presentation of community field work for ... of community field work for parasitesparasites and...
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Presentation of Community Field Work for
Parasites and Vector SurveyParasites and Vector Surveyin
Kanchanaburi Province
Group 2 , DTM & H (2012)Faculty of Tropical MedicineFaculty of Tropical Medicine
Mahidol University
G Group 2
∗ Leader ‐ Assoc. Prof. Wichit Rojekittikhun‐ Assoc. Prof. Narumon Komalamisra
∗ Instructors ‐ Dr. Poom Adisakwattana‐ Dr. Aongart Mahittikorng‐ Dr. Borimas Hanbookunupakarn
∗ Students ‐Mr. Kirakorn K. (M.Sc. Student)
DTM & H Students
Dr. Nobuchika H. Dr. Giulia Aroasio Dr. Yoshiaki Y.Dr. Khaing Zaw Latt
Dr. Ho Thi Hoai Thu Dr. Eliane R. ZeukengDr. Kanaka Sakamoto Dr. Thinzar Linn
OBJECTIVESOBJECTIVES
∗ To gain more knowledge and have experiences how to plan and work in the communityto plan and work in the community
∗ To get information about the situations of parasitic infection including medical vectors distributed in infection including medical vectors distributed in that areaT h h k hi h ill b ∗ To have a chance to work as a team which will be benefits for future work
St l E i tiStool Examination
∗ Sample ‐ 50 samples
∗ Method ‐ (1) Kato‐Katz Thick Smear Method(2) Simple smear with Normal saline
solution and Iodine solution
FINDINGSFINDINGS
∗ 19 stool samples ere positi e for proto oan ∗ 19 stool samples were positive for protozoan and/or helminthic infection ( 38% )
∗ Helminthic infection – 10 samples∗ Protozoan infection – 13 samples
H l i thi i f tiHelminthic infection
∗ 3 samples of Mixed infection3 p‐ 1 of Ascaris, Hookworm and Trichuris infection‐ 1 of Hookworm (eggs and Rhabditiform larva)( gg )and Trichuris infection‐ 1 of Hookworm and Opistorchis/MIF infectiono oo o Op o / o
∗ 2 samples of only Ascaris infection∗ 3 samples of only Hookworm infection (1 sample ∗ 3 samples of only Hookworm infection (1 sample with Rhabditiform larva)
l f l i h i i f i∗ 2 samples of only Trichuris infection
P t I f tiProtozoan Infection
∗ 4 samples for Blastocystis hominis cysts
∗ 3 samples for Giardia lamblia cysts
∗ 5 samples for Entamoeba coli cysts
∗ 2 samples for Chilomastix mesnili cysts
Ascaris lambricoides egg Hookworm spp. egg Blastocystis hominis
Entamoeba coli cyst Opistorchis spp. egg Giardia lamblia cyst
K t K t C l l tiKato‐Katz Calculation
∗ No. of eggs per gram (NEPG) = 1000X/YX = No. of eggs per thick smeargg pY = Weight of fecal sample used in mg
∗ No. of eggs per day (NEPD) = NEPG x Total Wt. of feces in 24 hours
∗ No. of female worms (NOFM) = NEPD/ No. of eggs per female per day
∗ Total worm load (according to their sex ratio)
Sample Parasite NEPG NEPD NOFM Total No. Comment
6 Ascaris 37 2 590 1 2 Light infection6 Ascaris 37 2,590 1 2 Light infection
8 Trichuris 185 12,950 Light infection
Hookworm 111 7,770 1 2 Light infection
9 Ascaris 666 46,620 1 2 Light infection
11 Trichuris 629 44,030 Light infection
17 Ascaris 27,343 1,914,010 8 16 Mod; infection
Trichuris 777 54,390 Light infection
Hookworm 185 12,950 1 2 Light infection, g
18 Hookworm 185 12,950 1 2 Light infection
23 Trichuris 37 2 590 Light infection23 Trichuris 37 2,590 Light infection
29 Hookworm 37 2,590 1 2 Light infection
38 Hookworm 333 23,310 1 2 Light infection
40 Hookworm 185 12,950 1 2 Light infection
RESULTSRESULTSProtozoan Infection
∗ 3 samples for Giardia lamblia cysts (Pathogenic)
∗ Other protozoal infection may be commensalOther protozoal infection may be commensal
SUGGESTIONSUGGESTION
∗ Community treatment for soil‐transmitted parasitic infection yearly or 6‐monthly
∗ Promotion of Hygiene in the community∗ Availability of soap in school latrines although school children gained knowledge about hand washing
M l i l P it SMalarial Parasite Survey
∗ Brief history taking∗ Physical ExaminationPhysical Examination∗ Blood film preparation∗ TreatmentTreatment
Bl d Fil E i tiBlood Film Examination
∗ 7 cases were positive on Thick film examination∗ Diagnosed as Plasmodium vivax infection in 5 g 5samples in Thin film examination
∗ Not diagnosed – 2 samples∗ Not diagnosed 2 samples
Cli i l R l tiClinical Relation
O t f hild (t t l hild / ∗ Out of 7 cases, 3 cases are children (total 13 children/ 25 patients)Th i hi f l i t j t h d h b t f b il ∗ Their chief complaints are just headache but afebrile and no abnormalities in physical examination ld hild l i t f bd i l i b t ∗ 12 year‐old child complaint of abdominal pain but no
abnormality in P.E d 6 th ld hild l i t f bd i l ∗ 3 year and 6 month old child complaint of abdominal
discomfort and passing worms with perianal itchiness∗ l f k hi t ( i l l )∗ 2 samples of unknown history (special samples)
SUGGESTIONSUGGESTION
∗ Increased awareness of malaria∗ Treatment of blood film ∗ Treatment of blood film positive patientsS ill f l i ∗ Surveillance of malaria infection in the community
Ad lt M it SAdult Mosquitoes Survey
∗ Place ‐ Bong Ti village, Kanchanaburi province∗ Date ‐ 21st June 2012∗ Date 21 June, 2012∗ BG trap day time ‐ 08:00 to 18:00
i h i 8 8∗ night time ‐ 18:00 to 08:00∗ CDC Light Trap ‐ 18:00 to 08:00
FINDINGSFINDINGS
∗ BG day time trap ‐ No mosquitoes trapped
∗ BG night time trap ‐ 6 mosquitoes & mothfly
‐ 2 female Aedes spp.‐ 2 female Culex spp.‐ 2 male Culex spp.pp
∗ CDC Light trap ‐ 4 mosquitoes and 1 sandfly
‐ 1 male Aedes spp.‐ 2 female Culex spp.‐ 1 female Anopheles spp.p pp
Sand fly
SUGGESTIONSUGGESTION
∗ Mosquitoes in this area probably have more night biting habitg
∗ Mosquitoes prefer real human skin (we got bitten at q p ( gday time!!!)
A d L SAedes spp. Larva Survey
∗ No. of Household ‐ 5∗ No of Positive houses 5∗ No. of Positive houses ‐ 5∗ House Index ‐ 100%
A d L SAedes spp. Larva Survey
∗ No. of surveyed containers ‐ 84∗ No of positive containers ‐ 32∗ No. of positive containers 32∗ Container Index ‐ 38.05%
∗ Breteau Index = 640(32 +ve containers/ 5 houses x 100)(32 +ve containers/ 5 houses x 100)
Containers in order of positive pfindings
∗ Tyre∗ Ant guardg∗ Bowl/Bucket∗ Other natural sources∗ Animal fed water∗ Plant & Dish∗ Discarded containers∗ VaseVase∗ Water‐storage containers∗ Bathroom waterBathroom water∗ Drinking water
FINDINGSFINDINGS
∗ Aedes spp. Larva and Pupae are found in every householdevery household
∗ Abate sand is used only in Health worker’s house but larva and pupae are present in house but larva and pupae are present in containers without abate use; e.g. bathroom, animal fed water animal fed water
SUGGESTIONSUGGESTION
∗ Availability and Usage of abate sand in every householdshouseholds
∗ Application of other intervention according to impact of Dengue infection in this community (like impact of Dengue infection in this community (like Thermal fogging)C i i i i i i f ∗ Community participation in preventive measures of DHF and vector control
E t it SEctoparasite Survey
DISCUSSIONDISCUSSION
In relation with stool examinationIn relation with stool examinationNo clinical correlation with the stool samplesOrganization of the rules in the groupOrganization of the rules in the groupWrong timing for preparation of the slides and the
examination (some KK had to be repeated twice, some SS dried examination (some KK had to be repeated twice, some SS dried during the waiting time!!)hard stool‐loose stool problem of quantitative examinationp qrecord of the resultsmany samples; each sample took a long time to be examined y p ; p g
by unexperts !!
DISCUSSION (C t’d)DISCUSSION (Cont’d)
In relation with blood film examination,Duty allocation among the group in a simple location with g glimited resources (few drugs, no prepared pt file, no place for visit the pt with privacy, unknown number of patients, unknown f l f iliti )referral facilities)Technical slides smear!U k lid f h l b l d!Unknown new slides from other group not labeled!We didn’t count the parasitaemia in the positive thin slides
DISCUSSION (C t’d)DISCUSSION (Cont’d)
l i i hIn relation with vector surveyLittle practice of the population to larva control ( )(they knew about the techniques)Difficult to trap mosquitoes (“0” during the day), but we got bitt ! bitten! Is the trap really attracting all the mosquito types?N d d No rodent trapped. Do they like meatball? h h d l f hWhat is the good place for the trap?
DISCUSSION (Cont’d)( )
1 Impro ed o r skill on microscopic diagnosis of 1. Improved our skill on microscopic diagnosis of parasites
2 Good interaction among the group members even 2. Good interaction among the group members, even in unexpected situations
3. Improved problem‐solving ability3 p p g y4. Contact with real life problems in the rural area
(poverty, infrastructure, diseases…)5. Worked in an enjoyable environment6. Good non‐academic extra‐activities7. Working + Fun= learning more!
SUGGESTIONSUGGESTION
• Practical study of the breeding place for Anopheles spp Larva can help us in our future field‐workspp. Larva can help us in our future field work
Q i k i i h l l h l h f ili ( h h • Quick visit to the local health facility (other than malaria clinic) to understand possibility of referral f i i ( li i l l b) after our examinations (clinical + lab).