Community burden of intestinal parasites and its public health concerns in Obizi, Amakama Olokoro, Umuahia South, Abia State, Nigeria

Abstract

Intestinal parasitic infections are the leading cause of morbidity and mortality in sub-Saharan Africa. This could be due to the dominance of factors such as poverty, poor hygiene, and the absence of basic infrastructures. The migration of people from parasite endemic regions due to insecurity has caused public health concerns. This study was conducted to ascertain the community burden of intestinal parasitic infections in a rural community South-east Nigeria. Formol-ether concentration technique was used in analyzing feacal samples, data analysis involved frequency and distribution statistics, the PAST statistical software was used to determine statistical significance. Results from the study showed that out of 284 respondents 96 (33.8%) were infected. Parasites observed were Ascaris lumbricoides (15.5%), Hookworm (3.9%), Taenia saginata (3.5%), Schistosoma mansoni (4.2%), Enterobius vermicularis (1.1%), Trichuris trichura (1.4%), Chilomastix mensnili (1.8%), Balatidium coli (1.1%), Fasciola hepatica (0.7%) and Entamoeba coli (0.7%). Mixed infections occurred. The combination of Hookworm and Taenia saginata occurred the most (1.8%). Females had the highest rate of infection (40.3%), also the age group (11–20) years (92.9%). Students had the highest prevalence (50.9%). Fever, Fatigue, blood in stool, and diarrhoea were the signs/symptoms of ill health reported. This study has revealed a community burden of intestinal parasites, which is of great public health concern. Public enlightenment and deworming through mass drug administration are recommended.

Introduction

Sub-Saharan Africa is specifically susceptible to intestinal parasitic infections (Akinboye 2016). Some people are more prone to infections than others; for example, a person who is already sick or has a compromised immune system is more at risk of infections. Individuals who lack potable water are also at risk of getting infected with parasitic infections. Also, a person who loves to swim in ponds, rivers, stagnant waters, or lakes and ingest the water is also at risk (Akinboye 2016). The burden of intestinal parasitic infections is also high among people living with HIV/AIDs (PLWHA) in Sub-Saharan Africa. A report by Amoo et al. (2018) recorded an overall prevalence of intestinal parasites of 36.4% among PLWHA in Abeokuta, Nigeria.

Disability-adjusted life years (DALY) analyses of the global burden of disease (BOD) of neglected tropical diseases (NTDs) have analytically demonstrated the dominance and wide epidemiological spread of intestinal nematode infections (INIs) with approximately 5.19 million DALYs (Hotez et al. 2014). The bulk is accounted for by hookworm diseases (3.23 million), then ascariasis (1.32 million), and finally, trichuriasis (0.64 million) (Hotez et al. 2014). The burden of intestinal infections (INIs) appears to vary greatly within major global regions, which is impressive with regards to the Ascaris lubricoides and Trichuris trichiura are acquired by ingestion of infective eggs from soil contaminated with human faeces containing eggs (Morenikeji et al. 2009). Others are transmitted from animals to man (Zoonoses), such as giardiasis. Methods by which these diseases are transmitted; include rain, water runoff, animals, and human migration amidst inadequate public sanitation and poor infrastructure (Pullan et al. 2014).

Many of these intestinal nematodes, like intestinal parasites, when ingesting contaminated vegetables containing eggs or cysts, while others are infected by consuming undercooked meat, such as in Trichinellosis.

In developing countries, intestinal parasitic infections have become a major public health concern, with the increasing case of insurgency, insecurity, poor nutrition, lack of adequate infrastructure, poor housing, and unhygienic environmental conditions. Although intestinal parasitic infections have become neglected by so many, including government agencies, researchers have continued to conduct studies on different aspects of parasitic disease prevalence with heavy reference to intestinal parasitic infections.

The main aim of this work is to determine the community burden of intestinal parasites in Obizi and their public health concerns through the following objectives:

1. To ascertain the prevalent rate with respect to Sex, Age, and occupation.

2. To determine the most prevalent symptoms associated with these parasites.

Materials and method

Study area

The research was carried out in Obizi, Amakama Olokoro, Umuahia-South L.G.A, Abia State in the Eastern part of Nigeria. Obizi is located between latitude (5° 28° 30′ N) and longitude (7° 28° 48′ E). The community consists largely of peasant farmers and traders, who live in close proximity to each other, with houses built very close to each other, just like a typical rural settlement. The community is in the rain forest zone, where the rainy season starts from April to October and the dry season between September to March. Infrastructures such as Health care centre and access roads were absent (Fig. 1).

Fig.1.

Map showing the study location of Obizi Hall in Umuahia South LGA, Abia State

Collection of faecal samples

Participants were given wide-mouthed sample bottles for the collection of faecal samples. They were instructed to collect a small quantity of their faecal samples with the bottles. These bottles were properly labelled on return for identification. Health workers from the University Medical Centre assisted in the Public Health Awareness program.

Faecal analysis

Faecal analysis was done using the formol-ether concentration technique. A little quantity of faeces about the size of a match-head was emulsified in 15 ml of 10% formol saline and mixed well. Thereafter 3 ml of the sample was poured into a centrifuge tube, and 7 ml of ethyl acetate was added to make it up to 10 ml. The sample was centrifuged at 1500 rpm for 5 min. The lipid and aqueous phases were decanted carefully, and the resultant pellet was emulsified in normal saline, dropped onto a slide, and viewed under the microscope using ×10 objective lens and ×40 to confirm (Cheesbrough 2009).

Statistical analysis

Data analysis involved frequency and distribution statistics. The results were tested with Pearson’s Chi-square to determine variability in the distribution of categorical variables of each study outcome, with an $\alpha$-level of P < 0.05 indicating statistical significance using the PAST statistical software.

Results

Socio-demographic characteristics of the respondents

The socio-demographic characteristics of the respondents showed that 32.7% were males and 67.3% were females. More persons fell within the age bracket of 61–70 years (31.0%), followed by persons within the age bracket of 41–50 years (17.6%). The age group 1–10 years recorded the least number of persons (3.52%) (Table 1).

Table 1.

Socio-demographic characteristics of the respondents n = 284

Sex	No of respondents	Percentage (%)
Male	93	32.7
Female	191	67.3
Age (years)
1–10	10	3.52
11–20	26	9.15
21–30	22	7.75
31–40	2	7.04
41–50	50	17.61
51–60	48	17.00
61–70	88	31.0
71–80	20	7.04
Occupation
Farmers	108	38.0
Traders	78	27.5
Civil servant	43	15.1
Students	55	19.4

Overall prevalence of intestinal parasites

Ascaris lumbricoides had the highest prevalence 44 (15.5%). However, Fasciola hepatica and the non-pathogenic Entaemoba coli had the lowest prevalence of 4 (1.4%) (Table 2).

Table 2.

Overall prevalence of intestinal parasites n = 284

Intestinal parasites	Number infected	%
Hookworm	11	3.9
Ascaris lumbricoides	44	15.5
Taenia saginata	10	3.5
Schistosoma mansoni	12	4.2
Enterobius vermicularis	3	1.1
Fasciola hepatica	2	0.7
Trichuris trichuria	4	1.4
Entamoeba coli	2	0.7
Chilomastix mesnili	5	1.8
Balatidium coli	3	1.1
Total	96	33.8

Prevalence of single and mixed infections of intestinal parasitic infection

Ascaris lumbricoides recorded the highest prevalence of single infection among intestinal parasites 41 (14.4%). Whereas Hookworm and Taenia Saginata recorded the highest prevalence of mixed infection 5 (1.8%) Fasciola hepatica and Schistosoma mansoni also Balatidium coli and Entamoeba coli all recorded the lowest prevalence of mixed infection 2 (0.7%) (Table 3).

Table 3.

Prevalence of single and mixed infections of intestinal parasites n = 284 single infection

Parasites	Number of parasites	%
Ascaris lumbricoides	41	14.4
Hookworm	6	2.1
Taenia saginata	2	0.7
Schistosoma mansoni	10	3.5
Enterobius vermicularis	3	1.1
Fasciola hepatica	0	0.0
Trichuris trichuria	4	1.4
Chilomastix mensnili	5	1.8
Entamoeba coli	0	0.0
Balatidium coli	1	0.4
Total	72	25.4
Mixed infection
AS + T	3	1.1
H + T	5	1.8
FH + SM	2	0.7
BC + EC	2	0.7
Total	24	8.5

AS = Ascaris lumbricoides, T = Taenia saginata, H = Hookworm, SM = Schistosoma mansoni, FH = Fasciola hepatica, BC = Balatidium coli, EC = Enterobius vermicularis

Gender-related prevalence of intestinal parasites

Intestinal parasitic infection was higher in females 40.3%, than in males 20.4% (Table 4).

Table 4.

Gender-related prevalence of intestinal parasites

Gender	No. examined	Number infected	(%)	P value
Male	93	19	20.4	0.20
Female	191	77	40.3
Total	284	96 (33.8%)

Prevalence of intestinal parasites with respect to age

The age group (11–20) years recorded the highest prevalence of 92.9%, while the age group (31–40) years recorded the lowest prevalence 18.2% (Table 5).

Table 5.

Prevalence of intestinal parasites with respect to age

Age (years)	No. examined	Number infected	(%)	P value
1–10	10	3	30.0	0.00
11–20	26	28	92.9
21–30	22	18	18.8
31–40	20	4	20.0
41–50	50	10	20.0
51–60	48	10	20.8
61–70	88	16	18.2
71–80	20	7	35.0
Total	284	96 (33.8%)

Prevalence of intestinal parasites with respect to occupation

Students recorded the highest prevalence of infection 50.9%, followed by farmers, with a prevalence of 38.9%, traders, with a prevalence of 32.1% (Table 6).

Table 6.

Prevalence of intestinal parasites with respect to occupation

Occupation	Number examined	Number infected	Percentage of infection (%)	P value
Farmers	108	42	38.9	0.00
Traders	78	25	32.1
Civil servants	43	1	2.3
Students	55	28	50.9
Total	284	96	33.8

Signs and symptoms of ill-health reported

The signs and symptoms of ill-health reported were fever (38.7%), Fatigue (32.2%), nausea (28.5%) and diarrhoea (17.6%) (Table 7).

Table 7.

Signs and symptoms reported

Symptoms	Yes	%	No	%	No response	%
Fever	110	38.7	102	35.9	72	25.4
Fatigue	91	32.0	60	21.1	133	46.8
Blood in stool	5	1.8	269	94.7	10	3.5
Nausea	81	28.5	92	32.4	111	3.9
Diarrhoea	50	17.6	95	33.5	139	48.9

Discussion

The community burden of intestinal parasites was established in the study population. Ascaris lumbricoides recorded the highest prevalence of 14.4%. This is similar to the report of Nduka et al. (2006), who recorded a prevalence of (17.88%) in Abia State. This value is also similar to studies by Awobode et al. (2016), who recorded a prevalence of (11.4%) in Oyo State. The prevalence value of (14.4%) is high compared to other authors who recorded low prevalences. These include Colman et al. (2013), who recorded a prevalence of (6.3%) among prison inmates in Maiduguri; Anosike et al. (2004), who recorded a prevalence of (6.2%) among nomadic Fulanis in the south-east; Amaechi et al. (2013) who recorded a prevalence of (8.2%) in rural communities in Abia State, Nigeria. The result, however, varied from those of other authors who reported higher prevalences, such as Ukpai and Ugwu (2007), who recorded a prevalence of (36.7%) among primary school children in Ikwuano, Abia state; Auta et al. (2013) (30.7%) among school children in Gwagwudu, Kaduna; Sigh and Muhammad (2017) (80.0%) among Noma patients in Sokoto; Morenikeji et al. (2009) who recorded a prevalence of (48.4%) in south-west Nigeria; Agbolade et al. (2003) (62.8%) in Ijebu, Ogun State while Mordi and Ngwodo (2007) recorded a prevalence of (30.0%) in Edo State. The prevalence recorded in this work could be a result of the transmission pattern of Ascaris lumbricoides and could be because of poor personal hygienic practices.

Ascaris lumbricoides infection appears to be the most prevalent intestinal helminth parasitic infection in most studies, especially in the tropics. This could be accredited to the micro-polysaccharide feature of the embryonated egg. This enables the parasite to withstand harsh environmental conditions and also enables the parasites to adhere easily to a wide range of surfaces; hence they can adhere to door handles, dust, fruits, vegetables, and money and enhance easy transmission.

Hookworm recorded a prevalence of (3.9%) (Table 2). This may be attributed to faecal pollution of the environment and inadequate sewage disposal systems. The prevalence of (3.9%) seems to be moderately low. This is lower than what was reported by Amaechi et al. (2013), who recorded a prevalence of (5.1%) and Colman et al. (2013), who recorded a prevalence of (6.47%). The result of (3.9%) however, contradicts the reports of Agbolade et al. (2003), who recorded a higher prevalence of (16.6%); Nduka et al. (2006), a prevalence of (14.8%) and Morenikeji et al. (2009) a prevalence of (15.6%). Taenia saginata recorded a prevalence of (3.5%). This compares with the results of Awobode et al. (2016), who also reported a low prevalence of (1.2%) and Houmsou and Amuta (2009), who reported a prevalence of (3.69%) among school children in Markurdi. Schistosoma mansoni had a prevalence of (4.2%). A lower prevalence of (0.05%) was reported by Colman et al. (2013) among prison inmates in Maiduguri, while Mordi and Ngwodo (2007) reported a higher prevalence of (11.7%). Chilomastix mensnili recorded a low prevalence of (1.8%), though it is a non-pathogenic intestinal protozoan. Trichuris trichiura recorded a low prevalence of (1.4%). This is similar to the result of Ukpai and Ugwu (2007), who also reported a low prevalence of (2.3%) and differed from the result of Morenikeji et al. (2009), who reported a higher prevalence of (21.8%) in their work. Enterobius vermicularis recorded a prevalence of (1.1%). Balantidium coli recorded the lowest prevalence of (1.1%). Mixed infections were observed. The highest combination was that of Hookworm and Taenia saginata (1.8%), followed closely by that of Ascaris lumbricoides and Taenia saginata (1.1%). Entamoeba coli and Fasciola hepatica occurred only as mixed infections. The combination of Entamoeba coli and Balantidium coli w.as (0.7%) while that of Fasciola hepatica and Schistosoma mansoni was 0.7%. The presence of mixed infections buttresses further the community burden of these intestinal parasites. The highest prevalence of intestinal parasites was recorded among female participants (40.3%), while the males recorded a prevalence of (20.4%). The prevalence of intestinal parasites is not dependent on gender, as supported by the statistical analysis. This means that both sexes can acquire the parasites with equal exposure. The high prevalence value recorded among the female participants could be accredited to the fact that females are exposed to a lot of outdoor chores, gathering infected vegetables, taking care of infected family members and friends, etc. This result is similar to Singh and Muhammad (2017), who recorded a higher prevalence among females (53.33%) than males (46.67%). Morenikeji et al. (2009), recorded a higher prevalence of intestinal parasites among females (57.8%). There is a significant difference between age and prevalence of parasitic infections. Age dependence in prevalence was observed as the age group (11–20) years which were predominately young school children, had the highest prevalence of intestinal parasites (86.1%). This is due to their frequent unhygienic practices such as eating unwashed vegetables and fruits obtained on their way home from school, eating with unwashed hands, poor toilet facilities in schools and homes, edaphagy (soil eating habits), and lack of hand washing habits. This is consistent with results reported by other parasitologists. Auta et al. (2013) recorded the highest prevalence between (13–15) years. Ukpai and Ngwu (2007) recorded high prevalence rates among the following age groups (5–7), (8–10), and (11–13) years, with the prevalence of (54.7%), (54.3%), and (57.8%) respectively. Students recorded the highest prevalence (50.9%), followed by farmers (38.9%), then traders (32.1%), and civil servants recorded the lowest prevalence of (0.4%). Statistical analysis confirmed that the prevalence of intestinal parasites with respect to occupation is significant among the various occupations. This implies that school children who were mostly classified as students were involved in unhygienic practices. Farmers are also exposed as a result of occupational hazards experienced on the farm. This is because there is a deficit of well-constructed toilet systems in most homes in rural communities. This agrees with Nduka et al. (2006), who recorded the highest prevalence of intestinal parasites among students (46.27%) and farmers (38.48%) in Ishiagu. A greater percentage indicated they felt tired easily (Fatigue), 75 (82.4%), and participants who ascertained they had recurrent fever had a prevalence of 89 (81.0%).

Conclusion

The results from this work have shown that intestinal parasitic infections have a great impact on the community burden of parasitic diseases with a total prevalence of (33.8%) especially among rural dwellers, and have become a public health concern especially among females, young people and farmers. I recommend increased public health education for the masses and deworming through mass drug administration (MDA). I advocate for an adequate, well-equipped, and functional health care system and diagnostic center for most rural dwellers to be executed by the government. I recommend for further studies on the prevalence of intestinal parasites in rural communities of Sub-Saharan Africa leveraging other methods of stool analysis such as wet mount and Kato Katz test.

Author contributions

OMU and CO conceptualized and designed the study, and also in the critical review of the paper. CO performed acquisition, analysis, and interpretation of data. QOL was involved in the laboratory analysis of samples and collation of data.

Funding

The research was jointly funded by the authors.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Permission was sought for and received from the Umuahia South Local Government Authority (AD/ 69/ VOL.11/S5/456), the village head, and the Chairman of the community union. The Chairman of the community union took the responsibility of informing the town crier to go around and create awareness and also made the Obizi community hall available for use as the focal point for bringing together the participants in the community. Following discussions with the community Chairman, an awareness campaign for the study was created. Days before the commencement of the study, public health awareness campaigns were carried out through the town crier. Permission was granted based on the agreement that patient anonymity will be maintained and that every finding will be treated with utmost confidentiality for the purpose of this research only. Informed consent of the participants was also sought and received before being included in the study. For the children, consent was received from their parents before their inclusion in the study. This is a cross-sectional study of persons who willingly gave their consent for themselves or their children to be included in the study spanning the period of December 2017 to May 2018.

Consent for publication

Not applicable.