Change in health profile of refugees resettling in New Zealand, 1980-2014.

AIM: To update data previously published on the health profile of the refugees resettling in New Zealand, and to draw attention to the change in health profile over time, with a decline of infectious disease/deficiencies, and a rise of non-communicable diseases, a worldwide phenomenon. METHOD: Comparative data was extracted from (1) written annual reports prepared by medical officers at the Mangere Refugee Resettlement Centre (1978-1991), (2) a Microsoft ACCESS patient management system between 1995 and 1999 and (3) a MEDTECH patient management system between 2010 and 2014. RESULTS: Over the period 1979-2014, the rate of infectious diseases has declined markedly in resettling refugees, and the rate of non-communicable diseases has increased. For example, the incidence of tuberculosis has decreased from 4% to 0.2%, gut parasites from more than 40% to, in some intakes, 15% and iron deficiency from 22% to 10%, while the diabetes rate has gone from 0.1% to 2.7%. CONCLUSION: While management of unfamiliar infectious diseases and deficiencies (especially vitamin D) still remains an important part of the management of refugee health, their management usually involves limited time and expense, and their burden is much less than before. However, refugees now resettling in New Zealand and the rest of the world often present with familiar non-communicable diseases that require long-term management.

Prevalence and subtype distribution of Blastocystis in ethnic minority groups on both sides of the China-Myanmar border, and assessment of risk factors.

Blastocystis is one of the most common intestinal parasites in humans worldwide. To understand its prevalence and to explore the risk factors for Blastocystis in humans in developing countries, a molecular epidemiological investigation of Blastocystis was conducted in ethnic minority groups on both sides of the China-Myanmar border. A total of 461 fecal specimens were collected from 289 Yao people in China and 172 Wa people in Myanmar, together with a questionnaire for each participant. Based on sequence analysis of the partial small subunit of ribosomal RNA (SSU rRNA) gene (barcode region or 260 bp region), an average prevalence of 6.29% (29/461) was observed, with 4.50% (13/289) in Yao people and 9.30% (16/172) in Wa people. Twenty-two Blastocystis isolates were successfully subtyped by sequence analysis of the barcode region. Three subtypes were identified: ST1 (n = 7), ST3 (n = 13) and ST4 (n = 2). A statistical difference in the prevalence of Blastocystis was only observed between children (12.37%, 12/97) and adults (4.95%, 16/323), and between not washing hands (11.02%, 14/127) and washing hands (4.76%, 15/315) after using toilets, emphasizing the importance and necessity of health education in people in the investigated areas, especially in children.

Community Epidemiology Approach to Parasitic Infection Screening in a Remote Community in Ecuador.

The Awa indigenous people of Ecuador live in remote areas and were included in health programs only recently. The first screening for parasitic infections in the Awa communities was implemented in the context of community epidemiology. During the site visits in each community, the health-care staff collected the samples for stool microscopy and serology for Strongyloides. A total of 705 individuals consented for the study, representing 40% of the Awa population living in the targeted communities; 184 (26%) participants supplied a stool sample. Giardia intestinalis was found in about 11% of samples. Prevalence of Ascaris lumbricoides and Trichuris trichiura was 54.9% and 36.9%, respectively. No hookworm eggs were found. In addition, Strongyloides stercoralis larvae were found in eight individuals (4.3%), whereas serology was positive in 22.7% of the individuals tested. The community-based approach resulted in an impressive participation. There was a high prevalence of parasites associated with relevant morbidity.

Shadow Puppets and Neglected Diseases: Evaluating a Health Promotion Performance in Rural Indonesia.

'Rama and the Worm' is a shadow puppet production targeting neglected diseases in Central Java. It is an entertainment-based intervention study to promote health by reducing the impact of parasitic diseases such as soil-transmitted helminths (STH). The study uses traditional Javanese shadow puppetry (wayang kulit) as a vehicle in village communities to disseminate health messages and promote behaviour change to prevent diseases caused, primarily, by inadequate sanitation and poor hygiene. The health education messages contained in the play, although using traditional characters and themes, required the creation of a completely new narrative script, using characters and plot lines familiar to the wayang kulit repertoire, but placing them in new situations that relate specifically to health promotion objectives. The intervention was piloted in a village in Central Java, Indonesia using a pre/post design with both qualitative and quantitative analysis. A total of 96 male and female villagers, aged between 7 and 87 years, provided both baseline and follow up data. Participant knowledge and behaviours related to gastrointestinal and helminth-related disease were assessed before and after the intervention through a questionnaire administered by interview. Results revealed statistically significant improvements in both knowledge (48.6% pre-intervention score vs. 62.8% post-intervention score, p < 0.001) and behaviour (77.4% vs. 80.6%, p = 0.004) related to gastrointestinal and helminth disease. Findings of the study indicate the wayang kulit performance is an effective health education tool. The results provide proof of concept with scaling up the next step forward. The wayang kulit production provides a significant additional component for an integrated, comprehensive approach to reduction and elimination of STH infection.

[Stratified sampling survey of major human parasitic diseases in Henan province].

Objective: To understand the prevalence of major human parasitic diseases and related factors in Henan province. Methods: This stratified sampling survey was carried out according to the requirement of national survey protocol of major human parasitic diseases, 2014-2015. The prevalence of soil-transmitted helminths infection, taeniasis and intestinal protozoiasis were surveyed in 104 sites selected from 35 counties (districts) and the prevalence of clonorchiasis was surveyed in 62 sites selected from 37 townships. In each survey spot, 250 persons were surveyed. A total of 26 866 persons and 15 893 persons were surveyed. Modified Kato-Katz thick smear was used to detect the eggs of intestinal helminthes. Tube fecal culture was used to identify the species of hookworm. The Enterobius eggs were detected in children aged 3 to 6 years by using adhesive tape. The cyst and trophozoite of intestinal protozoa were examined with physiological saline direct smear method and iodine stain method. Results: The overall infestation rate of intestinal parasites was2.02% in Henan, and the worm infection rate was higher than protozoa infection rate. Fourteen kinds of intestinal parasites were found, including nematode (5 species), trematode (2 species), and protozoan (7 species). The infection rate of Enterobius vermicularis was highest, and Qinba Mountain ecological area had the highest infestation rate of intestinal parasites in 4 ecological areas of Henan. There was no significant difference in intestinal parasite infection rate between males and females (χ(2)=3.630, P=0.057), and the differences in intestinal parasite infection rate among different age groups had significance (χ(2)=124.783, P=0.000 1). The infection rate reached the peak in age group ≤9 years and the major parasite was Enterobius vermicularis. Furthermore the overall human infection rate of parasite showed a downward trend with the increase of educational level of the people (χ(2)=70.969, P=0.000 1), the differences had significance (χ(2)=120.118, P=0.000 1). For different populations, the infection rate of intestinal parasites was highest among preschool children. The infection of intestinal helminth was mainly mild, only 2 severe cases were detected. The infection rate of Clonorchis sinensis in urban residents was only 0.006%. Logistic regression analysis showed that being preschool children (χ(2)=15.765, P=0.000 1) and drinking well water (χ(2)=45.589, P=0.000 1) were the risk factors for intestinal parasite infection, and annual income per capita of farmers was the protective factor against intestinal parasite infection. The infection rates of protozoa and intestinal parasites decreased sharply compared with the results of previous two surveys, and the rate of intestinal helminth infection also dropped sharply compared with the second survey. The numbers of protozoa, helminth and intestinal parasites detected in this survey were all less than the numbers found in the previous two surveys. Conclusions: Compared the results of three surveys in Henan, the infection rate of protozoa and intestinal parasites showed a downward trend. The prevention and treatment of Enterobius vermicularis infection in children should be the key point of parasitic disease control in the future.

Intestinal parasitic infections among expatriate workers in various occupations in Sharjah, United Arab Emirates.

Intestinal parasitic infections are prevalent throughout many countries. This study aimed to determine the prevalence of intestinal parasite carriers among 21,347 expatriate workers, including food handlers and housemaids attending the public health center laboratory in Sharjah, UAE. Stool sample collection was performed throughout the period between January and December 2013. All samples were examined microscopically. Demographic data were also obtained and analyzed. Intestinal parasites were found in 3.3% (708/21,347) of the studied samples (single and multiple infections). Among positive samples, six hundred and eighty-three samples (96.5%) were positive for a single parasite: Giardia lamblia (257; 36.3%) and Entamoeba histolytica/Entamoeba dispar (220; 31.1%), respectively, whereas mono-infections with helminths accounted for 206 (29.1%) of the samples. Infection rates with single worms were: Ascaris lumbricoides (84; 11.9%), Hookworm (34; 4.8%), Trichuris trichiura (33; 4.7%), Taenia spp. (27; 3.81%), Strongyloides stercoralis (13; 1.8%), Hymenolepis nana (13; 1.8%), and Enterobius vermicularis (2; 0.28%), respectively. Infections were significantly associated with gender (x2 = 14.18; p = 0.002) with males as the most commonly infected with both groups of intestinal parasites (protozoa and helminths). A strong statistical association was noted correlating the parasite occurrence with certain nationalities (x2= 49.5, p <0.001). Furthermore, the study has also found a strong statistical correlation between parasite occurrence and occupation (x2= 15.60; p = 0.029). Multiple infections were not common (3.5% of the positive samples), although one individual (0.14%) had four helminth species, concurrently. These findings emphasized that food handlers with different pathogenic parasitic organisms may pose a significant health risk to the public.

Prevalencia de las parasitosis intestinales en el Hospital de Enfermedades Infecciosas "Dr. Francisco Javier Muñiz" / Prevalence of intestinal parasites in Infectious Diseases Hospital "Dr. Francisco Javier Muñiz" / Prevalência de parasitoses intestinais no Hospital de Doenças Infecciosas "Dr. Francisco Javier Muñiz"

Se evaluaron en forma retrospectiva los resultados obtenidos del procesamiento de muestras fecales y escobillados anales, remitidos para su estudio al laboratorio de la Sección Parasitología del Hospital de Enfermedades Infecciosas "Dr. Francisco Javier Muñiz" de la Ciudad de Buenos Aires, durante el período comprendido entre enero y diciembre de 2016. Se tuvieron en cuenta los resultados de 1253 estudios parasitológicos de materia fecal y de 268 escobillados anales, correspondientes a 1207 pacientes. No fueron considerados los resultados de las muestras de 432 pacientes, de los cuales no se poseía alguno de los datos evaluados. Las muestras fecales resultaron positivas en 288 (22,98%) casos, mientras que en 33 (12,31%) escobillados anales, fueron positivas para la presencia de huevos de Enterobius vermicularis. La presencia de Blastocystis sp. fue detectada en 194 (17,1%) pacientes, seguida en orden de frecuencia por Entamoeba coli (51; 4,5%), Giardia lamblia (47; 4,1%) y Endolimax nana (32; 2,8%). El hallazgo de coccidios arrojó una prevalencia de 1,2% (n=14) para Cryptosporidium sp. y de 1,3% (n=15) para Cystoisospora belli. Cuando se evaluó la incidencia de parasitosis de acuerdo con la edad de los pacientes, se observó la existencia de significancia de diferencias entre proporciones de pacientes parasitados con edades menores o iguales a 15 años y mayores a esta edad. Por otro lado, no se encontró significancia de diferencias entre las proporciones de mujeres y varones con estudios coproparasitológicos positivos. El presente estudio, realizado con una metodología simple, al alcance de laboratorios de baja complejidad, ha puesto en evidencia que el número de géneros y especies encontrados en las muestras analizadas presenta heterogeneidad espacial, con los valores más altos representados por Blastocystis sp., seguido por protozoarios intestinales (Giardia lamblia y amebas no patógenas), así como una prevalencia importante de coccidios en las muestras fecales de la población estudiada, asociada a pacientes con SIDA. Estudios posteriores y más completos, que incluyan una mayor cantidad de datos de los pacientes evaluados, posibilitarán un mejor conocimiento de las coproparasitosis presentes en la población asistida en el Hospital Muñiz.

The results obtained during the period between January and December 2016 of the fecal samples and anal sclerosis, were submitted retrospectively to the laboratory of the Parasitology Section of the Hospital of Infectious Diseases "Francisco Javier Muñiz" of the City of Buenos Aires. The results of 1253 parasitological studies of fecal matter and of 268 gauzes anal swabbing, corresponding to 1207 patients, were taken into account. The results of the samples from 432 patients were left out, and none of their data was evaluated. Fecal samples were positive in 288 (22.98%) cases, while 33 (12.31%) were positive for the presence of Enterobius vermicularis eggs. The presence of Blastocystis sp. was detected in 194 (17.1%) patients, followed in order of frequency by Entamoeba coli (51. 4.5%), Giardia lamblia (47. 4.1%) and Endolimax nana (32. 2.8%). The finding of coccidiosis showed a prevalence of 1.2% (n = 14) for Cryptosporidium sp. and 1.3% (n = 15) for Cystoisospora belli. When the incidence of parasitosis was evaluated according to the age of the patients, the existence of significant differences between proportions of parasitized patients with ages less than or equal to 15 years and older was observed. On the other hand, no significant differences were found between the proportions of women and men with positive coproparasitological studies. The present study, performed with a simple methodology, within the reach of low complexity laboratories, has shown that the number of genera and species found in the analyzed samples presents spatial heterogeneity, with the highest values represented by Blastocystis sp., followed by Giardia lamblia and non-pathogenic amoebae, as well as an important prevalence of coccidia in fecal samples of the population studied, associated with AIDS patients. Further and more complete studies, including a greater amount of data of the evaluated patients, will facilitate a better knowledge of the coproparasitosis present in the assisted population in the Muñiz Hospital.

Foram avaliados os resultados em forma retrospectiva para o processamento de amostras fecais e swabs anais, enviados para sua consideração ao laboratório da Seção de Parasitologia do Hospital de Doenças Infecciosas "Dr. Francisco Javier Muñiz" da cidade de Buenos Aires. Foram considerados os resultados de 1253 estudos parasitológico das fezes e 268 de swab anal, correspondentes a 1207 pacientes. Não foram considerados os resultados de amostras de 432 pacientes, dos quais não existía algum dos dados avaliados. As amostras fecais resultaram positivas em 288 (22,98%) casos, enquanto que em 33 (12,31%) swabs anais foram positivas para a presença de ovos de Enterobius vermicularis. A presença de Blastocystis sp. foi detectada em 194 (17,1%) pacientes, seguida em ordem de frequência por Entamoeba coli (51, 4,5%), Giardia lamblia (47, 4,1%) e Endolimax nana (32, 2,8%). O achado de coccídios mostrou uma prevalência de 1,2% (n = 14) para o Cryptosporidium sp. e de 1,3% (n = 15) para Cystoisospora belli. Quando a incidência de parasitoses de acordo com a idade dos pacientes foi avaliada, observou-se a existência de significância de diferenças entre as proporções de pacientes parasitados com idade menor ou igual a 15 anos e com mais de15 anos. Por outro lado, não houve significância de diferenças entre as proporções de mulheres e homens com estudos coproparasitológicos positivos. Este estudo, realizado com uma metodologia simples disponível para laboratórios de baixa complexidade, mostrou que o número de gêneros e espécies encontradas nas amostras analisadas apresenta heterogeneidade espacial, com os mais altos valores representados por Blastocystis sp., seguido por protozoários intestinais (Giardia lamblia e amebas não patogênicas), bem como uma prevalência significativa de coccídios nas amostras fecais da população do estudo, associada com doentes de AIDs. Estudos posteriores e mais abrangentes, incluindo maior número de dados dos pacientes avaliados, permitirá uma melhor compreensão das coproparasitoses presentes na população atendida no Hospital Muñiz.

Coproscopy and molecular screening for detection of intestinal protozoa.

BACKGROUND: Intestinal parasitosis is one of several health concerns about immigrants who travel from endemic to non-endemic regions. Reliable rapid sensitive diagnostic tools, for use in non-endemic regions, are urgently required to enable frequent assessment of immigrant workers in jobs where risk of local transmission is a particular concern (e.g. food-handlers). We assessed the burden of intestinal protozoa in newly arrived immigrants and those applying for renewal of work permits in Qatar (n = 735), by both microscopic examination of stool samples and by Real Time PCR methodology. RESULTS: Prevalence was considerably higher using RT-PCR compared with coproscopy (Blastocystis hominis: 65.2 vs 7.6%; Giardia duodenalis: 14.3 vs 2.9%; Entamoeba histolytica: 1.6 vs 1.2%). Dientamoeba fragilis was sought only by RT-PCR (prevalence of 25.4%). Prevalence of G. duodenalis was significantly higher in male subjects, associated with blue collar workers and declined over time. Prevalence of B. hominis varied significantly with region of origin of subjects with highest values recorded among African immigrants. Prevalence of D. fragilis also varied with region of origin of subjects, and was lower in young female subjects and in renewal applicants compared with first-time applicants for work permits. CONCLUSIONS: We strongly recommend that, henceforth, intestinal protozoa should be screened by RT-PCR, with a particular focus on frequent assessment of immigrant food-handlers.

Neutropenia and eosinophilia among Ethiopian immigrants to Israel: Familial or environmental?

BACKGROUND: Due to trends of population movements, Israeli family physicians are treating increasing numbers of African immigrants from Ethiopia. These immigrants were found to have complete blood counts (CBC) that are different from other ethnic groups, with a higher prevalence of eosinophilia and neutropenia. OBJECTIVES: To evaluate haematological findings in an attempt to define whether they behave as familial (genetic) or environmental. METHODS: Retrospective chart review of 300 patients from a primary care clinic: 100 individuals of Ethiopian heritage born in Ethiopia (EE); 100 individuals of Ethiopian heritage born in Israel, whose parents were born in Ethiopia (EI), and a control group of 100 patients who were not of Ethiopian heritage (C). RESULTS: Absolute eosinophilia (greater than 500/dl) was found in 13% of the EE study group significantly higher than the two other groups (P < 0.05), with no difference between EI and C. neutropenia (defined as less than 1500/dl) was found in 32% of EE group, 20% of EI, and 1% of C (P < 0.01). CONCLUSION: On the one hand, findings point to a marked environmental influence on the eosinophilic response (most probably due to intestinal parasites present in immigrants from Ethiopia). On the other hand, a familial-genetic nature is probably the reason for the higher prevalence of neutropenia in this population, although some environmental influence may play a role. The knowledge of these findings may be useful for physicians treating people migrating from Africa.

Discordances Between Serology and Culture for Strongyloides in an Ethiopian Adopted Child With Multiple Parasitic Infections: A Case Report.

RATIONALE: infectious diseases screening of international adoptees is complex because of the concurrence of different pathogens in a child at same time. We describe an international adopted child born at Ethiopia infected by 5 different pathogens (Hymenolepis nana, Giardia intestinalis, Entamoeba histolytica, Strongyloides stercoralis, and Trichuris trichiura), 2 of them S. stercoralis and E. histolytica with a capacity to develop severe clinical complications if not detected promptly with appropriate diagnosis tests.Concerns of the patient: according to the screening protocol a stool sample is always processed for culture addressed to find out protozoan and helminthic pathogens but not specifically for S. stercoralis. Only, when eosinophilia is detected 3 serial stool samples are collected to rule out intestinal parasitic infection including S. stercoralis. INTERVENTIONS: in our case, S. stercoralis would not have been detected if we had followed the protocol because eosinophilia was absent and its specific serology was negative. Fortunately, the initial inclusion of the feces charcoal culture for S. stercoralis allowed us to detect this infection. OUTCOMES: discordances between direct methods such as culture and indirect as serology or antigen test forces us to be very cautious before ruling out S. stercoralis or E. histolytica infection, respectively. Also, if a child from tropical areas has persistent symptoms (such as diarrhea or fever) that have not been treated we have to rule out other infections that have not been detected yet.Main lessons: The introduction of different sequencing tests and the insistence to find out pathogens such as S. stercoralis or E. histolytica was determinant to be able to cure this symptomatic child and to prevent potential severe clinical forms in case of immunosuppression.

Health Status of Immigrant Children and Environmental Survey of Child Daycare Centers in Samut Sakhon Province, Thailand.

Samut Sakhon is a Thai province popular among immigrants attracted to work in factories and the Thai food industry, especially people from Myanmar. Poor personal-hygiene behaviors, crowded accommodation and limited sanitation, result in health problems among immigrant workers. Various infectious diseases among this group are seen and managed by Samut Sakhon General Hospital. The impact of intestinal parasitic infections on public health is well known; they can spread from infected immigrant areas to uninfected areas via close contact and fecal-oral transmission from contaminated food and water. This study aimed to determine the prevalence of intestinal parasitic infections among 372 immigrant children at 8 child-daycare centers during their parents' work time, by physical examination, fecal examination, and examination of the environment around the centers. Physical examinations were generally unremarkable, except that head-lice and fingernail examinations were positive in two cases (0.8 %). The results showed intestinal parasitic infections to be highly prevalent, at 71.0 %. These infections comprised both helminths and protozoa: Trichuris trichiura (50.8 %), Enterobius vermicularis (25.2 %), Ascaris lumbricoides (15.3 %), hookworm (11.6 %), Giardia lamblia (10.2 %), Endolimax nana (3.5 %), Entamoeba coli (2.7 %), and Blastocystis hominis (0.5 %). The environmental survey found a small number of houseflies near the accommodation to be positive for helminthic eggs (0.2 %), including A. lumbricoides, E. vermicularis, hookworms, Taenia spp., and minute intestinal flukes. Regarding the high prevalence of intestinal parasitic infections among children, it has been conjectured whether they were infected, along with their parents, during their daily lives before or after settling in Thailand. Intestinal parasites among immigrant children may involve a significant epidemiological impact, since immigrant children can serve as carriers and transmitters of disease.

[Environmental conditions and prevalence of parasitic infection in Xukuru-Kariri indigenous people, Caldas, Brazil]. / Condições ambientais e prevalência de infecção parasitária em indígenas Xukuru-Kariri, Caldas, Brasil.

OBJECTIVE: To describe the environmental conditions and the parasitic infection status of Xukuru-Kariri individuals living in the municipality of Caldas, state of Minas Gerais, Brazil. METHODS: A cross-sectional study was carried out in March 2009. Sociodemographic and environmental data were collected through interviews. Water and fecal samples were collected for determination of environmental contamination and parasitic infection status. RESULTS: The Xukuru-Kariri population living in Caldas included 86 people divided into 22 families. Of 22 heads of household, 81.8% had low schooling (not higher than elementary education). Of 26 water samples collected for microbiological analysis, 77.0% were positive for total coliforms and 4.0% for Escherichia coli. Residents of 27.3% of households defecated in the open. Trash was scattered in the yard of 54.5% of households. Fecal samples were collected from 60 individuals, with parasitic infection in 66.6%. The following prevalence rates were recorded: Entamoeba histolytica/dispar, 6.7%; Entamoeba coli, 60.0%; Endolimax nana, 1.8%; and Giardia duodenalis, 6.6%. CONCLUSIONS: The people included in this study faced environmental characteristics that contributed to their health vulnerability. Health actions as well as the implementation of public policies to provide sanitation, with quality water and adequate collection and treatment of human and household waste, are essential to prevent environmental degradation and improve the quality of life of these individuals.

[Health and nutrition of indigenous and nonindigenous children in the Peruvian Amazon]. / Situación de salud y nutrición de niños indígenas y niños no indígenas de la Amazonia peruana.

PURPOSE: Evaluate the nutritional status of indigenous and nonindigenous children under 5 in two provinces in the Peruvian Amazon. METHODS: . Descriptive cross-sectional representative study of families with children under 5 in the provinces of Bagua and Condorcanqui in Peru. The study consisted of an interview with the child's or children's mother or caregiver, anthropometric assessment, capillary hemoglobin measurement, screening for intestinal parasites in children under 5, access to health services, history of acute respiratory infections and acute diarrheal diseases, socioeconomic status, and intake of inadequately iodized salt. Using generalized linear methods, the determinants of chronic malnutrition and anemia in children were identified in each study population. RESULTS: . A total of 986 families and 1 372 children were assessed. The prevalence of chronic malnutrition was higher in the indigenous population than in the nonindigenous population (56.2% versus 21.9%); likewise for anemia (51.3% versus 40.9%). The determinants of chronic malnutrition in the two populations differed. In the indigenous population, the main determinants were an age of more than 36 months (OR 2.21; CI95% 1.61-3.04) and substandard housing (OR 2.9; CI95% 1.19-7.11), while in the non-indigenous population, they were extreme poverty (OR 2.31; IC95% 1.50-3.55) and institutional birth (OR 3.1; IC95% 2.00-4.83). CONCLUSIONS: There are marked gaps between the indigenous population and the nonindigenous population in terms of living conditions, access to health services, and the nutritional status of children under 5. Particular attention should be paid to the indigenous population to improve the way state programs and services are delivered in these contexts.

Neglected tropical diseases among two indigenous subtribes in peninsular Malaysia: highlighting differences and co-infection of helminthiasis and sarcocystosis.

Soil-transmitted helminth (STH) infections have been documented among these minority groups since 1938. However the prevalence of STH is still high among these communities. Most studies tend to consider the Orang Asli (indigenous) as a homogenous group. In contrary, different subtribes have their own cultural practices. To understand this variation better, we studied the prevalence and associated factors of STH and other gut parasitic infections among two common subtribes (i.e. Temuan and Temiar). Results showed that the prevalence of the overall STH infections was higher in the Temuan subtribe (53.2% of 171) compared to the Temiar subtribe (52.7% of 98). Trichuris trichiura (46.2%) was the most prevalent parasite in the Temuan subtribe, followed by Ascaris spp. (25.7%) and hookworm (4.1%). In contrast, Ascaris spp. (39.8%) was more prevalent among the Temiar subtribe, preceded by T. trichiura (35.7%) and finally hookworm (8.3%). There were also co-infections of helminthiasis and intestinal protozoa among both Temuan and Temiar subtribes with rates being three times higher among the Temiar compared to Temuan. The most common co-infection was with Entamoeba histolytica/dispar/moshkovskii (n = 24; 24.5%, 16.0-33.0), followed by Giardia spp. (n = 3; 3.1%, -0.3-6.5). In Temuan, STH infection individuals were also infected with Entamoeba histolytica/dispar/moshkovskii (n = 11; 6.4%, 5.0-13.8), Cryptosporidium spp. (n = 3, 1.8%, -0.2-3.8) and Giardia spp. (n = 2, 1.2%, -0.4-2.8). In comparison, there was no Cryptosporidium spp. detected among the Temiar. However, it was interesting to note that there was an occurrence of co-infection of intestinal helminthiasis and sarcocystosis (intestinal) in a Temiar individual. The last report of sarcocystosis (muscular) among the Orang Asli was in 1978. The present study highlighted the importance of understanding the variation of infections amongst the different Orang Asli subtribes. It is vital to note these differences and use this knowledge to customise effective control measures for the various subtribes.

Strategies in infectious disease prevention and management among US-bound refugee children.

For multiple reasons, including exposure to violence or trauma, nutritional deficiencies, and an inconsistent medical infrastructure, refugee children are at an increased risk for many infectious diseases. Among these are tuberculosis, malaria, helminthic infections, and neglected tropical diseases. Our purposes are to review the US Centers for Disease Control and Prevention's pre-departure program of testing and presumptive therapy for these infections and to review the possible presentations, symptomatology, diagnostic tools, and recommended therapies, if necessary, upon arrival to the US. An understanding of these non-endemic infections, their diagnosis, and their management will improve the domestic medical exam and help to ease the transition for newly arrived immigrant children, their families, and their receiving communities.

Nutritional status of refugee children entering DeKalb County, Georgia.

This study determines the nutritional status among refugee children entering one of the largest resettlement counties in the United States and identifies differences between incoming populations. Medical records of all newly arriving pediatric refugees (0-18 years) entering DeKalb County, Georgia between October 2010 and July 2011 were reviewed. Refugee children were grouped as African, Bhutanese, or Burmese (resettling from either Thailand or Malaysia) for comparative analysis. Approximately one in five refugees were anemic or malnourished, while a quarter had stool parasites, and nearly half had dental caries. African refugees had the highest anemia but the lowest underweight prevalence (p < 0.05). Compared to Burmese resettling from Malaysia, Burmese children from Thailand had a higher prevalence of anemia, underweight, and stool parasites (p < 0.05). Clinicians should use CDC medical screening guidelines for newly arriving pediatric refugees, as well as ensure proper nutritional support and follow-up care.

Ongoing deterioration of the nutritional status of Palestinian preschool children in Gaza under the Israeli siege.

This cross-sectional, community-based, household survey was carried out in Gaza City, Palestine during the first half of 2009 to study the nutritional status of Palestinian preschool children aged 2-5 years under blockade. The response rate was 95.2% from a total sample of 770. The majority (94.4%) of households faced difficulties accessing food, the main cause was the siege and the shortage of food products; and the majority (85.5%) were food insecure households. Just over 50% of the preschoolers were anaemic, 26.8% of those who had a stool test had parasitic infections, and 15.0 were stunted. Food insecurity was the first predictor of stunting andd underweight, and malnutrition indicators indicate the worst situation in the Gaza Strip for several decades.

[Prevalence of intestinal parasites in the Maxakali indigenous community in Minas Gerais, Brazil, 2009]. / Prevalência de parasitos intestinais na comunidade indígena Maxakali, Minas Gerais, Brasil, 2009.

A prevalence survey using the TF-Test technique to identify intestinal parasites was conducted in the Maxakali indigenous villages in Minas Gerais State, Brazil. Stool samples were collected on three alternating days, in separate tubes, containing 10% formalin, and unified in a laboratory by double filtering centrifugation. Samples of sediment aliquot were prepared in triplicate and examined by microscope (10x and 40x) for eggs, cysts, and larvae. Prevalence of parasites (89.5%) and polyparasitism (46%) were similar by sex and age, but varied by village. Prevalent species were: Entamoeba histolytica/Entamoeba dispar (48.9%), Giardia duodenalis (32%), Entamoeba coli (40.8%), Endolimax nana (10.3%), hookworms (37.9%), Schistosoma mansoni (23.7%), Hymenolepis nana (18.6%), Strongyloides stercoralis (5.4%), Ascaris lumbricoides (4.9%), and Trichuris trichiura (0.5%). The Maxakali population lives in socially vulnerable conditions, and government agencies need to introduce measures to improve sanitation infrastructure and health education.

Prevalência de parasitos intestinais na comunidade indígena Maxakali, Minas Gerais, Brasil, 2009 / Prevalence of intestinal parasites in the Maxakali indigenous community in Minas Gerais, Brazil, 2009 / Prevalencia de parásitos intestinales en la comunidad indígena Maxakali, Minas Gerais, Brasil, 2009

A prevalence survey using the TF-Test technique to identify intestinal parasites was conducted in the Maxakali indigenous villages in Minas Gerais State, Brazil. Stool samples were collected on three alternating days, in separate tubes, containing 10% formalin, and unified in a laboratory by double filtering centrifugation. Samples of sediment aliquot were prepared in triplicate and examined by microscope (10x and 40x) for eggs, cysts, and larvae. Prevalence of parasites (89.5%) and polyparasitism (46%) were similar by sex and age, but varied by village. Prevalent species were: Entamoeba histolytica/Entamoeba dispar (48.9%), Giardia duodenalis (32%), Entamoeba coli (40.8%), Endolimax nana (10.3%), hookworms (37.9%), Schistosoma mansoni (23.7%), Hymenolepis nana (18.6%), Strongyloides stercoralis (5.4%), Ascaris lumbricoides (4.9%), and Trichuris trichiura (0.5%). The Maxakali population lives in socially vulnerable conditions, and government agencies need to introduce measures to improve sanitation infrastructure and health education.

O objetivo deste estudo foi determinar a prevalência de parasitos intestinais na etnia Maxakali em Minas Gerais, Brasil. Os exames parasitológico das fezes foram realizados através da técnica TF-Test, sendo as amostras fecais coletadas em três dias alternados, em tubos independentes, contendo formol a 10%, unificados para dupla filtragem por centrifugação. Triplicatas de uma alíquota do sedimento foram examinadas em microscópio (10x e 40x) para identificação de ovos, cistos e larvas. A prevalência de parasitos (89,5%) e do poliparasitismo (46%) foi semelhante quanto ao sexo e idade, e variou entre as aldeias. As espécies prevalentes foram: Entamoeba histolytica/Entamoeba dispar (48,9%), Giardia duodenalis (32%), Entamoeba coli (40,8%), Endolimax nana (10,3%), ancilostomídeos (37,9%), Schistosoma mansoni (23,7%), Hymenolepis nana (18,6%), Strongyloides stercoralis (5,4%), Ascaris lumbricoides (4,9%) e Trichuris trichiura (0,5%). Os Maxakali vivem em condições de vulnerabilidade social, e medidas de infraestrutura e de educação em saúde necessitam ser implementadas pelas instituições governamentais.

El objetivo de este estudio fue determinar la prevalencia de parásitos intestinales en la etnia Maxakali. Los exámenes parasitológicos de las heces se realizaron a través de la técnica TF-Test, las muestras fecales se recogieron en tres días alternados, en tubos independientes, conteniendo formol a un 10%, unificados para un doble filtrado por centrifugación. Triplicados de una alícuota del sedimento se examinaron en microscopio (10x y 40x) para la identificación de huevos, quistes y larvas. La prevalencia de parásitos (89,5%) y del poliparasitismo (46%) fue semejante en cuanto al sexo y edad, y varió entre las aldeas. Las especies prevalentes fueron: Entamoeba histolytica/Entamoeba dispar (48,9%), Giardia duodenalis (32%), Entamoeba coli (40,8%), Endolimax nana (10,3%), ancilostomídeos (37,9%), Schistosoma mansoni (23,7%), Hymenolepis nana (18,6%), Strongyloides stercoralis (5,4%), Ascaris lumbricoides (4,9%) y Trichuris trichiura (0,5%). Los Maxakali viven en condiciones de vulnerabilidad social, y medidas de infraestructura y de educación en salud necesitan ser implementadas por instituciones gubernamentales.