreated water supply, poverty, low level of education (Kiani et al., 2016). Amuta et al. (2010) reported tha t improperly cooked meat exacerbates intestinal parasite infection. His The study further noted that sources of drinking water like the river, well, water bought from vendors and patronizing food vendors were observed as risk factors for the tra nsmission of intestinal parasite infections in the study area. Kiani et al. (2016) observed that educational status, contact with domestic animals and soil, age and seasons were significantly related to intestinal parasite infections. Signs and symptoms of intestinal parasitic infections can often be unclear and misleading or even asymptomatic. However, some of the symptoms include some common ones like abdominal pain, bl oating, nausea, and vomiting. Diarrhoea is also a common infection symptom usually observed in the chronic state. Intestinal parasites lead to the development of mild diarrhoea, which ma y last for several days or even months. E. histolytica occasionally may invade the brain, lungs, liver, and other organs forming cysts and giving rise to a disease called amoebic dysentery. Other symptoms include abdominal cramps and severe colitis, along with the development of an ulcer. In addition, blood and pus may be seen occasionally in the stool (WHO, 2022; Al Amin and Wadhwa, 2022). Intestinal parasitic infestations do not let the intestines absorb minerals and vitamins, resulting in pale skin and fatigue (Arora, and Arora, 2006). Transmission of parasitic infection can be prevented by employing good hygienic practices, avoiding soil consumption, discriminate defecation, and washing vegetables and fruits with clean water bef ore intake is highly recommended (Al Amin and Wa dhwa, 2022; Khan et al., 2022). The constant wearing of shoes or slippers (to prevent hookworm infection) should be instill on the population. Campaign progra ms should be employed to educate the population on the need for proper personal and environmental hygiene, i. e. washing hands after going to the toilet, playing outside, and preparing or eating food (Al Amin and Wadhwa, 2022; WHO, 2022). Safe single-dose drugs, such as albendazole, are International Journal of Applied Biology, 6(2), 2022 128 highly effective for treating intestinal parasites, available through healthca re services, school health progra ms, and community interventions directed at vulnerable groups (WHO,2022; Ughava and Okon, 2016). The study is aimed at determining the presence and prevalence of intestinal parasites and their risk factors among inmates in a Correctional Facility (Prison) in Umuahia, Abia State, Nigeria. Materials and Methods A cross sectional study was adopted for the purpose of this study which lasted between Februa ry and May 2017. T he study was carried out in Umuahia Prison located at Aba road in Afara, in Umuahia the capital of Abia state, South-Eastern Nigeria (Fig 1). It is located on latitude 5o31’12.0”N and longitude 7o29’16.8”E in Nigeria. The average annual rainfall is 133.7mm and temperature 74oc. The study a rea is within the tropical rainforest of eastern Nigerian states (within the ecological zones of Enugu, Akwa Ibom, Cross River, Ebonyi, Imo, and Rivers States). Samples were exa mined in Zoology and Environmental Biology (ZEB) postgraduate laboratory, Michael Okpara University of Agriculture Umudike (MOUAU). Figure 1. Map of Umuahia North showing the location of the Prison, Aba Road, Umuahia Sample collection Ethical clearance was sought and obtained from the ethical board of authorities of Nigerian Correctional Services, Umuahia, Abia State (Ref No: ABS/ SHQ/C.37/VOL.111/907), Ministry of Health Ethical Research Committee, Abia State (Ref No: AB/MH/E&HR/1/17/0 4) and Ethical Research Committee, College of Natural Sciences Ethical Research Committee, Michael Okpara University of Agriculture Umudike (Ref No: CREEC/004/18). Consent was sought from the inmates by educating them on the need and relevance of the study. A fresh stool sample was collected using a sterile labeled screwed capped bottle from 350 inmates (280 males and 70 females) aged 18->60 years and was transported to Zoology and International Journal of Applied Biology, 6(2), 2022 129 Environmental Biology Postgraduate laboratory, Michael Okpara University of Agriculture Umudike, Nigeria. Samples were assessed macroscopically and reported before laboratory analysis (Cheesbrough, 2005). Saline wet preparation and formol ether concentration methods were used for laboratory examinations. Saline wet preparation technique A drop of normal saline was placed on a clean grease free glass slide, and 2g of faeces was placed and gently mixed with the drop of normal saline. They were gently covered wi th cover slip to avoid air bubbles. The smear was examined under Binocular microscopy with x10 and then x40 objectives (Arora and Arora, 2006). Formol ether concentration technique Formol ether concentration techniques were used to demonstrate the presence of eggs and cysts of the parasites. About 2g of stool sample was emulsifi ed using a rod in approximately 3ml of 10% formol saline contained in a tube. 3-4ml of 10% formol saline was further added, mixed well, and then sieved. About 7ml was transferred into a test tube, and 3ml of formol ether was added to make it 10ml. Covered and shake very well for proper mixing. Samples were centrifuged immediately at 1500rpm for five minutes. With a stick, the faecal debris layer was loosed from the side of the tube and then inverted to discard the formol saline and faecal debris. The sediment was transferred to a slide, covered wi th a cover slide and examined microscopically using x10 and x40 objective to examine the small cyst and eggs of the parasites (Zongo et al., 2020). Statistical Analysis The PART statistical package (version 3.1) was used for data analysis to test the association between demog raphics, behavioral factors, and intestinal parasite infection. Results were analyzed using chi-square. The relationship was considered significant when the p-value was <0.05 (Hammer, 2001). Results and Discussion Results A total of 171 inmates were infected with at least one intestinal parasite; giving an overall prevalence rate of 48.8% (Table 1). The prevalence rate of intestinal parasites was highest among the females (72.8%) compared to the males (42.8%). There was a significance difference (P < 0.05) in the prevalence of the intestinal parasites among the female and male inmates. Table 1. Gender related prevalence of intestinal parasites infection among inmates in Umuahia Correctional Facility, Abia State Gender Total No Examined Total No Infected Percentage (%) P – Value Male 280 120 42.8 0.015572 Female 70 51 72.8 Total 350 171 48.8 df= 1, Chi 2=61846, p-val ue= 0.015572 International Journal of Applied Biology, 6(2), 2022 130 Age group prevalence among the males showed that age group (51-60) had the highest (63.33%) followed by 31-40 (44.87%), 41-50 (42.18%), 21-30 (36.7%), 60> (33.33%) and 18-20 was the least (25.0%). Those in the age groups 51-60 and >60 recorded 100% prevalence among the female inma tes, and those in age groups 31-40 and 41-50 recorded 75.00% prevalence, while those in the 18-20 age group were the least (33.33%) (Table 2). However, chi-square analysis showed no association between the prevalence of intestinal parasites and the age of both male and female inmates (P>0.05). Table 2. Prevalence of intestinal parasites among the inmates by sex and age group the study area Male Female Total No infected (%) Age group Number examined Number infected % Number examined Number infected % 10-20 4 1 25.00 9 3 33.33 4 (1.4 ) 21-30 98 36 36.7 10 6 60.00 42 (12.0) 31-40 78 35 44.87 20 15 75.00 50 (14.28) 41-50 64 27 42.18 16 12 75.00 39 (11.14) 51-60 30 19 63.33 10 10 100.00 29 (8.22) >60 6 2 33.33 5 5 100.00 7 (2.0) Total 280 120 42.85 70 51 72.85 171(48.84) Mal e: df = 5, Chi 2=2.8128, P-val ue= 0.72882 Femal e: df=5 Chi 2=2.3604, P-val ue= 0.79735 Five species of intestinal parasites was identified in the study which occurred 248 times as a single or multiple infections (polyparasitism) (Table 3). Hookworm was the most common parasite identified (95, 33.5%), followed by Ascaris lumbricoides (57, 20.1%), Entamoeba histolytica (56, 19.7%). Giardia lamblia (43, 15.1%) and Trichuris trichiuria was the least (33, 11.6%). Table 3. Prevalence of intestinal parasites species identified in Umuahia Correctional Facility, Abia State (N=284). Parasites species Identified No of parasite seen % Hookworm 95 33.5 Ascaris lumbricoides 57 20.1 Trichuris trichiuria 33 11.6 Giardia lamblia 43 15.1 Entamoeba.histolytica 56 19.7 Total 284 100 Table four highlighted Single and mixed infections recorded in the study area. Of the171 inmates that had intestinal parasite infections, 56.7% had a single infection, while 43.27% had mixed infection. Hookworm was the most (28.9%) frequent single parasites International Journal of Applied Biology, 6(2), 2022 131 recorded while T. trichiuria (9.3%) was the least (Table 4). Mixed infections with the combina tions of hookworm (HW) and E. histolytica (Eh) was highest (36.5%) while other mixed infection were combinations of more than two parasites (Table 4). Table 4. Prevalence of single and mixed (multiple) infections among inmates in Umuahia Correctional Facility, Abia State Parasite seen Male Female Total (N=171) No infected % No infected % No infected % Single infection Protozoal G. lamblia 14 20.3 8 28.6 22 22.6 E.histolytica 14 20.3 6 21.4 20 20.6 Helminths Hookworm 20 28.9 8 28.6 28 28.9 A.lumbricoides 16 23.2 5 17.9 21 21.6 T.trichiuria 5 7.2 1 3.6 6 9.3 Total 69 100 28 100 97 56.7 Mixed infection Hw+Al 17 33.3 3 13.0 20 27.0 Hw+Tt 5 9.8 6 26.0 11 14.9 Hw+Gl 8 15.6 0 0 8 10.8 Hw+Eh 15 29.4 12 52.1 27 36.5 Eh+Tt 0 0 1 4.3 1 1.4 A.l+Tt 1 1.9 0 0 1 1.4 G.L+Eh 1 1.9 0 0 1 1.4 Hw+Al+Tt 1 1.9 0 0 1 1.4 Hw+Eh+Gl 1 1.9 0 0 1 1.4 Hw+Al+Eh 1 1.9 0 0 1 1.4 Hw+Al+Tt+Eh 1 1.9 1 4.3 2 2.7 Total 51 100 23 100 74 43.27 KEY=Hw=hook worm, Al = As cari s lumb ricoides, Eh=Enta moeba histoly tica , Gl = Giardia la mblia, Tt= Tri chiuri s trichiuria. Out of the 350 questionnaire distributed among the participants, only 220 filled and returned to us. All the respondents agreed that they use borehole water for drinking and other usages. The infected inmates that have been in the correctional facility for years, months, and weeks accounted for varying prevalence rates - 74.6%, 40.5%, and 22.2% respectively that was significantly different (p< 0.05) see Table 5. Those that reported washing their hand after eating only were highly infected (90.0%), followed by those who said 'always' (69.6%), 'sometimes' (57.3%), and those that wash their hands before eating alone were the least infected (33.3%). There was no significant difference (p> 0.05) in this aspect (Table 5). Inmates who wash their hands sometimes after defecation had the highest International Journal of Applied Biology, 6(2), 2022 132 infection (70.0%) while those who wash thei r hand always recorded the least infection 59.3%. There was also no significant difference (p> 0.05) in this aspect (Table 5). Inmates that deworm monthly, yearly and not all accounted for 64.2%, 78.7%, and 39.2% of infections respectively. There was a significant difference (p< 0.05) in this aspect. Table 5. Risk factors of intestinal parasites among the participating inmates in Umuahia Correctional Facility, Abia State Variables No of Respondents (n=220) No infected (%) P-value How long have you been In the prison Years 142 106 (74.6) 0.022216 Months 69 28 (40.5) Weeks 9 2 (22.2) Total 220 136 (61.9) How often do you wash hands Before eating only 30 10 (33.3) 0.21929 After eating only 10 9 (90.0) Sometimes 68 39 (57.3) Always 112 78 (69.6) Total 220 136 (61.9) How often do you wash hands after defecation Sometimes 50 35(70.0) 0.8109 Always 150 89 (59.3) Not at All 20 12 (60.0) Total 220 136 (61.9) How often do you wash your fruits before intake Sometimes 52 26 (50.0) 0.32256 Always 128 90 (70.3) Not at All 40 20 (50.0) Total 220 136 (61.9) How often do you deworm yourself Monthly 28 18 (64.2) 0.020679 Yearly 108 85 (78.7) Not at All 84 33 (39.2) Total 220 136 (61.9) The inmates reported va rious symptoms associated with intestinal parasite infection: watery stool (50, 29.2%), stool accompanied by blood (11, 6.4%) and abdominal cramps (20, 11.7%), although a greater number 90 (52.6%) of people were asymptomatic. There was no significant difference (p> 0.05) in this aspect (Table 6). International Journal of Applied Biology, 6(2), 2022 133 Table 6. Symptoms associated with intestinal parasite infection among the inmates in Umuahia Correctional Facility, Abia State NO Examined Total No infected (%) Total No without symptoms (%) Characteristic symptoms Watery stool No infected (%) Stool accompanied with blood No infected (%) Abdominal cramps (%) 350 171 (48.9) 90 (52.6) 50 (29.2) 11(6.4) 20 (11.7) df=1, Chi 2= 0.32589, P-val ue = 0.57409 Discussion Intestinal parasites such as soil transmitted hel minthes (STH) remains a public health concern and part of Neglected tropical diseases (NTDs). Among the six 2030 global targets for STH by the World Health Organization is to achieve and maintain elimination of STH and is part of WHO global target 2030 (WHO, 2022). Microscopic examination using wet mount and formol ether concentration methods is still the most appropriate techniques widely used for the detection of intestinal parasites despite the advances in intestinal parasites diagnosis (Zongo et al., 2020). Our study employed the two above menti oned technique to determine the presence and prevalence of intestinal parasites among inmates in Umuahia correcti onal facility using stool samples. The study recorded an overall prevalence of 48.8% for intestinal parasitic infections, accounting for almost half of the population harboring at least one intestinal parasite species. The overall prevalence rate of 48.8% was high and agreed with Rasha et al. (2011) value that recorded a prevalence rate of 49% in Omduruma prison in Sudan. The high prevalence of intestinal parasite infection recorded could be linked to poor environmental and personal hygiene (Khan et al., 2022), common among prison inmates. These are among the major contributing factors to intestinal parasite transmission (Arora, and Arora, 2006). However, the prevalence was lower tha n the 72.7% recorded by Ma mo (2014) in North central Ethiopian prison, 74.85% by Amuga (2006) in Keffi prison, Nasarawa State and 77.0% by Okolie (2008) in Owerri prison but higher than 33.5% reported by Kadio et al. (2021) in central prison of Conakry, Guinea, 32.84% reported by Colman et al. (2013) among inmates of Maiduguri prison, 26.6% reported by Loraine et al. (2015) in Kajang prison in Malaysia and 20.2% reported by Curval et al. (2017) in Brazil. It is expected that prevalence rates should be on the decline in Nigeria due to some significant improvements in the level of awareness and personal and environmental hygiene val ues (Amuga et al. 2006; Okolie, 2008). Female inmates recorded a higher prevalence of intestinal parasite than the males. This may be associated with the different exposure rates and unhygienic environment often exposed during household chores (as seen in normal population), general unhygienic nature of the facility and females’ physiology. Studies have shown that latrines and unsanitary toilets disposes one to intestinal parasite infection. This is contrary to the findings of Colman et al. (2013) in Maiduguri, Borno State and Ughavah et al., (2016) in Jos, plateau State, International Journal of Applied Biology, 6(2), 2022 134 which reported higher prevalence among male inmates with a zero infection among female inmates. Males in the age group 51-60 years were more infected while age group 31-40 in females recorded 100% infection. On other ha nd, 18-20 years age group recorded the minor infection in both male and females. This finding did not agree with related studies. The highest infection recorded in Owerri prisons, Imo State was among those under 35 years of age group (Okolie, 2008), 15-20 years in Keffi prison, Nasarawa State (Amuga et al., 2006), 21-30 years in Omdurman prison, Sudan (Colman et al., 2013), <20 years in Jos prison, Plateau State (Ughava and Okn, 2016) and 15-24 yea rs in North central Ethiopia (Mamo, 2014). As seen in the present study, the highly infected age group may be because these groups lack proper personal hygiene. The male inmates from this age group are known for lackadaisical attitude of and frustration leading to less care about thei r health beings which may increase parasite transmission. Previous studies revealed that high intensity of helminthic parasites, especially hookworm, occurs in adults resulting from farming as an occupation (Kadio et al., 2022; Amuga et al., 2006; Brooker et al., 2006). However, there was no association between the prevalence of intestinal parasites and age group in both male and female inmates (p> 0.05). The most frequent parasite recorded was hookworm followed by A. lumbricoides (20.1%) as observed by Okolie (2008) in Owerri prisons but differ f rom A. lumbricoides reported as the most common pa rasite by Amuga et al. (2016) in Keffi prison, Nassarawa State. The high occurrence of hookworm infection c ould be due to a simple mode/mechanism of parasite transmission (WHO, 2022). Inmates that have spent years in prison were more parasitized than inmates who have been in the correctional facility for only months or weeks. This finding did not agree with Amuga et al. (2006) in Keffi prison, Nassarawa State that recorded 100% prevalence among inmates that had been in the correcti onal facility for less than one month. This current observati on may be linked to the fact that the immune systems of the newly confined inmates are still strong enough to resist parasitic infections of the intestine than those who have spent years in the correctional facility (Kadio et al., 2021). Besides, they have not been subjected to the prevailing conditions in the facility. Those that wash their hands after eating were more parasitized compared with those that wash their hands sometimes and those that wash their hands before eating. A significant difference was recorded between inmates that wash hands before meals and those that do not in Kissi prison, Kenya (Dickson et al., 2016). Maintaining a good routine of hand washing, especially before eating, can reduce intestinal parasite transmission ( Al Amin and Wadhwa, 2022). No significant difference was recorded between the inmates that regularly washed thei r hands and those that do not wash their hands always after defecation (p>0.05). This also differs from the findings of Dickson et al. (2016) in Kissi prison, Kenya. Improper washing of hands before eating and after defecation is associated with intestinal parasite infection and can explain the high prevalence recorded a mong those that wash their hands sometimes after defecation (Al Amin and Wadhwa, 2022). The effects of proper washing of fruits before intake on the transmission of intestinal parasite infections were accessed. Those that deworm yearly were found more infected than those that deworm monthly. The high prevalence recorded may be linked to an inconsistent deworming at least to a considerable interval; leading to increase parasite multiplication and transmission. Deworming practice and intestinal parasite burden were significantly related. International Journal of Applied Biology, 6(2), 2022 135 Since all the respondents agreed on using the sa me source of water supply and toilet facility type, we could not investigate or compare the effects of water source and toilet facility on the transmission of intestinal parasites. Studies have shown that inmates using boreholes are more prone to intestinal parasite infection (Kadio et al., 2021). However, related studies have demonstrated a strong relationship between the prevalence and transmission of intestinal parasitic infection to toilet facility and water source used (Amuga et al., 2006; Amuta et al., 2010; Dickson et al., 2016). A water closet facility assumed to be the best can amplify parasitic infection transmission, especially when the faeces accumulate for a long time or if the toilet is not adequately washed regularly. Studies have also opined that the transmission of intestinal parasites is related to the water closet type of toilet used by many household (either at public or private level) a result of splashing of water during defecation (Afolabi et al., 2016). Related studies revealed various factors responsible for high prevalence of intestinal parasite infection and incidence [Brooker et al., 2006; Kumie and Ali, 2005) These factors include inadequate and untreated water supply (to which borehole belong to, age, poor sanitation, low level of income, low level of education, consumption of unwashed vegetables and fruits, and low personal hygiene practice ( Al Amin a nd Wadhwa, 2022; Khan et al., 2021). They are considered significant risk factors for intestinal parasite infections ( Al Amin and Wadhwa, 2022). Symptoms of intestinal parasites reported by the inmates were watery stool, stool accompanied with blood and abdominal cramps, though a significant number of the inmates were asymptomatic. The presence of blood in the stool suggests amoebic dysentery, usually caused by E. histolytica. Diarrhoea is one of the most reported symptoms of the intestinal parasite to which G. lamblia is responsible (WHO, 2022) Conclusion The presence and prevalence of intestinal parasitic infections has been established among inmates of the Correctional Facility (prison), Umuahia, Abia State. Females were more infected than males. The most common intestinal parasites were soil transmitted helminthes, especially hookworm. Mixed infections of intestinal parasite species were confirmed. Variables like inconsistent deworming and duration spent in the prison were considered significant risk factors. The spread of parasitic infection could be controlled, reduced or even elimina ted by proper hygiene, and deworming the rapy latest every three months. We recommend that inmates should be checked and treated adequately (dewormed), especially before being released into the general population. 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