University of the Philippines Visayas

College of Arts and Sciences

Division of Biological Sciences

Miagao, Iloilo

Hand Hygiene and the Prevalence and Intensity of Ascariasis

In Partial Fulfillment

Of the Requirements for PH 172

Submitted to:

Miss Adrienne Marie Bugayong

Submitted by:

Afnan Omar Al-Abdalla

Christian Faith Gayatgay

Gideon Gulmatico

Hanisha Erica Villaester

Justine Bennette Millado

Karen Joie Lajo

Keanne Paula Amamanglon

Natasha Andrea Fernandez

Mary Camille Reyes

March 24, 2009

CHAPTER I

INTRODUCTION

Background of the Study

Over one billion are estimated to have ascariasis – human infection caused by Ascaris

lumbricoides (Belizario, 1998). Ascariasis occurs when embryonated eggs of Ascaris

lumbricoides or the soil-transmitted round worm are ingested. Ascaris lumbricoides are most

common in tropical regions where conditions are warm particularly in developing countries such

as the Philippines.

In the Philippines, prevalence of ascariasis may reach up to 80%. High density of

country’s population and the involvement of agricultural production of the country contribute to

the incidence of ascariasis. Lack of education on proper disposal of human waste and poor health

sanitation promote transmission of the infection making it a public health issue.

Patients are usually asymptomatic especially when there is only light infection but heavy

worm infestation may cause nutritional deficiency, obstruction of bowel and obstruction of bile

and pancreatic duct and other complications. Complications of ascariasis are sometimes fatal

wherein at least 20, 000 of infected individuals, mostly children die annually (Belizario, 1998).

Children’s susceptibility to ascariasis is due to their poorer hygiene habits than adults,

their playing environment which usually involves soil and also their tendency to put anything in

their mouth. Understanding of the essentials of hand washing in children especially after using

bathroom and before eating significantly reduces the occurrence of ascariasis.

Prevention of ascariasis is of equal importance as with the treatment due to its high

prevalence. Safe and sanitary disposal of human waste which transmits eggs is the most

important measure. Since ascariasis is spread by ingesting parasite eggs from contaminated soil,

hands that had been in contact with contaminated soil act as a vector. Thus, hand washing

preferably with soap before handling food is one of the best defenses against ascariasis.

This study aims to determine whether hand hygiene affects the prevalence and intensity

of ascariasis in preschool children ages 4 to 5 in Brgy. Mat-y, Miagao, Iloilo.

Objectives of the Study

This study aimed to determine whether hand hygiene is related to the prevalence and

intensity of ascariasis among the pre-school children ages 4 and 5 in Barangay Mat-y, Miagao,

Iloilo.

Specifically it aimed to:

1. Determine the prevalence and intensity of Ascaris infection in pre-school children ages 4

and 5 in Barangay Mat-y, Miagao, Iloilo.

2. Determine whether prevalence of Ascaris infection is affected by sex, duration of outdoor

activities, and frequency of hand washing.

3. Determine whether the intensity of Ascaris infection is affected by sex, duration of

outdoor activities, and frequency of hand washing.

Significance of the study

This study aimed to determine whether hand hygiene is related to the prevalence and

intensity of ascariasis among the pre-school children ages 4 and 5 in Barangay Mat-y, Miagao,

Iloilo. This would specifically benefit the following: the family, school, and community.

With the awareness of the prevalence of ascariasis, this study would encourage

individuals especially the parents to improve proper hygiene practice of the whole family.

Also, schools would be more likely put emphasis on the importance of hand washing

especially among children by educating them.

This study would help individuals of the community be more aware of the prevalence of

ascariasis and in turn would give them idea on how to prevent occurrence of such infection.

Delimitation of the Study

This study aimed to determine role of hand hygiene in the intensity and prevalence of

ascariasis among pre-school children of Mat-y, Miagao, Iloilo. Likewise, it aimed to ascertain

how sex and length of time spent outdoors affect the intensity and prevalence of the infection.

The study was conducted from March 8, 2010 to March 19, 2010. The respondents of the

study were the 18 selected pre-school children ages 4 to 5, chosen using Purposive sampling.

This descriptive research focused on the intensity and prevalence of infection as the

dependent variables. The sex and length of time spent outdoors were the independent variables.

To gather the data for this study, the researchers conducted Kato thick smear on stool

samples of the children for the prevalence and intensity of infection, together with a

questionnaire to gather data on personal information.

To describe the data gathered the mean and cross tabulation was used. The t-test and

Pearson correlation set at 0.05 alpha level of significance was used to describe correlations

between variables.

CHAPTER II

REVIEW OF RELATED LITERATURE

Health and disease requires us to consider the circumstances, experiences and dynamics

of groups and populations. Personal health is influenced by day-to-day circumstances such as

exposure to influenza viruses, food purchasing choices, physical activity, alcohol consumption,

and urban air quality (Rogers, 1962).

Infection is the outcome of a complex series of events and processes. The success or

failure of the infective agent to become established as a parasite depends partly on its own

condition and partly on the condition of the host. The vigor of the infective agent depends on its

genetical constitution and on the environment to which it has been exposed, whether it was free-

living or parasitic in an intermediate host, and the susceptibility or resistance of the host also

depends upon genetical and environmental factors (Rogers, 1962).

Ascariasis is a worm (nematode or roundworm) infection of the small intestine which

causes digestive and nutritional disturbances, rashes, restlessness and insomnia. Symptoms in

85% of the cases are mild or absent. During its development, the worm larvae migrate through

the circulatory system. This can lead to numerous other secondary infections such as pneumonia.

In children with heavy loads, ascariasis can cause other serious complications, e.g., severe

malnutrition or intestinal blockage. Prevalence is worldwide, but mostly in tropical countries

where it can reach 50% of the population. Young children are more frequently and more heavily

infected. Prevalence from 60-90% of children and 10-50% of the aged are not uncommon. Up to

1 billion people are estimated to be infected worldwide, resulting in some 20,000 deaths

annually. It has been suggested that mortality due to ascariasis as a contributing factor is much

higher than estimated but generally unreported or attributed to another disease listed as

immediate cause of death. Unfortunately, its widespread mild occurrence has led many people to

assume it is harmless, a part of life (Listori, 1990).

Ascariasis tends to be spread in the immediate vicinity of the households. Where night

soil or sewage effluent is used as fertilizer, ascariasis can be spread through raw or uncooked

vegetables. This distribution pattern, therefore, may be due to cultural and occupational factors

where the very young and very old tend to spend more time near the house, a feature which tends

to compound the problem in a vicious cycle. Because it is so widespread and difficult to

eliminate, due to the persistence of Ascaris eggs, it is a serious health problem. However, in view

of its proportionate low mortality rate (less than 0.02%) and symptomless infection, it is not

considered a priority when compared with other diseases seen to be more serious (Listori, 1990).

Humans are the reservoir, but pigs, chickens, cats and dogs can act as vectors by eating

human feces and passing on the eggs, which aggravates transmission in work and living

environments. Ascariasis is spread by ingestion of eggs from soil contaminated with human

feces. Salads and raw vegetables are the most frequent vehicles, especially when manured with

human feces. Dirty hands and children’s play things that have fallen on the ground also tend to

be the major vehicles of transmission. By and large, the bulk of transmissions in highly endemic

areas appear to focus on household activity, exacerbated by small children’s defecation

indiscriminately around the living areas. Soil on feet, shoes and sandals can also transport eggs

long distances; transmission in dust is also possible (Listori, 1990).

After eggs are swallowed, they eventually develop passing through the circulatory system

and settle in the intestines as mature worms, a process which it takes about 2 months. About two

to several weeks after being shed, eggs develop into an infective stage in soil under ambient

conditions (loose, moderately damp soil with ample oxygen and temperature over 15°C) but eggs

can tolerate adverse conditions. Eggs die within 1 hour at temperatures over 50°C, and within 15

hours of exposure to direct sunlight. Humans remain infective as long as live female worms

inhabit the intestines. A female can produce 200,000 eggs daily or 26 million eggs over her life

time, about 6-18 months average. About 60% of these can become infective. Average worm life

span extends 6 to 18 months. Eggs in the soil can remain viable for several months; up to 10

years has been reported. The general population is at risk, though some individuals seem to

develop some immunity with age (Listori, 1990).

Since water is not significant in transmission, proper disposal of feces, prevention of

contamination in areas adjacent to living quarters, especially play areas are some of the primary

preventive measures. Because children appear to be the main reservoirs of infection, education

about hygiene and food handling, focusing on them, is indispensable, including the design of

toilets. Given that eggs do not become infective for about two weeks, regular environmental

clean-up of household areas is not unrealistic. A variety of sanitation measures are possible and

effective, but depend on three overriding complementary variables: time, temperature, and

moisture. Mass deworming with drugs is of questionable value except in severe cases because of

high probability of reinfection unless effective sanitary measures and hygiene education are also

taken. To be effective, deworming campaigns should be repeated at intervals of less than 2

months as long as individuals are shedding eggs. Otherwise, reinfections to pre-treatment levels

are likely to return within 6-12 months. Effective sanitation measures, however, will only work if

accompanied by proper education (Listori, 1990).

CHAPTER III

METHODOLOGY

Research Design

The sampling procedure that was used was the Purposive Sampling. The population

frame was obtained from the barangay authorities. The researchers went around the site,

knocking on doors during the time when the children and the parents were home (usually 4-

6pm). The sample was selected by including people of interest (children between 4-5 years old)

and excluding those who do not suit the purpose as the group went from house to house. Those

who were absent or busy at the time were noted, and the houses were visited again the next day.

This was performed from March 8, 2010 to March 19, 2010.

On each of the sample population, a questionnaire was given about hygiene habits,

especially hand washing, and a fecal sample was taken the next day for laboratory analysis for

presence of Ascaris lumbricoides worms. Some which did not provide fecal samples the day

after the group first visited were checked up on again until these samples were available.

Formalin was also provided to preserve the stool samples in case the group collected the fecal

samples hours after the child defecated. Worm burden was also noted.

The questionnaire was provided for the children’s parents or guardians to answer. The

questions were related to hand washing (when they wash their hands, how frequent, etc), history

of worm infection in the family, and anti-helminthic drugs taken in a 6-month time span. The

answers were limited to yes or no.

Fecal sample was collected from these children for laboratory analysis. The Kato Katz

Technique was used because light infections can be detected using this procedure, and worm

burden can be determined as well. The following materials were to be prepared: Kato-set

(template with hole, screen, nylon or plastic, plastic spatula), newspaper, microscope slides,

cellophane as cover slip soaked in Glycerol-malachite green solution, and gloves.

Before starting, the work area was disinfected. Newspapers were placed on top of the

working area. The laboratory gown, mask, and gloves were worn. The layer was prepared by

cutting the newspaper to a size of about 5 inches by 5 inches. The template with the hole was

then placed in the center of the microscopic slide. A small amount of fecal material was then

placed on the newspaper. The screen was pressed on top so that some of the feces filtered

through and with the flat spatula; it was scraped across the upper surface to collect the filtered

feces. The collected feces were afterwards added in the hole of the template until it was

completely filled. The template was carefully removed so that the cylinder of feces was left on

the slide. The fecal material was covered with the pre-soaked cellophane strip. The microscope

slide was inverted and the fecal sample was firmly pressed against the cellophane strip on a

smooth hard surface such as a tile. The material was spread evenly. The slide was carefully

removed by gently sliding it sideways to avoid separating the cellophane strip. The slide was

placed with the cellophane upwards. The smear was examined in a systematic manner and the

eggs of Ascaris lumbricoides reported. It was later multiplied by the appropriate number to give

the number of the eggs per gram feces (KatoKatz, 2005).

Statistical analysis was done using SPSS version 16. The mean, standard deviation and

variance were determined. These data were used to test the hypothesis, whether there really is a

relationship between hand washing habits of pre-school aged children with incidence of Ascaris

lumbricoides in their age group.

CHAPTER IV

RESULTS AND DISCUSSION

Descriptive Data Analysis

This study aimed to determine the role of hand washing in the intensity and prevalence

of Ascariasis among pre-school children ages 4-5 years old in Barangay Mat-y, Miagao, Iloilo.

55.56%44.44%

2.001.00

Age

Based on the number of patients who have agreed and helped us in the study, the

majority of the ages of the children were 55.56% comprising of 5 year olds while the remaining

44.44% were composed of 4 year olds.

50.0% 50.0%

2.001.00

Sex

There was an equal distribution between the sex of the respondents combining both the 4

and 5 year old age groups.

55.56%27.78%

16.67%3.002.001.00

Play

Majority of the respondents have reported that on average, the number of play hours of

the children are in the 4.1-6 hours of playtime followed by 2.1-4.0 and close to it is the 0-2

hours.

11.11%

88.89%

2.001.00

Prevalence

Since the barangay has frequent Ascaris treatments and that most of the respondents

have undergone through the program, there is quite a low number of Ascaris prevalence in the

study with about 88.89% as being negative for any Ascaris infection.

2.001.00

Prevalence

8

6

4

2

0

Count

Bar Chart

3.002.001.00Play

Those that tested positive for ascariasis were those children who played 4.1-6 hrs for one

day.

2.001.00

Prevalence

10

8

6

4

2

0

Count

Bar Chart

2.001.00Sex

This shows that 2 males tested positive for ascariasis while all of the girls tested

negative.

2.001.00

Prevalence

8

6

4

2

0

Count

Bar Chart

2.001.00Age

Only two 5-year olds tested positive for Ascaris infection.

61.11%38.89%

3.002.00

Handwashing

A lot of the children have practiced good hand hygiene practices mainly with washing

with soap and water which was at 61.11% indicating that most of them are taught early on to

practice sanitary practices thus reducing the risk of Ascaris infection after activities especially

playtime.

3.002.00

Handwashing

6

5

4

3

2

1

0

Count

Bar Chart

3.002.001.00Play

The cross tabulation is between the number of hours of playtime designated as 1.00 (0-2

hrs), 2.00 (2.1-4 hrs), and 3.00 (4.1-6 hrs) and handwashing designated as 2.00 for sometimes

and 3.00 for always. No value was assigned for never in handwashing because all the children

wash their hands either sometimes or always. Most of the children that play for 4.1-6 hrs wash

their hands sometimes while most children that play for more than 2 hours wash their hands

always.

3.002.00

Handwashing

6

5

4

3

2

1

0

Count

Bar Chart

2.001.00Sex

In this chart, females are assigned as 1.00 and males are assigned as 2.00. More male

children wash their hands sometimes, while more female children wash their hands always.

3.002.00

Handwashing

6

5

4

3

2

1

0

Count

Bar Chart

2.001.00Age

In this bar graph, 4-year-olds are assigned as 1.00 and 5-year-olds are assigned as 2.00.

It is shown that more 5-year-olds than 4-year-olds wash their hands both sometimes and always.

Inferential Data Analysis

Table 1. Significance in the Prevalence and Handwashing when subjects are grouped according to variables

t/ F Sig. (2-tailed) SignificancePrevalence

Age -1.333 0.201 Not significant Sex -1.512 0.001 Not significant Playtime 0.833 0.454 Not significantHandwashing Age 0.102 0.840 Not significant Sex 0.459 0.414 Not significant Playtime 2.526 0.113 Not significant

The table above shows that there is no significant difference in the prevalence of Ascaris

infection when the children are grouped according to a. age, b. sex, and c. playtime. Moreover,

there is no significant difference in the hand washing frequency of the children when they are

group according to a. age, b. sex, and c. playtime. This explains that for this population, the child

is at risk of contracting Ascaris infection regardless of his age, 4 or 5, Sex, or the hours of

playtime.

Table 2. Correlations of Prevalence and Handwashing

Prevalence HandwashingPrevalence Pearson Correlation 1 -0.081 Sig. (2-tailed) 0.751 N 18 18Handwashing Pearson Correlation -0.081 1 Sig. (2-tailed) 0.751 N 18 18

Results of Pearson correlation shows that there is no significant relationship between

hand washing frequency and the prevalence of Ascaris infection among pre-schoolers of

Barangay Mat-y, Miagao, Iloilo. Although hand washing plays a huge role in the hygiene of

children, there are also external factors that might have affected the results. In this population,

most of the respondents have taken anti-helminthic drugs within the past 6 months that may have

directly affected the results.

CHAPTER V

SUMMARY AND CONCLUSION

This study aimed to determine the role of hand washing in the intensity and prevalence of

Ascaris infection among preschoolers aged 4 and 5 in Barangay Mat-y, Miag-ao, Iloilo.

The population is composed of 9 males and 9 females where 8 are four year olds and 10

are five year olds. Among these 18, 2 have an Ascaris infection while the others remain negative.

61.11% of the population said that they always wash their hands before meals, after playing, and

after using the toilet while 38.99% only wash their hands when they remember to.

Descriptive analysis of the variables show that both the prevalence and the frequency of

hand washing is not influenced by age, sex, and the time spent playing. Intensity of infection

remains constant since both the subjects who turned out positive have light infections. Moreover,

there was no correlation between the prevalence and frequency of hand washing with the alpha

set at 0.05.

CHAPTER VI

RECOMMENDATIONS

The accuracy of the study would have increased if the sample size were bigger. Since the

sample size only covered about half of the actual number of children in Barangay Mat-y, then it

cannot fully describe the worm burden situation and hand washing habits of the pre-school

children.

Also, it is recommended that the age groups tested would have had a wider range. The

ages covered in the study are only 4 and 5 year olds. There is only a one year age gap, and their

hygiene habits and play hours do not necessarily have a significant difference.

Using fresh stool samples could have obtained the group more accurate results. Due to

time constraints and regular load of classes, the group had to soak the stool sample in formalin in

order to observe it in a more convenient time. Also, some children defecated at night or late in

the afternoon, making it impossible for the group to analyze the sample within a two hour period.

Upon observation of the stool samples, other eggs of worms were noted. Examples are

Trichiuris and hookworm eggs. It is recommended that other worms be included in the preceding

studies.

It is also recommended that probability sampling be used instead of non-probability

sampling which can be subject to bias and error.

Finally, it helps to conduct other studies on hand washing and worm burden in other

barangays in order to compare them and aide the barangay health workers in eradicating soil

transmitted helminth infections.

REFERENCES

Belizario, Vicente Y. Philippine Textbook of Medical Parasitology 2nd ed. Philippines: The

Publication Program, 1998. Print.

Listorti, James A. Environmental Health Components for Water Supply, Sanitation, and Urban

Projects. Washington, D.C.: World Bank, 1990. Print.

Rogers, W. P. The Nature of Parasitism. New York: Academic,, 1962. Print.