Buletin SK 6(1)(2022): 39 – 42 ISSN 2250-1852
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Copyright © 2022 Faculty of Health Science UKM. All right reserved Artikel Asli/Original Article
Giardiasis amongst the Orang Asli (Aborigine) Schoolchildren of Pos Kuala Mu, Sungai Siput, Perak, Malaysia
Giardiasis dalam kalangan Pelajar Sekolah Orang Asli Pos Kuala Mu, Sungai Siput, Perak, Malaysia
MOHAMED KAMEL, A. G., LAU SUE YING, NG KIM TIEN, YASODHA ANNE
& TEOH SOO PENG
ABSTRACT
Giardia intestinalis is among the protozoa commonly found in human faecal samples throughout the world. The prevalence of infection is higher among people living in developing countries than in developed countries. This study was conducted to determine the prevalence of giardiasis 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. Faecal samples were collected and examined for Giardia intestinalis using the direct faecal smear technique. The overall prevalence of Giardia intestinalis infection among Orang Asli schoolchildren was 8.1%. The infection rate was 7.3% in females and 9.1% for males but in terms of age, those in higher primary school, aged between 10-12 years had a significantly higher rate of 12.5%, compared to children from lower primary school, aged 7<10 years with only 2.3%. Giardiasis is still a significant health issue in Malaysia, especially among children of the aboriginal community. This study recommends stepping up of health awareness of the Orang Asli community by organizing health talks, especially on the aspect of personal hygiene and sanitation.
Keywords: Giardia intestinalis, Orang Asli (aborigine), Schoolchildren, Malaysia
ABSTRAK
Giardia intestinalis adalah antara protozoa yang kerap ditemui di dalam sampel feses manusia di serata dunia.
Prevalens infeksi adalah lebih tinggi dalam kalangan orang yang tinggal di negara membangun berbanding negara maju. Kajian ini telah dijalankan untuk menentukan prevalens giardiasis dalam kalangan kanak-kanak sekolah Orang Asli di Pos Kuala Mu, di negeri Perak. Sembilan puluh sembilan kanak-kanak sekolah Orang Asli daripada Sekolah Kebangsaan Pos Kuala Mu, Sungai Siput, Perak telah mengambil bahagian dalam kajian ini. Kanak-kanak tersebut dibahagikan mengikut jantina dan kumpulan umur. Sampel feses telah dikumpul dan diperiksa untuk menemukan Giardia intestinalis dengan menggunakan kaedah apusan langsung feses. Prevalens keseluruhan infeksi Giardia intestinalis dalam kalangan kanak-kanak sekolah Orang Asli ialah 8.1%. Kadar jangkitan adalah 7.3% pada kanak-kanak perempuan dan 9.1% pada kanak-kanak lelaki tetapi dari segi umur, kanak-kanak di peringkat kelas atas yang berumur antara 10-12 tahun menunujukkan kadar jangkitan lebih tinggi secara signifikan iaitu 12.5% berbanding kanak-kanak kelas bawah yang berumur 7<10 tahun dengan hanya 2.3%. Giardiasis masih merupakan masalah kesihatan yang signifikan di Malaysia terutamanya dalam kalangan kanak-kanak Orang Asli.
Kajian ini mengesyorkan peningkatan tahap kesedaran kesihatan dalam kalangan masyarakat Orang Asli dengan mengadakan ceramah-ceramah kesihatan, terutamanya berkaitan aspek higen diri dan sanitasi.
Kata kunci: Giardia intestinalis, Orang Asli, Kanak-kanak sekolah, Malaysia
INTRODUCTION
Giardiasis is the most common intestinal protozoal infection worldwide and it occurs throughout the tropical and temperate regions. Prevalence varies
between 2% and 5% in developed countries and up to 20% and 30% in developing countries (Farthing 1994). In developing countries, giardiasis is endemic and is usually considered a faecal–oral disease.
Socio-demographic factors such as poverty, poor
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personal hygiene and lack of proper sanitation have been identified as significant risk factors (Faustini et al. 2006; Naelah et al. 2011). In Malaysia, giardiasis is considered an endemic infection. The prevalence varies according to the population studied and the infection is predominantly seen in children, especially in the underprivileged community (Al- Mekhlafi et al. 2005; Mohammed et al. 2008).
In Malaysia, intestinal protozoan infection is endemic among indigenous communities (Orang Asli) in rural areas. 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 intestinal infections compared to adults. Previous study has demonstrated that infections caused by intestinal parasites are still prevalent among aboriginal children, with 87.4%
positive for one or more parasites, with children aged 7 to 9 years old appearing to be the most significantly infected (Hartini et al. 2013). 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 Giardia intestinalis infection amongst the aboriginal schoolchildren of Sekolah Kebangsaan Pos Kuala Mu, Sungai Siput, Perak.
EXPERIMENTAL 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, comprises 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 7 to 12 years old were recruited as study subjects. After an informed consent was obtained, plastic containers for collecting faecal samples were distributed to the students. Each container was labelled with the student’s name and class number. The faecal samples were collected and immediately screened upon arrival at the laboratory.
FAECAL EXAMINATION
The faecal samples were examined for Giardia intestinalis using the direct faecal smear technique.
Only a single faecal specimen was collected from each individual student.
RESULTS
A total of 99 faecal 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 (7 < 10 years old) and higher primary school students (10-12 years old). Forty-three (43.4%) students are in the lower primary school and 56 (56.5%) in the higher primary school. Table 1 shows that out of 99 faecal samples collected, 8 (8.1%) are positive for Giardia intestinalis. As shown in Table 2, the prevalence of giardiasis in female students is 7.3% and 9.1% for male students. In terms of age groups, there is a higher rate of infection in those in higher primary school (12.5%), than those in lower primary school (2.3%) as shown in Table 3.
TABLE 1 Overall Prevalence of Giardiasis at SK Pos Kuala Mu No. of Students
Examined
No. of Positive
samples Prevalence (%)
99 8 8.1
TABLE 2 Prevalence of Giardiasis according to Gender
Male Female
N = 44 (%) N = 55 (%) 4 (9.1) 4 (7.3)
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TABLE 3 Prevalence of Giardiasis according to Age Group
Age No. of students examined No. of positive cases Prevalence (%) Lower primary school
(7<10 years) 43 1 2.3
Higher primary school (10-12 years) 56 7 12.5
Total 99 8 8.1
DISCUSSION
The prevalence of giardiasis among the Orang Asli in Malaysia has remained relatively similar over the years and our study confirmed that this infection is still significant in these communities. The overall prevalence of giardiasis in this study was 8.1% and it was in agreement with previous reports from Malaysia (Hartini et al. 2013; Choy et al. 2014).
However, this prevalence rate can be considered lower than most previous reports from Malaysia (Al- Mekhlafi et al. 2005; Mohammed et al. 2008; Hartini
& Mohamed Kamel 2009; Mohamed Kamel &
Anisah Musa 2018). Giardiasis plays a significant role in causing malnutrition and stunted growth in children. Al-Mekhlafi et al. (2005) conducted a study in Selangor, Malaysia, showing a significant relationship between Giardia intestinalis infection and protein-energy malnutrition, vitamin A deficiency, and iron deficiency anaemia. The study also showed that the prevalence of Giardia intestinalis infection among children was around 24.9%.
A previous study conducted by Talal et al.
(2013), at the Orang Asli settlement of Pos Senderut in the state of Pahang, in 2008, showed a prevalence of 21.8%, but a repeat study at the same place in 2015 showed a prevalence of 34.6% (Mohamed Nur Adli & Mohamed Kamel 2020). A recent study done at Pos Titom, Pahang (Mohamed Kamel & Anisah Musa 2018) showed an infection rate of 23.4%.
However, a study done at Pos Lenjang, Pahang showed a much higher rate of Giardia infection at 43.7% (Hartini & Mohamed Kamel 2009). However, our current study showed a lower prevalence than most previous studies, which might be due to geographical location, socio-economic level, smaller sample size, or due to the study design.
Our result showed no significant difference (p>0.05) in the prevalence of infection according to gender. Males had a 9.1% prevalence as compared to females at 7.3%. This finding is also in line with our previous study conducted at Pos Sungai Rual (Hartini
& Mohamed Kamel 2009) where there was no gender predominance.
This study also demonstrated a higher prevalence of giardiasis amongst students aged 10-12 years old (12.5%) compared to than 7<10 years old. This was comparable with our previous studies done at Pos Titom, Pahang (Mohamed Kamel & Anisah Musa 2018). The infection rate was higher for school-aged children and negative among preschoolers. Children tend to be at higher risk of getting infected with Giardia intestinalis because of their risky behaviour as they are actively spending more time outside the house. Therefore, they are prone to intestinal infection especially when playing in contaminated areas. Their exposure to the outside world is more than younger children as younger children are usually under constant supervision by their parents and spend more time indoors.
In our study, only a single faecal specimen was taken from every participant. Had more than one specimens were taken, the detection rate would have increased. Furthermore, only the direct faecal smear technique was employed in this study. A more sensitive technique such as the formalin-ether concentration or trichrome staining, was not employed in this study due to the insufficient amount of faecal samples available as only a single specimen was collected from each participant.
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
Our findings highlight that giardiasis is still a public health problem in Orang Asli communities, especially amongst the schoolchildren. They are still exposed to the many risk factors that influence the
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spread of the protozoa via the fecal-oral route.
Therefore, in order to control the infection, it is necessary to promote health awareness and good hygiene practices, especially in 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 gratitude also goes to Associate Prof. Dr. Hidayatulfathi, our scientific officer, laboratory technicians and all MSc students (Infectious disease module) batch 2008/09 for their support and technical assistance.
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Mohamed Kamel, A. G.
Center for Diagnostic, Therapeutic and Investigative Studies
Faculty of Health Sciences Universiti Kebangsaan Malaysia 50300 Jalan Raja Muda Abdul Aziz Wilayah Persekutuan Kuala Lumpur Malaysia
Lau Sue Ying Ng Kim Tien Yasodha Anne Teoh Soo Peng
Biomedical Science Program Faculty of Health Sciences Universiti Kebangsaan Malaysia 50300 Jalan Raja Muda Abdul Aziz Wilayah Persekutuan Kuala Lumpur Malaysia
Corresponding Author: Mohamed Kamel, A. G.
E-mail: mohamedkamela@yahoo.com Tel: +603-92897634
Fax: +603-26929032 Received: 3 February 2022 Revised: 10 March 2022
Accepted for publication: 18 May 2022
