Central Annals of Public Health and Research

Research Article *Corresponding author Yamssi Cedric, Department of Biomedical Sciences, Faculty of Health Sciences, University of , Prevalence and Risk Factors of , PO Box 39 Bambili, Cameroon, Tel: 237677413547 ; Email [email protected] Submitted: 31 August 2020 Gastrointestinal Protozoans in Accepted: 23 September 2020 Published: 25 September 2020 Ntamuchie, Mezam Division, North Copyright © 2020 Cedric Y, et al. , Cameroon OPEN ACCESS Keywords 1 2 Yamssi Cedric *, Noumedem Anangmo Christelle Nadia , Calvin Bisong • Protozoans Ebai3, Flore Nguemaïm Ngoufo1, Gerald Ngo Teke1, Tangwah Louisa • Ntamuchie • Trophozoites 3 3 4 4 Bihnyuy , Joyceline Dulafe , Tsila Henri Gabriel , Vincent Khan Payne • Prevalence and Helen Kuokuo Kimbi1 • Cameroon 1Department of Biomedical Sciences, University of Bamenda, Cameroon 2Department of Microbiology, University of Dschang, Cameroon 3Department of Medical Laboratory Science, University of Bamenda, Cameroon 4Department of Animal Biology, University of Dschang, Cameroon

Abstract

Background: Parasitic infection remains a major public health problem worldwide, particularly in developing countries. This study was aimed at determining the prevalence and risk factors associated with gastrointestinal protozoans in persons living in the Ntamuchie community.

Method: A total of 100 people were sampled in the Ntamuchie community found in Bamenda III. A questionnaire was administered to people who accepted to sign the consent form. The stool samples were evaluated by parasitological methods including, direct wet-mounting, Formalin-either concentration formalin ethyl acetate concentration, for the detection of protozoan infections.

Result: From a total of 100 stool samples collected and analyzed, 33 samples were infected with at least one species of parasitic protozoans making an overall prevalence of 33.0%. Six different parasitic protozoans were seen with Entamoeba histolytica demonstrating the highest prevalence of 28%, followed by Entamoeba coli with a prevalence of 12 %, and Blastocystis hominis 3 %. Less occurring species were Giardia lamblia and Iodoameoba bustchilii with a prevalence of 2% each and lastly followed by Trichomonas intestinalis with a prevalence of 1%.

Conclusion: The result of the research indicates that the community of Ntahmuchie is highly contaminated with protozoan parasites. They were recommended to take preventive measures aimed at reducing the environmental contamination with gastrointestinal protozoans as the best prevention against the spread of gastrointestinal protozoans.

INTRODUCTION greatest single worldwide cause of illness and disease. The World Health Organization estimates that 3.5 billion are infected with Parasitic diseases contribute significantly to the burden some types of intestinal parasites [5]. Previous studies on the of infectious diseases worldwide [1]. While most infections prevalence of parasitic infection in different parts of the country and death from parasitic diseases affect people in developing have shown infection rates from 2% to 6% [6]. An estimated countries, they also cause significant illness in developed 60% of the world population is infected with intestinal parasites countries. Enteric protozoa continue to be the most commonly including amoebiasis and giardiasis. The incidence of infections encountered parasitic diseases and cause significant mobility is 50% in developed countries as compared to the incidence and mortality throughout developing regions of the world [2]. rate of 95% in developing countries [7]. The epidemiology of Numerous protozoans inhabit the gastro-intestinal tract of intestinal parasitic infections shows that these parasites are humans. The majority of these protozoans are non-pathogenic, found in every age group and both sexes. However, the incidence or only result in mild disease. Some of these organisms can is high in some areas and some age groups. In a study carried cause severe diseases under certain circumstances. Intestinal out in Buea, out of 356 outpatients 100 (28.1%) were infected parasites belong to the most frequent causes of parasitic diseases with intestinal protozoans [8]. An intestinal protozoon is that deteriorate the health of the global population [3]. The transmitted by the fecal-oral route (soiled hands, ingestion occurrence of these parasitic diseases is closely related to the of food or water contaminated with feces) and exhibits a life economic status of the population, personal hygiene standards, cycle consisting of a cyst stage and a trophozoite stage. This and safe drinking water [4]. Intestinal parasite infections are study was aimed at determining the prevalence and risk factors globally endemic and have been described as constituting the Cite this article: Cedric Y, Christelle Nadia NA, Ebai CB, Ngoufo FN, Teke GN, et al. (2020) Prevalence and Risk Factors of Gastrointestinal Protozoans in Ntamuchie, Mezam Division, North West Region, Cameroon. Ann Public Health Res 7(2): 1097. Cedric Y, et al. (2020)

Sample size determination associated with gastrointestinal protozoans in persons living in the Ntamuchie community, in order to contribute to existing The sample size was calculated using the Lorentz’s formula data on the epidemiology of protozoans in Cameroon, and make [10] at 95% confidence interval: recommendations for further regional and nationwide control 2 2 programs.MATERIAL AND METHODS n =z p(1-P)/d Study site where, n = required sample size

This study was carried out in Ntamuchie. Ntamuche is found z = confidence level at 95% (standard value of 1.96) in Bamenda III Council, Mezam Division, North West Region of p = estimated prevalence of the infection under investigation Cameroon (Figure 1). It is a semi-urban area in Bamenda III. E. histolytica Bamenda is the chief town of the North West Region which is The prevalence of intestinal protozoa in the North-west a multicultural and metropolitan town whose inhabitants are region was 19.4% with being the most prevalent engaged in various socio-economic activities. The town has both protozoan species, with an overall prevalence of 17.2% (38). government and private hospitals taking care of over 650 360 d = margin of error at 5 % (standard value of 0.05) inhabitantsStudy design and other villages around its localities. If z = 1.96 This was a cross- sectional and random study, in which d = 0.05 subjectsStudy period were persons living in Ntamuchie community. p = 19.4 % = 0.194 P= 17.2% = 0.172 InclusionThis study criteria was carried and Exclusionout between criteria May and June of 2020. 2 2 n = (1.96) (0.172) (1-0.194)/ (0.05) Hence n= 213.03=213 All those who signed the informed consent form and children whose’s parents signed for them were included in the study. All Hence a total of 213 people in the Ntamuchie community in those who refused to sign the consent form were excluded from Bamenda III were supposed to be sampled. This sample size was the study. not attained due to the corona virus outbreak.

Figure 1

Peri-urban land situation of Bamenda III with Ntamuchie in the map [9]. Ann Public Health Res 7(2): 1097 (2020) 2/7 Cedric Y, et al. (2020)

Data collection

A structured questionnaire was used to collect data on socio-demographic and risk factors of intestinal protozoans. 33% Socio-demographic data included age, sex, profession, and the Number of positive cases highest level of educational attainment. Questions on factors that 67% Negative influenced the prevalence of gastrointestinal protozoans, sources of water bodies and type of toilet used in the locality were asked. Questionnaires were administered in English and exceptionally inSample oral Pidgin collection English where and necessary. Laboratory analysis of stool sample

Figure 2

Labelled clean proof containers were given to participants for Overall prevalence of parasitic protozoans among the the collection of stool samples. The Formalin-either concentration population in Ntamochie. technique was used to concentrate parasites for identification under the microscope. A direct wet mount with normal saline 30 28 was done to identify motile trophozoites. 1g of stool sample was 25

emulsified in 3mls of 10% Formalin, it was sieved into a beaker )

% 20 (

e

and later on transferred into a tube. Four (4) ml of formalin were c n 15 e l 12 added in the tube to make it to 7ml formalin. After 3ml of ether a v e r 10 were added into the tube, it was well corked mixed and then P centrifuged at 3000 Rpm for 5 minutes to obtain sediments. The 5 3 2 2 supernatant was poured out and only the sediment was left in 1 0 the tube. A drop of iodine was added to each sediment to ease Entameoba Entamoeba Blastosis Gardia Iodoameoba Trichomonas the visibility of the cyst of protozoans on the slide. It was covered histolytica coli hominis lamblia bustchilii intestinalis with a cover slide and viewed using the x10 and x40 objectives of Single infection theManagement light microscope. and Statistical analysis Figure 3

Prevalence of Single protozoan infections. The prevalence of intestinal protozoan was calculated as the proportion of positive samples. Data collected from the field were presented using descriptive statistics. Data were entered into MicrosoftRESULTS Excel AND and DISCUSSION analyzed. Results

Figure 2 shows the overall prevalence of parasitic protozoans. It follows from the analysis of this figure that out of the 100 study participants, 33 were infected with at least one species of parasitic protozoans making an overall prevalence of 33.0%.

FromEntamoeba figure histolytica 3 below, out of the 100 samples examined for parasitic protozoans, 6 different parasitic protozoans were seen Entamoeba coli Figure 4 andwith Blastoisis hominis demonstrating the highest prevalenceGiardia lambliaof 28%, followedand Iodoameoba by bustchilii with a prevalence of 12 %, Prevalence of parasitic infection based on double and triple Trichomonas3 %. Less occurring intestinalis species were infection. with a prevalence of 2% respectively and lastly with a prevalence (22%) of gastrointestinal protozoans meanwhile males showed of 1%. a prevalence of 11%. Figure 4 shows the prevalence of parasitic infection based Figure 6 presents the prevalence of parasitic protozoans on a double and triple infection. It appears from this figure that according to age range. From this figure infection in the different the occurrence of single parasite infection was at 23% while occurrence of Iodoamoeba buschilii + E. histolytica + E. coli, and age group, 0-14 years was higher (19%) but lower (14%) in the double parasite occurrence was at 8%. For triple infections, the Giardia lamblia + E. histolytica + E. coli age group 15 and above.

were at 1% each. Figure 7 presents the frequency of parasitic protozoans with respect to the type of toilet used. It follows that 25% of positive Figure 5 presents the prevalence of parasitic protozoans cases were from participants using pit toilets, and 8% from those with respect to sex. Females presented the highest prevalence using water closet system toilets. Ann Public Health Res 7(2): 1097 (2020) 3/7 Cedric Y, et al. (2020)

Figure 8 shows the prevalence of parasitic protozoans based of those with protozoan infections had just primary education, on sources of drinking water. This figure shows that the highest 10% secondary school and lastly 6% who had attained tertiary frequency of infection occurred in people who used streams and education. rivers (13%) as their sources of water. Figure 11 shows the frequency of parasitic protozoans based Figure 9 presents the frequency of parasitic protozoans based on whether respondents put fingers and other objects into their on the profession. From this figure, we observed that out of the 33 mouth. The highest prevalence occurred among those who had positive samples, 28% were from persons in other works of life, the habit of always putting fingers and other objects into their while only 4% and 1% were farmers and teachers respectively. mouths (20%) followed by (8%) those who sometimes do this. Figure 10 is shown the prevalence of intestinal parasites in The Frequency of parasitic protozoans based on whether relation to the level of education. Our findings showed that 17 % respondents generally had Diarrhea or Dysentery is presented in Figure 12. From this figure we notice that the frequency of 25 22 parasitic protozoans was higher among those who sometimes

20 had diarrhea (20%) followed by 12% for those who never had

) and lastly 1% in those who always had diarrhea. ( % 15 e c n

e 11 The frequency of parasitic protozoans based on when a l

v 10 e respondents took treatment for diarrhea is presented in figure r P 13. We observe that the highest frequency of parasitic protozoans 5 was seen in those who never use to take drugs for diarrhea and

0 followed by those who sometimes take drugs for diarrhea (4%) Male Female and 0% in those who always take drugs for diarrhea or dysentery. Figure 14 shows the frequency of parasitic protozoans with

respect to whether the respondent consumes fruits. This figure Figure 5 indicates that all the participants who were positive for parasitic protozoans had the practice of taking fruits such as pear, pawpaw, Prevalence of parasitic protozoans with respect to Sex. andDiscussion others.

20 19 18 The result of this cross-sectional study carried out in the 16 community of Ntamuchie shows, that 33% of the sample 14 14 ) population were infected with gastrointestinal protozoan which % ( 12

c e was more than the results reported from a study in the Eastern n 10 l e

a region of Nepal (18.5%) [11]. This high prevalence may be due v 8 r e

P to poor hygienic condition and environmental hygienic habits 6 4 practiced by people in the community, such as, playing in dirty 2 surroundings of houses, putting on dirty dresses, playing with 0 fingers on the ground, putting dirty fingers and objects into the 0--14 Age group ≥15 mouth, not washing fruits and hands beforeE. histolytica eating, picking foodE. from the ground and eating and moving bare footed. The most Figure 6 coli prevalent intestinal protozoansE. were histolytica (28%) E.and coli Occurrence of parasitic protozoans according to age group. (12%). The results of this study confirm with those reported in Bambili, Cameroon, where (8.9%) and 30 (7.6%) had the highest prevalence of intestinal protozoans [12]. 25 25 et al. Intestinal protozoan infection was high among females ) 20 % (22%) than males (11%). A similar study conducted by Payne ( e c

n [12] in Cameroon also showed a higher prevalence of infection

e 15 l a

v in females as compared to males. This higher prevalence in e r P 10 8 females may be due to the various activities in which females are

5 involved such as farming and because they handle the food they tend to eat unwashed/unboiled food, vegetables, or salads which 0 PIT TOILET WATER SYSTEM may be contaminated with protozoan cysts. The prevalence was Types of toilets high in the age of 0-14years than in the age group 15 and above. This result is similar to that observed from the of Cameroon where the prevalence of (50%) was reported in the Figure 7 age group 8-15 [13]. In Tanzania a result of 20.9 % was in the age Prevalence of parasitic protozoans according to the type of group 5-14, followed by the age 21and above 18.9% and the result Toilet used. is also similar to the result gotten in Ethopia where the result was Ann Public Health Res 7(2): 1097 (2020) 4/7 Cedric Y, et al. (2020)

14 13 13

12 but lower than the results reported from Palestine with double

10 infection 10% and triple 3% [18]. This mixed infection could be ) % ( because food, fruits, and water sources are likely contaminated 8 c e n

l e with more than one parasite taken by the various individuals. a 6 v r e P 4 3 This study shows parasite infection with respect to water 2 2 2 sources. With tap water 13%, spring 13%, stream 3%, river 2%, and others 2% which is different from what researchers from 0 Stream River Spring Tap Other Sources Ethiopia recorded where tap water was 24% lower than stream Water Sources 34% [14] and spring 26.9% and stream 29.8%. This could be because the water bodies are not decontaminated or not well decontaminated whereas the water bodies are contaminated also Figure 8 based on the fact that people may defecate or urinate which can Prevalence of parasitic protozoans based on the source of be drained in to water bodies. Putting an object in the mouth is water. a high risk of gastrointestinal infection. Putting fingers and other objects into the mouth is not safe because it’s not certain if they 30 28 are free from parasites. Diarrhea can act as an indicator of gastro 25 intestinal infection a high proportion of the infected individuals

) 20

% sometimes (20%) have diarrhea which is similar to the result (

e c obtained from Western Iran where those who presented with n 15 e l a

v diarrhea had a percentage of 37.8% and those who did not 27.7% e r P 10 [19]. The percentage of those having diarrhea is highly likely to

5 4 the fact that they are already infected with the parasite and are 1 presenting symptoms and for those not having is likely because 0 Teachers Farmers Other jobs their immune systems are strong enough to resist the parasite. Types of Jobs 18 17 16 Figure 9 14 )

% 12 (

10

Prevalence of parasitic protozoans based on Job type. e

c 10 n e l

a 8 v 6 e r 6 P high in the age group 11-15 21.8%, 25% in the age 21and above 4 [14]. The result being high in the age group 0-14 could be due to 2 the fact that this age group do not respect hygiene and sanitation 0 Primary school Secondary Tertiary practices they do not drink clean potable, eat unwashed food and school education their immune system is not well developed Level of Education

The results show that pit toilet (25%) is a major risk factor as compared to the water system (8%). These results are similar Figure 10 to earlier observations noticed in the Newbell Central Prison Prevalence of parasitic protozoans based on level of Cameroon with a percentage of 25.6% for pit toilet and 18.7% education attained. water system [15]. However, they are different from the results from Ethiopia where pit toilet had 3% and 31% for private toilets Do you put fingers in your mouth? [14]. This high percentage for pit toilets could be because many 25 20 people tend to use such toilets even passerby and most of the 20 ) % time these passersby are infected. Farming had a percentage ( 15 c e of 4%, persons employed 1%, and others 28% which is very n l e a

v 10 8

low compared to results obtained from the West region which r e

P 5 farming had a percentage of 38.5% and employed 35.5% [16]. 5

This high percentage of other job activities of life could be 0 Always Sometimes Never because it involves so many activities like pupils,E. histolyticastudents, food and traders, and others. This study shows the prevalence of infection Responses E. coli E. histolytica and Blastocis hormonis Iodoameoba bustchilii,with respect E. to histolytica, double and and triple E. coli infection and with Giardia lamblia E. histolytica, 8%, and E. coli 2%, Figure 11 1% Prevalence of parasitic protozoans based on whether 1%. These results are higher than the respondents put fingers and other objects into their mouths. result recorded in the Centre region Cameroon 3.84% [17, 13], Ann Public Health Res 7(2): 1097 (2020) 5/7 Cedric Y, et al. (2020)

ACKNOWLEDGEMENT Do you generally have Diarrhea? 25 20 20 The author sincerely thank the laboratory management staff ) % (

of Green Light Vision Foundation especially Mr. Sama Cedric who 15 c e 12 n tookETHICAL time to ensure APPROVAL that the work ANDwas well CONSENTSdone. TO l e a

v 10

r e PARTICIPATE P 5 1 0 Always Sometimes Never The ethical approval to carry out this study was obtained Responses from the Ethical Review Board of the Faculty of Health Sciences UniversityREFERENCES of Bamenda.

Figure 12

Prevalence of parasitic protozoans based on whether 1. Vivornpun S, Srinchaipon N, BunKasem U, Srirungruang S, respondents generally had Diarrhea. Nuchprayoon S. 2016. Prevalence of intestinal protozoan infection among children in Thailand. A large scale screening and comparative study of three standard detection methods, the southeast Asian Do you usually take drugs for Diarrhea? journal of tropical medicine and public health. 2016; 6: 1223-1234. 20 19 18 2. Khalesd A, El-Aziz M. Detection and differentiation of human 16 14

) protozoan parasite in stool specimen by using multiplex, Allele specific 14 % ( 12 polymerase chain reaction. Zagazig university medical journal. 2013; c e n 10 6: 1-4. l e a

v 8 r e

P 6 3. Dawit A, Kibru E, Nagesh S, Gebreselassie S, Fetene D, Jemal A. Medical 4 parasitology. 2006; 1-139. 2 0 0 4. StrkoKova G, Mravcova K, Barbusinova E, Musha R, Varady M, Goldova Always Sometimes Never M. Prevalence of intestinal parasites in children living in Various living Responses condition in, slovaKia j pediatr perinatal child health. 2019; 3: 174- 185.

Figure 13 5. Shahid SB, Wazib A, Chowdhury A, shamsuzzaman SM, Mamum Z. A study on different laboratory methods for diagnose of intestinal Prevalence of parasitic protozoans based on when the protozoal infection. Bangladesh medical journal. 2011; 40: 47-49. respondents take drugs for diarrhea. 6. RoKni MB. The present status of human helminthic diseases in Iran. Ann tropical parasite. Ann trop med parasitol. 2008; 4: 283-295. 7. Behailu H, Geleto A, Muhedin R. Prevalence of feco-oral transmitted protozoan infections and association factors among university student in Ethiopia a cross sectional study. BMC infectious diseases. 2019; 499. 8. Vimbuh J, Ntonifor H, Ojong T. The incidence, intensity and most mobility of human parasitic protozoan infections in gastrointestinal disorder outpatients in Buea sub-division Cameroon. J infect Dev Ctries. 2009; 1: 38-43. 9. Jude Ndzifon Kimengsi, Balgah Sounders Nguh, Achia Soulange Nafoin. Peri-Urban Land Use Dynamics and Development Implications in the Bamenda III Municipality of Cameroon. Sustainability in Environment. 2017; 2 : 2470-6388. Figure 14 10. Naing L, Winn T, Rusil BN. Practical issues in calculating sample size Prevalence of parasitic protozoans with respect to whether for prevalence studies. Arch Orofac Science. 2007; 1: 9-14. the respondent consumes fruits. CONCLUSION 11. Sah RB, Paudel IS, Baral R, Poudel P, Jha N, Pokharel PK. A study of prevalence of intestinal protozoan infections and associated risk factors among the school children of Itahari, Eastern region of Nepal. Journal of Chitwan Medical College. 2013; 3: 32-36. The results of our study indicate that the community of 12. Payne V, Awantu M, Anandmo C, Yamssi C. Prevalence and risk factors Ntamuche is highly contaminated with protozoan parasites. of gastrointestinal infection amongst children in Bambili. Asian The population was recommended to take preventive measures journal of epidemiology. 2020; 13: 31-36. aimed at reducing environmental contamination with parasites 13. Oyong G, lehman G, Samuel F, bilong B. Multiparasitism among school as the best prevention against the spread of gastrointestinal children of Akonolinga nyong of mfoumou division centre region protozoans. The most reliable precautions were to emphasize Cameroon. 2019; 1-21. the importance of personal hygiene, public sanitation, health 14. Hablamu S, Tekelia D. Prevalence and factors associated with education, and sanitation of the environment. Ann Public Health Res 7(2): 1097 (2020) 6/7 Cedric Y, et al. (2020)

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Cite this article Cedric Y, Christelle Nadia NA, Ebai CB, Ngoufo FN, Teke GN, et al. (2020) Prevalence and Risk Factors of Gastrointestinal Protozoans in Ntamuchie, Mezam Division, North West Region, Cameroon. Ann Public Health Res 7(2): 1097.

Ann Public Health Res 7(2): 1097 (2020) 7/7