1400 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 Detection of Intestinal Helminthic Infection in Rural Communities Using Concentration Method
Nathkapach Kaewpitoon Rattanapitoon1, Schawanya Kaewpitoon Rattanapitoon2, Nattawut Keeratibharat3, Pundit Asavaritikrai4, Alisa Boonsuya5, Phornphitcha Pechdee6 1 Assistant Professor, Parasitic Disease Research Center, 2Associate Professor/HOD, School of Translational Medicine, 3Lecturer, School of Surgery, 4HOD, Department of Medical Education, 5Research Assistant, Institute of Medicine, 6Research Scholar, Institute of Research Development, Suranaree University of Technology, Thailand
Abstract This study was aimed to determine the intestinal helminthic infections (IHIs) among rural communities of Bua Yai district, Nakhon Ratchasima province, northeastern Thailand. A cross-sectional study was conducted between July 1, 2018 and June 30, 2019 among rural villagers from 22 rural villages of 2 sub-districts. The participants were randomly selected from village enrollment list after proportional allocation of the total sample size. IHIs were prepared by the mini parasep sf faecal concentrator; concentration method, and then were detected using light microscope. Data were analyzed using STATA for windows version 13 and p-value less than 5% was considered as statistically significant. Of the total 454 faecal specimens examined, 6 were positive for at least one intestinal helminthes making the prevalence 1.32%. The most prevalent helminthes were Opisthorchis viverrini (1.26%) and followed by Ascaris lumbricoides (0.39%), Strongyloides stercolaris (0.19%), and Taenia spp. (0.19%), respectively. No significant association was found between IHIs and socio-demographic characteristics (P >0.05). This study reveals that the decreased infection rate is under control and elimination is possible through the prevention and control campaign from Ministry of Public Health in collaborated with network teams in this areas. However, IHIs are found in adults that were particularly apparent regarding the food borne and soil transmitted species of helminthes. A greater focus on intervention is required by improving personal hygiene and sanitation to prevent the spread of IHIs. Using MPFC indicates that concentration method is useful in the rural communities, increasing the yield of parasites with greater processing time and cost.
Keywords Detection, Intestinal helminthic Infection, rural community, Thailand
Introduction in certain areas of the country3. Humans become infected by accidental ingestion of eggs at their infective The most common intestinal helminthic infections stages or through penetration of the skin by infected (IHIs) are the neglected tropical diseases (NTDs). These larvae in soil, depending on the nematode species. indicate that more than 1.5 billion people, or 24% of the People with infections of heavier infections can cause a world’s population, are infected with soil-transmitted range of symptoms including intestinal manifestations; helminthic infections (STHs) worldwide1. In the abdominal pain and diarrhea, general malaise and ASEAN countries, it is estimated that 300 million people weakness, malnutrition, impaired growth and physical are infected with IHIs2. In 2014, the national prevalence development. Infections of very high intensity can cause rate of IHIs was 18.1% among 15,555 Thais with a high intestinal obstruction that should be treated surgically. prevalence rate of liver fluke and hookworm infections In the case with light infection and intensity usually do not suffer from the infection1. There are urgent needs to expand surveillance activities in rural areas of Thailand, Correspondence author: Nathkapach Rattanapitoon; as well as to ensure mass drug administration is provided [email protected] to populations at risk for intestinal helminthes infections. Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 1401 Previous studies of the prevalence of intestinal was examined under the microscope, initially screened helminthes among villagers showed a low incidence with a low-power objective lens. Suspected intestinal in Bua Yai district, Nakhon Ratchasima province4. helminthes objects were subsequently examined under a However, no information was available regarding the high-power objective. All of samples were examined by prevalence and intensity of IHIs among the residents in two laboratory technologists. Patients who were infected the level of villages. Recently, Mini Parasep SF Faecal with intestinal helminthes and other known parasites Concentrator (MPFC); a concentration diagnosis tool were treated with anti- intestinal helminthic drugs. is used for detected the intestinal parasitic infection. Statistical analysis MPFC is the solvent-free faecal parasites concentrator represents a simple and useful method for isolating and Statistical analyzes were performed using the identifying helminth’s eggs and larvae, and protozoal computer program; STATA for windows version 13 cysts. The closed concentration system allows rapid, (StataCorp LLC, Lakeway Drive, College Station, reliable, and safe detection of intestinal parasites by Texas, USA). Socio-demographic characteristics of 5-8 inexperienced technologists . This data may able useful the participants were presented as frequencies and for further tool support the epidemiological survey in the percentages for the categorical variables. The different community. of infection between the categorical variables were assessed using Chi-square. Multivariate logistic Materials and Method regression analysis was performed to estimate the odds Study design and area ratio (OR) and 95% confidence interval (95% CI) to assess the associations between potential risk factors and A cross-sectional survey was carried out from July prevalence of IHIs. A P-value of <0.05 was considered 1, 2018 and June 30, 2019 and included people living to be statistically significant. in 22 rural villages located in Khun Thong (12 villages) and Nong Bua Sa-At (10 villages) sub-district, Bua Yai Results district, Nakhon Ratchasima province, northeastern A total of 454 participants (296 male, 158 female) Thailand. The study area is located 355.4 km northeast were included. The overall prevalence of IHIs was of Bangkok and covers an area of 548.5 km2. 1.32% (6/454). The prevalence rate was frequently found Participants were randomly selected from each village in males 1.32% (6/454), aged 31–40 years old 1.32% using a voluntary sampling method. A total of 454 (6/454), primary school 1.32% (6/454), and agriculture volunteers were recruited. Data on socio-demographic 1.32% (6/454), and income of less than 5,000 Baht/ characteristics was collected using a questionnaire. All month (7.23%, 22/304) Table 1. Socio-demographic participants provided their own written consent before characteristics of the participants and IHIs were submitting stool specimens. computed the different in each variable using Chi-square Faecal collection and examination test and found that there were no a significant different between the prevalence of intestinal helminthes and Clean plastic containers were distributed to the each characteristics (Table 1). IHIs were identified asO. participants at enrollment with detailed instructions viverrini 1.26% (2/454) and followed by A. lumbricoides about the procedure for faecal specimen collection. 0.39% (2/454), S. stercolaris 0.19%(1/454), and Taenia All faecal samples were collected early in the morning spp. 0.19%(1/454), respectively. Socio-demographic and conserved in the iceboxes before transportation characteristics associated with IHIs were analyzed to the laboratory at the Parasitic Disease Research using multivariate analysis, are shown in Table 2. No Center, Institute of Medicine, Suranaree University of significant association was found between IHIs and Technology. Each specimen was prepared and examined participants’ gender, level of age, education, job status, for the presence of intestinal helminthes organisms by and location (P >0.05). mini-parasep sf faecal concentrator8,9. Each specimen 1402 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 Table 1. Positive rate of intestinal helminthic eggs categorized by general characteristics
No. Samples No. positive Infection rate Variables Chi-square P-value n(%) n(%) (%)
Gender Male 158(34.80) 4(2.53) 0.88 0.905 0.014
Female 296(63.87) 2(0.67) 0.44
Age (yr) 21-30 16(3.52) 0(0) 0
31-40 59(12.99) 3(5.08) 0.66
41-50 144(31.72) 2(1.39) 0.44 5.836 0.559 51-60 155(33.25) 1(0.64) 0.22
61-70 71(15.64) 0(0) 0
71-80 9(1.98) 0(0) 0
Education Illiterate 2(0.44) 0(0) 0 4.180 0.382
Primary 341(75.11) 3(0.88) 0.66
Secondary 93(20.48) 1(1.07) 0.22
Diploma 7(1.54) 1(14.28) 0.22
Academic 11(2.42) 1(9.09) 0.22
Job Status Famer 331(72.91) 4(1.20) 0.88 2.315 0.382
Employed 80(17.62) 1(1.25) 0.22
Trade 18(3.96) 0(0) 0
Housewife 15(3.30) 0(0) 0
Government officer 6(1.32) 1(16.67) 0.22
Other 4(0.88) 0(0) 0
Location (District) Nong Bua Sa-At 208(45.81) 3(1.44) 0.66 1.385 0.239
Khun Thong 246(54.18) 3(1.22) 0.66 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 1403 Table 2. Factors associated to intestinal helminthic infection using multivariate logistic regression analysis
No. positive Infection Variables No. Samples n(%) OR (95%CI) P-value n(%) rate (%)
Gender Male 158(34.80) 4(2.53) 0.88 1.066 (0.377-3.011) 0.905
Female 296(63.87) 2(0.67) 0.44
Age (yr) 21-30 16(3.52) 0(0) 0 0.920(0.576-1.470) 0.559
31-40 59(12.99) 3(5.08) 0.66
41-50 144(31.72) 2(1.39) 0.44
51-60 155(33.25) 1(0.64) 0.22
61-70 71(15.64) 0(0) 0
71-80 9(1.98) 0(0) 0
Education Illiterate 2(0.44) 0(0) 0 1.422(0.737-2.744) 0.382
Primary 341(75.11) 3(0.88) 0.66
Secondary 93(20.48) 1(1.07) 0.22
Diploma 7(1.54) 1(14.28) 0.22
Academic 11(2.42) 1(9.09) 0.22
Job Status Famer 331(72.91) 4(1.20) 0.88 1.043(0.548-10987) 0.804
Employed 80(17.62) 1(1.25) 0.22
Trade 18(3.96) 0(0) 0
Housewife 15(3.30) 0(0) 0
Government officer 6(1.32) 1(16.67) 0.22
Other 4(0.88) 0(0) 0
Location Nong Bua Sa-At 208(45.81) 3(1.44) 0.66 0.279 (0.029-2.702) 0.239
Khun Thong 246(54.18) 3(1.22) 0.66 1404 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 Discussions uncooked food18. The infection rate is frequently found in the participants who are the agriculture and education IHIs are important public health problems in tropical level in primary school. This is similar to previous countries. Unlike in developed countries where efficient studies indicate that people in the community have a low control, urbanization and other socioeconomic factors level of education, and these people have a relatively have created better conditions for the decline in prevalence high prevalence of parasites10,12. The agriculture may of IHIs, these infections still continue to be a major be taking risks with their work in the farm12. Health health problem in the third world countries particularly education programs should target this group and teach STHs have been recognized as important public health them about the benefits of wearing shoes, and the risky problems in many developing countries10,11. The public eating habits. Four species of intestinal helminthes health problems caused by IHIs have been neglected in were identified; two species were identified as STHs rural areas of Thailand where there remains a lack of and the other two species were FBHs. However, the hygiene and an inadequate supply of sanitary water12. presence of STHs and FBHs was not significantly Surveillance and epidemiological survey in the rural different with infection rate. FBHs also were identified community using the rapid, reliable, and safe detection as O. viverrini and Taenia spp. that concerning tool of intestinal parasites is needed. MPFC is used for about O. viverrini, the carcinogenic liver fluke and isolating and identifying helminth’s eggs and larvae, serious problem in Thailand. Our data showed that O. and protozoal cysts. The organisms eventually present viverrini infection is the highest prevalence in these without altering their morphological characteristics, participants (1.26%) but it was lower than previously concurring also to an easy acknowledgment of the same studies in that near areas. Kaewpitoon et al19 reported through microscope observation. The filter concentrator that O. viverrini infection among a Thai rural population tube is a newer modification of the closed concentration from Nakhon Ratchasima, Khonkaen, and Chaiyaphum system, which can easily be adopted in any routine provinces was found to be 2.86%. Kaewpitoon et al4 also microbiology laboratory5-8. Presently, the overall reported that O. viverrini infection was found in people prevalence of IHIs among the entire tested participant in the border areas of three provinces, northeastern group who live in rural communities using MPFC was Thailand included Kaeng Sanam Nang district of Nakhon 1.32%. These results was compared to other study and Ratchasima province, Waeng Noi district of Khon Kaen found that recent infection rate of these study were lower province, and Khon Sawan district of Chaiyaphum than previous reported among gardeners who were province, Thailand. In addition, of 209 faecal samples studied in Nakhon Ratchasima province4, Khon Kaen13, have been surveyed in the rural areas of Nakhon Chachoengsao province14. This result indicates that the Ratchasiam province, Thailand and found that Taenia successful of decreased infection rate is under control spp. infection was 0.48%20. These result indicates that and elimination is possible through the prevention and people still have the culturally embedded habit of eating control campaign from Ministry of Public Health in uncooked meat and poorer education. Findings from our collaborated with network teams in each areas during last study demonstrated that the most prevalent STHs found 5 years periods15-17. Our study demonstrated that gender in human feces was S. stercolaris (0.19%), which were showed a significant association between the prevalence also the common prevalent nematode in the Thailand of intestinal helminthes. The infection rate was higher study of previous studies3,4,12,14. These study showed in males than in females. The gender difference may that S. stercolaris infection is more prevalent than other be due to male-specific behavioral factors13 such as the types of STH infection. This STH has a direct life cycle alcohol drinking with colleagues, eating raw meat, and and the main route of exposure is contact with larvae taking risks with their work in the farm12. In our study, contaminated soil due to lack of footwear21. Other the prevalence of IHIs in middle age group was higher STH with significant prevalence was A. lumbricoides. than in young and old people. This result is similarly to Therefore, preventive measures should be taken to previous studies that middle aged people is needed to improve the health of the people against such helminths. screen for IHIs4,12. This may be because older people These results indicate that O. viverrini is still a problem still have poorer education, live in conditions of poor in Thailand that these liver fluke still exists and raises sanitation, and the culturally embedded habit of eating Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 1405 concerns regarding public health. PL. Comparison between the midi parasep and midi parasep solvent free (SF) faecal parasite Conclusion concentrators. J Clin Pathol. 2011;64(10):901-904. In conclusion, our results show concentration 6. Useh MF, Asuquo AE, Otu-Bassey IB, OL Ubi. method is useful in the epidemiological survey, increase Evaluation of the efficacy of the mini parasep sf in the yield of parasites, processing time and cost. A faecal parasite concentrator; a new technique against prevalence rate of IHIs among adult age groups living the direct smear and formol ether concentration technique for the detection of intestinal parasites in in the rural communities. These infections result mainly Stool. J Med Lab Sci. 2011;20(1):37-43. from food borne helminthes and skin-penetrating nematode. Therefore, focus on intervention should 7. Zeeshan M, Zafar A, Saeed Z, Irfan S, Sobani ZA, Shakoor S,, et al. Use of Parasep filter fecal concentrate on personal hygiene of the population and concentrator tubes” for the detection of intestinal improving the sanitation to reduce IHIs in this area. parasites in stool samples under routine conditions. Ethical Clearance: This study was approved by Indian J Pathol Microbiol. 2011;54(1):121-123. the Ethics Committee for Research Involving Human 8. Kaewpitoon SJ, Rujirakul R, Tongtawee T, Subjects of Suranaree University of Technology, Matrakul L, Panpimanmas S, Wakkuwattapong Thailand (EC- 59-38). P, et al. Detection of the carcinogenic liver fluke Opisthorchis viverrini using a mini parasep sf Source of Funding: The present study was faecal parasite concentrator. Asian Pac J Cancer supported by the National Research Council of Thailand Prev. 2016;17(1):373-376. (NRCT), fiscal year 2018, and the SUT research and 9. 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