Banji B.Barnabas et al. / JPBMS, 2012, 15 (07)

Available online at www.jpbms.info ISSN NO- 2230 – 7885 Original Research article CODEN JPBSCT

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JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Survey Of And Other Intestinal Helminthiases Among School-Aged Children In Agaie, Niger State, Nigeria * BARNABAS, B. BANJI (M. Sc.), ALIYU, M. BABADOKO (Ph. D) , GBATE, MOHAMMED (M. Sc.) , OBI, U. PAULINE (B. Sc.) AND ATTAIRU, A. A. (HND). 1 Department of Science Laboratory Technology, P. M. B. 55, The Federal Polytechnic, Bida, Niger State, Nigeria.

Abstract: Prevalence study of schistosomiasis and other intestinal helminthic was undertaken among school- aged children in Agaie, Agaie LGA of Niger State; between January, 2010 and September, 2011. Aim: The study is aimed at status assessment of these diseases in the Town and its environs. Base-line information could be useful in integrating the area into the National Schistosomiasis Control Initiative of Nigeria Federal Ministry of Health. Design/Materials and method: A total of 718 urine and stool samples were collected for microscopic examination. Concentration method was used to process the urine and stool samples. The data for this project work were analyzed using SPSS 10.0 version. The data were subjected to Pearson correlation coefficient test which measures the degree of relationship between two or more variables as well as the chi-square test of association. The proportion value of P > 0.01 was not significant while a value of P< 0.01 was significant. Result: The study showed an overall prevalence of urinary schistosomiasis to be 37.0%, and infection prevalence of other intestinal helminthiases to be 43.2%. The commonest intestinal helminth infection identified was (13.8%). The overall prevalence of infections was higher among the males and age group 5-9 years. Conclusion: The study has shown a gloomy picture of infections of schistosomiasis and other intestinal helminthiases in Agaie and its environs. Recommendations: Although assessment of the medical and public health implications of these parasitic intestinal helminthic diseases were not part of the current study, there is urgent need for mass administration (MDA) in order to reduce the impacts of these diseases and reduce the potential of transmission in this local government area and the state in general.

Key Words: Agaie, Children, Niger State, Nigeria, Prevalence; and Schistosomiasis. million are asymptomatic with 20 million having severe Introduction: clinical disease. Once the parasite has found its host, Schistosomiasis, also known as bilharziasis is a parasitic the miracidium divides, producing thousands of new disease caused by several species of trematode fluke of the parasites (cercariae). School- age children, 10 to 14 years genus . It is commonly found in , Africa and old are the most affected by this silent debilitating disease. South America, especially in areas with fresh water The disease causes stunted growth; poor school which serve as the intermediate hosts for the parasites. performance and are great hindrance to the youth, The disease affects many people in developing countries the life blood of any civilization (3). and in certain African communities and East Asia (1). Extreme poverty, unawareness of the risk, inadequacy or An estimated 700 million people worldwide may be at risk total lack of public health facilities plus the unsanitary of infection as their agricultural, domestic and recreational conditions in which million of people live their daily lives activities expose them to infected water bodies. More than are all factors contributing to the risk of infection 207 million people are infected worldwide – most live in particularly in developing tropical countries (4). There are poor communities without access to safe drinking water five species of these that are implicated in and adequate sanitation (2). Of the 207 million people with schistosomiasis: schistosomiasis, 85% live in Africa. S. mansoni, S. japonicum, S. mekongi, S. intercalatum that Schistosomiasis is endemic in 76 countries and territories. causes intestinal schistosomiasis and S. haematobium that Active transmission is reported from 67 countries and causes urinary schistosomiasis (1).. There are two forms of territories, of these, 46 (68.7%) of these countries are in schistosomiasis in Nigeria and a number of other African Africa. Estimates of morbidity and mortality from countries and they include: urinary schistosomiasis and schistosomiasis vary considerably. About 779 million intestinal schistosomiasis (3).. people (more than 10% of the world’s population) were at Urinary schistosomiasis affects 66 million peoples the risk of being infected with schistosomiasis in mid - throughout 54 countries in Africa (4).. According to (5).S. 2003. Other workers (2), have reported that, more than 200 haematobium infection is widely distributed in Nigeria and million people in 74 countries are infected, of which 120 is hyper endemic in many states of the North and 1 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 15, Issue 15 Banji B.Barnabas et al. / JPBMS, 2012, 15 (07)

Southwest with moderate to low endemicity in the the latter stages of the disease, the pathology is associated Southeast. S. haematobium lives in the venous plexus near with collagen deposition and fibrosis, resulting in organ the urinary bladder and ureters (6).. (4).reported that the damage that may be only partially reversible (6).. worms lives in the blood vessels of the bladder only about Intestinal helminthic infections are recognized as a major a half of the eggs are excreted in the urine while the rest public health problem, which can cause significant stay in the body damaging other vital organs. During the nutritional and educational insults (13).. In the case of period of migration of the organism, allergic symptoms Ascaris infection, the causative agent is found world wide. develop in the form of fever, itch, skin eruptions and Its world wide prevalence is estimated at over one billion eosinophilic in filtration of the lungs. Several months after people especially in most tropical and sub-tropical regions, infection, the eggs of Schistosoma appear in the urine and but also in cooler climates. Although characterized with these sign and disease are associated with their movement low morbidity and mortality, the global prevalence of in the tissue (7).. still results in approximately 20,000 deaths Intestinal schistosomiasis particularly caused by mansoni annually, primary as a consequence of intestinal is the most prevalent in 52 African countries, has a non obstruction. specific clinical picture of , diarrheoa and Niger State is one of the leading states in Nigeria, excised blood in the stool. Liver enlarge is common in advanced from the defunct North-Western State in February 1976. It cases, frequently associated with and other signs of became a full-fledged state in the Federation by April of the increased portal pressure. In such cases there may also be same year. The State derived its name from the Niger River splenomegaly (4).. However, medical attention is needed. In that flows across the entire State. The available massive intestinal schistosomiasis, the worm resides in the blood water bodies from rivers-Niger, Kaduna and their vessels lining the intestine (4).. tributaries, favors the long sustained status of People are infected by contact with infected water used in schistosomiasis endemicity in the state. normal daily activities such as personal or domestic hygiene and swimming or by professional activities such as Apart from the abundant water bodies in the state, fishing, rice cultivation, and irrigation. Schistosomiasis occupational, behavioral water contact activities like mainly affects adults’ workers in rural areas, employed swimming, bathing, washing, practiced by the inhabitants either in agriculture or the fresh water fishing sector or of the state exposes them to the contaminated water road construction workers, hence, its justification as an bodies. Other occupational and agricultural practices “occupational disease” (4).. include: swampy-rice cultivation and fishing which form Other intestinal helminthic diseases in humans includes: the main stay of the economy of the indigenous inhabitants ascariasis, infections, , of the state. The average educational status of the , , fasciolopsiasis, enterobiosis. (8). indigenous inhabitants of the state is very low thus; the reported that soil-transmitted helminths are some of the health promoting habits is perceptibly poor. All these have most common and infective agents of mankind and are aggravated the vulnerability of the state indigenous responsible for high morbidity and mortality throughout inhabitants to schistosomiasis infection over the years. the developing world. Approximately 3 billion people Hence, this study aims at prevalence assessment of the globally, are infected with helminths (9).. disease in this Town and its environs. Base-line According to (10; 11; 12). and others schistosomiasis and information could be useful in integrating the area into the intestinal have long been recognized as National Schistosomiasis Control Initiative of Nigeria human infections of significant public health importance Ministry of Health. especially in the tropics and are known to be more common in children than in adults. Hence this study is Materials and methods: undertaken to determine the prevalence of schistosomiasis Study Area: and other intestinal helminthic infections among school- The study was conducted among school-aged children in aged children in Agaie, Agaie LGA of Niger State, Nigeria. both secular and Quran schools in Agaie community of (4). opined that there is an association between urinary Niger State between January, 2010 and September, 2011. schistosomiasis and a form of cancer of the bladder in Agaie is the headquarter of Agaie LGA, and head of the some regions. In Egypt schistosomiasis linked with cancer traditional Agaie Emirate Council under the ruler-ship of is the primary cause of death among men aged 20 and 44 First Class Emir in the State. Agaie is found in a low basin years. In the industrialized countries, cancer of the bladder found by the valleys of one river Gbakogi, the mean annual without schistosomiasis is usually prevalent among rainfall of the town is 1227 mm3 and mean monthly workers aged around 65. In some regions of Africa where temperature of 31oC. The predominant tribe is Nupe with S. haematobium is prevalent, the incidence of cancer of the an average low representation of other tribes. The bladder linked to schistosomiasis is 32 times higher than indigenous habitants are mostly Muslims. The residents the incidence of cancer of the bladder in the U.S.A. are predominantly farmers and fishermen. The socio- Schistosomiasis is due to immunological reactions to economic status of the town is on the average as most Schistosoma eggs trapped in tissues. Antigens released people use pit latrines and the literacy level is averagely from the egg stimulate a granulomatous reaction low. Infrastructural facilities present in the town include a comprised of T cells, macrophages, and eosinophils that government owned general hospital, electricity and pipe- results in clinical disease. Symptoms and sign depend on borne water that is erratic in its supply like other major the number and location of eggs trapped in the tissues. parts of the country. Initially, the inflammatory reaction is readily reversible. In 2 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 15, Issue 15 Banji B.Barnabas et al. / JPBMS, 2012, 15 (07)

Pre –survey visit: Table 3: The table shows the Prevalence of urinary Schistosomiasis Because of the socio-cultural, religious and political infection in agaie, by sex. Species of parasites No (%)male No(%) female reasons, there was an arranged visit to this community to infected,N=373 infected,N=345 enlighten the school-aged children on the benefits and the S. haemalobium 141 (37.8) 125 (36.2) importance of the study. Although participation in the study was voluntary, the school-aged children were Table 4: The Table Depicts the Spread of Urinary Schistosomiasis by encouraged to participate voluntarily. Age-Groups. Age- group (Yrs) Number infected % infected Sample collection: 5-10 87 12.1 Each subject was given two sterile containers, well labelled 10-14 68 9.5 15-19 21 2.9 to supply their bio-data information which includes: name, 20-24 90 12.5 sex and age. The samples were collected and brought into microbiology laboratory, The Federal Polytechnic, Bida, Table 5: The Table Shows the Prevalence of Intestinal Helminthiases Niger State; where they were immediately analyzed and By Age-Groups. examined microscopically. Type of Age Groups (Years) Parasites 5-9 10-14 15-19 20-24 Parasitology: N=381 N=138 N=43 N=156 For the urine samples, urinalysis was carried out, to Mansoni 42 20 7 18 determine the presence of protein and blood. For Ascaris 53 16 8 22 Hookworm 26 12 1 0 microscopic analysis of urine samples, concentration Taenia 10 5 0 4 method was used. Concentration method was involved Mixed 22 10 6 17 centrifuging the urine sample at 1500 rpm for 5 minutes infection after which, the supernatant fluid was discarded and the sediment transferred into a clean glass slide, covered with Table 5: The Table Shows the Relationship between Prevalence of cover slip and examined microscopically using the low- Urinary Schistosomiasis and Positivity for Protein presence in Urine power objective with the condenser iris closed sufficiently samples. Total Sample Size Nos Positive for Positive Sample for to give good contrast. Conclusive diagnosis was based on N Protein S. Haematobium finding the characteristic egg. For the examination of stool 718 97 266 sample, formol-ether concentration method was used.

Conclusive diagnosis was based on finding the Table 6: The Table Shows the Relationship between Prevalence of characteristic eggs in the stool samples. Urinary Schistosomiasis and Positivity for Haematuria presence in Urine samples Total Sample Size Nos Positive for Positive Sample for Data Analysis: (N) Protein S. Haematobium The data for this project work were analyzed using SPSS 718 250 266 10.0 version. The data were subjected to Pearson correlation coefficient test which measures the degree of relationship between two or more variables as well as the Discussion: chi-square test of association to test relationship that exists The present study has shown an overall prevalence of between the different variables. The proportion value of P 37.0% and 47.2% for urinary schistosomiasis and other > 0.01 was not significant while a value of P< 0.01 was intestinal helminthiases infections in agaie; Agaie LGA of significant. Niger State. Although there is no base-line information for this town however, the observed prevalence is high since Results: human beings are involved. Plausible reason for this lies in Table 1: The Table depicts the various species of Parasites Isolated in continual contamination and repeated exposure of these the Study. school-aged children to the same. Earlier workers have Species of parasites Number infected % infected reported that there is intricate relationship between the S. haematobium 266 37.0 environment and the spread of parasitic diseases (14).. S. mansoni 87 12.1 Earlier documented studies in a similar location-Bida, that A. lumbricoides 99 13.8 shares both socio-cultural and geographical attributes to Hookworm 50 7.0 Agaie; showed seemingly high prevalence to these parasitic Taenia spp 19 2.6 diseases (15; 16; 17) Multiple infection of parasites 55 77 Prevalence of infection by sex for both urinary

Table 2: The Table Shows the Prevalence of Intestinal Helminthic schistosomiasis and other intestinal helminthic infections Infections by Sex. shows that males (37.8%) and age-group 5-9 years Species of parasites No (%)male No(%) female (21.3%) had higher infection prevalence for urinary infected infected schistosomiasis other helminth infections respectively. A. lumbricoides 58 (8.1) 41 (5.7) Although these observed difference is of no statistical S. mansoni 45 (6.3) 42(5.8) significance (P>0.01). This observed prevalence compared Taenia spp 11 (1.5) 8 (1.1) to other studies that have reported higher infection Hookworm 27 (3.8) 2 3(3.2) prevalence among the males than females and this Multiple infections 26 (3.6) 29 (4.0) particular age bracket. (6). states that the reason is plausibly because of increased exposure of males to infected water 3 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 15, Issue 15 Banji B.Barnabas et al. / JPBMS, 2012, 15 (07) via bathing, swimming negligence act to sanitary and Recommendations: agricultural activities. (18)., opined that this age bracket is There is need for mass deworming programme for all the generally the most active and is often exposed repeatedly school-aged children. to the contaminated environment. They are very playful There is need for provision of basic amenities like good and negligent thus more vulnerable to common parasitic and portable drinking water, adequate safe waste disposal infections. and the training of the populace to maintain such. This will According to (19)., the following features characterize limit the possibility of further environmental people and households vulnerable to schistosomiasis contamination. infection: Lack of access to resources, especially health There is need for public enlightenment programme that services, safe water and sanitation and education; Poor will change the behavioural practice of the inhabitants. people who are poorer because of their health, need more health care, but often get less. The poor are defined as References: “hard to reach”; care is more expensive and difficult to 1. Schistosomiasis, 2010: Wikipedia online Encyclopedia deliver. Poor people are more likely to have an inadequate 2010 retrieved February 14,2010, Fromhttp://en diet than the better off. The result of these accumulated Wikipedia org/wiki/schistosomiasis disadvantages is marginalization and social exclusion from 2. World Health Organization 2010: Fact sheet February, the larger society. Thus, poverty is often hidden and its 2010Schistosomiasis. Retrieved on October, 28, 2011 from extent underestimated and contributes significantly to the http://www.google.com.ng. high prevalence of schistosomiasis in developing countries. 3. Targeting Schistosomiaisis 2010: Schistosomiasis. The commonest intestinal helminth parasite identified in Retrieved October 15, 2009 from http://en Wikipedia the present study is Ascaris lumbricoides (13.8%). This org/wiki/targetingschistosomiasis roundworm is a prominent parasite in both 4. World Health Organization 2007: Schistosomiasis. temperate and tropical zones but more common in warm Division of control of Tropical Diseases. Genera countries where sanitation is poor and low. This further Switzerland. Retrieved on May 15, 2010 from strengthens the fact that this community must have been http://www.google.com.ng. highly contaminated through indiscriminate defaecation in 5. Cowper, S. G., 1973: Bilharziasis (schistosomiasis) in and around their living premises and their farms. Although, Nigeria. Trop Geog & Med,25,105-18. the present study did not directly investigate the common 6. Kogulan, P. & Lucey, R.D., 2010: Schistosomiasis. available toilet facility in the town; however, the economic Contributed information and Disclosure.Nokes, C.; Cowper, and educational status of the town is on the average. E. S.; Robinson, B.A., & Bundy, D.A., 1991: Geoleheminth Indiscriminate defaecation must have been the practice in infectionand academic assessment in Jamican Children. the town thereby increasing the exposure of the Tans R Soc. Trop Med Hyg, (85) 272 –73. inhabitants of the town the environment, thereby 7. Kassirsky, I.; and Plotnikov, N. 1969: Disease of Warm completing the life cycle of these parasites. land (4th Ed.). Academic Press, London Santrucisio: 17-31. Results shows that there is a strong association between 8. Bundy, D.A.P., 1995: Epidemiology and transmissions of urinary schistosomiasis infection and haematuria in the intestinal helminthes, in Farthing, M.J.G., Keusch, G.T & urine (P<0.01). There had been strong need for reliable, Wakelin, D (Eds.), Enteric infection 2, intestinal helminthes, simple and rapid diagnostic community tool; for a detailed Chapman & Hall Medical. 5-24. map on the distribution of the disease in the country and in 9. , 2010: Wikipedia online Encyclopedia order to prioritize control activities, as well as to monitor 2010 retrieved October 15, 2009. From http:// en the effectiveness of control operations (20).. The present Wikipedia.org/wiki/parasitic worm.10. Nokes, C.; study has justified the use of haemturia in urine as an Grantham-McGregor, S.; Sawyer, A. W.; Cooper, E. S.; indication for urinary schistosomiasis infection. The only Robinson, B.A. and Bundy, D. A. P. (1992): Moderate to limitation to its usage in epidemiological survey is that it heavy infections of affect cognitive does not take menstruating girls into cognizance thus function in Jamaican school children. Parasitology 104, resulting in false positive result. However, there was no 539–47. relationship between urinary schistosomiasis infection and 11. World Health Organization 1993: The Control of presence of protein in urine. Schistosomiasis: second report of the WHO expert committee. Genera, Switzerland; 1-4. Conclusion: 12. Gillespie, S. H., 2001: Principles and practice of Clinical In conclusion the study has revealed a high prevalence of Parasitology. In Gillespie S.H.,Pearson RD, editors both urinary and intestinal schistosomiasis as well as other Cluchester, England: John Wiley & Sons Ltd. ; 561 – 83. helminthic infections in Agaie, Agaie LGA of Niger State, 13. Warren, K. S.; Bundy, D. A.; Anderson, R. M.; Davis, A.; Nigeria. This epidemiological status is very high that Henderson, D. A.; Jamison, D. T.; Prescot, N. & Senff, A., demands mass deworming program (prevalence >20% but 1993: Helminth infections in Disease control priorities less than 50%). Also the infections affected both sexes and in developing countries. Oxford uni. Press. 131-60. all the school-age groups sampled. Although there is no 15. Ramsey, G. W., 1934: A study on schistosomiasis and statistical significance, males had more infections than the certain other helminth infections in Northern Nigeria.West females. In order to reduce the prevalence of these Afri Medical Journal. 8(2) (Series), 5-8.Old infectious parasitic intestinal helminth diseases the 16. Barnabas, B. Banji. 2005: The prevalence of intestinal following recommendations are therefore proffered. helminthiasis in children of Selected schools in Bida Niger

4 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 15, Issue 15 Banji B.Barnabas et al. / JPBMS, 2012, 15 (07) state, Nigeria. Nigeria journal of Applied Arts and Science among school children in the Babana district, Kwara State, 1:22-26. Nigeria. Afr. Jour. Med. Sci.17: 187-93. 17. Barnabas, B. B.; Mann, A.; Nma, E. M.;Obi, P. U. and 19. TDR/WHO, 2008: For Research of Poverty: Ezeako, I. A. 2011: Prevalence of Schistosomiasis and Other Schistosomiasis. Retrieved on October, 28, 2011 from Intestinal Helminth Parasites among School Children in 20. Mafe, M. A.; Appelt, B.; Adewale, B.; Idowu, E. T.; Bida, Niger State, Nigeria. European Journal of Scientific Akinwale, O. P.; Adeneye, A. K.; Manafa, O. U.; Sulyman, M. Research ISSN 1450-216X 48 (4). 621-26. A.; Akande, O. D. and Omotola, B. D. 2005: Effectiveness of http://www.eurojournals.com/ejsr.htm. different approaches to mass delivery of 18. Edungbola, L. D.; Asaolu, S. O.; Omonisi, M. K. and among school-aged children in rural communities in Aiyedun, B. A. 1988: infection Nigeria. Acta Trop. 93: 181-90.

Conflict of Interest: - None. Source of funding: - Publication Funding Grant was from The Management of The Federal Polytechnic, P. M. B. 55, Bida, Niger State, Nigeria.

*Corresponding author: BARNABAS, B. BANJI. Science Laboratory Technology Department, Federal Polytechnic, Bida, Niger State, Nigeria Tel.: +2348035968355

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