604 Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 The Correlation Between Worm Infection and Stunting Incidence in The First-Third Grade Students of Pematang Limau Elementary School, Gunung Mas District

Astri Widiarti1, Ni Nyoman Sri Yuliani2, Indria Augustina3

1Department of Public Health, 2Department of Nutrition, 3Department of Parasitology, Faculty of Medicine, University, Central ,

Abstract The highest prevalence of worm infection in was in Gunung Mas (76.67%). Elementary school students especially grade I, II, and III were vulnerable to worm infection because they still actively play in the dirt and paid less attention to personal hygiene, thus facilitate the contamination of worm eggs. Prolonged worm infestation causes stunted child growth, leading to stunting. Pematang Limau Elementary School in Pematang Limau Village, Sepang District, Gunung Mas Regency was located in a riverside region, which is a high risk region of worm infection. This research aim to determine the correlation between worm infection and personal hygiene knowledge and stunting incidence in Pematang Limau Elementary School, Sepang, Gunung Mas. This cross-sectional study was conducted in Pematang Limau Elementary School, in Pematang Limau Village, Sepang, Gunung Mas. The samples were Grade I-III students obtained by total sampling. Weight and height measurement, fecal microscopic, and assessment of personal hygiene knowledge were conducted on the students. Out of 47 participants, 3 students had worm infection (6.4%) and 2 students experienced stunting with low personal hygiene knowledge. There was insignificant correlation between worm infection and stunting. There was, however, a correlation between personal hygiene knowledge and stunting incidence in Grade I-III students in Pematang Limau Elementary School.

Keywords: Worm infection, personal hygiene, stunting.

Introduction indirectly affects economic loss.1 The negative impact on nutritional status caused by Ascaris lumbricoides Worm infection is the infiltration of parasites in the infection is the absorption of 0.14 gram/worm/day form of worms into human body.1 Worm infection is carbohydrates, 0.035 gram/worm/day protein, while affected by various factors, including tropical climate, Trichuris trichiura absorbs 0.005 ml/worm/day blood.4 low awareness of personal hygiene, poor sanitation, low This condition can lead to chronic nutritional deficiency socioeconomic status, and population density.2,3 This and chronic anemia, thus causing chronic malnutrition infection can lead to reduced nutritional status, immunity, which lead to stunting. intelligence, and productivity of those infected, thus Worm infection is often found in areas with high humidity, especially in population with poor personal hygiene and environmental sanitation.2 Central Kalimantan is a tropical region with wide freshwater, Corresponding Author: such as rivers, lake, and peat swamps ideal for worm Astri Widiarti growth, and the population mostly lives in the riverside, Jl. Kampus Tunjung Nyaho Jalan Yos Sudarso, which is a high risk region of worm infection.5 According Palangka Raya,, Indonesia to the result of data recapitulation on anthelminthic e-mail: [email protected] administration on pre-school children and school Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 605 children in Central Kalimantan, only five regencies The mean age of grade I-III students was 7-9 years old. were given anthelminthics, i.e. Sukamara, Kotawaringin More than 50% of grade I-III students had good personal Barat, Barito Utara, Murung Raya, and Palangka Raya, hygiene, although 34.1% of them had poor personal while the rest nine regencies, including Gunung Mas hygiene. According to the data in Table 2, stunting had not received worm infection mass prevention drug incidence in grade I-III students of Pematang Limau administration (Provision of Bulk Preventive Medicine; Elementary School was 21.3%. POPM).6 According to the data from Basic of Health Research in 2018 the prevalence of stunting in Gunung Table 1. Characteristics of grade I-III students in Mas Regency was 32%, more than the national rate of Pematang Limau Elementary School stunting in Indonesia.7 Characteristic Frequency (n) % A study in Dodap Pantai Village, North Sulawesi Age found that there was a correlation between personal 7 years 15 31.9 hygiene and poor neighborhood sanitation on worm 8 years 19 40.4 infection in toddlers.8 Good personal hygiene can cut off 9 years 13 27.7 the transmission chain of worm egg derived from dirt or Gender other materials contaminated with worm eggs. Based on Male 28 59.6 a study by Ahdal, prolonged worm infection can cause Female 19 40.4 growth inhibition, thus leading to stunting.9 Grade Grade I 17 36.2 This study was aimed to determine the correlation Grade II 16 34 between worm infection and personal hygiene Grade III 14 29.8 knowledge on stunting incidence in Pematang Limau Personal Hygiene Elementary School, Gunung Mas Regency. Good 31 65.9 Poor 16 34.1 Materials and Method This study used observational analytical method Table 2. Characteristics of nutritional status of with cross-sectional approach. This study was conducted grade I-III students in Pematang Limau Elementary in Pematang Limau Elementary School, Sepang, School based on height-by-age Gunung Mas from July 2019. The samples were Grade Characteristic Frequency (n) % I-III students obtained through total sampling. Fecal assessment was conducted to identify worm egg or larvae Age 7 years 15 31.9 using 2% eosin and reading was performed through 8 years 19 40.4 microscope. Data on personal hygiene knowledge was 9 years 13 27.7 obtained by interview using previously validated and rehabilitated questionnaire. Stunting assessment was Gender Male 28 59.6 conducted using the 2007 WHO height-by-age growth Female 19 40.4 curve indicator. Stunting is considered if Z-score is < -2 SD.10 The independent variables were worm infection Grade and personal hygiene knowledge, while the dependent Grade I 17 36.2 Grade II 16 34 variable was stunting. Data were analyzed using SPSS Grade III 14 29.8 15.0. The correlation between variables were analyzed using Chi-square with p value < 0.05. Alternative test Personal Hygiene if the requirements for Chi-square was not met was Good 31 65.9 Poor 16 34.1 Fisher’s test. The result of fecal assessment (Table 3) performed Findings and Discussion on 47 participants found worm infection of 6.4% and the The results of characteristic data of participants worm eggs identified were ofAscaris lumbricoides. The according to Table 1 showed that the total participants infected students were grade I and II. of 47 students were dominated by male, with 59.6%. 606 Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 Table 3. Distribution of worm infection incidence in grade I-III students in Pematang Limau Elementary School

Ascariasis Grade Positive Negative Frequency (n) % Frequency (n) % I 2 4.3 15 31.9 II 1 2.1 15 31.9 III 0 0 14 29.8 Total 3 6.4 44 93.6

The data of worm incidence and its relation to stunting in participants (Table 4) showed that there was insignificant correlation between both variables (p = 0.11). Significant correlation was found between worm infection and personal hygiene knowledge (p = 0.042).

Table 4. Correlation between worm infection incidence and stunting in children based on height-by-age indicator

Stunting Yes No p PR n % n % Positive 2 4.3 1 2.1 Worm infection Negative 8 17 36 76.6 0.11* 3.7 Total 10 21.3 37 78.7

The participants of this study were 47 grade I-III study was skin, hands, legs, and nails hygiene. Worm students of Pematang Limau Elementary School. infection transmitted through dirt is often found in The results of this study showed that worm infection elementary school children and contact with dirt became incidence in grade I-III students affected 3 people (6.4%) the cause of worm egg transmission that enters the body in grade I and II students. Microscopic examination in along with food.16 this study revealed that the worm egg found was those from Ascaris lumbricoides. Helminthiasis is prevalent Worm infection can cause decrease of nutritional in the tropical region.11 There are 1.2 million cases of status, intelligence, work productivity and chronic 16,17 Ascaris lumbricoides infestations in human throughout anemia. In this study, stunting incidence of grade the world.12 Helminthiasis often affects 5-7 years old I-III students of Pematang Limau Elementary School children in developing countries, including Indonesia.11 was 21.3% and 2 students infected with Ascariasis In Indonesia, ascariasis in children reached 14.5% and lumbricoides experienced stunting. According to the the prevalence was higher than other worm species.13 analysis of correlation between worm infection and The risk factor of ascariasis such as high humidity, poor stunting found insignificant result between the two sanitation and hygiene and population of tropical region of them. However, ascariasis became a risk factor to with poor hygiene.14,15 In this study, 65.9% grade I-III stunting due to > 1 prevalence ratio. Based on previous students had good personal hygiene, while 34.1% had studies, worm infection can affect nutritional status poor personal hygiene. In this study the students who because it causes anorexia, increase energy need, inhibit had worm infection had poor personal hygiene. Personal the ability of intestinal mucosa to absorb nutrition and 13,18 hygiene is important because poor personal hygiene will loss of blood. The infection of Ascaris lumbricoides lead to vulnerability to infectious disease such as worm is related to growth disorder. According to a cohort study infection.16 The personal hygiene mentioned in this in North Eastern Brazil in 2-7 years old children for 9 Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 607 years, children who experienced helminthiasis were 4.63 Penel Gizi Makanan. 2014; 37 (2): 155–60. 13 cm shorter by the time they were 7 years old. Other 5. Ananta A, Nurvidya Arifin E, Sairi Hasbullah M. studies found that elementary school students in China Demography of Indonesia’s Ethnicity [Internet]. who had moderate to severe worm infection became a Singapore: ISEAS – Yusof Ishak Institute 19 risk factor of stunting. Singapore; 2015. The limitation of this study was inadequate 6. Central Kalimantan Provincial Health Office in observation on the risk factors of stunting such as Disease Control and Eradication. Recapitulation of socioeconomic status, history of antenatal care and POPM Results of Worms in Toddlers, Preschoolers, parent’s education. Future studies are expected to and School Children in 2017, Central Kalimantan. observe those risk factors and better assess worm eggs Palangka Raya; 2017. using Kato-Katz method. 7. Ministry of Health of the Republic of Indonesia. 2018 Basic of Health Research National Report Conclusion Central Kalimantan Province. Jakarta; 2018. There was insignificant correlation between worm 8. Creepy AK, Boky H, Maddusa SS. The Relationship infection and stunting. However, worm infection Between Individual Hygiene To Worms In Toddlers became a risk factor of stunting in grade I-III students of In Flood Prone Areas in Dodap Pantai Village Pematang Limau Elementary School. Tutuyan Subdistrict East Bolaang Mongondow District. J Kesehatan Masyarakat. 2018; 7 (4): 1–9. Ethical Clearance: Before conducting the data 9. Tasbih Ahdal M, Sirajuddin S, Alharini A. The retrieval the researchers conducted a decent test of Relationship of Worm Infestation with Nutrition ethics conducted at the Faculty of Medicine, Palangka Status on Child Cambaya SDN in the Coastal Raya University to determine that this study has met the Region Makassar. Makassar; 2014. feasibility. Information on an ethical test that the study is eligible to continue. The feasibility of the research was 10. World Health Organization. Training Course on conducted to protect the human rights and security of Child Growth Assessment. Vol. 7, World Health research subjects. Organization. Geneva: WHO Press; 2008. 1–58 p. 11. Wintoko R. Relationship aspects of personal Source Funding: This study was done by self- hygiene and behavior aspects with worm eggs funding from the authors. nail contamination risk at 4 years, 5 years and 6 years grade of state elementary school 2 Raja Basa Conflict of Interest: The authors declare that they districts Bandar Lampung academic year 2012 / have no conflict interests. 2013. Juke. 2014; 4 (7): 136–41. References 12. Parija SC, Chidambaram M, Mandal J. Epidemiology and clinical features of soil-transmitted helminths. 1. Ministry of Health of the Republic of Indonesia. Trop Parasitol [Internet]. 2017 Jun 16; 7 (2): 81-5. Regulation of the Minister of Health of the Republic of Indonesia No.15 of 2017 Handling of Worms. 13. Simarmata N, Sembiring T, Ali M. Nutritional Jakarta; 2017. 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