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The Epidemiology and Impact of Cystic Echinococcosis in Humans And The epidemiology and impact of cystic echinococcosis in humans and domesticated animals in Basrah Province, Iraq By Mohanad Faris Abdulhameed BVM&S, MVS Title School of Veterinary and Life Sciences Murdoch University Western Australia This thesis is presented for the degree of Doctor of Philosophy of Murdoch University, 2018 Declaration I declare that this thesis is my own account of my research and contains as its main content work which has not previously been submitted for a degree at any tertiary education institution. Mohanad Faris Abdulhameed Statement of Contribution This PhD thesis comprises a number of scientific publications, and each paper has been co- authored by multiple authors. The extent to which the work of others has been used is clearly stated in each chapter and certified by my supervisors. I declare that I, Mohanad Faris Abdulhameed, have undertaken the majority of the original research presented in these papers and am the principal author of this work. Mohanad Faris Abdulhameed ii Statement of Contribution (1) Title of Paper A Retrospective Study of Human Cystic Echinococcosis in Basrah Province, Iraq Publication Status Publication Details Acta Tropica (2018) no. 178:130-133. Principal Author Name of Principal Author Mohanad Faris Abdulhameed (Candidate) Contribution to the Paper MFA conceived the idea and conducted the survey in Iraq (Basrah province) and wrote an initial draft. Overall percentage (%) 60% Signature Date: 7/09/2018 Co-Author Contributions By signing the Statement of Contribution, each author certifies that: i. the candidate’s stated contribution to the publication is accurate (as detailed above); ii. permission is granted for the candidate to include the publication in the thesis; and iii. the sum of all the co-author contributions is equal to 100% less the candidate’s stated contribution. Ian Robertson Name of Co-Author IR supervised the project, obtained ethics approval and reviewed and Contribution to the Paper edited the manuscript. Overall percentage (%) 15% Signature Date: 7/09/2018 Name of Co-Author Ihab Habib IH was involved in manuscript administration, statistical analysis, Contribution to the Paper reviewing and edition. Overall percentage (%) 20% Signature Date: 7/09/2018 Name of Co-Author Suzan A. Al-Azizz SA helped obtain permission from the health department of Basrah Contribution to the Paper for accessing data at the hospitals. Overall percentage (%) 5% Signature Date: 7/09/2018 iii Statement of Contribution (2) Neglected Zoonoses and the Missing Opportunities for One Health Title of Paper Education: The Case of Cystic Echinococcosis among Surgically Operated Patients in Basrah, Southern Iraq Publication Status Publication Details Disease no.7 (1):1-10. Principal Author Name of Principal Author Mohanad Faris Abdulhameed (Candidate) MFA administrated the questionnaire survey to the 50 surveyed Contribution to the Paper patients in Basrah province. MFA had validated and analysed the data and wrote the initial manuscript draft Overall percentage (%) 70% Signature Date: 22/01/2019 Co-Author Contributions By signing the Statement of Contribution, each author certifies that: iv. the candidate’s stated contribution to the publication is accurate (as detailed above); v. permission is granted for the candidate to include the publication in the thesis; and vi. the sum of all the co-author contributions is equal to 100% less the candidate’s stated contribution. Name of Co-Author Ian D. Robertson IR supervised the project, obtained the necessary ethics approvals Contribution to the Paper and reviewed and edited the manuscript. Overall percentage (%) 15% Signature Date: 22/01/2019 Name of Co-Author Ihab Habib Contribution to the Paper IH oversaw the project and reviewed and edited the manuscript. Overall percentage (%) 10% Signature Date: 22/01/2019 Name of Co-Author Suzan A. Al-Azizz SA helped MFA in administration the questionnaire survey to the Contribution to the Paper 50 surveyed patients in Basrah province. Overall percentage (%) 5% Signature Date: 22/01/2019 iv Statement of Contribution (3) Knowledge, Awareness and Practices Regarding Cystic Title of Paper Echinococcosis among Livestock Farmers in Basrah Province, Iraq Publication Status Publication Details Veterinary Sciences (2018) no. 5 (1):1-10 Principal Author Name of Principal Author Mohanad Faris Abdulhameed (Candidate) MFA travelled to Basrah province to perform the questionnaire Contribution to the Paper survey. MFA administer the manuscript and statistical analysis. Overall percentage (%) 65% Signature Date: 7/09/2018 Co-Author Contributions By signing the Statement of Contribution, each author certifies that: vii. the candidate’s stated contribution to the publication is accurate (as detailed above); viii. permission is granted for the candidate to include the publication in the thesis; and ix. the sum of all the co-author contributions is equal to 100% less the candidate’s stated contribution. Name of Co-Author Ian D. Robertson IR supervised the project and the analysis, obtained the necessary Contribution to the Paper animal ethics approval and reviewed and edited the manuscript. Overall percentage (%) 10% Signature Date: 7/09/2018 Name of Co-Author Ihab Habib IH had also involved in statistical analysis, reviewing and editing Contribution to the Paper the manuscript. Overall percentage (%) 20% Signature Date: 7/09/2018 Name of Co-Author Suzan A. Al-Azizz SA obtained permission from the main veterinary hospital of Contribution to the Paper Basrah to allow the survey to be conducted. Overall percentage (%) 5% Signature Date: 7/09/2018 v Statement of Contribution (4) Prevalence of taeniid eggs in the faeces of owned and free- Title of Paper roaming dogs in Basrah, Iraq, and the knowledge of dog owners on cystic echinococcosis Publication Status Submitted for publication to the Japanese Journal of Infectious Publication Details Disease Principal Author Name of Principal Author (Candidate) Mohanad Faris Abdulhameed MFA performed the laboratory work and administered the Contribution to the Paper questionnaire survey to the dog owners. MFA undertook the statistical analysis under the guidance of IR Overall percentage (%) 65% Signature Date: 22/01/2019 Co-Author Contributions By signing the Statement of Contribution, each author certifies that: x. the candidate’s stated contribution to the publication is accurate (as detailed above); xi. permission is granted for the candidate to include the publication in the thesis; and xii. the sum of all the co-author contributions is equal to 100% less the candidate’s stated contribution. Name of Co-Author Ian D. Robertson IR supervised the project, obtained animal ethics approval and Contribution to the Paper reviewed and edited the manuscript. Overall percentage (%) 20% Signature Date: 22/01/2019 Name of Co-Author Ihab Habib IH also reviewed and edited the manuscript and provided input Contribution to the Paper into the study design. Overall percentage (%) 10% Signature Date: 22/01/2019 Name of Co-Author Suzan A. Al-Azizz Contribution to the Paper SA provided advice on the tests to use in the laboratory. Overall percentage (%) 5% Signature Date: 22/01/2019 vi Statement of Contribution (5) Cystic Echinococcosis in Edible Offal of Sheep in Basrah, Iraq: Title of Paper Abattoir-based Survey and a Probabilistic Model Estimation of the Direct Economic Losses Due to Hydatid Cyst Publication Status Publication Details Parasite Epidemiology and Control (2018) no. 3 (1):43-51 Principal Author Name of Principal Author (Candidate) Mohanad Faris Abdulhameed MFA conducted all the field work in Basrah province and Contribution to the Paper undertook the statistical analysis and wrote an initial draft Overall percentage (%) 60% Signature Date: 7/09/2018 Co-Author Contributions By signing the Statement of Contribution, each author certifies that: xiii. the candidate’s stated contribution to the publication is accurate (as detailed above); xiv. permission is granted for the candidate to include the publication in the thesis; and xv. the sum of all the co-author contributions is equal to 100% less the candidate’s stated contribution. Name of Co-Author Ian Robertson IR supervised the complete project, was responsible for the animal Contribution to the Paper and human ethics approval and finalised the reviewing and editing of the manuscript. Overall percentage (%) 15% Signature Date: 7/09/2018 Name of Co-Author Ihab Habib IH helped in statistical analysis as well and reviewed and edited Contribution to the Paper the manuscript. Overall percentage (%) 20% Signature Date: 7/09/2018 Name of Co-Author Suzan A. Al-Azizz SA helped obtain permission to access samples and historical data Contribution to the Paper at the abattoir. Overall percentage (%) 5% Signature Date: 7/09/2018 vii Dedication I dedicate this Doctoral Thesis to the most precious people in my life, for their everlasting love, full understanding and strong support in my study: My wife: Rusul ALshetiwi My sons: Ahmed & Ali My Daughters: Rawan & Haneen My parents Abstract Cystic Echinococcosis (CE) is a zoonotic disease caused by the larval stages of Echinococcus spp.. The disease results in significant public health effects to the community and economic burden for livestock owners. Although CE is endemic in Iraq, few studies have been undertaken in Basrah Province on the disease’s epidemiology in humans and other animals. This study was designed to address these deficiencies. Medical records from five public hospitals for the period 2005 to 2015 were examined for records of CE. Data on 748 surgical cases of CE were retrieved representing an annual incidence of 4.5 cases per 100,000 people. More females were affected (61.2%) than males (38.8%). Cysts were detected most frequently in the liver (46.3%) and lungs (28.1%) of the patients. A questionnaire was administered to 50 CE patients who had undergone surgery to describe the characteristics of the patients and their knowledge, attitudes and practices about the disease. The majority of patients were found to adopt poor hygienic practices and had a low level of understanding of how the disease was transmitted.
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