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Blastocystosis amongst the Orang Asli (Aborigine) Schoolchildren of Pos Kuala Mu, Sungai Siput, Perak, Malaysia
Blastosistosis dalam kalangan Kanak-kanak Sekolah Orang Asli di Pos Kuala Mu, Sungai Siput, Perak, Malaysia
MOHAMED KAMEL, A. G., LAU SUE YING, NG KIM TIEN, YASODHA ANNE & TEOH SOO PENG
ABSTRACT
Blastocystis hominis is among the protozoa that is commonly found in the human fecal throughout the world. The prevalence of infection is higher among people living in developing countries than developed countries. This study was conducted to determine the prevalence of blastocystosis among the Orang Asli schoolchildren of Pos Kuala Mu, in the state of Perak. Ninety nine aboriginal schoolchildren from Sekolah Kebangsaan Pos Kuala Mu, Sungai Siput, Perak participated in this study. The children were divided according to gender and age groups. Fecal samples were collected and examined for the presence of Blastocystis spp. using the direct fecal smear technique. The overall prevalence of Blastocystis spp. infection among Orang Asli schoolchildren was 16.2%. The infection was higher in females (21.8%) compared to males (9.1%) (p < 0.05) but in terms of age, there was no significant difference between children from lower primary school, aged 7<10 years (18.6%) compared to those in higher primary school, aged between 10-12 years (14.3%) (p > 0.05). The prevalence of blastocystosis indicates that it is still a significant health issue in Malaysia especially among the children of the aboriginal community. This study recommends increasing the health awareness of the Orang Asli community by organizing health talks especially on the aspect of personal hygiene and sanitation.
Keywords: Blastocystis hominis, Orang Asli (aborigine), Schoolchildren, Malaysia
ABSTRAK
Blastocystis hominis adalah di antara protozoa yang sering ditemui di dalam sampel feses manusia di serata dunia.
Prevalens infeksi lebih tinggi dalam kalangan orang yang tinggal di negara membangun berbanding negara maju.
Kajian ini dijalankan untuk menentukan prevalens blastosistosis dalam kalangan kana-kanak sekolah Orang Asli di Pos Kuala Mu, di Perak. Sembilan puluh sembilan kanak-kanak sekolah Orang Asli di Sekolah Kebangsaan Pos Kuala Mu, Sungai Siput, Perak menyertai kajian ini. Kanak-kanak dibahagikan mengikut kumpulan umur dan jantina. Sampel feses dikumpul dan diperiksa untuk kehadiran Blastocystis spp. menggunakan teknik apusan langsung feses. Prevalens keseluruhan jangkitan Blastocystis spp. dalam kalangan kanak-kanak sekolah Orang Asli ini adalah 16.2%. Jangkitan didapati lebih tinggi dalam kalangan kanak-kanak perempuan (21.8%) berbanding lelaki (9.1%) (p < 0.05) tetapi dari segi umur, tiada perbezaan signifikan (p > 0.05) di antara kanak-kanak kelas rendah berusia 7<10 tahun (18.6%) berbanding kelas tinggi berusia antara10-12 tahun (14.3%). Prevalens blastosistosis ini menunjukkan ia masih menjadi isu kesihatan yang signifikan di Malaysia khasnya dalam kalangan kanak-kanak komuniti Orang Asli. Kajian ini mengesyorkan peningkatan kesedaran kesihatan dalam kalangan komuniti Orang Asli melalui penganjuran ceramah kesihatan terutamanya mengenai aspek higen dan sanitasi.
Kata kunci: Blastocystis hominis, Orang Asli, Kanak-kanak sekolah, Malaysia
INTRODUCTION
Parasitic infections, caused by protozoan parasites, are among the most prevalent infections in humans in developing countries. For over 50 years, Blastocystis hominis has been held to be a harmless intestinal yeast;
probably frequent in stool samples from man and other primates, but usually ignored until recently, when its status as a protozoan parasite has been accepted. It is now increasingly recognized as an agent of intestinal
disease, usually self-limiting but occasionally causing severe diarrhea.
The Orang Asli (aborigines) of Malaysia, frequently face these parasitic infections probably due to low socioeconomic status, poor environmental sanitation and poor personal hygiene. Intestinal parasites including Blastocystis spp. are transmitted by fecal-oral route and the infections can be severe if left untreated and if the immune system is weak (Idris et al.
2010). In Malaysia, intestinal protozoan infection is
endemic among indigenous communities (Orang Asli) in rural areas, especially among children. Although the social infrastructure in Malaysia has, in general, reached a commendable level ever since after independence, there are still local communities, especially the Orang Asli (aborigines) that have not benefited from adequate social infrastructure facilities.
Aboriginal children are particularly susceptible and typically have the largest number of intestinal infections compared to adults. Previous study has demonstrated that infections caused by intestinal parasites are still prevalent among aboriginal children with 87.4% were positive for one or more parasites, with children aged 7 to 9 years old appeared to be the most significantly infected (Hartini et al. 2013).
Blastocystis hominis infection was also inflicted in 30.6% of that study population. Nevertheless, there is still limited information with regards to the occurrence, prevalence and geographical distribution of blastocystosis in Malaysia. Pos Kuala Mu is an Orang Asli settlement located about 75 km from the town of Sungai Siput in the state of Perak. Very few studies or health surveys if any, has been conducted there.
Therefore this study was conducted to evaluate the prevalence of Blastocystis hominis infection amongst the aboriginal school children of Sekolah Kebangsaan Pos Kuala Mu, Sungai Siput, Perak.
MATERIALS & METHODS
SUBJECT AND STUDY AREA
A cross-sectional study was conducted at Sekolah Kebangsaan Pos Kuala Mu, a primary school near Sungai Siput, in the state of Perak, in February 2009.
The students were mostly from the nearby villages and
most of their parents worked as plant collectors from the forest or earned a living by selling forest products.
The community of this little village of Kuala Mu, is comprised of three Orang Asli main tribes comprising the Negritos, Semai and Orang Asli Melayu. Pos Kuala Mu is located about 75 km from the town of Sungai Siput in the state of Perak. In this study, students aged from 7 to 12 years old were recruited as study subjects.
After an informed consent was obtained, plastic containers for collection of fecal samples were distributed to the students. Each container was labelled with the student’s name and class number. The fecal samples were collected and immediately screened upon arrival at the laboratory.
FECAL EXAMINATION
The stool samples were examined for the presence of Blastocystis hominis using the direct fecal smear technique. Only a single stool specimen was collected from each individual student.
RESULTS
A total of 99 stool samples were obtained from the aboriginal students, of which 44 (44.4%) were from male students and 55 (55.5%) from female students.
The samples were also divided into two age groups comprising the lower primary school students (age 7
< 10 years old) and higher primary school students (10-12 years old). There were 43 (43.4%) students in the lower primary school and 56 (56.5%) in the higher primary school classes. Table 1 shows that out of 99 stool samples collected, 16 (16.2%) are positive for Blastocystis hominis.
TABLE 1 Overall prevalence of Blastocystosis at SK Pos Kuala Mu
No. of Student Examined
No. of Positive
samples Prevalence/%
Blastocystis hominis 99 16 16.2
As shown in Table 2, the prevalence of blastocystosis is higher (p < 0.05) among the female students (21.8%) as compared to the male students (9.1%). In terms of age groups, there is a slightly higher
rate of infection, though not significant (p > 0.05) in those who are in lower primary school (18.6%) than those who are in higher primary school (14.3%), as shown in Table 3.
TABLE 2 Prevalence of Blastocystosis according to Gender
Male Female N = 44 (%) N = 55 (%) Blastocystosis 4 (9.1) 12 (21.8)
TABLE 3 Prevalence of Blastocystosis according to Age
DISCUSSION
Parasitic infections can cause a tremendous burden of disease in both the tropics and subtropics as well as in temperate climates. The most common intestinal parasites found in human is Blastocystis spp. This study revealed that 16.2% of the aboriginal schoolchildren had Blastocystis spp. in their feces. This result was similar to Kalimuthu et al. (2016), among schoolchildren across the Peninsular Malaysia which showed an overall prevalence of 10.6%. They also found that the highest prevalence rate was evident in rural area (13.7%) whereas the urban area had 7.2%. A study done by Tengku et al. (2013), in Negeri Sembilan, Perak and Pahang, had a prevalence of 20.4%. This is a huge difference compared to our previous study (Mohamed Kamel & Hartini 2011) conducted among the Orang Asli children at Pos Lenjang, Pahang which showed very high prevalence of blastocystosis at 93%. Our more recent study (Mohamed Nur Adli & Mohamed Kamel 2020) at Kuala Kubu Bharu also showed a high prevalence of 83.7%. Another study by Hartini et al. 2013, conducted among the Orang Asli children at Pos Rual, Kelantan also found high prevalence of blastocystosis at 30.6%.
Our study at Pos Senderut (Mohamed Kamel & Faten Najah 2021) also showed a high prevalence of 32.7%.
Although our current study showed a much lower rate of infection compared to previous studies, Blastocytstis hominis remained to be the most common parasite to be isolated. A possible reason for this finding may be because of the global distribution of Blastocystis in human and animal in the world as well as failure to observe good hygienic practice. Although the role of Blastocystis hominis in human disease is often referred to as controversial, a systematic survey of research studies conducted by 11 infectious disease specialists from nine countries, found that over 95 percent of papers published in the last 10 years
identified it as causing illness
in immunocompetent individuals (Boorom et al. 2008).
Our current result showed higher rate of infection in female students compared to male students (21.8%
and 9.1% respectively), similar to our previous studies conducted at Pos Lenjang (Mohamed Kamel & Hartini
2011), Pos Senderut (Mohamed Kamel & Faten Najah 2021) and Kuala Kubu Bahru (Mohamed Nur Adli &
Mohamed Kamel 2020). This is also in line with a previous study (Tengku et al. 2013) where the majority infected were females (21.7%) compared to males (18.7%). Another study done by Nabilah et al. (2017), showed that there wasn’t any significant differences in the infection rate between males (40.8%) and females (40.6%).
This study also demonstrated a higher rate of blastocystosis in students aged 7<10 years old (18.6%) compared to 10-12 years old (14.3%). This was comparable with our previous studies done at Kuala Kubu Bharu (Mohamed Nur Adli & Mohamed Kamel 2020) and Pos Sungai Rual (Hartini et al. 2013) where the infection rate was higher for children aged 7 to 9 years old. These results also coincide with another study done in Thailand (Rapeeporn et al. 2006) where 26% of the children infected with Blastocystis spp.
were at the age of 8 - 9 years old compared to children at the age of 12-13 years old (22%). In contrast, a study in Thailand (Duangnate et al. 2015) showed that adult aged >20 years had a higher (26.9%) rate of infection compared to children < 10 years old (13.5%) but this was most likely due to a much smaller sample size of adults (n=26) compared to children (n= 182). Children tend to be at higher risk of getting infected with Blastocystis spp. because of their risky behaviour as they are actively spending more time outside the house.
Therefore, they are prone to get intestinal infection especially when playing in contaminated areas. Their exposure to outside world is more than younger children as younger children are usually under constant supervision by their parents and spent more time indoors. Other factors such as poor personal hygiene and eating raw food were observed among the aboriginal students due to the lack of knowledge about health and hygiene practices.
In our study, only a single stool specimen was taken from every participant. Had more than one specimens were taken, the detection rate would have increased. Furthermore, only the direct fecal smear technique was employed in this study. A more sensitive technique such as the formalin-ether concentration, trichrome staining, in-vitro culture or molecular
Age No. of student
examined
No. of positive
cases Prevalence/%
Lower primary school
(7<10 yrs.) 43 8 18.6
Higher primary school (10-12 yrs.) 56 8 14.3
Total 99 16 16.2
techniques were not employed in this study due to the insufficient amount of stool samples available as only a single specimen was collected from each participant.
Furthermore, those techniques are also more expensive and time consuming to perform.
Our findings have provided baseline data for the authority to define and promote strategic plans in reducing parasitic infections amongst the Orang Asli.
Besides providing basic facilities, health education, campaigns should be activated and expanded for all regardless of age in order to nurture the community about health awareness.
CONCLUSION
The prevalence of Blastocystis spp. amongst the aboriginal schoolchildren is still high, indicating that these children are still exposed to the many risk factors that influence the spread of the protozoa via fecal-oral route. Therefore, in order to control the infection, it is necessary to promote health awareness and good hygiene practices especially among schoolchildren.
ACKNOWLEDGEMENT
We wish to thank the headmaster and all teachers of Sekolah Kebangsaan Pos Kuala Mu, Sungai Siput, Perak for supporting us in this study. Our gratitudes also go to Associate Prof. Dr. Hidayatulfathi, our scientific officer, laboratory technicians and all MSc students (Infectious disease module) batch 2008/2009 for their support and technical assistance.
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Lau Sue Ying Ng Kim Tien Yasodha Anne Teoh Soo Peng
Biomedical Science Program Faculty of Health Science Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz
50300 Wilayah Persekutuan Kuala Lumpur, Malaysia
Mohamed Kamel, A. G.
Center for Diagnostic, Therapeutic and Investigative Studies Faculty of Health Science
Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz
50300 Wilayah Persekutuan Kuala Lumpur Malaysia
Corresponding author: Mohamed Kamel, A. G.
E-mail: profkamel@ukm.edu.my, mohamedkamela@yahoo.com Tel: 03-92897634
Fax: 03-26929032
Received: 27 July 2021 Revised: 9 August 2021
Accepted for publication: 23 September 2021
