International Journal of Limnology
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Research Article | Open Access
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  • The Prevalence of Intestinal Parasite Infection in El Behara Schoolchildren.

    Eman H. Radwan 1       Amel Abd El Rahman Hassan 1     Wael M. Lotfy 2     Ahmed Abd El-Mawgood 3     Hala M. Mashaal 1    

    1Faculty of Science, Damanhour University, Egypt.

    2Faculty of Nursing, Dean of Matrouh University, Egypt.

    3Egypt-Japan University of Science and Technology, Egypt.

    Abstract

    This study was conducted to evaluate the prevalence of intestinal parasite in schoolchildren in Damanhur, Egypt and some of its villages. The pathogenic enteric protozoa have been progressively involved in bargaining the soundness of a great many individuals, for the most part in creating nations. Mediations are being set up to control the dreariness and mortality because of these protozoan contaminations. A portion of these mediations target school going kids with regards to class based wellbeing intercession. The present examination concentrated on exploring the commonness of intestinal protozoan contaminations among younger students chose networks comprising of urban, urban-poor and per urban settlements in the Damanhour and a few towns. In the present work Giardia lamblia was the second usually identified protozoan with a diseases rate 10.4% among the analyzed cases. In the present examination generally speaking level of parasitic contaminations among the kids was 57.3%. It's viewed as Enterobius vermicularis was the most usually identified protozoan as it spoke to 4.1% of the parasitic diseases in the considered cases pursued by Ascaris lumbricoides; 1.4% and Giardia lamblia contaminations as they spoke to 0.6%; separately. The protozoa like Giardia and Cryptosporidium are regularly present in surface waters and cause episodes in this manner legitimately affecting human wellbeing.

    Received 11 May 2019; Accepted 13 Jun 2019; Published 15 Jun 2019;

    Academic Editor:Patricio De los RÃos, Universidad Católica de Temuco, Chile.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright©  2019 Eman H. Radwan, et al.

    License
    Creative Commons License    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Eman H. Radwan, Amel Abd El Rahman Hassan, Wael M. Lotfy, Ahmed Abd El-Mawgood, Hala M. Mashaal (2019) The Prevalence of Intestinal Parasite Infection in El Behara Schoolchildren.. International Journal Of Limnology - 1(1):33-51.
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     Introduction

    Protozoa are eukaryotic cells distributed worldwide in nature and are receiving increasing attention as human and animal pathogens and potential vehicles for the transmission of bacteria in the environment. One of two persons in the world is affected by waterborne or foodborne parasites 1, 2, 3. Acanthamoeba is a genus of free-living amoebae (FLA), which are environmental eukaryotic cells distributed worldwide in nature 4, 5, increasing the risk of human illness caused by bacteria or Acanthamoeba. Acanthamoeba species are showing an increased role as human pathogens causing pneumonitis, and dermatitis 6, the infection routes are mostly from the environment. The Cryptosporidium species and Giardia intestinally are major pathogens in the waterborne transmission of infections and they are able to persist in the environment due to the robustness of the oocysts and cysts 7. Entamoeba histolytica is an anaerobic parasitic protozoan, part of the genus Entamoeba. Predominantly infecting humans and other primates, E. histolytica is estimated to infect about 50 million people worldwide. Intestinal protozoan infections are of public health importance globally, particularly among children of school going age and the immunocompromised 8, 9. Protozoan parasites contribute immensely to the burden of intestinal parasitic infections among children 10, 11. Poor hygiene coupled with children voracious eating habits particularly puts them at greater risk of acquiring these infections 12, 13. Transmission is by feco-oral route and most infections tend to be asymptomatic. The common symptoms include vomiting, abdominal discomfort and dysentery 14.The consequences of intestinal parasites among children particularly include malnutrition, poor physical and mental development, and cognitive and behavioral deficiencies 15, 16. It is believed that children of school going age forms the majority of them at risk population, and are therefore capable of maintaining the transmission of the infection in the community, particularly among their peers 17, 18.

    Intestinal parasitic infections are major international health concerns, affecting approximately one fourth of the world population, they cause a large scale of morbidity and mortality in developing countries. In tropical and subtropical areas, three hundred millions are severally ill due to intestinal worms, and of these at least 50% are school age. Intestinal nematodes infect many of world's children and constitute a formidable public problem. Although helminthic infections are common, the infected children may suffer nutritional deficits, serious illness, cognitive impairment and occasionally death. More than one billion people worldwide are infected with one or more species of intestinal nematodes 19. Enterobius vermicularis was found in the appendices of children between the ages of 7 and 11 years 20, 21. Pinworms as many other gastrointestinal nematodes don't need to rely on a vector for transmission. Autoinfection usually occurs via ingestion of infectious eggs by direct anus-to-mouth transfer. This is facilitated by the perianal itch induced by the presence of pin worm eggs in the perianal folds and commonly occurs as a result of nail biting, poor hygiene, or inadequate hand washing. Ascariasis is the most common helminthic infection seen in human being as one fourth of the world population is infected 22. Although the clinical pictures of this illness mostly silent or with chronic symptomatology, the massive infection in children can give rise to serious complications that require surgical interference 23. More than 20,000 deaths occur in endemic areas per year, moderate infections cause stunting of linear growth and malnutrition in children. Ascaris lumbricoides is the largest of intestinal nematodes affecting human. It is most prevalent in the 5 to 9 years old group of preschool and young school children who are more frequently exposed to contaminated soil than adults. The incidence is approximately the same in both sexes 24. Ascaris infections can be detected by finding the characteristic Ascaris eggs in stool by direct saline preparation technique in heavy infections, while in light infections concentration techniques are required as formol ether concentration and MIFC techniques. Trichuris trichiura is the third most common nematodes of humans (Ascaris and Enterobius vermicularis are number one and two). Adult worms inhabit the large intestine of man mainly the caecum. Less commonly the appendix and colon, where they live embedding their anterior thin part inside the submucosa 25, 26. Trichuris trichiura cause irregular and nodular thickening of the wall of the colon, it damages enterocytes in the terminal ileum, appendix and caecum. It may cause obstruction of the lumen of the appendix. Secondary bacterial infection or protozoal infections e.g (Amoebiasis, Balantidiasis) may also occur 27. Light infections are asymptomatic as the worms live harmlessly in the caecum and appendix. But heavy infection especially in children between 2-6 years cause chronic diarrhea, epigastric pain, vomiting, distention, flatulence, anorexia, and loss of weight. Eosinophilia is usually moderate but eosinophils and charcot-leyden crystals are often abundant in the stools. In massive infection rectal prolapse may occur 28.

    Filariform larvae enter the lymphatic system 29, they are carried by the blood to the lung, where the larvae burst out of the capillaries into the patient's main respiratory system. They migrate upwards where they are swallowed and carried down into the digestive tract to settle in the small intestine and mature into adults that deposit eggs 30. Infected patients complain from mild diarrhea and cramps, fever, leucocytosis, vomiting, general weakness, blood or mucus in stool. When the larvae migrate to the lungs and air passage, the patient may have symptoms ranging from a simple dry cough to fever, difficulty in breathing and coughing up blood or pus 31, 32. Inflamed appendix had been reported in two siblings (8 years and 7 years old) presented with chronic abdominal pain and similar physical findings. The surgical findings included inflamed appendix with a cross section of the parasite Strangyloides. Strongyloides appendicitis has occurred almost exclusively in areas endemic to the parasite 33. Strongyloides stercoralis infection is diagnosed by performing fecal examination to detect larvae by using; wet mount, Harada-Mori filter paper, Baermann method and the agar plate culture technique (APCT). The latter is the most reliable method for the detection of Strongyloides stercoralis.

    Schistosoma haematobium was implicated as the causal agent of granulomatous inflammatory reaction with eosinophilia and fibrosis. Intramural oviposition was associated with frank acute appendicitis, and serosal involvement in peritoneal adhesions, with ileoileal intussusceptions in one patient 34. The actual role of schistosomal infection as a contributory factor in appendicitis is still open to debate but the diagnosis must be enterpreted in patients in the tropics with features of acute appendicitis or recurrent abdominal pain 35. Amebiasis is an infection of the large intestine caused by Entamoeba histolytica that infect 10% of the world's population resulting in 100.000 deaths per year 36. Although its prevalence is higher in poor developing countries having the lowest level of sanitation, the convenience of modern travel, high rates of emigration cause existence of high risk group in developed countries. Entamoeba histolytica affects all groups of people, regardless of age or sex. Amebiasis spreads through food and water that has been contaminated by human feces but it also spreads by person to person contact 37. The ameba exists in two different forms: the infective cyst or capsulated form and the trophozoite form. Trophozoite cannot survive once excreted in the feces, so it cannot infect others. In the digestive tract the cysts are broken open by digestive secretion releasing the mobile trophozoities. Once released within the intestine, the trophozoites multiply by feeding on intestinal bacteria or by invading the linning epithelium of the large intestine and the appendix 38. The trophozoites may remain inside the intestine, in the intestinal wall or it may be carried by blood to the liver, lung, brain or other organs 39. The ability of Entamoeba histolytica to produce pathological changes depends on several factors as the virulence of the infective strain of the parasite, the host resistance, the host nutritional status and the bacterial infection of the colon 40. Entamoeba histolytica is rare to occur. Giardia lamblia is the most common protozoal infection of humans worldwide 41 and the second most common parasite in the United States after pin worms 42, 43. The centers for disease control and prevention (CDC) estimated more than 2.5 million cases of giardiasis annually 44. Giardiasis is an infection of the small intestine of people and animals by a microscopic flagellated protozoan Giardia lamblia 45 that spread via contaminated water and food also by direct person to person contact. Giardiasis is more prevalent in children than adults because adults have a stronger immune system to fight the disease 46. Giardiasis causes diarrhea and weight loss, hypersensitivity reactions in the form of rashes and urticaria. The most chronic stages is associated with vitamin B12 malabsorbtion, disaccharidase deficiency and lactose intolerance 47, as a result of covering the intestinal epithelium by the trophozoites and degeneration or damage of the mucosal surface 48. Giardia lamblia may spread from the duodenum to the gall bladder and biliary ducts to cause cholecystits, cholangitis and granulomatous hepatitis. Human cryptosporidiosis is caused by infection with the Apicomplexa protozoan of the genus Cryptosporidia 49. Cryptosporidium is an intracellular protozoan, there are two main genotypes that induce infection in humans: C hominis and C parvum. It causes gastrointestinal disease in humans as well as animals such as cattle, cats and dogs. It is one of the most common parasitic infections in humans 50. Cryptospordium parvum is the main pathogen responsible for human infection, it infects both immunocompotent and immunocompromised individuals. Up to 30% of childhood infections are asymptomatic, thus children can be a reservoir and transmit infection to others. Infection occurs via feco-oral route, humans shed oocysts in their feces which are then ingested via contaminated food, water or inhaled. Autoinfection could occur. Diagnosis of Cryptosporidium depends on visualization of oocysts by stool examination after concentration using sheather-sugar solution. Oocysts are better visualized when stained by modified Ziehl Neelsen acid fast stain where the organism appears bright pink. Entero test and intestinal biopsy help in the diagnosis 51.

    Aim of the present study; The first aim of this study was to detection of parasites from feces and water samples. The second aim was the survey for school students, age of (6-17) years in Beheira Governorate. Whereas the third aim was to study the soil samples and makes questionnaire for sources of drinking water and food. Detection any infective stage of the intestinal parasites contaminating the soil in school yard and other play ground in the study area.

    Material and methods: The Study Site has been undertaken in Beheira Governorate as the first study in this area which can provide status of parasitic infections among students. Beheira Governorate located in the west of the Delta and is bordered to the north by the Mediterranean Sea and east by the Rasheed branch and to the west by the governorates of Alexandria. The Governorate of El-Beheira enjoys an important strategic location. It is located between the Rashid branch in the east and the governorates of Alexandria and Matrouh in the west and the Mediterranean Sea in the north and Giza governorate in the south. This study was conducted on several schools in Damanhour and some of its villages which were selected to be representative to most districts of the city. The schools included in the survey were namely; Bastarah Primary, Zawia Ghazal Preparatory, Primary and Zarkoun Primary and within Damanhour Random samples from the secondary military school, secondary namozagy boys and secondary namozagy girls. The staff members of the investigated schools were informed about the objective of the survey and the activities that would be undertaken, therefore headmasters, teachers and other staff was very helpful and formed an important role in collection of samples and required data.

    Questionnaire

    The questionnaire sheet was designed to cover a variety of items concerning personal, environmental data and socio-economic data of the examined students which can be related to parasitic infections. The socio-economic data (education and occupation of parents)52. A sample of 810 students (578 male and 232 female) whose ages ranged between 6 -17 years was selected by stratified random sample.

    Collection of Samples

    I. Stool and Urine Specimens

    Each student was provided with two clean, dry and labeled plastic containers for urine and stool specimens, at the second day the specimens were collected and the relevant data were recorded in the designed questionnaire sheet. The students who didn't give specimens were excluded from the sample. The urine specimens were examined by centrifugation sedimentation technique in the laboratory of the villages and Dr. Zebada Desoqy laboratory on the same day of collection. Stool specimens were visually scanned for the presence of the parasitic worms, blood and mucus, about one gram of each stool specimen was placed in 10 ml plastic bottle and (Merthiolate - formaldehyde) solution was added until it almost filled the container except the neck.

    II. Soil Samples

    In order to conduct soil examination, 60 soil samples were collected (10 samples from the shaded area of each studied school yard, 20 samples from sporting club and 30 samples from the areas around the houses). About 100 g of each sample was divided into two parts, one for detection of larvae of parasites by using Baermann's technique on the day of collection and the other part was kept in the labeled plastic bag to be examined by sugar floatation technique to detect eggs of helminthes in the laboratory of Faculty of Science Damanhour University.

    III. Water Sample

    The minimal volume of water necessary for analysis of the presence of parasitic protozoa is 10 L, while there on upper limit. Published reports include volumes 600 L and even more, when analyzing drinking water 53, 54, 55. Sampling is carried out by collecting from a depth of (20-30) cm below the surface. It is recommended to avoid water layers close to the surface or sediment, as they can contain various biological materials such as plant matter and mud, which can block filters and /or interfere with downstream analysis. So 40 L water sample were collected (10 L of drinking water from Damanhour city, 10 L of drinking water from villages, 10 L from Damanhour canal and 10 L from Bastra village canal) for detection protozoa in water, in the same day of collection to examine.

    Parastioligical Examination

    I. Urine Examination

    Centrifugal sedimentation technique 56, the urine specimen was snaked and transfered into centrifuge tube, and centrifuged at 1500 r.p.m. for two minutes. Decanted supernatant and the sediment was examined for the presence of ova, using the XI0 objective to screen the whole of the deposit.

    II. Stool Examination

    Collection and Macroscopic Stool Samples

    Fecal samples were collected in clean plastic containers, mothers were asked to handle the sample immediately after being passed stool sampled were examined macroscopically for the color, odor, consistency and presence of mucous , blood or visible parasites.

    Preservation

    Fecal samples were immediately preserved by different methods: MF preservation: approximately 1gm of the stool was placed in a plastic bottle containing 5 ml merthiolate formalin solution 57, then the stool was thoroughly broken into the solution to ensure accurate preservation. 2- Formalin preservation: about 1 g of the stool was placed in a second bottle containing 3ml 10% formalin and mixed thoroughly 58, the bottles were firmly covered and labeled. 3 - Methanol fixation: a smear was made from each specimen, labeled and immediately fixed in methanol for 5 minutes.

    Microscopic Examination

    MF direct smear; The MF preserved sample was mixed and one drop was placed on slide, covered with coverslip and examined micaroscopically 57. Concentration technique: MF preserved samples were concentrated using merthiolate Iodine Formaldehyde concentration technique (MIFC) 59.

    III. Soil Examination

    A. Baermann's technique using the examination described by Lima and Delgado 60. B. Sugar flotation technique using the examination described by Groenen 61.

    IV. Water Examination

    Filtration of collected water sample is necessary to concentrate the (oo) cysts into a volume suitable for further processing, usually measured in ml. For this purpose water can be filtered through nitrocellulose or polycarbonate membranes 54.

    Data Analysis

    Data were coded, tabulated and analyzed by researcher’s computer; the chi-squared test was used to test statistical significance of the produced results.

    Results

    The present study was carried out to study the prevalence of intestinal parasitic on several school children in Damanhour and some of its villages. The result of the present study has been illustrated under the following items; socio-demographic and environmental characteristics of the studied sample, prevalence of intestinal parasitic infection among cases, in stool samples, distribution of the studied cases according to gender, distribution of the studied cases according to demographic data and comparison between the two studied groups according to the overall distribution on intestinal protozoa infection by sex. (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).

    Figure 1. Ascaris egg
    Figure 1.

    Figure 2. Giardia cyst
    Figure 2.

    Figure 3. Hymanolepis nana egg
    Figure 3.

    Figure 4. Schistosoma mansoni egg
    Figure 4.

    Figure 5. Entamoeba histolytica Trovozoite
    Figure 5.

    Figure 6. Enterobius vermicularis egg
    Figure 6.

    The distribution of the studied cases according to gender in the present study included 810 children (578 male – 232 female) with sex ratio of 71.4:28.6 (Table 1). The comparison between the two studied groups according to infection was found that, the infected samples of 578 children were 61 samples by 10.6%, but for girls found that the infected samples of 232 are 30 samples by 12.9% (Table 2). The comparison between the two studied sex groups according to the overall distribution of intestinal protozoa infection showed types of parasites and their prevalence rates among examined students, two species of protozoa and five of helminthes were identified. Amongest protozoa Amoeba trophozoite the most frequent (1.3%) followed by Giardia lamblia (0.9%), Enterobius vermicularis was the most common helminth (4.1%) followed by Ascaris lumbricoides (1.4%) two cases of S. mansoni and only one case of H. nana was observed (Table 3). In the comparison between the four studied seasons according to infection was measured quarterly. The results showed that; in the summer, 275 samples were collected, of which 43 samples were infected with (15.6%), which is the highest percentage in the spring, 115 samples were collected, 10 of which were infected with an (8.7%). In the autumn, 254 samples were collected, of which 22 samples were infected with (8.7%). Finally, in winter, 166 samples were collected, 16 samples were infected with (9.6%) (Table 4).

    Table 1. “The composition of the sample by gender”
      no %
    Total samples 810 100
    Males 578 71.4
    females 232 28.6

    Table 2. “The proportion of infected individuals in gender groups”
    Infection males females X2 P
    no % no %
    Non infected 517 89.4 202 87.1 0.94 0.33
    Infected 61 10.6 12.9 12.9

    X2: Chi square test
    P: P value for comparing between the two groups
    Table 3. “Gender-specific distribution of intestinal parasitic infection in the study sample”
    Intestinalparasitic Males(n=578)   Females(n=232)   Total(n=810)   X2 P
      no % no % no %
    E. vermicularis 20 3.5 13 5.6 33 4.1 1.9 0.16
    E. coli 0 0 0 0 0 0 - -
    G. lamblia 5 0.9 0 0 5 0.6 2 0.3
    H. nana 1 0.2 0 0 1 0.1 0.4 1
    A. lumbricoides 7 1.2 4 1.7 11 1.4 0.3 0.5
    E. histolitica 0 0 0 0 0 0 - -
    S. stercoralis 0 0 0 0 0 0 - -
    S. haematobium 0 0 0 0 0 0 - -
    Taenia spp. 0 0 0 0 0 0 - -
    T. trichiura 0 0 0 0 0 0 - -
    S. mansoni 0 0 2 0.9 2 0.2 4.9 0.8
    H. heterophyes 0 0 0 0 0 0 - -
    Fasciola spp. 0 0 0 0 0 0 - -
    Amoeba trophozoite 0 0 3 1.3 3 0.4 7.5* 0.02*

    X2: Chi square test
    P value for comparing between the two groups
    * : statistically significant at P<0.05.
    Table 4. “Prevalence of infection by season”
    Infection Winter(n=166) Autumn (n=254) Spring (n=115) Summer (n= 272) X2 P
    no % no % no % no %
    Non infected 150 90.4 232 91.3 105 91.3 232 84.4 8.2* 0.04*
    Infected 16 9.6 22 8.7 10 8.7 42 15.6

    X2: Chi square test
    P value for comparing between the two groups
    * : statistically significant at P<0.05.

    The distribution of the studied cases according to demographic data and show prevalence of parasitic infections among males and females in different age groups. In general, the males showed slightly higher rates of infection (60.1%) than female (39.9%). In the age ≤ 10 (6 – 10) Infection rate reaches (58.1%) and in age > 10 (11 -18) Infection rate reaches (41.9%) (Table 5). The distribution of the studied cases according to infect and parasite. This table shows that the percentage of infection E. vermicularis is higher than any other type where infection rate of (76.5%) followed by G. lamblia (11.8%) follwed by A.lumbricoides (8.8%) finaly, H.nana (2.9%)(Table 6). The relation between gender and age (n=148) showed that the percentage of parasites in the age of≤10 (6 – 10) in boys (61.8%) is higher than that of girls (52.5%), while the highest rate is >10 (11 – 18) years. The percentage of infection among girls (47.5%) is higher than that of boys (34%) (Table 7). The relation between gender with infect and parasite Infected male (27%) higher than female (16.9%) (Table 8). The relation between age with infect and parasite showed, in the age ≤10 (6-10) E. vermicularis (76.9%) and in the age of >10 (11-18) is (75 %) higher rates from any type of parasites (Table 9).

    Table 5. distribution of the studied cases according to gender and age
      no %
    Gender    
    Males 89 60.1
    Females 59 39.9
    Age (years)    
    <10(6-10) 86 58.1
    >10(11-18) 62  41.9
    Min – Max 6.0-18.0
    Mean ±SD 11.2±3.4

    Table 6. Distribution of the studied cases according to the infection and the parasites (n=148)
      no %
    Infection    
    Non infected 114 77
    Infected  34  23
    Parasites    
    E. vermicularis 26 76.5
    G. lamlia 4 11.8
    A. lumbricoides 3 8.8
    H. nana 1 2.9

    Table 7. Relation between gender and age of the infected cases (n=148)
    Age (years) gender Test of significance P
      Males (n=89) Females (n=59)
      no % no %
    <10 (6-10)            
    >10 (10-18) 55 61.8 31 52.5 X2=1.2 0.26
    Min –Max            
    Mean ± S.D. 34 38.2 28 47.5 T=0.74 0.46

    X2: Chi square test
    t: Student t- test
    P:P value for comparing between the groups
    Table 8. Prevalence of the different parasitic infections in the different sex groups
      Gender X2 P
    Males (n= 89) Females (n= 59)
    no % no %
    Infection         2.0 0.15
    Non infected 65 73 49 83.1    
    Infected  24  27  10 16.9    
    Parasites            
    E. vermicularis 17 70.8 9 90    
    G. lamblia 4 16.7 0 0    
    A. lumbricoides 2 8.3 1 10    
    H. nana  1 4.2 0 0 2.3 0.6

    Table 9. Prevalence of the different parasitic infections in the two age groups (n=148)
      Age (years) X2 P
      <10(6-10) (no.=86) >10(11-18) (no=62)
      no % no %    
    Infection:            
    Non-infected 60 69.8 54 87.1 6.1* 0.01*
    infected  26  30.2  8  12.9    
    Parasites            
    E. vermicularis 20 76.9 6 75  1.2  1.0
    G. lamblia 3 7.7 1 12.5    
    A. lumbricoides 2 11.5 1 12.5    
    H. nana 1  3.8 0  0    

    X2: Chi square test
    P:P value is for comparing between the two categories
    * : statistically significant at P<0.05

    The Relation between age with infect and parasite E. vermicularis and G. lamblia Min(6%)-Max (17%) followed by A. Lambricoides Min (7%)-Max (14%) (Table 10). The prevalence of intestinal parasitic infections in relation to socio-economic classes of the examined students. It was found a statistically significant relation between parasitic infection and socio-economic classes of examined students, whereas the highest rate of infection (48.7%) was among the students of low socio-economic class compared to those of middle (26.1%) and high class (20.9%), (Table 11). The prevalence of intestinal parasitic infections among examined students in relation to the educational level of their fathers. The results indicated inverse correlation between parasitic infection and educational level of father, where the students belonged to illiterate or read and write fathers showed the highest rate of infection (50.6%) as compared to the students whose fathers were primary or preparatory educated (20.2%) and the students whose fathers were secondary or university educated (21.5%) this difference was statistically significant (Table 12). The prevalence of intestinal parasitic infections among examined students in relation to the educational level of their mothers. The results indicated inverse correlation between parasitic infection and educational level of the mothers, where the students belonged to illiterate or read and write mothers showed the highest rate of infection (48.2%) as compared to the students whose mothers were primary or preparatory educated (33.9%) and the students whose mothers were secondary or university educated (19.6%) this difference was statistically significant, (Table 13).

    Table 10. The distribution of the different parasitic infections by age
      no Age(years)    
        Min -Max Mean ±S.D. T-test P
    Infection          
    Non-infected 11 7-18 11.68±3.0 3.3* 0.001*
    infected  34  6-17  9.7±3.5    
    Parasites       F-test  
    E. vermicularis 26 6-17 9.5±3.5 0.77 0.38
    G. lamblia 4 6-17 10±4.9    
    A. lumbricoides 3 7-14 10.3±3.5    
    H. nana  1    10    

    T: T-test
    F: F-test
    P:P value is for comparing between the two categories
    * : statistically significant at P<0.05.
    Table 11. Prevalence of intestinal parasitic infections in relation to class
    Socioeconomic classes infection free total
      no % no % no %
    Low 169 48.7 178 51.2 347 100
    Middle 76 26.1 215 73.8 291 100
    High 36 20.9 136 94.7 172 100
    Total 281 35 529 65 810 100

    Table 12. Prevalence of intestinal parasitic infections among examined students in relation to the educational level of their fathers
    Educational levels of their fathers Examined students total
      Infected free
      no % no % no %
    Read and write 165 50.6 161 49.3 326 100
    Primary or preparatory education 18 20.2 71 79.7 89 100
    High school or University education 85 21.5 310 78.4 395 100
    total 268 33 542 67 810 100

    Table 13. Prevalence of intestinal parasitic infections among examined students in relation to the education levels of their mothers
    Educational level of their mothers Examined students total
      Infected free
      no % no % no %
    Read and write 170 48.2 182 51.7 352 100
    Primary or preparatory Education 19 33.4 37 66 56 100
    High school or University education 79 19.6 323 80.3 402 100
    Total 268 33 542 67 810 100

    Results of urine samples: The total number of examined urine samples 50 samples from students. Examination of this samples showed that all samples were free from eggs of the parasites. The total number of examined soil samples were; (10) samples from each studied school yard, (20) samples from sporting club, and (30) samples from the area around the house. Examination of these samples showed that all samples were free from eggs of the parasites. Result of drinking water sample: It is natural to have protozoa in the water of the canals both in the city and in the villages, but the strangest ones are found in drinking water Giardia lamblia was found in the drinking water samples.

    Discussion

    Parasitic sicknesses keep on being a noteworthy general medical issue particularly in youngsters 62. Being a reason for ailing health, development hindrance, pallor and perhaps different lacks could result in diminished efficiency and poor academic accomplishment 63. Parasitic sicknesses might be a reason for other medical issues, for example, a ruptured appendix, cholicystitis, and intestinal obstacle. The present examination was intended to explore the commonness of parasitic diseases among worked understudies by stool investigation. In the present examination in general level of parasitic contaminations among the youngsters was 57.3%. In Turkey the outcomes were in concurrence with the present examination which was 53% 64. In Riyadh, Saudi Arabia, the rates of parasitic contaminations were 42.2% in urban territories and 47.1% in zones where sewage is arranged in open channels 65. In Egypt, parasitic contamination among school age kids extended from 7.3%-30% 66, 67. Yassin et al. 68 from Gaza detailed that this rate was 27.6% when stool example was handled by direct smear and zinc sulfate floatation strategy and formol ether sedimentation method. Comparative rates were accounted for in Brazil in 2000 69, and in Quetta Pakistan (27.6% and 31%; individually 70.

    The distinction in these rates of parasitic diseases in various nations might be influenced by various natural and epidemiological elements. Potentiating hazard factors incorporate feco-oral, air borne transmission and soil transmission in school age people. The high level of parasitic diseases in the present examination might be ascribed to terrible individual cleanliness of the contemplated test "school age kids". Low financial standard additionally influences their wholesome status and thusly lessens protection from contamination with crafty pathogens. Beside high rates watched might be because of the mix of various procedures done in the present investigation which encourage the determination of various kinds of protozoa. As to variety of intestinal parasitic contamination among kids, the present work uncovered that 49% of inspected cases harbored one parasite. In concurrence with the present investigation, it was discovered that 69.1% of tainted understudies in the Red Sea Governorate, Egypt were contaminated with one parasite, 22.5% and 7.6% were contaminated with two and three parasites individually 71.

    In the present work, various procedures "formal ether focus, trichrome stain agar plate culture and Hematoxylin and Eosin recolor strategies" were utilized for examination of feces tests and ppendiceal content. It was discovered that Enterobius vermicularis and Ascaris lumbricoides diseases speak to 4.1% and 1.4% separately. This is demonstrative of the spread of wellbeing mindfulness in the home and school, where there is little proof of damage contrasted with earlier years. The high pervasiveness of Enterobius vermicularis might be because of the genuine increment in water borne contamination water borne malady. The little size of Enterobius vermicularis egg makes them hard to be dispensed with from polluted water even by utilizing filtration framework 72. Chlorine sanitization, which has incredibly added to the decline in water conceived ailment coming about because of pathogenic microorganisms in the water supply has no impact on Enterobius vermicularis and Giardia lamblia blister. Such oocyst has an invulnerable divider that opposes different burdens and chlorine cleansing 73. Fayad et al. 74 expressed that Cryptosporidium was perceived as a typical enteric pathogen among diarrhoeic youngsters in Egypt. In Zagazig Governorate, Egypt, a predominance of 16.7% was accounted for among youngsters matured from 2-12 years 75. Since the investigation test having a place with school age kids and their wholesome status is relied upon to be low and the parasitic diseases among them may impact the respectability of invulnerable framework rendering them increasingly vulunerable to secure cryptosporidiosis 76. Thus, absence of explicit treatment and general wellbeing consciousness of cryptosporidiosis in contrast with other intestinal protozoa as G. lamblia and E. histolytica may represent high contamination rate of Cryptosporidium 77.

    In the present investigation, protozoal diseases were more typical than helminthes, this might be credited to the distinction in their method of transmission, the vast majority of sore or growths of protozoa are transmitted legitimately starting with one individual then onto the next. The transmission of most helminthes requires a middle of the road have, an outside hatching for development of infective stages 78. It's viewed as Enterobius vermicularis was the most ordinarily recognized protozoan as it spoke to 4.1% of the parasitic contaminations in the contemplated cases pursued by Ascaris lumbricoides; 1.4% and Giardia lamblia diseases as they spoke to 0.6%; separately. Mc Carthy et al. 79, feature the potential general wellbeing hugeness of endemic obtrusive amoebiasis in view of its high transmissibility in setting where cleanliness is imperfect. The present investigation has faith in particular screening and fitting treatment of patients and contacts. It was found India revealed that the commonness of Entamoeba histolytica in appendectomized kids was (1.4%) 80. In Czechoslovakia, Cerva et al,81 expressed that Entamoeba coli speak to 1 % of appendectomized cases. The present work Giardia lamblia was the second regularly identified protozoan with a diseases rate 10.4% among the inspected cases. Giardia was analyzed in 9% of grade younger students in Alexandria 82, and in Saudi Arabia. In Guinae, 8.6% of urban outpatients had giardiasis 83. Further low rate coming to down to 2.2% was accounted for in Gaza 84. The high rates of giardiasis can be disclosed by its protection from the chlorine level in typical faucet water 85. The commonest helminthic contamination identified in our investigation, was Enterobius verrnicularis. It was accounted for that 30% of the youngsters worldwide are contaminated with Enterobius verrnicularis86.

    Wiebe 87 demonstrated that pinworms can enter effectively through the flawless inside divider, along these lines, it is relied upon to attack informative supplement. It was accounted for that its quality in reference section can give side effects of intense an infected appendix 88. Al Rabiah et al. 89 from Saudi Arabia revealed 3% histo-pathologically demonstrated instances of Enterobius verrnicularis among 201 appendectomy example. In England, it was accounted for to be 2.7% 90. Arca et al.91 from USA announced that the relationship of Enterobius verrnicularis contamination with intense an infected appendix shifts from 0.2-41.8% around the world. An examination done in Turkey demonstrated that Enterobius verrnicularis present in 3.8% of appendectomized kids 92. In the present work Ascaris lumbricoides was available in 1.4% of inspected cases. An examination done among younger students in Alexandria, it was discovered that the disease rates of Trichuris trichiura and Ascaris lumbricoides were 9.1% and 2.5%; separately 93. In Venzuela, it was accounted for that Ascaris lumbricoides present in 7.4% of appendectomized cases, and Trichuris trichiura present in 5.4% of them 94. In the present work H. nana was available in 0.1% of inspected cases. While as in Ismailia H. nana were accounted for among 5.5% of younger students 95, Dakahlia 5% 96 and Alexandria 2.2% 97.

    As respect the sociodemographic parameter and parasitic contamination among the considered example no factually huge distinction was recognized between both genders. The present examination uncovered that the most elevated level of parasitic contaminations was among patients under 10 years, this could be ascribed to their terrible clean practices. It was trailed by 10-14 years classification, this can be clarified by their eating out entryway propensities. In Assiut, Abdel-Hafez 98 revealed that infective parasitic maladies were serious issue especially among the more youthful age gathering and those of low financial status. In Gaza, Shubair et al.99 demonstrated that kids matured 6-7 years were the most powerless age bunch obtaining parasitic contaminations. An examination done in Iran in 2003, demonstrated that the most helpless age to parasitic diseases was under 10 years of age, at that point the rate of contamination diminished bit by bit and the least contamination rate was among 14-15 years of age 100. As respects the instructive dimension of the mother, the present examination uncovered that the level of parasitic diseases was higher among kids whose moms were of lower and medium classifications of training than the individuals who have advanced education, this can be clarified via inconsiderateness of moms, This is demonstrative of the spread of wellbeing attention to the informed moms of their youngsters. Despite what might be expected, in Alexandria, higher rates of diseases were found among youngsters whose guardians were uneducated or simply perused and compose (41.3% and 56%; separately) 101. In Mexico, kids having a place with lower pay families and with less instructed moms had higher rates of intestinal parasitism 62.

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