ZENITH International Journal of Multidisciplinary Research Vol.2 Issue 7, July 2012, ISSN 2231 5780 PREVALENCE AND EFFECT OF PERSONAL HYGIENE ONTRANSMISSION OF HELMINTHES INFECTION AMONG PRIMARY SCHOOL CHILDREN LIVING IN SLUMS R.M. KAPILA THARANGA RATHNAYAKA & ZHONG-JUN WANG* *Department of Statistic, Science Collage, Wuhan University of Technology, Wuhan, PR China - 433070. ABSTRACT Soil–Transmitted Nematode Inflections are the most common helminthes infections among the world population, while it causes serious infections in developing countries, mainly in south Asia and Africa. Day by day the rate of infection has been rising rapidly. Aim of the present survey was to explore the relationship between the prevalence and intensity of risk factors for Ascaris infection among primary school children in Badulla district, Sri Lanka, using standard parasitological techniques. In this paper we analyze these effects via two models, one multiple regressive technique, to identify the association between prevalence of infection and some risk factors, and the other multiple logistic regression analysis, to study the independent association of factors for Ascaris infection. Results provide an estimate that socio economic conditions, de-worming and rate of infection are highly co-related with each other. Authorities should pay more attention for these factors in order to control the rate and spread of infection. KEYWORD: Ascaris infection, Helminthes infection, Kato- katz technique, Logistic Regression Analysis. ______________________________________________________________________________ 1. INTRODUCTION Soil – transmitted nematode inflections are one of most plenteous nematode infections in the world today. Especially it is wide- spread throughout the developing world, including Sri Lanka and other south Asian counties. According to the World Heath Organizational (WHO) reports of 2010, approximately 0.807-1.221 billion humans have been infected with Nematode infection, 604-795 million have trichuriasis, and 576-740 million have hookworm infections all over the world. At least 20,000 people die annually due to these infections (WHO, 2010). Children and teenagers between 6 to 14 years of age are more heavily infected than the adults. A considerable number of people in Sri Lanka live in poor living conditions (e.g.-slums), www.zenithresearch.org.in mostly in congested urban areas and also in the plantation sector. Due to the low socio- 1 ZENITH International Journal of Multidisciplinary Research Vol.2 Issue 7, July 2012, ISSN 2231 5780 economic status, environmental conditions, and poor personal hygiene, transmission and distribution of Ascaris infection is generally higher among people living in such conditions compared with others. In addition poor sanitation and low literacy rate are the other main factors which influence the rate of infection. According to a recent study, there are at least 60 species of nematodes, which cause parasitic infections in the Human body. Ascariasis, trichuriasis, hookworm, enterobiasis, strongy loidiasis, filariasis, and trichinosis are the main nematode species that infects to humans (G.S.A Gunawardane et. al, 2004). They are also called round worms. Ripe round worms are white or yellow in color and 15-35 cm in length. Normally their life cycle spans, 10-24 months in the jejunum and ileum of the Human intestine. While a majority of species are parasites some live freely in the nature. They can oblong with bilaterally symmetric bodies that contain an intestinal system and the body activity. However, life cycles of nematodes are complicated and closely related with modes of transmission in to the Human body. An in-depth knowledge of their life cycles is important clinically for prevention and treatment. There are three main modes of transmission. Nematodes such as Enterobiusvermicularis are transmitted directly from infected person to non infected person. While ova of other species such as Ascaris lumbricoides, Necatoramericanus and Ancylostomaduodenale mature in soil and subsequently the adult nematode infect Human beings (R.M Andoson et. al, 1985). This study was designed to determine the relationship between the prevalence and intensity of Ascaris infection in primary school children who live in slums in suburban and plantation regions of Badulla, Uva Province, Sri Lanaka, and factors such as availability of proper sanitary facilities, socio- economic status and health habits have affected its prevalence. Homes of each selected individual were visited and clear instructions were given to students, parents and guardians regarding the study and collection of stool samples. Stool samples were collected from the selected population and analysis was carried out under the Kato- katz technique. Multivariate Regressive methods were performed to compare the effect of potential risk factors for helminth infection in primary school children of Badulla district in 2010. Independent associations of the variables were fully described using Logistic Regression Methods. All steps were conducted according to the biomedical guidelines. 2. MATERIALS AND METHODS 2.1 STUDY AREA The study was carried out from July – November 2011, in Badula district. It is located in the hill country of the island, surrounded by many mountains with wide spread tea and rubber plantations. This area is rich in water resources; there are many streams flowing www.zenithresearch.org.in through the region which constitutes the major source of water supply to its inhabitants. 2 ZENITH International Journal of Multidisciplinary Research Vol.2 Issue 7, July 2012, ISSN 2231 5780 Under the local climate zone classifications, Badulla is classified under up country intermediate zone. Annual average rainfall is between 1000 and 1400 mm and average atmospheric temperature is between15to 27 0C (CCAU, 2011). The total population is approximately 1 million with multi ethnicity groups such as Sinhala, Tamils, Muslims, Malays and Burghers. Badulla is an agricultural district. Therefore most of the people are directly involved in vegetable cultivation; livestock and working as laborers in tea estates. Due to this educational and socio-economic statuses of the inhabitants are relatively low compared to other areas in the country. This study was conducted for the primary school children aged 6-12 from randomly selected schools, namely Haputale Tamil Collage (HTC), Koslanda Tamil Collage (KTC), Rathkarawwa Maha Vidyalaya (RMV) and Guratalawa Maha Vidyalawa (GMV). Most of the students studying in the HTC and KTV are from the Tea plantation areas, living with fewer facilities. RMV situated in rural area and GMV in sub – urban area. 2.2 DATA COLLECTION AND EXAMINATION OF SOIL SAMPLES The study population included 500 students, from grade 1 to 5. For ease of handling samples, unique identification numbers were assigned to each and every student based on their gender, school and grade. After obtaining informed and written consent from their parents or guardians, a structured questionnaire was distributed for collection of data such as Socio-economic status, living environment demographic data, Sanitary facilities, worm treatments and behavioral habits like washing hands before meals, drinking boiled water. Questionnaire was given in their native language (Sinhala and Tamil). Upon completion of the questionnaires, clean and dry wide mouthed vials (with the identification numbers) were given to all the participants for collection of stool samples. Standard procedure of sample collection was explained clearly and thoroughly, to the students, their parents and guardians individually. Stool samples were collected on the following morning from their homes. All samples were kept in cold storage at 8 0C without any preservatives and taken to the laboratory for analysis, in order to minimize the sample transport time. All samples were examined by the medical laboratory technician under the supervision of the microbiologist. Out of 500, only four hundred and sixty (460) stools samples were collected twice a week. Formal Ether Sedimentation Technique was used to determine the prevalence and intensity of nematode infection. It is a standard method used for diagnosis of the disease and also for accurate estimation of the egg count. An applicator stick was used to mix approximately 0.2g of stool sample with one drop of saline on clean slides. According to the Kato- katz technique, egg counts were recorded in www.zenithresearch.org.in each positive sample. After that intensity of infection was categorized using cut- off values 3 ZENITH International Journal of Multidisciplinary Research Vol.2 Issue 7, July 2012, ISSN 2231 5780 recommended by WHO [(number of positive cases in the sample/ number of samples examined) ×100]. 3. STATISTICAL ANALYSIS Collected data was transferred in to a Microsoft XL data base and analyzed using Minitab and R statistical soft ware packages. Multiple regressive techniques for continuous variables and chi-square test for categorical variables were used to identify the association between prevalence of infection and some risk factors. Furthermore, logistic regression analysis with odd ratios used to study the independent association of variables. Results were discussed under the 0.05 level of significance. TABLE 1: NUMBER OF INFECTED STUDENTS HTC KTC RMV GMV Infected 88 78 38 56 Not Infected 35 40 85 60 Total 123 118 123 116 Based on results in table 1, out of 480 students, 260 (54%) of subjects were found to be excreting stools with Ascaris eggs. The students