research article intestinal protozoal parasites in...

Research ArticleIntestinal Protozoal Parasites in DiarrhealChildren and Associated Risk Factors at Yirgalem HospitalEthiopia A Case-Control Study

Teshome Firdu1 Fufa Abunna2 and Mekonnen Girma3

1 Biology Department Madawalabu University PO Box 247 Bale Robe Ethiopia2Department of Clinical Studies Addis Ababa University PO Box 34 Bishoftu Oromia Ethiopia3Microbiology-Parasitology Unit College of Medicine and Health Sciences Hawassa University PO Box 1560 Hawassa Ethiopia

Correspondence should be addressed to Teshome Firdu firezewgmailcom

Received 30 May 2014 Revised 21 August 2014 Accepted 22 August 2014 Published 29 October 2014

Academic Editor David Carmena

Copyright copy 2014 Teshome Firdu et alThis is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

AimA case-control study was conducted to determine the prevalence of G lamblia Cryptosporidium spp and E histolyticadisparin diarrheal children at YirgalemHospital from February 2011 to August Subjects andMethodsA total of 230 children participatedin the study of which 115 (50) were cases and 115 (50) were controls A single stool sample was collected and examined by directsaline wet mount formol-ether concentration and modified Ziehl-Neelsen Results Eighty-four (3652) were positive for at leastone intestinal parasites (57 (4956) from diarrheal children and 27 (2347) out of nondiarrheal children) The prevalence of Glamblia Cryptosporidium spp and E histolyticadispar was 1565 956 and 435 in children with diarrhea and 174 521and 174 in those without it respectively Cryptosporidium spp and E histolyticadispar revealed higher infection in males (1081and 54 resp) than in females (732 and 243 resp)G lamblia infection was higher in females (2927) than inmales (811)Cryptosporidium spp infection was higher in the age groups of le4 years old (5384) Significant difference was seen between 10and 13 (769) years old Higher prevalence of E histolyticadispar was found in 5ndash9 years (8571) than le4 years old (1428)Conclusion Cryptosporidium spp E histolyticadispar and G lamblia were higher in children with diarrhea than in those withoutit

1 Introduction

Parasitic protozoa that infects intestinal tract includes Enta-moeba histolytica Giardia lamblia and Cryptosporidiumspecies the causative agents of amoebiasis giardiasis andcryptosporidiosis respectivelyThese organisms are commoncauses of diarrhea in children Asymptomatic infection is alsocommon in this population [1]

Like other developing countries the prevalence of intesti-nal parasites is widely spread in Ethiopia Among the com-mon intestinal protozoan parasites Giardia Cryptosporid-ium and helminthes like Ascaris are widely distributed[2] Reports from different parts of the country showeddifferent prevalence rates of giardiasis and cryptosporidiosisStudy conducted in pediatric diarrheal and nondiarrhealpatients in Addis Ababa Hospitals [3] proved infection of

C parvum (81) and other parasites like A lumbricoides(05) G lamblia (63) and E histolyticadispar (14)Similar study conducted inWondoGenet southern Ethiopiaalso confirmed the prevalence of G lamblia (132) andE histolyticadispar (035) [4] In addition a number ofstudies and routine diagnosis in Ethiopia pointed out thatamoebiasis is one of the most widely dispersed diseases [5]In a nationwide study of amoebiasis (in 97 communities) theoverall prevalence of E histolytica infections as measured byrate of cyst-passers in nonschool communities was 35 [6]Thus based on this point of view this study was intended todetermine the prevalence of intestinal parasites (G lambliaCryptosporidium spp and E histolyticadispar) in diarrhealchildrenwith insight to the associated risk factors at YirgalemHospital South Ethiopia

Hindawi Publishing CorporationInternational Scholarly Research NoticesVolume 2014 Article ID 357126 8 pageshttpdxdoiorg1011552014357126

2 International Scholarly Research Notices

Study area (Yirgalem)

Ethiopia

Southern Ethiopia

Sidama zone

Figure 1 Map of the study area

2 Materials and Methods

21 Description of the Study Area and StudyDesign The studywas carried out at YirgalemHospital located at 317 kilometerssouth of Addis Ababa Ethiopia The area has a latitude andlongitude of 6∘451015840N 38∘251015840E675∘N 38417∘E675 38417 andan elevation of 1776masl (Figure 1)

A case-control study design was used to determinethe infection of E histolyticadispar G lamblia and Cryp-tosporidium spp in diarrheal children and compared withnondiarrheal children The sample size was determined byconsidering the prevalence of Cryptosporidium spp frompediatric diarrheal patients which was 81 at Addis Abababy Adamu et al [3] in Ethiopia Therefore a total of 230children participated in the study of which 115 were casesand 115 were controls Children with diarrhea and abdominalproblem (discomfort) were considered as cases and childrenwithout diarrhea and abdominal discomfort as control duringthe study periodDiarrhea in this paper is defined a subjectivereport from study participantsparents as having passageof unformed stool for more than 2 or 3 times per dayChildren of both sexes of ages under 13 years were includedwhere as children greater than thirteen years old and takingantiparasite treatment were excluded from the study Thestudy population was chosen consecutively according theirarrival during study period

22 Parasitological Methods Single fecal sample from eachchild was collected with proof and tightly cupped and sterilestool cup All stool samples were labeled with childrenrsquosidentification number which was given in the sequence oftheir registration during treatment and then the resultswere combined with demographic information of childrenrsquossuch as age and sex Identification of parasites was basedon the morphology of trophozoites cysts Oocysts and ova(diagnostic stages) Each specimen was then examined bydirect saline wet-mount formol-ether concentration andalso stained by modified Ziehl-Neelsen(MZN) to detect the

Oocysts ofCryptosporidium spp [7] Structured questionnairewas utilized to collect factors possibly causing differences inprevalence of intestinal parasites such as source of drinkingwater level of education the presence of a latrine and othersocial and environmental factors

23 Statistical Analysis Statistical analysis was performedby using STATA version 9 An association between theprevalence of the parasites and the identified risk factorswas performed using the Chi-square (1205942) test Multivariatelogistic regression was also performed for factors obtainedsignificant by 1205942 test All values were considered statisticallysignificant at 119875 lt 005

3 Results

In this study 230 children were participated of which 95 werefemales and 135 were males The percentage of males was5869 of which 71 (5259) were from rural and 64 (474)from urban Similarly females account 413 of which 48(5052) were from rural and 47 (4947) from urban(Table 1)

The prevalence of intestinal parasites in case was 57(4956) and 27 (2347) in control group The majority ofthe isolates were eggs of Ascaris lumbricoides 19 (165) incases and 11 (956) in controls followed by trophozoitesand cyst stage of Giardia lamblia 18 (1565) in cases and 4(348) in controlsCryptosporidium sppOocyst11 (956) incases and 2 (174) in controls Entamoeba histolyticadisparcyst and trophozoites and ova of other helimenths (Table 2)

The overall prevalence of G lamblia Cryptosporidiumspp and E histolyticadispar across ages in cases was 31(2695) and 8 (695) in control which was significantlyhigher in cases (119875 = 00001) (Table 3)

Giardia lamblia was more prevalent in the age groupsof less than or equal to four years old 10 (4545) thanfive to nine and ten to thirteen which were 8 (3636) and4 (1818) respectively Similarly the prevalence was notsignificantly different between age groups of less than orequal to four 10 (4545) and ten to thirteen years old 4(1818) (119875 = 01027) and no significant difference wasobserved between five to nine 8 (3636) and ten to thirteen4 (1818) years old (119875 = 02468) Cryptosporidium spp wasmore prevalent in the age groups of less than or equal tofour years old 7 (5384) than in five to nine 5 (3846) butthe difference was not significant (119875 = 02196) Howeverit was significantly different when compared with ten tothirteen years old 1 (769) (119875 = 00088) and no significancedifference was seen in the age of five to nine 5 (3846) andten to thirteen 1 (769) years old (119875 = 0067) Furthermorethe prevalence of E histolyticadispar was more in the agegroup of five to nine 6 (8571) than in the age groups of lessthan or equal to four years old 1 (1428) with significancedifference (119875 = 00355) The total prevalence of G lambliaCryptosporidium spp and E histolyticadispar was compared

International Scholarly Research Notices 3

Table 1 Sociodemographic distribution of cases and controls in a study of intestinal parasites infections in diarrheal children

Category Cases (119873 = 115)no ()

Controls(119873 = 115)no ()

Totalno ()

Age (in year)le4 51 (4434) 33 (2869) 84 (3652)5ndash9 43 (3739) 49 (426) 92 (40)10ndash13 21 (1826) 33 (2869) 54 (2348)

SexMale 74 (6435) 61 (53) 135 (5869)Female 41 (3565) 54 (47) 95 (413)

ResidenceRural 64 (5565) 55 (4782) 119 (5217)Urban 51 (4434) 60 (5217) 111 (4826)

Table 2 The overall prevalence of intestinal parasites in diarrheal (cases) and nondiarrheal (controls) children

Parasites Children with diarrhea and GI problem 119899 () Children without diarrhea and GI problem 119899 () 119875 valuesProtozoan

G lamblia 18 (1565) 4 (348) 00019lowast

Cryptosporidium spp 11 (956) 2 (174) 00109lowast

E histolyticadispar 5 (435) 2 (174) 02506Helimenths

A lumbricoides 19 (165) 11 (956) 01194H nana 2 (174) 1 (087) 05616Hworm 5 (435) 3 (261) 04723T trichuria 4 (348) 4 (348) 1000S stercoralis 1 (087) 0 (0) 03172

Total 57 (4956) 27 (2347) 00000lowastlowastSignificance difference at 119875 lt 005GI Gastro intestinal

Table 3 Prevalence of G lamblia Cryptosporidium spp and E histolyticadispar in case and control groups across age

Parasites

Cases (119873 = 115) Controls (119873 = 115)Age (in year) Age (in year)

le4119899 ()

5ndash9119899 ()

10ndash13119899 ()

Total119899 ()

le4119899 ()

5ndash9119899 ()

10ndash13119899 ()

Total119899 ()

G lamblia 9 (50) 6 (3333) 3 (1667) 18 (1565) 1 (25) 2 (50) 1 (25) 4 (347)Cryptosporidium spp 7 (6363) 4 (3636) 0 11 (956) 0 1 (50) 1 (50) 2 (174)E histdispar 1 (20) 4 (80) 0 5 (435) 0 2 (100) 0 2 (174)Total 17 (5483) 14 (4516) 3 (968) 31 (2695)lowast 1 (1428) 5 (625) 2 (25) 8 (695)lowastlowastSignificance difference at 119875 lt 005

among the three age groups A significant difference wasnot seen between age groups of less than or equal to four18 (4615) and five to nine 19 (4871) (119875 = 08704) butsignificant between ten to thirteen years old 5 (1282) (119875 =00046) (Table 4)

Having animal contact and disposing waste in compoundwere significant risk factors (119875 lt 005) forG lamblia positivechildren As well no breast fed child educationschoolingand no hand washing after toilet were significant risk factors

for Cryptosporidium spp positive children (119875 lt 005) More-over improper storage of food and drinks and contact withanimal were the identified risk factors for E histolyticadisparpositive children (119875 lt 005) The associated risk factors aregiven with noted 119875 values by Chi-square (1205942) test as below(Table 5)

Values obtained significant in 1205942 test were subjected tomultivariate logistic regression for further analysis Frommultivariate analysis disposing waste in the compound was


Table 4 The combined prevalence of G lamblia Cryptosporidium spp and E histolyticadispar across age

Parasites

(119873 = 230)Age groups (in year)

le4no ()

5ndash9no ()

10ndash13no ()

Totalno ()

G lamblia 10 (4545) 8 (3636) 4 (1818) 22 (956)Cryptosporidium spp 7 (5384) 5 (3846) 1 (769) 13 (565)E histolyticadispar 1 (1428) 6 (8571) 0 (0) 7 (304)Total 18 (4615) 19 (4871) 5 (1282) 39 (1695)

Table 5 Associated risk factors for G lamblia Cryptosporidium spp and E histolyticadispar positives in cases

Risk factors Option G lamblia 119875 values Cryptosporidium spp 119875 values E histolyticadispar 119875 values

Residence Rural 10 (5556) 0928 7 (636) 0254 3 (60) 0873Urban 8 (4444) 4 (364) 2 (40)

Mothers educ Educated 8 (4444) 0297 4 (364) 0176 2 (40) 0471Illiterate 10 (5556) 7 (636) 3 (60)

Breast fed Yes 3 (1667) 0512 5 (4545) 0008lowast 0 (0) 0217No 15 (8333) 6 (5454) 5 (100)

Childs educ Schooling 9 (50) 0380 4 (364) 0002lowast 4 (80) 0231None 9 (50) 7 (636) 1 (20)

Animal contact Yes 14 (7778) 0027lowast 9 (818) 0051 5 (100) 0035lowastNo 4 (2222) 2 (182) 0

CDc Yes 15 (8823) 0079 5 (455) 0542 5 (100) 0089No 3 (1667) 3 (273) 0

PFS Yes 9 (50) 0196 4 (364) 0050 2 (40) 0003lowastNo 9 (50) 7 (636) 3 (60)

Water sourcePipe 7 (3889)

02033 (273)

02952 (40)

0381River 9 (50) 6 (5454) 3 (60)Spring 2 (1111) 2 (182) 0

DWIC Yes 6 (3333) 0007lowast 6 (545) 0892 5 (100) 0902No 12 (6667) 5 (455) 0

HWAT Yes 8 (4444) 0055 4 (364) 0031lowast 2 (40) 0226No 10 (5556) 7 (636) 3 (60)

HWWF No 11 (1642) 0100 5 (455) 0156 3 (60) 0255Yes 7 (3889) 6 (545) 2 (40)

lowastSignificance at 119875 lt 005PFS proper food storage DWIC disposing waste in compound and HWAT hand washing after toiletHWWF handwashing when feeding CDc cow dung contact Educated those who have learned at some school level and have knowledge concerning parasitesinfection

a significant risk factor for Cryptosporidium spp positivechildren (119875 = 0016) Correspondingly no proper foodstorage was a significant risk factor for E histolyticadisparpositive children (119875 = 0029) (Table 6)

4 Discussion

The overall prevalence of intestinal parasites in this studyis 84 (3652) which was higher than the one reportedfrom Quetta Hospital 31 by Ahsan-ul-Wadood et al [8] inPakistan and lower than the one reported by Fatemeh et al[9] in Iran 477 In this study infection with G lamblia

in stool samples from children is 1565 The finding wasdifferent with studies conducted in Ethiopia and other coun-tries A study in Gondar teaching hospital by Huruy et al[10] revealed 5 which is lower from this study In additionstudy from Pakistan by Adnan et al [11] revealed 103 andEjiofor et al [12] from South East Nigeria showed 101 andDarsquoas [13] reported 44 fromPalestineThis difference in thisstudy might be due to the hygienic practice or environmentalfactors and the societyrsquos awareness toward this parasite andor educational status of childrenrsquos family or better livingconditions of children among these countries On the otherhand the finding is also different from the one reported from


Table 6 Multivariate logistic regression of significant risk factors from Chi-square (1205942) test

Risk factors Options G lamblia 119875 values Cryptosporidium spp 119875 values E histolyticadispar 119875 values

Breast fed Yes 3 (1667) 0312 5 (4545) 0099 0 (0) 0896No 15 (8333) 6 (5454) 5 (100)

Childs educ Schooling 9 (50) 0271 4 (364) 0120 4 (80) 0184None 9 (50) 7 (636) 1 (20)

Animal contact Yes 14 (7778) 0422 9 (818) 0077 5 (100) 0874No 4 (2222) 2 (182) 0

PFS Yes 9 (50) 0902 4 (364) 0198 2 (40) 0029lowastNo 9 (50) 7 (636) 3 (60)

DWIC Yes 6 (3333) 0053 6 (545) 0149 5 (100) 0270No 12 (6667) 5 (455) 0


lowastSignificance difference at 119875 lt 005PFS Proper food storage HWWF hand washing when feeding DWIC disposing waste in compound CDc cow dung contact and HWAT hand washingafter toilet

Ethiopia Addis Ababa by Adamu et al [3] from pediatricdiarrheal children which was 63 and Liza et al [4] fromsouth Ethiopia Wondo Genet town which was 132 Thisindicates that this parasite is prevalent in Yirgalem area Thedifference from Liza et al [4] south Ethiopia Wondo Genettown might be due to the study participant variation whereno diarrhea was seen in these children

On the basis of age the finding is in agreement withEjiofor et al [12] study from South east Nigeria in Awkawhere high prevalence was reported in age groups of sixmonths to four years old (556) and lowers between agegroup of ten to thirteen years old (111) However itis inconsistent with the study in Guma from Nigeria byNyamngee et al [14] where higher prevalence was in the agegroup of five to nine years old (483) than in the age of lessthan or equal to four years old (187) and ten to thirteenyears old (33) The reason for this age group (less than orequal to four years old) vulnerability in this study might beexplained by milk bottles contamination or unbreast feedersand creeping on a contaminated grounds and accessing dirtymaterial (especially fecally contaminated water and soil) intotheir mouth Adnan et al [11] In addition this age groupchildren use diaper which may allow the transmission viahand to mouth contamination if not used properly

Sex-based result of this study discloses high prevalenceof G lamblia in females (2927) than in males (811)significantly (119875 = 00034) This is not supported withAl-Saeed and Issa [15] in Dohuk from Iraq where highprevalence was reported in males (416) and low in females(356) and Nyamngee et al [14] in Guma from Nigeriareported high prevalence in males (565) than in females(435) The possible reason for this finding is that femalesrsquopractical activity in Ethiopia like fetching water for theirfamily and some indoor activity The associated risk factorswere analyzed in the current study to look at the possiblesource of infection however no significant factors were seen(119875 lt 005) The prevalence of G lamblia among differentwater sources (river pipe and spring) of the study participant

reveals high infection in river water users However theprevalence was not significantly different in river water users(119875 gt 005) This may show that the entire water source in thestudy area might be the source of infection Because the cystof the parasite is not be killed by common water disinfectantsor the infection is not only restricted to water sources used

The result of this study demonstrates that the prevalenceof Cryptosporidium spp is 956 among diarrheal children atYirgalemHospitalThe figure is different more or less relativeto the prevalence of this parasite reported in other studiesconducted in several parts of Ethiopia and other countriesAdamu et al [3] studied the prevalence of intestinal parasitesin pediatric diarrheal children in Addis Ababa and showed81 of Cryptosporidium parvum in stool of children agedless than 5 years However in this studyCryptosporidium sppinfection is (956) which is higher This could be due tothe fact that the study participants in this study were under13 and also in this study all Cryptosporidium species wereconsidered as Cryptosporidium spp Furthermore variationmight be arisen from the variation of hygienic practiceperformed between the two environments Nevertheless thestudy is in agreement with reported prevalence of C parvumfrom developing countries which was 4ndash32 [16] The resultshowed that 144 of children greater than 5 years old hadCryptosporidium spp in their stool samplesThe present studyis in agreement with the finding of Mumtaz et al [17] whichwas 9 from pediatric unit of North West Pakistan andJacobsen et al [18] 89 in young children in Ecuador In thisstudyCryptosporidiumOocyst is more frequently detected inchildren less than or equal to 4 years old (5384) followedby five to nine years of old (3846) and ten to thirteenyears of old (769) with no significant difference (119875 gt005) This age based prevalence of Cryptosporidium spp isin line with Mumtaz et al [17] from Pakistan Adamu et al[3] in Ethiopia and Darsquoas [13] in Palestine Cryptosporidiumspp infection in relation to sex in this study reveals thatmales are more susceptible to infection (1081) than females(732) insignificantly (119875 = 05434) However this result is


in agreement with Mumtaz et al [17] who reported higherprevalence of infection among males (722) as comparedto female (278) children Males being more susceptible tothis infection might be attributed to the genetic variabilitywhich may require further investigation Of the analyzed riskfactors no hand washing after toilet was seen the significantrisk factor (119875 lt 005) This is in agreement with Molbak et al[19] from Guinea Bissau and Mumtaz et al [17] in PakistanPatients using river pipe and spring water for domesticpurposewere found to be infectedwith this infection 5454273 and 182 of infection respectively Infection washigher among those who use river water However thedifference among water sources and Cryptosporidium sppinfection was not seen significant statistically (119875 = 0295)which is in agreement with Darsquoas [13] The possible reasoncould be due to the ability of the Oocysts to survive thecommon sterilizing agents of water In addition the possibleexplanation for the absence of variation among the watersource in this study might be attributed to whatever watersource used the infection was not restricted to water source

In this study the prevalence of E histolyticadispar islow (435) relative to both Cryptosporidium spp (956)and G lamblia (1565) across all age groups and sex of thestudy participants This finding is higher than the findingsin Damghan from Iran by Heidari and Rokni [20] whichwas 23 This variation might be due to the differences inthe study population in which they were selected from daycare centers and in this case the majority of the subjectscould be healthy unless some asymptomatic cases mightbe presented However in this study the study populationswere children of pediatrics patients On the other handthe difference might be due to familiesrsquo awareness towardparasitic infection and the way of handling their childeconomic status and climatic condition Furthermore it isnot in linewithDawah et al [21] inKadunaMetropolis where143 of E histolyticadispar was reported The differencemight be sourced from the technique employed becausemicroscope together with ELISA technique was employed inthe study whereas this study was based on microscope onlyHowever this study coincides with Al-Harthi and Jamjoom[22] fromMakkah where the finding was 43 Furthermorethe result is different from studies conducted in differentparts of Ethiopia A study conducted by Adamu et al [3] inAddis Ababa revealed 14 prevalence and Liza et al [4] atWondo Genet showed 035 both of which were lower thanthis finding But this finding is almost in conformity withKloos and Tesfayohanis [5] study which revealed 35 fromnationwide study of amebiasis in 97 communities and theoverall prevalence of E histolytica infections as measured byrate of cyst-passers in nonschool communities

The relationship between sex and E histolyticadisparin children was assessed in this study According to theresult the infection of E histolyticadispar is more prevalentin males (54) as compared to females (243) but nosignificant difference was seen (119875 = 04557) The findingon the basis of sex in this study is not supported with thefinding of Munazza et al [23] from Pakistan where highprevalence was recorded in females (315) than in males(196) However it is in agreement with Chabalala and

Mamo [24] in Nakuru district where higher prevalencewas reported in males than in females from Kenya Malesare more susceptible than females to infections caused byparasites males generally exhibit reduced immune responsesand increased intensity of infection compared to females[25 26] These differences are usually attributed to eco-logical (sociological in humans) and physiological usuallyhormonal in origin Ecological factors include differentialexposure to pathogens because of sex-specific behavior ormorphology [27] Other proximate cause of sex differencesin infection is differences in endocrine-immune interactions[25] Sex steroid hormones also alter genes and behaviorsthat influence susceptibility and resistance to infectionThusmales may be more susceptible to infection than femalesnot only because androgens reduce immunocompetence butbecause sex steroid hormones affect disease resistance genesand behaviors that make males more susceptible to infection[25]

The relationship between age and the prevalence of Ehistolyticadispar reveals that higher prevalence is recordedamong age groups of five to nine (8571) than less than orequal to four years old (1428) with significant difference(119875 = 00355) The finding is in line with Caballero-Salcedo etal [28] study in Mexico where 11 of the tested populationaged five to nine years old was infected with amoebaHowever this finding is not supported with Munazza etal [23] from Pakistan where finding in the prevalence ofE histolyticadispar was higher among age groups of oneto five years old But this study is in line with Astal [29]who reported prevalence of E histolyticadispar from KhanYounis Government Hospital with the prevalence of 342in age group of six to eleven years old children than otherage group in Palestine The prevalence decreases with ageincrement in the present study Children in this age groupare free to play anywhere irrespective of the cleanliness ordustiness area while the younger ones are quite and protectedby their parents Playing areas are the main sources ofinfection because waste materials of homes might be thrownthere which might be the source of E histolyticadisparinfection Additionally children in these age groups areindependent in use of toilet and other activities This studyshows improper food storage as the associated risk factorfor E histolyticadispar (119875 lt 005) Having no proper foodstorage might be favorable for insectshouse flies to spreadthis parasite Adnan et al [11]

5 Conclusion

The prevalence of Cryptosporidium spp E histolyticadisparand G lamblia in children with diarrhea is higher than inthose without it The prevalence Ascaris lumbricoides washigher both in case and controls The occurrence of theparasites is associated with disposing waste in compoundimproper food and drink storageTherefore constant appro-priate health education for community and molecular typingof these protozoan isolates should be carried out


Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

Authorsrsquo Contribution

Teshome Firdu designed the study collected all stool samplesand performed all the laboratory works and was involvedin the analysis and paper preparation The original researchwas the requirement for his MSc in applied microbiologyFufa Abunna and Mekonnen Girma were his major andcoadvisors respectivelyThey were also involved in the paperpreparation and altogether authors read and approved thefinal paper

Acknowledgments

The authors would like to thank Hawassa University Yir-galem Hospital Ethiopian Ministry of Education and chil-drenrsquos parents for their kind and effective collaborationduring this work andMr Aklilu Kassaye for the edition of thispaper This research was financially supported by EthiopianMinistry of Education

References

[1] K S Ghenghesh E A Franka K A Tawil S Abeid BA Mustafa and I A Taher ldquoInfectious acute diarrhea inLibyan children causative agents clinical features treatmentand preventionrdquo Libyan Journal of Infectious Diseases vol 2 no1 pp 357ndash365 2008

[2] Berhane Epidemiology of Health andDisease in Ethiopia ShamaBooks Printing Press Uttar Pradesh India 2005

[3] H Adamu T Endeshaw T Teka A Kifle and B PetrosldquoThe prevalence of Intestinal parasites in pediatric diarrhealand non-diarrheal patients in Addis Ababa Hospitals withspecial emphasis on opportunistic parasitic infections and withinsight into the demographic and socio-economic factorsrdquoTheEthiopian Journal of Health Development vol 20 no 1 pp 45ndash52 2006

[4] A Liza L Mengistu M Belay et al ldquoIntestinal parasiticinfections among under-five children and maternal awarenessabout the infections in Shesha Kekele Wondo Genet SouthernEthiopiardquo Ethiopian Journal of Health Development vol 24 no3 pp 185ndash190 2010

[5] H Kloos and T M Tesfayohanis ldquoIntestinal parasites inEthiopiardquo inEcology ofHealth andDisease in Ethiopia H KloosEd pp 223ndash225 West View Press Oxford UK 1993

[6] B Erko H Birrie and S Tedla ldquoAmoebiasis in EthiopiardquoTropical and Geographical Medicine vol 47 no 1 pp 30ndash321995

[7] S C Parija Text Book of Practical Microbiology Ahuja Publish-ing House New Delhi India 2007

[8] Ahsan-ul-Wadood A Bari A Ur Rhman and K F QasimldquoFrequency of intestinal parasite infestation in children hospitalquettardquo Pakistan Journal of Medical Research vol 44 no 2 pp87ndash88 2005

[9] T Fatemeh N Kokab Z Asghar and S Gholamreza ldquoIntestinalparasitic infection among school children in South Khorasan

Province Iranrdquo Journal of the Royal Horticultural Society vol11 no 1 pp 45ndash50 2011

[10] K Huruy A Kassu A Mulu et al ldquoIntestinal parasitosisand shigellosis among diarrheal patients in Gondar teachinghospital northwest Ethiopiardquo BMC Research Notes vol 4article 472 2011

[11] I Adnan A Hindi and E Aboud ldquoOccurrence of gastrointesti-nal parasites among pre School children Gaza Palestinerdquo Jour-nal Islamic University (Series of Natura Studies and Engineering)vol 16 no 1 pp 125ndash130 2008

[12] O S Ejiofor N B Onyire and J A Ofomata ldquoThe prevalenceof giardia lamblia in children presenting with diarrhoea at sec-ondary health facility in Awka South-East Nigeriardquo EuropeanJournal of Scientific Research vol 57 no 4 pp 529ndash532 2011

[13] H Darsquoas ldquoPrevalence of Cryptosporidium Species AmongChildren le5 Years Old in North West-Bank PalestineCrossSectional Studyrdquo 2010

[14] A Nyamngee O M Kalowole K A Durowade and C FKalowole ldquoPrevalence of giardiasis among children in GumaRefugee camp in Guma LGA Benue state Nigeriardquo San MateoDaily Journal vol 6 no 1 pp 32ndash39 2009

[15] A T Al-Saeed and S H Issa ldquoFrequency of Giardia lambliaamong children in Dohuk northern Iraqrdquo Eastern Mediter-ranean Health Journal vol 12 no 5 pp 555ndash561 2006

[16] Y Hamedi O Safa andMHaidari ldquoCryptosporidium infectionin diarrheic children in Southeastern Iranrdquo Pediatric InfectiousDisease Journal vol 24 no 1 pp 86ndash88 2005

[17] S HMumtaz J Ahmed and L Ali ldquoFrequency of cryptosporid-ium infection in children under five years of age having diarrheain theNorthWest of PakistanrdquoAfrican Journal of Biotechnologyvol 9 no 8 pp 1230ndash1235 2010

[18] K H Jacobsen P S Ribeiro B K Quist and B V RydbeckldquoPrevalence of intestinal parasites in young Quichua childrenin the highlands of rural Ecuadorrdquo Journal of Health Populationand Nutrition vol 25 no 4 pp 399ndash405 2007

[19] K Molbak N Wested N Hojlyng et al ldquoThe etiology of earlychildhood diarrhea a community study from Guniea BissaurdquoJournal of Infectious Diseases vol 169 no 3 pp 581ndash587 1994

[20] A Heidari and M B Rokni ldquoPrevalence of intestinal parasitesamong children in day-care centers in Damghan Iranrdquo IranianJournal of Public Health vol 32 no 1 pp 31ndash34 2003

[21] I S Dawah H I Inabo and E D Jatau ldquoComparative Study ofmicroscopy with ELISA antibody based amoebiasis diagnosisin patients presenting with Dysentery at government HospitalsinKadunaMetropolisrdquoContinental Journal Biomedical Sciencesvol 4 pp 43ndash49 2010

[22] S A Al-Harthi and M B Jamjoom ldquoDiagnosis and differenti-ation of Entamoeba infection in Makkah Al Mukarramah usingmicroscopy and stool antigen detection kitsrdquo World Journal ofMedical Sciences vol 2 no 1 pp 15ndash20 2007

[23] E Munazza G Murtaza M Ahmad et al ldquoDetermination ofthe prevalence of Entamoeba histolytica in human at a privatefertilizer company hospital in Pakistan using microscopic tech-niquerdquo African Journal of Microbiology Research vol 5 no 2pp 149ndash152 2011

[24] H P Chabalala and H Mamo Prevalence of water-bornediseases within the health Facilities in Nakuru district Kenya[Dissertation submitted for the requirement of certificate inapplied epidemiology] Department of Community Health Fac-ulty of Medicine of the University of Nairobi Nairobi Kenya2001


[25] S L Klein ldquoThe effects of hormones on sex differences in infec-tion from genes to behaviorrdquo Neuroscience amp BiobehavioralReviews vol 24 no 6 pp 627ndash638 2000

[26] S L Klein ldquoHormones and mating system affect sex andspecies differences in immune function among vertebratesrdquoBehavioural Processes vol 51 no 1ndash3 pp 149ndash166 2000

[27] M Zuk and K A McKean ldquoSex differences in parasite infec-tions patterns and processesrdquo Neuroscience amp BiobehavioralReviews vol 24 pp 627ndash638 2000

[28] A Caballero-Salcedo M Viveros-Rogel B Salvatierra et alldquoSeroepidemiology of amebiasis in Mexicordquo American Journalof Tropical Medicine and Hygiene vol 50 no 4 pp 412ndash4191994

[29] Z Astal ldquoEpidemiological survey of the prevalence of parasitesamong children in Khan Younis governorate Palestinerdquo Para-sitology Research vol 94 no 6 pp 449ndash451 2004

Submit your manuscripts athttpwwwhindawicom

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Anatomy Research International

PeptidesInternational Journal of


Hindawi Publishing Corporation httpwwwhindawicom

International Journal of

Volume 2014

Zoology


Molecular Biology International

GenomicsInternational Journal of


The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014


BioinformaticsAdvances in

Marine BiologyJournal of



Signal TransductionJournal of


BioMed Research International

Evolutionary BiologyInternational Journal of



Biochemistry Research International

ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014


Genetics Research International


Advances in

Virolog y

Hindawi Publishing Corporationhttpwwwhindawicom

Nucleic AcidsJournal of

Volume 2014

Stem CellsInternational



Enzyme Research



Microbiology


Study area (Yirgalem)

Ethiopia

Southern Ethiopia

Sidama zone

Figure 1 Map of the study area

2 Materials and Methods

21 Description of the Study Area and StudyDesign The studywas carried out at YirgalemHospital located at 317 kilometerssouth of Addis Ababa Ethiopia The area has a latitude andlongitude of 6∘451015840N 38∘251015840E675∘N 38417∘E675 38417 andan elevation of 1776masl (Figure 1)

A case-control study design was used to determinethe infection of E histolyticadispar G lamblia and Cryp-tosporidium spp in diarrheal children and compared withnondiarrheal children The sample size was determined byconsidering the prevalence of Cryptosporidium spp frompediatric diarrheal patients which was 81 at Addis Abababy Adamu et al [3] in Ethiopia Therefore a total of 230children participated in the study of which 115 were casesand 115 were controls Children with diarrhea and abdominalproblem (discomfort) were considered as cases and childrenwithout diarrhea and abdominal discomfort as control duringthe study periodDiarrhea in this paper is defined a subjectivereport from study participantsparents as having passageof unformed stool for more than 2 or 3 times per dayChildren of both sexes of ages under 13 years were includedwhere as children greater than thirteen years old and takingantiparasite treatment were excluded from the study Thestudy population was chosen consecutively according theirarrival during study period

22 Parasitological Methods Single fecal sample from eachchild was collected with proof and tightly cupped and sterilestool cup All stool samples were labeled with childrenrsquosidentification number which was given in the sequence oftheir registration during treatment and then the resultswere combined with demographic information of childrenrsquossuch as age and sex Identification of parasites was basedon the morphology of trophozoites cysts Oocysts and ova(diagnostic stages) Each specimen was then examined bydirect saline wet-mount formol-ether concentration andalso stained by modified Ziehl-Neelsen(MZN) to detect the

Oocysts ofCryptosporidium spp [7] Structured questionnairewas utilized to collect factors possibly causing differences inprevalence of intestinal parasites such as source of drinkingwater level of education the presence of a latrine and othersocial and environmental factors

23 Statistical Analysis Statistical analysis was performedby using STATA version 9 An association between theprevalence of the parasites and the identified risk factorswas performed using the Chi-square (1205942) test Multivariatelogistic regression was also performed for factors obtainedsignificant by 1205942 test All values were considered statisticallysignificant at 119875 lt 005

3 Results

In this study 230 children were participated of which 95 werefemales and 135 were males The percentage of males was5869 of which 71 (5259) were from rural and 64 (474)from urban Similarly females account 413 of which 48(5052) were from rural and 47 (4947) from urban(Table 1)

The prevalence of intestinal parasites in case was 57(4956) and 27 (2347) in control group The majority ofthe isolates were eggs of Ascaris lumbricoides 19 (165) incases and 11 (956) in controls followed by trophozoitesand cyst stage of Giardia lamblia 18 (1565) in cases and 4(348) in controlsCryptosporidium sppOocyst11 (956) incases and 2 (174) in controls Entamoeba histolyticadisparcyst and trophozoites and ova of other helimenths (Table 2)

The overall prevalence of G lamblia Cryptosporidiumspp and E histolyticadispar across ages in cases was 31(2695) and 8 (695) in control which was significantlyhigher in cases (119875 = 00001) (Table 3)

Giardia lamblia was more prevalent in the age groupsof less than or equal to four years old 10 (4545) thanfive to nine and ten to thirteen which were 8 (3636) and4 (1818) respectively Similarly the prevalence was notsignificantly different between age groups of less than orequal to four 10 (4545) and ten to thirteen years old 4(1818) (119875 = 01027) and no significant difference wasobserved between five to nine 8 (3636) and ten to thirteen4 (1818) years old (119875 = 02468) Cryptosporidium spp wasmore prevalent in the age groups of less than or equal tofour years old 7 (5384) than in five to nine 5 (3846) butthe difference was not significant (119875 = 02196) Howeverit was significantly different when compared with ten tothirteen years old 1 (769) (119875 = 00088) and no significancedifference was seen in the age of five to nine 5 (3846) andten to thirteen 1 (769) years old (119875 = 0067) Furthermorethe prevalence of E histolyticadispar was more in the agegroup of five to nine 6 (8571) than in the age groups of lessthan or equal to four years old 1 (1428) with significancedifference (119875 = 00355) The total prevalence of G lambliaCryptosporidium spp and E histolyticadispar was compared




Controls(119873 = 115)no ()

Totalno ()


SexMale 74 (6435) 61 (53) 135 (5869)Female 41 (3565) 54 (47) 95 (413)




G lamblia 18 (1565) 4 (348) 00019lowast






Parasites


le4119899 ()

5ndash9119899 ()

10ndash13119899 ()

Total119899 ()

le4119899 ()

5ndash9119899 ()

10ndash13119899 ()

Total119899 ()








Parasites


le4no ()

5ndash9no ()

10ndash13no ()

Totalno ()









CDc Yes 15 (8823) 0079 5 (455) 0542 5 (100) 0089No 3 (1667) 3 (273) 0

PFS Yes 9 (50) 0196 4 (364) 0050 2 (40) 0003lowastNo 9 (50) 7 (636) 3 (60)


02033 (273)

02952 (40)

0381River 9 (50) 6 (5454) 3 (60)Spring 2 (1111) 2 (182) 0



HWWF No 11 (1642) 0100 5 (455) 0156 3 (60) 0255Yes 7 (3889) 6 (545) 2 (40)



4 Discussion






Breast fed Yes 3 (1667) 0312 5 (4545) 0099 0 (0) 0896No 15 (8333) 6 (5454) 5 (100)



PFS Yes 9 (50) 0902 4 (364) 0198 2 (40) 0029lowastNo 9 (50) 7 (636) 3 (60)

DWIC Yes 6 (3333) 0053 6 (545) 0149 5 (100) 0270No 12 (6667) 5 (455) 0














5 Conclusion







Acknowledgments


References







































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology




Controls(119873 = 115)no ()

Totalno ()


SexMale 74 (6435) 61 (53) 135 (5869)Female 41 (3565) 54 (47) 95 (413)




G lamblia 18 (1565) 4 (348) 00019lowast






Parasites


le4119899 ()

5ndash9119899 ()

10ndash13119899 ()

Total119899 ()

le4119899 ()

5ndash9119899 ()

10ndash13119899 ()

Total119899 ()








Parasites


le4no ()

5ndash9no ()

10ndash13no ()

Totalno ()









CDc Yes 15 (8823) 0079 5 (455) 0542 5 (100) 0089No 3 (1667) 3 (273) 0

PFS Yes 9 (50) 0196 4 (364) 0050 2 (40) 0003lowastNo 9 (50) 7 (636) 3 (60)


02033 (273)

02952 (40)

0381River 9 (50) 6 (5454) 3 (60)Spring 2 (1111) 2 (182) 0



HWWF No 11 (1642) 0100 5 (455) 0156 3 (60) 0255Yes 7 (3889) 6 (545) 2 (40)



4 Discussion






Breast fed Yes 3 (1667) 0312 5 (4545) 0099 0 (0) 0896No 15 (8333) 6 (5454) 5 (100)



PFS Yes 9 (50) 0902 4 (364) 0198 2 (40) 0029lowastNo 9 (50) 7 (636) 3 (60)

DWIC Yes 6 (3333) 0053 6 (545) 0149 5 (100) 0270No 12 (6667) 5 (455) 0














5 Conclusion







Acknowledgments


References







































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology



Parasites


le4no ()

5ndash9no ()

10ndash13no ()

Totalno ()









CDc Yes 15 (8823) 0079 5 (455) 0542 5 (100) 0089No 3 (1667) 3 (273) 0

PFS Yes 9 (50) 0196 4 (364) 0050 2 (40) 0003lowastNo 9 (50) 7 (636) 3 (60)


02033 (273)

02952 (40)

0381River 9 (50) 6 (5454) 3 (60)Spring 2 (1111) 2 (182) 0



HWWF No 11 (1642) 0100 5 (455) 0156 3 (60) 0255Yes 7 (3889) 6 (545) 2 (40)



4 Discussion






Breast fed Yes 3 (1667) 0312 5 (4545) 0099 0 (0) 0896No 15 (8333) 6 (5454) 5 (100)



PFS Yes 9 (50) 0902 4 (364) 0198 2 (40) 0029lowastNo 9 (50) 7 (636) 3 (60)

DWIC Yes 6 (3333) 0053 6 (545) 0149 5 (100) 0270No 12 (6667) 5 (455) 0














5 Conclusion







Acknowledgments


References







































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology




Breast fed Yes 3 (1667) 0312 5 (4545) 0099 0 (0) 0896No 15 (8333) 6 (5454) 5 (100)



PFS Yes 9 (50) 0902 4 (364) 0198 2 (40) 0029lowastNo 9 (50) 7 (636) 3 (60)

DWIC Yes 6 (3333) 0053 6 (545) 0149 5 (100) 0270No 12 (6667) 5 (455) 0














5 Conclusion







Acknowledgments


References







































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology







5 Conclusion







Acknowledgments


References







































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology






Acknowledgments


References







































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology














Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology

research article intestinal protozoal parasites in...

Documents