PrEVALENCE OF INTESTINAL Nematodes AMONG ChildrEN BELOW TEN YEARS ATTENDING KiwokO Hospital Pediatric Unit, Kasana, Nakaseke, District, Uganda. Henry Pecos NvuleA A Faculty OF Health Sciences , Uganda Martyrs University, Uganda AbstrACT Background:A INTESTINAL NEMATODES ARE AMONG THE MOST COMMON PARASITES INFECTING HUMANS IN DEVELOPING countries, PRECISE ESTIMATES OF THE POPULATIONS AT RISK OF INFECTION ARE DIffiCULT TO derive. TherEFORE TO UNDERSTAND THE DISEASE BURDEN THERE IS A NEED FOR RELIABLE DATA ON THE PREVALENCE OF INFECTION AS WELL AS INFORMATION ON THE RISK FACTORS OF infection. Methodology: 99 STOOL SAMPLES WERE COLLECTED FROM CHILDREN WHO PRESENTED WITH diarrhea, FEver, ITCHY ANUS OPENING ALL SYMPTOMS OF INTESTINAL NEMATODE infection. Stool SAMPLES WERE SCREENED USING THE DIRECT SALINE method. Samples NEGATIVE BY DIRECT SALINE WERE FURTHER EXAMINED USING THE FORMAL ETHER TECHNIQUE AND STAINED BY EOSIN FOR VISUALIZATION OF PARASITES eggs. A QUESTIONNAIRE WAS ADMINISTERED TO THEIR GUARdians/parENTS TO ASSESS THE RISK FACTORS OF infection. Results: The PREVALENCE OF INTESTINAL NEMATODE INFECTION WAS FOUND TO BE 62.6% (62/99). The INTESTINAL NEMATODE INFECTION RATE WAS FOUND TO BE HIGHER IN CHILDREN OVER fiVE YEARS AS COMPARED TO CHILDREN BELOW fiVE YEARS WITH A PREVALENCE OF 64.2% (43/67) AND 59.4% (19/32) RESPECTIVELY. The PREVALENCE OF INFECTION BY SEX WAS 66% (31/47) IN MALES AND 59.6% (31/52) IN females. Ascaris LUMBRICOIDES WERE THE MOST PREVALENT PARASITE IDENTIfiED IN 25 OF THE 62 PATIENTS INFECTED WITH INTESTINAL nematodes. This WAS FOLLOWED BY Hookworm (17/62), TRICHURIS TRICHIURA (12/62), AND StrONGYLOIDES STERCORALIS (8/62). Poor HYGIENE WAS THE MOST COMMON RISK FACTOR CITED FOLLOWED BY ILLITERACY AND POVERTY. Conclusion AND Recommendations: The RESULTS SHOW INTESTINAL NEMATODE INFECTION IS COMMON IN CHILDREN ATTENDING THE KiwokO PEDIATRIC unit. This, THEREFORe, CALLS FOR DIffERENT STAKEHOLDERS SUCH AS PUBLIC HEALTH Officers, MEDICAL personnel, AND THE COMMUNITY TO DEVELOP NEW STRATEGIES TO EDUCATE THE COMMUNITY ON EXISTING GOVERNMENT PROGRAMS AIMED AT THE ELIMINATION OF INTESTINAL NEMATODE INFECTION IN CHILDREN IN THE NakasekE district. ARECIEved: 11th/02/2021 accepted: 10th/04/2021 email: [email protected] IN RURAL COMMUNITIES (BrOOKER 2010). Glob- ET al., 1 BackgrOUND ALLY, MORE THAN ONE BILLION PEOPLE ARE INFECTED WITH INTESTINAL NEMATODE INFECTION IS A BIG BURDEN IN ONE OR MORE OF THE DIffERENT INTESTINAL NEMATODES SPECIES WITH AND BEING AT DEVELOPING COUNTRIES PARTICULARLY IN CHILDREN LIVING A. LUMBRICOIDES T. TRICHURA 2 Pecos Nvule MAXIMUM PREVALENCE IN CHILDREN BELOW TEN years, (Risika 2013; Ojja 2018). INTESTINAL ne- 2 Methodology ET al., ET al., MATODES ARE GLOBALLY DISTRIBUTED IN THE TROPICS AND Study AREA KiwokO Hospital IS A community-based HOSPITAL SUBTROPICS REGIONS OF THE world, PARTICULARLY IN Sub- FOUND IN NakasekE district, Uganda. The Hospital SaharAN Africa, WHERE PARASITES PRESENT A MAJOR SERVES THE POPULATION IN NakasekE AND THE NEARBY PUBLIC HEALTH PRoblem. INTESTINAL NEMATODES ARE DISTRICTS LIKE Nakasongola AND Luwero. A DEBILITATING PARASITIC DISEASE IN MANY PARTS OF KiwokO Hospital IS LOCATED APPROXIMATELY 80 Uganda INCLUDING THE NakasekE district. PrEVIOUS KILOMETERS NORTHWEST OF Kampala, THE CAPITAL OF STUDIES IN THE LuweerO DISTRICT INDICATED THAT in- Uganda. Up TO APPROximately100 PATIENTS PER DAY TESTINAL NEMATODE INFECTION CAUSED 9% MORBIDITY ARE ATTENDED TO AT THE LABORATORY. IN CHILDREN BELOW fiVE YEARS AND WAS RANKED THIRD AMONG THE TOP 10 DISEASES OF THE DISTRICT IN CHILDREN Study DESIGN This WAS A CRoss-sectional STUDY DONE FROM June UNDER five. 2016 TO July 2016 AT KiwokO HOSPITAL PEDIATRIC unit. The HELMINTH INFECTIONS OF CHILDREN CONSISTED ChildrEN BELOW TEN (10) YEARS WHO PRESENTED WITH OF 82.1% OR Ancylostoma DUODENALE Necator CLINICAL SIGNS AND SYMPTOMS OF INTESTINAL NEMATODE 18.9% 7.0% americanus, Ascarislumbricoides, INFECTIONS WERE RECRUITED WITH THE CONSENT OF THEIR , 1.0% WITH , TRICHURISTRICHIURA EnterOBIUSVERMICULARIS CARETAKer. Their STOOL SAMPLES WERE collected, Ex- AND 0.5% WITH (Dumba Hymenolepis NANA ET al., AMINED BOTH MACROSCOPICALLY AND MICROSCOPICALLY 2008). These PARASITES ARE TRANSMITTED VIA THE FOR THE PRESENCE OF INTESTINAL nematodes. fecal-orAL ROUTE THROUGH OF CONSUMPTION OF FOOD OR WATER CONTAMINATED WITH PARASITE EGGS AND Study Population larvae. The EGGS AND LARVAE OF THESE PARASITES The STUDY INCLUDED ALL CHILDREN BELOW TEN (10) REMAIN DORMANT BUT INFECTIVE FOR LONG PERIODS IN YEARS ATTENDING KiwokO Hospital Pediatric UNIT WITH THE ENVIRONMENT FACILITATING THEIR TRansmission. CONSENT FROM THEIR GUARDIANS DURING THE STUDY be- An INFECTION WITH THESE PARASITES IS ASSOCIATED TWEEN June AND July 2016. with, POOR hygiene, LACK OF ACCESS TO SAFE water, LOW INCLUSION CRITERIA PIT LATRINE COVERage, LOW SOCIAL status, AND POVERTY ChildrEN BELOW 10 YEARS ATTENDING PEDIATRIC UNIT (Gizaw , 2018). ChildrEN INFECTED BY THESE PRESENTING WITH CLINICAL SIGNS AND SYMPTOMS OF in- ET al. PARASITES COMMONLY SUffER INTESTINAL obstruction, TESTINAL NEMATODE INFECTIONS LIKE STOMACH UPSETS anaemia, malnutrition, DYSENTERY, FEver, DEHYDRa- DIARRHEIC stool, FEver, AND ITCHY ANAL OPENING WHOSE tion, vomiting, COLITIS COGNITIVE AND OTHER impair- GUARDIANS CONSENTED WERE ENROLLED FOR THE STUDY. MENTS WHICH MAY LEAD TO FAILURE TO FULLY DEVELOP ChildrEN THAT DID NOT PRESENT WITH CLINICAL SIGNS AND MENTALLY AND PHYSICALLY. SYMPTOMS OF INTESTINAL NEMATODE INFECTION AS WELL TherE IS A HIGH BURDEN OF INTESTINAL NEMATODE AS THOSE WHOSE GUARDIANS DID NOT CONSENT WERE INFECTION IN DEVELOPING COUNTRIES INCLUDING Uganda. EXCLUDED FROM THIS STUDY. Due TO THE POOR HEALTH systems, MOST CASES ARE Ethical CONSIDERATIONS UNDIAGNOSED AND AS A Result, THERE IS A PAUCITY OF Authorization WAS OBTAINED FROM THE Medical INFORMATION ON THE PREVALENCE OF INTESTINAL nema- DirECTOR KiwokO Hospital AND THE In-charGE Pedi- TODE INFECTIONS PARTICULARLY IN CHILDREN WHO BEAR ATRIC UNIT AND LABORATORY IN CHARGE BEFORE THE STUDY A GREATER RISK OF infection. Secondly, THE GOvern- commenced. Only PATIENTS WHOSE GUARDIANS HAD MENT OF Uganda INTRODUCED PROGRAMS TO PROVIDE CONSENTED WERE INCLUDED IN THE STUDY. TO ENSURE FREE DEWORMING SERVICES TO CHILDRen, HOWEver, THE CONfiDENTIALITY, VOLUNTEER’S INITIALS AND LABORATORY EffECTIVENESS OF THIS PROGRAM IS NOT KNOwn. NUMBERS WERE USED AND NOT THEIR names, AND THEIR This STUDY, THEREFORe, SOUGHT TO ELUCIDATE ON THE RESULTS WERE KNOWN ONLY TO THE TECHNICIAN AND THE PREVALENCE OF INTESTINAL NEMATODES AMONG CHILDREN CLINICIAN FOR APPROPRIATE MEDICAL intervention. BELOW TEN YEARS OF age, AND ACCESS THE RISK fac- Sample SIZE TORS ASSOCIATED WITH infection. Furthermore, THIS The SAMPLE SIZE WAS DETERMINED USING THE FOLLOw- STUDY SOUGHT TO EVALUATE THE EffECTIVENESS OF THE ING formula; n=4PQ/E2 SINCE THE STUDY WAS qualita- FREE DEWORMING PROJECT BY THE GOVERNMENT IN THE TIVE AND AIMED AT ESTIMATING PROPORTIONS ACCORDING NakasekE district. TO Mahajan (2010) WherE n= SAMPLE size. PrEVALENCE OF INTESTINAL Nematodes AMONG ChildrEN BELOW TEN YEARS ATTENDING KiwokO Hospital Pediatric Unit, Kasana, Nakaseke, District, Uganda. 3 E = ALLOWABLE ERRor- 10% The FECAL SUSPENSION WAS THEN PASSED THROUGH THE P= PREVALENCE FROM LITERATURe- 54.8%. Q=1-P. fiLTER INTO THE CENTRIFUGE TUBE UNTIL THE 7ml MARK 8% WAS THE PREVALENCE USED BASED ON A STUDY BY WAS Reached. 3ml OF ETHER WAS ADDED TO THE sam- Mahajan (2010). TherEFORe; PLE AND MIXED FOR 1 minute, THEN CENTRIFUGED AT N=4*0.548*0.452/(0.1)2 3000 RPM FOR 1 minute. Using THE APPLICATOR stick, N=99. DEBRIS WAS LOOSENED AND THE SUPERNATANT POURED TherEFORe, 99 PATIENTS WERE ENROLLED INTO THE QUICKLY BY INVERTING THE tube. The SEDIMENT WAS STUDY. MIXED THOROUGHLY AND A SMEAR PREPARED AND AN EOSIN PREPARATION MADE FOR Examination. Sample COLLECTION DemogrAPHIC DATA WAS COLLECTED FROM THE eligi- The PARASITES FOUND WERE COUNTED AND RESULTS BLE PARTICIPANTS USING A DATA COLLECTION form. The REPORTED as; SEVERAL PARASITES counted, SPECIES PARTICIPANT WAS GIVEN A well-labeled sterile, DRY, PER LOW POWER OBJECTIVES e.g., 2 EGGS OF Tirichuris leak-prOOF CONTAINER AND REQUESTED TO PROVIDE AN seen/LPF. TRICHURA ADEQUATE AMOUNT OF stool, NOT CONTAMINATED WITH Any OTHER fiNDINGS SUCH AS RED BLOOD cells, FAT urine. The TIME OF COLLECTION WAS NOTED ON THE spec- globules, AND OTHER INTESTINAL PARASITES WERE ALSO IMEN CONTAINER AS SOON AS THE VOLUNTEER RETURNED REPORTED ONLY FOR THE BENEfiT OF THE PATIENT’S man- THE specimen. AGEMENT BY THE clinician. For ALL THE STOOL samples, THE MACROSCOPIC Exami- Data COLLECTION TOOL NATION WAS DONE AND THEN FOLLOWED BY MICROSCOPIC A QUESTIONNAIRE WAS USED AS A DATA collec- EXAMINATIONS USING THE DIRECT SALINE AND 10% for- TION tool. IT COMPRISED OF THREE parts; socio- MOL ETHER CONCENTRATION technique. DEMOGRAPHIC status, lifestyles, AND LABORATORY in- The PARASITES FOUND WERE COUNTED AND RESULTS vestigations. IT WAS WRITTEN IN English COMPRISING REPORTED AS FOLLOws; BOTH open-ended AND close-ended QUESTIONS • Number OF PARASITES COUNTED species, STAGE PER Data MANAGEMENT AND ANALYSIS LOW POWER OBJECTIVES e.g. 2 EGGS OF Data WAS APPROPRIATELY MANAGED BY THE Re- seen/loW POWER fiELD (LPF). Tirichuris TRICHURA SEARCHER TO ENSURE CONfiDENTIALITY AND SECURITY. LaborATORY PROCEDURES Data MANAGEMENT ALSO INVOLVED CRoss-checkED TO The SAMPLES WERE RECORDED INTO THE LABORATORY ENSURE THAT ALL QUESTIONS WERE PROPERLY ANSWERED REGISTER AND ASSIGNED A LABORATORY number; THE BEFORE THE PARTICIPANTS LEFT THE STUDY ARea. SAMPLES WERE THEN