Intestinal parasites among young children in the interior of Guyana

Intestinal parasites contribute greately to morbidity in developing countries. While there have been several studies of the problem in the Caribbean, including the implementation of control programmes, this has not been done for Guyana. The aim of this study was to determine the prevalence of intestinal parasites among young children in a town located in the interior of Guyana. Eighty-five children under the age of 12 years were studied prospectively for intestinal parasites in Mahdia, Guyana. Stool samples were transported in formalin to the Department of microbiology, the University of the West Indies, Jamaica, for analysis using the formalin-ether concentration and Ziehl-Neelsen techniques. Data on age and gender of the children were recorded on field sheets. At least one intestinal parasite was detacted in 43.5 percent (37/85) of the children studied and multiple parasitic infections were recorded in 21.2 percent (18/85). The most common intestinal helminth parasite was hookworm (28.2 percent; 24/85), followed by Ascaris lumbricoides (18.8 percent; 16/85) and then Trichuris trichuria (14.1 percent; 12/85). Among the protozoan infections Giardia lamblia was detected in 10.5 percent (9/85) of the study population while Entamoeba histolytica appeared rarely. All stool samples were negative for Cryptosporidium and other intestinal Coccidia. There was no predilection for gender with any of the parasites. The pattern of distribution of worms in this area of Guyana was unlike that seen in other studies. Hookworm infection was the most common among the children and a large proportion had multiple infections. The study established the occurrence and prevalence of a number of intestinal parasites in the population of Guyana. This sets the stage for the design and implementation of more detailed epidemiological studies. (AU)

Intestinal parasites in human immunodeficiency virus infected patients

Treatment of concurrent opportunistic and non-opportunistic infections is a priority in improving quality of life in HIV infected patients in developing countries. The objective of the study was to determine the prevalence of opportunistic intestinal parasites in persons with and without HIV infection in Honduras. It was based on study of 52 HIV-positive and 48 HIV-negative persons at the Social Security Hospital in San Pedro Sula. Data sheets recording age, sex, stool parasitology, HIV serology and clinical state of HIV infection were completed for each study participant. Cryptosporidium parvum and Strongyloides stercoralis, which are intracellular or live in the mucosa, were found exclusively in persons infected with HIV. In contrast, the prevalence of the extracellular parasites Giardia lamblia, Ascaris lumbricoides and Trichuris trichiura was significantly higher in persons who were HIV-negative. It appears that infection with HIV may selectively deter the establishment of some intestinal parasites. This may be due to HIV induced enteropathy which does not favor the establishment of extracellular parasites. However, intracellular and mucosal dwelling organisms may benefit from pathological changes and reduced local immune responses which are induced by the virus which, in turn, lead to higher prevalence among HIV-infected individuals. We further postulate that the switch from a Th-1 to a predominantly Th-2 response as HIV infection progresses to AIDS may lead to an environment which is unsuitable for parasite survival (AU)

Ascaris lumbricoides in the paranasal sinuses of a Jamaican adult

While preparing a routine sagittal section of the human head and neck for the teaching of anatomy, 3 mature Ascaris lumbricoides worms were seen in the maxillary sinus and 3 in the sphenoidal sinus. Of the worms in the maxillary sinus, 2 were males and one was female, while in the sphenoidal sinus all 3 worms were females. The worms measured 7 - 11 cm in length Light microscope examination of the maxillary sinus wall revealed a few eggs of the parasite in close relation to the epithelium. The migratory abilities of A. Lumbricoides adult worms are well documented and most often involve the bile and pancreatic ducts (Asrat & Rogers, 1995). In a endemic area of Kashmir, India, A. Lumbricoides was the cause of acute pancreatis in 23 percent of 256 patients (Khuroo et al., 1992). Worm extraction and biliary drainage were indicated in 32 percent of 156 patients who had acute hepatobiliary and pancreatic ascariasis, and this resulted in rapid relief of symptoms in most patients (Khuroo et al., 1993). In the case represented, the ostia of the sinuses were between 3 and 4 mm in width and were therefore large enough for the passage of the worms as adults. We are not aware of any other report of ectopic ascariasis involving the sinuses. Clinical data on the current case were not available to us. A. Lumbricoides has high fecundity and the fact that only a few eggs were seen in the sinuses suggests that the worms were immature or that there was a reduction in egg production due to overcrowding or lack of adequate nutrition.(AU)

Does poor health nutrition affect school achievement in rural Jamaican children?

In recent years, increasing attention has been given to the effects of health and nutrition on schoolchildren's ability to learn. This study was conducted to determine whether nutritional status, anaemia and geohelminth infections were related to school achievement after controlling for a wide range of social variables. Eight hundred children were randomly selected from all those enrolled in grade 5 in 16 rural primary schools in Jamaica. School achievement was assessed by the Wide Range Achievement Test (WRAT). Children's weights and heights were converted to Z-scores using the NCHS references. Haemoglobin was measured using a haemoglobin photometer (Hemocue), and the presence and intensity (eggs per gram stool) of Trichuris trichura and Ascaris lumbricoides assessed by the Kato Thick Smear method. Socio-economic variables were assessed by questionnaire and observation, and school attendance obtained was from the class registers. The mean height-for-age of the children was -0.4 ñ 1.0 SD with 25.3 percent having heights <-ISD of the NCHS references. Fourteen point seven per cent (14.7 percent) of the children were anaemic (Hb < 1lg/dl), 38.3 percent were infected with Trichuris trichura and 19.4 percent with Ascaris lumbricoides. Height-for-age (p<0.001) was positively correlated with scores on the WRAT, and anaemia (p<0.05), Trichons and Ascaris infections (p<0.001) were associated with lower scores. In a multiple regression analysis, after controlling for attendance, sex, socio-economic status, possession of school books and uniform quality, the achievement of children with Trichuris infections was significantly worse than that of uninfected children in spelling, reading and the total WRAT score (p < 0.01). Height-for-age (p < 0.001) and anaemia (p < 0.05) contributed significantly to the variance in arithmetic. Despite the mild levels of undernutrition and the low intensity of the geohelminth infections, they were still associated with achievement. This suggests that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children (AU)

Prevalence of trichuris trichiura and ascaris lumbricoides in Jamaican schoolchildren - abstract

There is increasing concern that geohelminth infections may adversely affect the growth and development of children. The relevance of this in the Caribbean is unclear since in many territories the prevalence of these parasites is unknown. We report the results of three surveys conducted in Jamaican schools located in areas thought to be at high risk of geohelminthiasis. The first was conducted in 12 primary schools in Kingston and comprised children in grades 2 to 5 (age 7 to 10 years). The second and third surveys were conducted in rural areas with children in grades 2 to 5 and 4 and 5 respectively. Overall, 9 244 children provided stool samples for analysis. The prevalence of Trichuris trichiura ranged from 42 per cent to 47 per cent among the surveys while that for Ascaris lumbricoides ranged from 15 per cent to 37 per cent. When differences by grade were examined, the children in grades 2 and 3 had lower prevalences of T. trichiura than those in grades 4 and 5 in the first and second surveys (p<0.05 and p<0.005, respectively). The only significant grade difference in A. lumbricoides was in the second survey with children in grades 4 and 5 having higher prevalences than those in grades 2 and 3 (p<0.005). Most of the infections were light with approximately 1 per cent of the sample having heavy egg densities of greater than 7000 T. trichiura eggs per gram or 35 000 A. lumbricoides eggs per gram. Because of the sampling methodology, the observed prevalences are likely to be overestimates of national infection levels. However, it appears that Trichuriasis and Ascariasis are still common infections in Jamaican school-children (AU)

Geohelminth infections in school-aged children in Jamaica

There is concern that geohelminthiasis may adversely affect the growth and development of children. The relevance of this in the Caribbean in unclear since in many territories the prevalence of geohelminths is unknown. We report the results of three surveys conducted in Jamaican primary schools located in areas at high risk for geohelminthiasis. The first was conducted in 12 Kingston schools and comprised children in grades 2 to 5 (age 7 to 10 years). The second and third surveys were conducted in rural areas with children in grades 2 to 5 and grades 4 and 5, respectively. Overall, 9244 children provided stool sample for analysis. The prevalence of Trichuris trichiura ranged from 42 percent to 47 percent among the surveys while that for Ascaris lumbricoides ranged from 15 percent to 37 percent. Children in grades 2 and 3 had lower T. trichiura prevalences than those in grades 4 and 5 in the first and second surveys (p<0.05 and p<0.005, respectively). In the second survey only, children in grades 2 and 3 had a lower prevalence of A. lumbricoides than those in grades 4 and 5(p<0.005). Most infections were light with approximately 1 percent of the sample having heavy egg densities (AU)

Helminthiasis in Montserrat after the parasite control programme and hurricane Hugo - abstract

The Parasite Control Programme of Montserrat, West Indies, was a child-targeted chemotherapeutic control programme which ran from August 1986 to July 1989. The Programme involved the delivery of a broad spectrum antihelminthic to children (2-15 years old) once every school term. Two months after the end of the Programme, Hurricane Hugo devastated Montserrat on September 17, 1989. The Health Department (Montserrat) felt that the reductions in prevalence and intensity of Trichuris trichiura and Ascaris lumbricoides gained as a result of the Programme would be compromised by the disruption to sanitation and water supply caused by Hugo. In December 1989, a cycle of treatment was therefore administered to the child target group using the same infrastructure and procedure as that used in the Control Programme. The treatment compliance was 97.0 percent of the student population (n=2,125). Six months later, an age-stratified survey was done to assess the level of infection in the population and the age-standardised prevalence of T. trichiura for the overall population. Changes in the age-standardised intensity of both helminths before and after Hugo were recorded for the overall population: for T. trichiura the intensity went from 0.8 to 1.5 epg-faeces, while for A. lumbricoides the intensity rose from 1.2 to 1.7 epg.faeces. The observed rise in the infection levels of the overall population not statistically significant. The changes seen in the prevalence and intensity of both parasites taken from the surveys before and after Hugo were all found to be non-significant. There appeared to have been a non-significant increase in parasitic infection levels 9 months after Hugo to levels seen in the latter part of the Control Programme (AU)

Refeeding the malnourished child: effect on the fecundity of trichuris trichiura and ascaris lumbricoides - abstract

Ten children with either Trichuris trichiura and/or Ascaris lumbricoides infection were admitted to the nutrition rehabilitation ward at the Tropical Metabolism Research Unit, U.W.I. Treatment with anthelminthic was delayed until the children attained their normal weight-for-height. Total daily stool output and changes in faecal egg density were monitored for each child, the latter by Kato analyses of sub-samples taken from all daily stools, from admission through to anthelminthic treatment. Worm burdens were then assessed by the collection of expulsions. The fecundity of the whipworm appeared not to be affected by dietary rehabilitation. However, roundworm fecundity decreased, in some instances to zero. In some cases, the roundworms were expelled during the course of refeeding. Refeeding was seen to have an antagonistic effect on the fecundity of A. lumbricoides. The fact that whipworm fecundity went unaltered may be an indication of modulation of the host immune response (AU)

The age-targeted chemotherapeutic control of helminthic infections in Montserrat - abstract

This study describes the age-targeted chemotherapeutic control of Trichuris trichiura and Ascaris lumbricoides in the total population (n = 11,479) of Montserrat, West Indies. The intervention programme involved the treatment with a single dose albendazole of all children aged 2-15 years (approximately 2,500) in seven sequential cycles at 4 monthly intervals. Infection status was monitored by an initial coprological survey of an age-stratified sample (11.5 per cent) of the population, and by surveys of smaller samples (4-5 per cent) after two (7 months), 4 (15 months), 6 (23 months), and 7 (29 months) cycles of treatment. The programme delivered treatment to > 90 per cent of the target population at each cycle. The overall prevalence of T.trichiura fell from 12.1 per cent at the initial survey to 1.4 per cent 29 months later. Similarly, the prevalence and intensity of infection was observed to fall in both the target group and the adults (>15 years) even though the treatment of the latter was not actively sought. The study demonstrates that child targeted chemotherapy is effective and can be practically implemented within an existing health and educational infrastructure (AU)

The effect of targeted chemotherapy on the prevalence and intensity of helminthic infections in Montserrat - abstract

The Parasite Control Programme targeted treatment to all registered school children in Montserrat. The effect of this targeted chemotherapy was later assessed by two parasitological surveys and compared with a baseline survey conducted before the star of the treatment rogime. Once in a school term, between March 1987 and June 1988, students (2 to 15 years old) were given a dose of 400 mg albendazole. Adults were treated upon request or if they were diagnosed for an helminth infection. Parasitological surveys were done before and twice during the study period. Faecal specimens were collected through selected schools and district clinics, using an age-stratified protocol, and were processed by the Kato thick smear method. Six school visits were conducted with almost 96 percent of the students receiving treatment. The baseline survey sampled 12 percent (1,320 samples) of the island's population, while the September 197 survey sampled 4.6 percent (531 samples), and the May 1988 survey sampled 4.1 percent (472 samples). The overall prevalence oa Ascaris lumbricoides decreased from 2.0 percent to 0.6 percent to 0.2 percent at successive surveys. For Trichuris trichiura, the prevalence declined from 12.1 percent to 4.5 percent to 3.0 percent. From the baseline to each subsequent survey, the prevalence and intensity of both helminths showed a noticeable decrease in the child age groups. This implies that targeted chemotherapy to the school age population reduces the risk of morbidity due to i nfection and the potential for infection transmission from this group. A final island-wide parasitological survey will be carried out at the end of the programme to assess the longitudinal effects of targeted chemotherapy. This Programme is supported by the Ministry of Health, (Montserrat), Imperial Colloge (London) and Smith, Kline and French Labs. Ltd (AU)

Helminths and nutritional status in Jamaica toddlers - abstract

Malnutrition, ascariasis and trichuriasis are prevalent and co-exist among the poor. However, the nature of the relationship between nutritional status and helminthiasis remains unclear. We therefore compared the prevalence and intensity of infection with Trichuris trichuria and Ascaris lumbricoides in 11 to 25-month-old children in two groups from the same slum communities in Kingston, Jamaica. One group comprised 66 malnourished children (<90 percent weight-for-age) and the other 55 well-nourished children (<90 percent weight-for-age). Both groups of children had similar mean ages, comprised similar proportions of boys and girls and had similar socio-economic status. Duplicate faecal specimens were examined twice, using the Kato thick Smear technique. Infected children were treated with mebendazole (Janssen, Pharmaceuticals). Helminths occurred with similar prevalence among the well-nourished (38 percent) and the malnourished (44 percent) children. However, the prevalence was highest in the mildly wasted children (57 percent, n=30) and least in the moderately/severely wasted children (15 percent, p<0.05). Similar patterns were observed for both Ascaris and Trichuris. In both groups, the presence of helminths was positively associated with age (Xý = 10.7, p<0.05), acess to water (Xý = 9.1, p<0.05)and geophagia(Xý = 4.2, p<0.05). These results show that nutritional status alters the host-parasite relationship. Perhaps mild malnutrition increases whereas more severe malnutrition decreases susceptibility to helminths, as Bundy and Golden (Parasitolgy, 1987) have suggested (AU)

Ascaris lumbricoides and Trichuris trichiura in rural Surinam

From 1956 to 1972 mass anti-helminthiasis campaigns were conducted in rural Surinam. In door-to-door surveys, faeces of 100,012 persons were examined. One single faeces specimen was obtained per individual and concentrated. Although the law requires that every littoral house be provide with toilet facilities, infants and toddlers defaecate inside and around the houses, seeding the soil with helminth ova. The overall rates were 30.5 per cent for Ascaris and 6.7 per cent for Trichuris. Both rates were usually higher in suburban than in rural areas. They were highest in Amerindians, Bushnegroes and Creoles; and lowest in Javanese. They were higher in women than in men, and higher in children than in adults. The Ascaris rates were much higher than the Trichuris rates, although Surinam has a high annual rainfall......(AU)

Helminthiasis in the Brokopondo district, Surinam

In 1957 the Surinam Bureau of Public Health (B.O.G), together with the Surinam-American Technical Cooperative Service, conducted an intestinal helminthiasis survey among 875 Bushnegroes in the district of Brokopondo in Surinam. One single faeces specimen was obtained per individual and after being concentrated, examined for helminth ova. Schistosoma ova were found in none of the faeces samples. The faeces examination revealed that 30.1 per cent of the subjects harboured hookworm, 50.7 per cent Trichuris trichiura and 1.6 per cent Strongyloides stercolaris. These results are still valid, since the sanitary habits among the Bushnegroes have not changed since the survey was conducted