International Journal of Zoology and Research (IJZR) ISSN 2278–8816 Vol. 3, Issue 2, Jun 2013, 9-18 © TJPRC Pvt. Ltd.
POOR PERSONAL HYGIENE AND SOCIOECONOMIC STATUS PROMOTED ANCYLOSTOMIAISIS IN CHILDREN RESIDING IN URBAN AREAS OF LAHORE
SHAHIDA AZHAR ALI1, TANVEER AKHTAR2, AZHAR MAQBOOL3, MAJID ALI ZAKI4, WAJID ALI SAFI5 & MUHAMMAD FIAZ QAMAR6 1&2Department of Zoology, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan 3University of Veterinary and Animal Sciences, Lahore, Pakistan 4Mayo Hospital, Lahore, Pakistan 5Solid Waste Management, Lahore, Pakistan 6Department of Zoology, GC University, Lahore, Pakistan
ABSTRACT
The study was launched to observe the status of Ancylostoma duodenale (A.duodenale) in the faecal samples of children residing in urban areasof Northern Lahore, Punjab from November 2006 to October 2008, showed an overall prevalence (%) of A. duodenale’s eggs(0.18 %).Direct microscopic technique was used to identify the eggs.Demographic data showed 10.50 % children were the habit of pica, 12.08 % nail biting, 21.58 % sucked thumb, 26.03 % and 6.11 % did not wash hands before meal and after defecation,8.33 % walked bare footed and 15.36 % used junk food (Table 1; Figure 1). Highest prevalence was observed in AllamaIqbal Town (0.67 %) (0.67±0.33)followed by Gulberg (0.50 %) (0.50±0.29), Wapda Town (0.17 %) (0.17±0.17) and (0.17 %) (0.17±0.17) in Valancia, Samanabad (0.33 %) (0.33±0.24) and Cantt (0.33 %) (0.33±0.24)respectively.Statistically prevalence was significantly higher in autumn (0.50±0.29)(P<0.001), winter (0.08±0.08) (P<0.001) and lowest zero percent in spring. Month wise high prevalence was observed in October (0.67 %) (P<0.001) that gradually decreased in January zero percent and again zero percent in Marchrespectively.
KEYWORDS: Ancylostomiaisis, Children, Lahore
Part of Ph.D Thesis of first author
INTRODUCTION
A.dodenale caused chronic infection in manAndrew et al. (2008).About 2 billion were infected per year by Soil Transmitted Helminths (STH) including Pakistan (Subhani et al.(2010) and 740 million people were being infected per year (Demitrios et al.(2010) worldwide. Eggs hatched at 280C to 320C into larva (Frank et al. (2005), intermediate host was not required (Robert and Janovy, 2010). It entered human skin by direct contact to soil via circulation enter in intestine and made attachment there, fed on blood, grew to adult again repeated the life cycle. Helminth eggs from soil could be transferred onto vegetables (Kokabshi, 1999). when children ate raw vegetables (Mustafa et al.(2001) being contaminated with helminth’s eggs, they ingested. In Zanzibar 424 children of 5-9 months’ old children (Davidet al.(2007) had helminth prevalence 9.4%. out of 122 million, 21 million 1-5 years old children were infected with hookworm (Patrick et al. (2009) worldwide, 4-15 years old children in India( Norhayati et al. (2003) had (52%) hookworm prevalence ( Verleet al. (2003) and decreased with increase in age (Sara et al.(2006); Archiet al.(2010 ). In children helminthiasis was caused by direct soil contact activity. 10 Shahida Azhar Ali, Tanveer Akhtar, Azhar Maqbool, Majid Ali Zaki, Wajid Ali Safi & Muhammad Fiaz Qamar
It was more common in 2-7 years old children due to habit (Mekhlafi et al.(2009) of pica. Increase in urbanization and population density increased STH infection (Simon et al. (2004). 288 faecal samples were collected and observed in 2000-2006 from contaminated parks showed(20.47%) prevelance (Rubel and Wisnivesky, 2010) and (p =0.0076) on sidewalks of the contaminated park. It was also observed that helminth prevalence decreased (Parveen et al. (2005) with improved sanitation.
OBJECTIVE
The study was launched to observe the status of ancylostomiasis in the urban community of Lahore to assess the degree of prevelance (%) in faecal samples of children to improve the health status of them as they had been neglected since now. This study would be helpful to control ancylostomiaisis by launching deworming programme at national level with collaboration of veterinarians and health department.
MATERIAL AND METHOD Study Area A total of 25 faecal samples of children were collected from 6 different urban localities of Lahore i.e. (Allama Iqbal Town, Wapda Town, Valencia, Cantt, Gulberg, and Samanabad) of Lahore, Punjab, Pakistan, fromNovember 2006 to October 2008 (Map.a and b) along with collection of demographic data (Performa 1) and social behavior of the natives (Figure 3a, 3b).
Faecal Sample Collection From each locality a total of 25 faecal samples per month of children were collected in screw caped plastic vials clearly labeled with name, sex, date and place of collection. For the presence of helminth’seggs these samples were examined on the same day by direct microscopic examination (Urquhart et al. (2005). The samples not processed on the same day were preserved in 3.0% formalin to prevent the eggs development and hatching. Direct Microscopic Examination A small amount of faecal sample was mixed with saline solution (0.9%) in a petri dish. Few drops of it were placed on glass slide, covered with cover glass. Helminth’seggs were observed under (10x10 and 10x40) microscope. Eggs were identified on the basis of morphology (Yamaguti, 1975). Prevalence of infection was monthly recorded. The area wise, genderwise and seasonal variations were noted.The prevalence of the infection / disease was recorded following the modified formula described as.
Statistical Analysis
Collected soil data was entered into Excel Data Sheet version ―7‖ of the computer and transferred to SPSS Version 15.5, Z-test was applied on the soil data as it was suitable for analysis, level of significance at the 0.05, 0.01 and 0.001 was considered as i.e. *, ** and *** respectively (Steel and Torrie, 1981).
RESULTS
Children were found in the habit of pica (10.5 %), nail biting (12.08%), thumb sucking (21.58%), who did not wash their hands before meal (26.03%) and (6.11%) after defecation, walked bare footed (8.33%) and those who were fond of junks (15.36%) respectively (Table 1; Figure 2). Poor Personal Hygiene and Socioeconomic Status Promoted Ancylostomiaisis in Children Residing in Urban Areas of Lahore 11
A total of 3600 i.e.600 faecal samples of children from each area were examined out of which overall prevalence (0.18±0.05) was found (Table 2) in 6 urban (Allama Iqbal Town, Wapda Town, Valencia, Cantt, Gulberg, and Samanabad) areas of Lahore, Punjab, Pakistan, from November 2006 to October 2008 (Table 2; Figure 2).
Overall Prevalence (%)
An overall prevalence (%) of ancylostomiasis in urban areas was found (0.18 %) (P<0.001) in Lahore, Punjab from November 2006 to October 2008.
Area Wise Prevalence (%)
Area wise faecal prevalence of infected children in six urban areas of Lahore, Punjab province indicated the infection was highest at (AllamaIqbal Town (0.67 %) (0.67±0.33) as nomads were residing there along with their pet dogs and had frequent contact with them, followed by Gulberg (0.50 %) (0.50±0.29), Wapda Town (0.17 %) (0.17±0.17) and (0.17 %) (0.17±0.17) in Valancia, Samanabad (0.33 %) (0.33±0.24) and Cantt (0.33 %) (0.33±0.24) respectively. (Table 2; Figure 2a).
Month Wise Prevalence (%)
Highest pevalence rate was observed in October(0.67 %) (0.67±0.33) that gradually decreased in November zero percent followed by a decline to the lowest prevalence zero percent again inMarch. When statistical analysis (Z-test) was applied on month wise data, prevalence of the month of the March was the lowest, so the month of March was compared with other months. Results showed that no-significant difference between prevalence (%) of the month February, April, May, June, July and August. But September (P<0.05) showed significant difference with respect to March (Table 2; Figure 2b).
Season Wise Prevalence (%)
The highest prevalence in all urban areas of Lahore, Punjab was observed during autumn (0.50±0.29) followed by summer (0.17±0.12**), winter (0.08±0.08) and lowest in spring zero percent. Statistically prevalence was significantly higher in autumn (P<0.001), summer (P<0.01) and in winter (P<0.05) as compared to spring (Table 2; Figure 2c).
Gender Wise Prevalence (%)
Overall gender wise prevalence was observed higher in males (P<0.001) (72.113.70) than females (27.893.70) because males were in close contact with dogs and soil (Figure 3a). However, statistical difference was not found (P>0.05) between the prevalence of male and female (Table 1; Figure 3e).
DISCUSSIONS
Infection was widely distributed throughout tropical and subtropical areas with prevalence rate as high as 90% in some communities (WHO, 2010). The common habit of children was to walk barefooted and improper disposal of human feces were the important features for high prevelance of helminthes in Pakistan. No survey had been planned by the government at national level and even by the World Health Organization (WHO) at in Pakistan to estimate the total prevalence rate of Soil transmitted helminths (STHs) and dog transmitted helminth (DTH) (WHO, 2005) yet up to now. The agricultural areas showed Ancylostoma sp. (0.4%) (Dubná et al., 2007) in the Prague city centre.
Out of 175 faecal samples of dogs, 78.9 % were infected with the highest prevalence of hookworm sp 45.1%, in urban dogs (76.7%) had hookworm. Children when played with dogs and touched fur, ingested hookworm eggs.Overall 12 Shahida Azhar Ali, Tanveer Akhtar, Azhar Maqbool, Majid Ali Zaki, Wajid Ali Safi & Muhammad Fiaz Qamar prevalence (%) of A.duodenale was (0.18±0.05), less than 55 % in Zanzibar children represented by (Cox et al.(2001), 51.3 % in Vietnam reported by (Olsen et al. (2006) and also lesser than 99.4 % as reported by (Knoop et al.(2008) in Khatmandu in Zanzibar due to changed climatic conditions and difference in population diversity and geographical distribution of helminth and 32.1 % in Uganda, here the prevalence might be due to soil type, environmental factors and demographic data prevailed there. About 60,000 deaths occurred per year in the world due to A.duodenale (Ejima and Ajogun, 2011).
Results of this study were also lesser than results reported by (Jardim et al. (2009) in Brazil about 69.8 % in male (74.9 %) and 65.1 % (p< 0.001) in femalegreater than the present study.It was very significant in Allama Iqbal (0.67 %) lesser to (22.4 % to 49.4 %) in urban area of Zanzibar reported by (Knoop et al. (2008), while in USA infection was (3.6 %) even due to increased medical and infrastructural facilities in California (YuRong et al.(2010) followed by Gulberg (0.50 %) (0.50±0.29), Valancia, Samanabad (0.33 %) (0.33±0.24) and Cantt (0.33 %) (0.33±0.24) respectively.Prevalence in Wapda Town was (0.17 %) (0.17±0.17) and Valencia (0.17 %) (0.17±0.17) less than the above mentioned areas,here people were aware of deworming and vaccination (Ejima and Ajugun, 2011).
The children were in close proximity with dog’s fur (Endrias et al.(2011).In Faisalabad (Pakistan) the overall prevalence ofAncylostoma spps (OR = 31.4, 95% CI 4.1-243) and (OR = 5.7, 95% CI 2.1-16) in their children, risk for hookworm infection was greater in farmers > textile labourers (Ensink et al.(2005) greater than the findings of present study. In island in Tuvalu out of 206 faecal samples of STH (69.9%) were observed, prevalence of A.duodenale was (11.7 %) in all age groups were positive (Totkova et al. (2006).
In Pakistan, Muzaffarabad city overall prevalence of hookworms was (2.4%) greater than present study and children had higher prevalence of parasites in rural > urban (Hussain et al.(2006), justified the results of this study. In Brazil the overall prevalent helminth infection was (68.2%) greater than the present study. In Qatar coprological examination of food handlers were observed the overall prevalence was 33.9% (13.6% for nematodes) and out of seven species, 3 were nematodes (Manrawan et al.(2008).
High prevalence was observed in Allama Iqbal (0.67±0.33) (p<0.001) due to lack of infrastructural facilities because of dense population, nomads children wandered bare-footed, played in contaminated soil with their pets like dogs. The sewerage system (Figure 3b) was poor, inhabitant defecated in open place, flies (WHO, 2011) and other insects sit on human and animal excretain slum areas of Addis Ababa, Ethiopia (Wana et al.(2008), transmitted (Knoop et al.(2011) the eggs of A.duodenale from one place to other place on fruits and vegetables. When children ate these contaminated raw vegetables or fruits could ingest the helminth eggs and got helminthiasis.Helminth prevalence had been determined by determining the rate of prevalence in contaminated parks, public playgrounds and surroundings contaminated soil (Kurnosov, 2009).
CONCLUSIONS
Children of the age 4-13 years old were the vulnerable class as
They played in parks or playground being come in contact with contaminated soil was a risk factor for health.
Did not wash their hands before meal and after defecation.
Had the habit of nail biting and suck their thumbs too.
Always wandered bare footed. Poor Personal Hygiene and Socioeconomic Status Promoted Ancylostomiaisis in Children Residing in Urban Areas of Lahore 13
Performa I Serial No: Date: ______Area Rural/Urban: _____Fecal Sample No: ______
Soil Sample No.: ______Male/Female: ______Age: _____
Name of Hospital/School: ______Name of Patient: ______
Address: ______Education: ______B.P.S: ______
Monthly income: ______Occupation: ______
Family Size: ______No. of Old: ______
No. of Young: ______No. of Children: ______
House constructed of Concrete/Mud: ______No. of Rooms:______
Fecal Refuse……Low/Moderate/High: ______
Domestic Refuse…..Open/Bin: ______
Personal Hygiene: ______Habit of Nail biting Yes / No , sucking thumb Yes / No, hand washing before meal and after defecation Yes / No, walk bare-footed Yes / No, fond of street junk food Yes / No.
Well Nourished/Under Nourished/Malnutrition: ______
Drainage…… Open/Underground: ______
Locality surrounded by Water Body/Fields: ______
Fecal dispersal via Sanitary/Unsanitary/No Facility: ______
Water supply... Tap/Hand Pump/Well/Spring/River: ______
Table 1: Showing the Prevalence (%) of Social Habits of Children Residing in Urban Areas of Northern Lahore, Punjab, Pakistan from November 2006 to October 2008
Don’t Wash Don’t Wash Walk Use Junk Food Habit Nail Suck Factors Hands Hands after Bare from Street of Pica Biting Thumb before Meal Defecation Footed Hawkers Total no of
children 3600 378 435 777 937 220 300 553
observed n= Percentage (%) 10.50 % 12.08 % 21.58 % 26.03% 6.11 % 8.33 % 15.36 % Prevalence 10.50±0 12.08±0 21.58±0 26.03±0.73* 6.11±0.40** 8.33±0. 15.36±0.60*** (%)±S.E .51*** .54*** .69*** ** * 46*** Age (years) 4-10 5-8 3-5 6-11 5-13 4-11 4-13
14 Shahida Azhar Ali, Tanveer Akhtar, Azhar Maqbool, Majid Ali Zaki, Wajid Ali Safi & Muhammad Fiaz Qamar
Z-test: *=P<0.05, **=P<0.01, ***P<.001 Figure 1: Showing Prevalence (%) of Social Status of Children Residing in Urban Areas of Northern Lahore from November 2006 to Oct 2008 Table 2: Area Wise, Seasonwise and Genderwise Prevalence (%) of Ancylostoma duodenalein Faecal Samples of Children in Six Urban Areas of Lahore, Punjab, Pakistan from November 2006 to October 2008
Total No. of Infected Faecal Samples (Ancylostoma duodenale) in Children Total Study Observed 1st Factors Prevalence 2ndYear(n Prevalence Year1&Ye Prevalence Samples Year(n (%)±S.E =1800) (%)±S.E ar2 (%)±S.E (n=3600) =1800) (n=3600)
Allama Iqbal Town (U) 2 0.67±0.47 2 0.67±0.47 4 0.67±0.33 Wapda Town (U) 1 0.33±0.33*** 0 0.00±0.00*** 1 0.17±0.17 Valenchia Town (U) 0 0.00±0.00*** 1 0.33±0.33*** 1 0.17±0.17 n =600 Cantt (U) 0 0.00±0.00*** 2 0.67±0.47*** 2 0.33±0.24 Gulberg (U) 2 0.67±0.47*** 1 0.33±0.33*** 3 0.50±0.29 Urban Areas Urban Samnabad(U) 1 0.33±0.33 1 0.33±0.33*** 2 0.33±0.24 Total 3600 6 0.33±0.14*** 7 0.39±0.15*** 13 0.18±0.05
Nov2006,2007 0 0.00±0.00 0 0.00±0.00 0 0.00±0.00 Dec 2006,2007 1 0.33±0.33 0 0.00±0.00 1 0.17±0.17 Jan 2007,2008 0 0.00±0.00 0 0.00±0.00 0 0.00±0.00
Feb 2007,2008 0 0.00±0.00 0 0.00±0.00 0 0.00±0.00 Mar 2007,2008 0 0.00±0.00 0 0.00±0.00 0 0.00±0.00
onths) Apr 2007,2008 0 0.00±0.00 1 0.33±0.33 1 0.17±0.17
M May 2007,008 n=300 0 0.00±0.00 2 0.67±0.47 1 0.17±0.17 Jun 2007,2008 0 0.00±0.00 0 0.00±0.00 0 0.00±0.00
Time Time ( Jul 2007,2008 1 0.33±0.33 0 0.00±0.00 1 0.17±0.17 Aug 2007,008 1 0.33±0.33 0 0.00±0.00 1 0.17±0.17 Sep 2007,2008 1 0.33±0.33 2 0.67±0.47 3 0.50±0.29 Oct 2007,2008 2 0.67±0.47 2 0.67±0.47 4 0.67±0.33*
Total 3600 6 0.33±0.14*** 7 0.39±0.15*** 13 0.18±0.05
Winter 1200 1 0.08±0.06 1 0.08±0.08 2 0.08±0.08 Spring 600 0 0.00±0.00 0 0.00±0.00 0 0.00±0.00** Summer 1200 2 0.13±0.07 2 0.17±0.12* 3 0.17±0.12** Seasons Autumn 600 3 0.67±0.23 4 0.67±0.33 8 0.50±0.29 Male 44 29.93±3.78 62 42.18±4.07 106 72.11±3.70*** Gender Female 17 11.56±2.64*** 24 16.33±3.05*** 41 27.89±3.70 *P<.05, **P<.01, ***P<.001 Z-test
Poor Personal Hygiene and Socioeconomic Status Promoted Ancylostomiaisis in Children Residing in Urban Areas of Lahore 15
Z-test: *=P<0.05, **=P<0.01, ***P<.001 Figure 2: Area Wise (a), Month Wise (b) and Season Wise (c) Prevalence of Ancylostoma duodenale in Faecal Samples of Children from November 2006 to October 2008 in Urban Areas of Northern Lahore 16 Shahida Azhar Ali, Tanveer Akhtar, Azhar Maqbool, Majid Ali Zaki, Wajid Ali Safi & Muhammad Fiaz Qamar
(a)
(b) Figure 3: Showing Poor Sewerage System (a) and Children with Excreta of Animals and Man (b)
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