http://doi.org/10.33698/NRF0021 Rosamma KJ, Indarjit Walia and Dubey ML
Abstract: A descriptive cross sectional study was carried out at village Dhanas, UT, Chandigarh to describe the prevalence of intestinal parasitic infections among women between the age group of 21 to 45 years. Women residing in two third of the houses were registered for the study. Total 224 women comprised the study sample. The subjects were studied for socio demographic variables related health status and the presence of intestinal parasites. Prevalence of infection was found to be 26.8% and Giardia Lambila was found to be the most prevalent parasite. It was present in the stool samples of 38(17.0%) of the subjects. Prevalence rate of Hookworms was found to be 17%. Two (3.1%) of the subjects were found to have tape worms. E. coli was present in 28(12.5%) of the stool samples whereas lodamoeba Bustchilli was present in 10(4.5%) of the subjects. The higher prevalence rate of intestinal parasites was observed among younger subjects, economically poor and illiterates. Fifty four (90%) of the subjects with intestinal parasites had anemic appearance. Abdominal pain and discomfort was being experienced by 56(93.3%) of the study subjects and 55(91.7%) subjects reported of having altered bowel movements.
Key words: Intestinal parasites, rural females, prevalence of infection, anemic appearance.
Correspondence at:
Or IndarjitWalia,
Principal,
National Institute of Nursing Education, PGIMER, Chandigarh, India.
Introduction
People have always had worms1. Today, intestinal parasites affect more than a quarter of the world’s population. It is estimated that about 3.5 billion people are affected and that 450 million people are ill as a result of these infections2. Field studies suggest that another 70%of the worms occur in 15-30 % of the people and minority of the heavily infected people is the major source of infection in the community causing compromised health3. Intestinal parasitic infections are greatly influenced by socio economic factors that facilitate the dispersion of human feces in the environment, and thus contaminate skin, food and soil with eggs or larvae4. Parasites live off life’s force and the food intake. In addition toa loss of nourishment and cellular damage, the toxins produced by these creatures play havoc with immune system and degrade the optimum level of human beings. Parasitic infections cause and aggravate malnutrition, anemia and considerable prevalence of morbidity, but low incidence of seriousmorbidity2. WHO have developed a policy forthe control of soil transmitted helminthes infections, recommending that the program to begin with baseline survey. Literature is not very rich with baseline information on extent of the intestinal parasitic burden on the females and their related health problems. For sound basis for estimating current status and a need for future intervention, a survey was planned to investigate prevalence of parasitic infections and health of the females in a rural community.
Materials and methods
Union territory, Chandigarh has 24villages. On city’s northwest corner the village Dhanas is situated. The village is surrounded by low socio-economic colonies. The village Dhanas was chosen purposely as the investigator already had good rapport with the village community. The village has civic amenities like clean drinking water, sanitary latrines and sewerage disposal system. It also has Anganwaries, nursery, middle and highschool. There is market for purchase ofmaterial for daily living, post office, bank, computer center and govt. dispensary manned by a doctor, pharmacist and a multipurpose worker. In addition, there are many private medical practitioners. Residents are mainly farmers but some run petty business, sell milk or are employed. Some of the residents are migrants from Punjab, Himachal Pradesh, UP, Bihar, Rajasthan and Haryana.
The study included observation of the subjects for their health, an interview on socio demographic information and health profile, and laboratory test of stool by conventional method to detect intestinal parasites. Village has about 3154 people residing in about 522houses. Survey of the village was undertaken. Houses were randomly chosen and women of 21 to 45 years age who resided in the chosen houses were selected as sample population. Two third of the houses were found to have 226 women of the selected age group. However two women left the village after the initial survey and thus 224 subjects participated in the study. All the subjects gave the verbal consent and willingly participated in the study. Data was collected at the houses of each of the subjects. They were provided with wide mouth covered plastic container and explained to collect early morning stool sample without getting it mixed with urine. They were also explained to wash hand with soap and running water after collection of stool sample. Stools were tested at parasitology laboratory of an apex medical institute. Every subject found having intestinal parasite in the stool sample was informed of the result and educated to seek treatment. Other subjects were asked to collect stool sample again. On three consecutive negative stool samples the subjects were informed that they were free of intestinal parasites. Socio demographic data was collected for all the subjects and anemic appearance was observed for those subjects who were found to harbor intestinal parasites.
Results
The mean age of the subjects was 31 years. The age of 16.4% subjects was 21 to 25 yrs. About 35% of the subject’s age ranged between 26 to 30 years and age of the 26.8% of the subjects was 31 to 35 yrs whereas 1/5 of the subjects were above the age of 36 years.
Table 1: Socio demographic characteristics of the study subjects
N=224
| Demographic Variables | f(%) |
| Age (yrs)
21-25 26-30 31-35 36-40 41-45 |
37 (16.4) 79 (35.1) 60 (26.8) 31 (13.8) 17 (07.6) |
| Education Status
Illiterate Primary Middle High Secondary Graduation |
103 (45.8) 58 (25.9) 29 (12.9) 20 (08.9) 13 (05.1) 1 (00.4) |
| Occupation
Housewives Employed |
219 (97.8) 5 (02.2) |
| Per capita Income (Rs)
<400 401-1000 1001-2000 >2000 |
65 (29.0) 105 51 (22.8) 3 (01.3) |
There were 103 (45.8%) illiterate subjects, 58(25.9%) subjects studied up to primary education level, 29(12.9%) s studied up to middle school level and 20(8.90%) studied up to high school. Only 14(5.5%) of the subjects studied up to high secondary and above education level. About 2% of the subjects earned their living as housemaids and rest of the subjects were housewives only. Among 224 subjects, 65(29.0%) subjects had per capita income below Rs 400 per month,46.9% of the subject’s per capita monthly income was Rs 400/- month to Rs 1000/-,and rest of the subjects per capita monthly income was above Rs 1000 as given intable-1.
Of 224 subjects, Thirty-nine subjects were positive for intestinal parasites at the first stool examination. The second stool test was conducted for185 subjects found to be negative for intestinal parasites on the first stool examination. Of these only 15 were found positive for harboring intestinal parasites. Third stool examination was conducted for the remaining negative 170 subjects and only 6 of the subjects were found to be positive for the intestinal parasites as given in figure 1. Thus total 60 subjects were found having intestinal parasites, and the prevalence rate of intestinal parasite was found to be 26.8%.
| Stool examination | Subjects and results | |
| 224 | ||
| First | Positive | Negative |
| 39 | 185 | |
| Second | Positive | Negative |
| 15 | 170 | |
| Third | Positive | Negative |
| 6 | 164 | |
| Result 39+15+6 = 60/224 =26.8% | ||
Figure 1: Stool examinations for intestinal parasites and results
There were total 60 subjects who had intestinal parasites. Of these, the subjects whose age was up to 25 years, the prevalence rate of intestinal parasitic infection among them was equivalent to that of sample population and it was 27%. The prevalence rate of infection was 39.2% among which is higher than that of the sample population among the subjects whose age was 26 to 30 years. Among the higher age group subjects, the prevalence rate of infection was less than that of sample population. There were only five subjects who were employed to earn and the prevalence of parasitic infection among them was only 0.5%. Table 2 depicts that with increasing income and educational status the prevalence rate of parasitic infection decreased among the study subjects. Among illiterates, the infection rate was as high as 43.7%. It was 15.5% among those who studied up to fifth class. Prevalence of parasitic infection was found to be 10.9% and 10% respectively among those who studied up to middle and secondary level. Infection’s prevalence was only 7.6% among graduates. Subjects whose per capita monthly income was up to Rs 400, the prevalence rate among them was as high as 53.8%. It was noted that 105 subjects whose per capita monthly income ranged between Rs. 601 to 1000, the prevalence rate of infection was 19%. And it was 9.8% among those whose per capita monthly income was Rs 1001 to 2000.
Table 2: Prevalence of parasitic infection as per education and economic status of the subjects
| Education and economic status | f(%) |
| Education
Illiterate Primary Middle Secondary High Secondary Graduation |
45(43.2) 9(15.5) 3(10.9) 2(10.0) 1(07.6) 0(00.0) |
| Per capita monthly Income (Rs)
<400 401-1000 1001-2000 >2000 |
35(53.8) 20(19.0) 5(09.8) 0(00.0) |
Figure3 depict c; the percentage distribution of subjects according to the types of intestinal parasites present in the stool samples. The most prevalent intestinal parasite was Giardia Lambila that was detected in 38(17.0%) subjects. The hookworm infestation was found al–gong 8(3.6%) of the subjects. Endamoeba histolytic was found among 7(3.1%) of the subjects where as two subjects were found to harbor tapeworms. End amoeba histolytic was prevalent in seven and H nana in 4 (1.8%) of the subjects. Roundworm was the least prevalent parasite among study subjects as it was detected only in one of the stool sample. E-coli was present in 28(12.5%) of the stool samples and Endamoeba Butchily in 10(4.5%) of the stool samples.
Table 3: Percentage distribution of subjects according to the type of Intestinal parasites
N=224
| Type of infection | f (%) |
| Giardia lambila
Hook worms Endamoeba histolytic H nana Tape worm Ringworms |
38 (17.0)
8(03.6) 7(03.1) 4(01.8) 2(00.9) 1(00.4) |
Out of total 60 positive cases, 56 of the subjects complained of abdominal pain and discomfort and 55 of the subjects had altered bowel movements. Fifty-four of the subjects had anemic appearance as they had pale conjunctiva, pale nails and pale tongue. Twenty-three of the subjects had cracked and dirty hands and 44 of the subjects had cracked and dirty feet.
Discussion
The prevalence of intestinal parasitic infection in the present study was 26.8% which is in agreement with current estimates that at least one quarter of the world’s population is chronically infected with intestinal parasites.2However the prevalence rate reported in the present study is found to be much less than reported from other parts of India for example 56.37% from West Bengal5, 60.6% from Tamil Nadu6, 64.4% from Bihar7, 54.5% from Himachal Parades8, 52.9%from Delhi9 and 38.6% to 80.5% at Nicobar and Andaman Island10. Present study report on rate of prevalence of intestinal infections is higher than reported from Kerala as 23.3%10. Findings of the present study are in agreement with of Usha et.al from Delhi11 who also found the prevalence rate of intestinal parasites to the 26.75%. In the present study females of 26 to 30 years were found most affected as 35.44% cases belonged to this age group. These findings are in agreement with that of Virket at from Uttar Pradesh12. Chatterjeeet at from Calcutta13 reported that people from the poverty line, low socioeconomic conditions, illiterate and having poor knowledge of environmental sanitation were more prone to parasitic infections. The observations of the present study are in agreement with these findings as among 60 positive subjects 45 were illiterate, 35 had per capita monthly income less than Rs 400. Table 2 deptts that as the education status goes up and the economic status improves the prevalence of infection rate comes down. The population chronically affected by intestinal parasites live in the developing countries as the poor socio economic factors facilitates the dispersion of human feces in the environment and contaminate skin and soil. Giardia Lambila was found to be the most prevalent intestinal parasite (17%). Baveja et al found that Giardia lambilia is more common among females as compared to male subjects. Prevalence rate of Giardia was followed by Hookworms (3.57%) among the present study subjects. The prevalence of Endamoeba Histolytic was found to be 3.12% among the present study subjects .And it is much lower than the reported prevalence rate from Rajasthan (17.5%)13, Chennai (4%),14 Delhi (13.89%)6 WHO estimated that 3000 million people live in uns ewered environment in developing countries and the rate of Giardiasis among them could rise up to 30% and thus contribute to deaths due to diarrhea diseases. In the present study 90% of the subjects had anemic appearance contributing to 800-900 million’s anemic people in the world. Hookworms have long been recognized as an important cause of iron deficiency anemia. Fifty-five out of 60 subjects who had intestinal parasites complained of abdominal pain. Bavejaet al11 report that Giardia Lambila Infection is associated with pain in abdomen and diarrhea. In the present study 93.3% of the subjects who were positive for parasitic infection complained altered bowel movements. The present study was conducted on female subjects only.
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