1

بسم الله الرحمن الرحيم

2

INTESTINAL PARASITES AMONG STUDENTS OF A MULTI-NATIONALITY INTERMEDIATE SCHOOL

IN JEDDAH

DONE BY :

ALI DEHIGI

JAFAR AL-SHARDI SUPPERVISED BY :

DR. MAJED WAKID

3

CONTENTS• INTRODUCTION• AIMS OF PROJECT• MATERIALS AND METHODS• RESULTS• DISCUSSION• CONCLUSION

4

What is the parasite?

Parasite is an organism living in or on another living organism, obtaining from it part or all of its organic nutriment, usually to the detriment (harm) of its host.

5

What are the intestinal parasites?

Intestinal parasites are organisms that inhabit the gastro- intestinal tract of the host.

They are often spread by poor hygiene related to feces, contact with animals, or poorly cooked food.

6

Intestinal parasites are one of the public health problems worldwide, especially in tropical and subtropical countries. Some 3.5 billion people are affected Some 450 million of them are symptomatic. 2,00,000 deaths annually are directly attributed to the intestinal parasites.

WHO

7

How are intestinal parasites transmitted? Poor sanitation and hygiene. Contaminated foods & drinks. Lack health education. Via vectors. Skin penetration.

8

OF INTESTINAL PARASITES CLASSIFICATION

PROTOZOA HELMINTHS

9

INTESTINAL PROTOZOA

Amoeba Flagellate Ciliate Coccidia

E. histolytica G. lamblia B. coli C. parvum

10

INTESTINAL HELMINTHS

Trematoda Nematoda Cestoda

Heterophyes heterophyes

Ascaris lumbricoides

Hymnolepis nana

11

AIMS OF THE PROJECT

To study prevalence of intestinal parasitic infection among the chosen intermediate school in Jeddah.

To compare the results between Retchie technique and direct technique.

To study prevalence of Cryptosporidium parvum by using Modified Kinyoun’s Stain.

To compare the result of Modified Kinyoun’s Stain with CERTEST CRYPTO CARD.

To study prevalence of Giardia lamblia by using CERTEST GIARDIA CARD.

To study the correlation between intestinal parasitic infection and several parameters.

12

MATERIALSAND

METHODS

13

IN COOPERATION WITH MINISTRY OF EDUCATION AND SCHOOL HEALTH UNIT

14

Questionnaire form

15

SAMPLES COLLECTIONStool samples were collected from students of an intermediate school

16

DIRECT SMEAR

The steps of direct smear:

Glass microscope slide

Stool sample

Wooden stick

Saline and Iodine

17

FORMAL ETHER SEDIMENTATION TECHNIQUE

In this technique four layers formed:1) Top layer of ether2) Plug of debris3) Layer of formalin4) Sediment

MODIFIED KINYOUN STAIN This technique useful for detection Cryptospridium

1) Thin fecal smear was prepared

2) The smear was fixed with methanol for 1 min

3) Slide was stained with Kinyoun’s Carbol Fuchsin for 3 min

4) Decolonization with acidified alcohol to several dips

5) Water washing

6) Staining with methylene blue for 1 min

7) Water washing

8) Microscopic examination

CERTEST CRYPTO CARD

1) 150 mg of stool sample was dissolved well with diluente

2) 4 drops were dispensed.

3) at 10 minutes the colored band can be read.

Principle of this test use one step immunochromatographic system and by using mouse monoclonal antibodies directed against antigen of Cryptosporidium

CERTEST GIARDIA CARDPrinciple of this test is immunochromatographic assay for detection Giardia in stool samples. The membrane is precoated with antibodies on the test band region against Giardia antigen.

1) 150 mg of stool sample was dissolved well with diluente

2) 4 drops was dispensed.

3) at 10 minutes the colored band can be read.

21

Statistical analysis

22

RESULTS

23

Multi- nationalities male governmental intermediate

school.

120 students were included in this study.

Age ranged between 12 – 18 years (15 ± 1.38)

NUMBER AND AGE OF STUDENTS

24

PERCENTAGE OF STUDENTS AGE

1.7%

19.2%

17.5%

28.3% 22.5%

7.5%3.3%

25

NATIONALITIES OF STUDENTSThe students were from 11 countries: Yemeni (30%) Saudi (21.7%) Afghani (20.8%) Palestinian (3.3%) Nigerian (2.5%) Chadian (13.3%) Somali (0.8%) Sudanese (5%) Turkish (0.8%) Pakistani (0.8%) Blushestani (0.8%)

26

PERCENTAGE OF NATIONALITIES

27

23 (19.2%) students were infected with

intestinal parasites.

97 (80.8%) students were not infected.

INFECTION AMONG STUDENTS

28

80.8%

19.2%

PERCENTAGE OF INFECTED STUDENTS

Infected samples Total samples

%b %a No % No Nationality

39.13 7.5 9 30 36 Yemeni

26.08 5 6 21.7 26 Saudi

13.04 2.5 3 20.8 25 Afghani

4.35 0.8 1 3.3 4 Palestinian

0 0 0 2.5 3 Nigerian

8.7 1.66 2 13.3 16 Chadian

0 0 0 0.8 1 Somali

8.7 1.66 2 5 6 Sudanese

0 0 0 0.8 1 Turkish

0 0 0 0.8 1 Pakistani

0 0 0 0.8 1 Blushestani

100% 19.2% 23 100% 120 Total

%a: calculated to the total number %b: calculated to the infected number.29

30

INFECTION PER NATIONALITY

31

Six parasites were detected among the students:

Blastocystis hominis

Endolimax nana

Entameoba coli

Entameoba histolytica

Giardia lamblia

Hymenolepis nana

DETECTED PARASITES

32

DETECTION BY MICROSCOPIC TECHNIQUES

Parasites B. hominis E. nana E. coli E. histolytica G. lamblia H. nana

Frequency 17 3 4 2 4 1

%a 14.2 2.5 3.3 1.7 3.3 0.8

%b 73.91 13.04 17.39 8.69 17.39 4.35

%c 54.84 9.68 12.90 6.45 12.90 3.23

%a calculated to the total number of students.%b calculated to the infected number of students.%c calculated to the total number of detected parasite.

33

DETECTION BY USIND MODIFIED KINYOUN STAIN

Non of the 120 samples reacted positively for

Cryptosporidium oocyst.

34

DETECTION BY USING CERTEST CRYPTO CARD

Non of the 120 samples reacted positively with CERTEST CRYPTO CARD

35

DETECTION BY USING CERTEST GIARDIA CARD

Among 120 samples, 4 samples reacted positively with CERTEST GIARDIA CARD

36

DISCUSSION AND

CONCLUSION

37

DISCUSSION AND CONCLUSION

Prevalence of parasitic infection was 19.2%

Students were from 11 countries

Students from six countries were infected,

Yemenis (39.13%), Saudis (26.08%), Afghanis

(13.4%), Chadians (8.7%), Sudanese (8.7%) and

Palestinians (4.35%).

38

Only 12 samples were positive with direct smears.

23 samples were positive using Ritchie concentration technique.

Non of the samples gave positive results for Cryptosporidium by staining and CERTEST CRYPTO CARD.

All four positive samples of Giardia lamblia in microscopic examination reacted positively with CERTEST GIARDIA CARD

39

Illiterate fathers were 22.5%

Illiterate mothers were 31.7%

37.5% of students have intestinal symptoms

40

37.5%

62.5%

PERCENTAGE OF SYMPTOMATIC AND ASYMPTOMATIC STUDENTS

41

22.5% 23.3% 20%

24.2%

7.5%

1.7% 0.8%

PERCENTAGE OF FATHER EDUCATION

Father education

42

31.7%

25%

16.7%22.5%

2.5% 0.8% 0.8%

PERCENTAGE OF MOTHER EDUCATION

Mother education

43

Total Non infected Infected Father education

27 23 4 Illiterate

28 22 6 Primary

24 21 3 Secondary

29 22 7 University

9 7 2 Master

2 1 1 PhD

1 1 - Read and write

120 97 23 Total

FATHER EDUCATION AND INFECTION

44

MOTHER EDUCATION AND INFECTION

Total Non infected Infected Mother education

38 33 5 Illiterate

30 24 6 Primary

20 18 2 Intermediate

27 20 7 Secondary

3 1 2 University

- - - Master

1 - 1 PhD

1 1 - Read and write

120 97 23 Total

45

There was no correlation between parasitic infection and parents education. (P = 0.8)

46

• Blastocystis hominis was the common parasite

(54.84%) then Entameoba coli (12.90%), Giardia

lamblia (12.90%), Endolimax nana (9.68%) and

Hymenolepis nana ( 3.23%)

47

Protozoan infection was 96.77% while helminthes

infection was 3.23%.

High incidence of infection was in Yemenis

followed by Saudis due to the high number of

students from these nationalities.

48

Detected parasites

Nationality B. hominis E. nana E. coli E. histolytica G. lamblia H. nana

Yemeni 6 - 1 - 3 -

Saudi 5 2 1 1 - -

Afghani 2 - - - 1 1

Palestinian - 1 - - - -

Nigerian - - - - - -

Chadian 2 - - - - -

Somali - - - - - -

Sudanese 2 - 2 1 - -

Turkish - - - - - -

Pakistani - - - - - -

Baluchi - - - - - -

DISTRIBUTION OF INTESTINAL PARASITES PER STUDENTS NATIONALITY

49

There was no correlation between parasitic infection and nationality. (P = 0.8)

50

Infection with single parasite was in 73.96% of the

infected students.

Double infection was in 17.19%.

Triple infection was in 8.85%.

51

80.8%

1.7%3.3%14.2

%

PERCENTAGE OF INFECTIONS TYPES

52

The majority of students, 108 (90%) were from south region of Jeddah and 20 (19%) of them were infected with intestinal parasites.

There was no correlation between parasitic infection and region of residency in Jeddah. (P = 0.8)

HAND WASH AFTER WC AND INFECTION

53

Total Not infected Infected Hand wash after W.C

110 90 20 Yes

10 7 3 No

120 97 23 Total

HAND WASH BEFORE MEAL AND INFECTION

54

Total Not infected Infected Hand wash before meal

102 85 17 Yes

18 12 6 No

120 97 23 Total

55

20

90

37

Hand wash after WC

56

17

85

612

Hand wash before meal

57

There was no correlation between parasitic infection and hand wash after WC visiting and before meal. ( P = 0.70)

58

AGE AND INFECTIONTotal Not infected Infected Age

2 1 1 12

23 19 4 13

21 12 9 14

34 30 4 15

27 24 3 16

9 7 2 17

4 4 - 18

120 97 23 Total

59

There was no correlation between parasitic infection and age of the students. (P = 0.3)

The highest infection was among the students of the age 14.

60

Each student was provided with a report about his diagnosis result, so the infected group get treatment and reexamination

RECOMMENDATION Health education and awareness programs for students regarding intestinal parasites.

Increase the Cooperation between ministry of health and ministry of education regarding intestinal parasitic infection among students.

Using other techniques in addition to direct smear such as: Ritchie tech, kits, acid fast stain and other technique.

61

62

ACKNOWLEDGMENT First, we would like to thank the Allah. Special thanks to our supervisor Dr. Majed Wakid for all what he gives us from support, time and teaching. We thank the Ministry of Education. We thank the cooperated intermediate school, manager, teachers and students. We thank School Health Unit and specially to Dr. Mohammed Khashugji. Finally, We would like to thank our parents and friends

63

Thank you