Buletin SK 4(1)(2020): 9-12 ISSN 2250-1852
Trichuriasis in Aboriginal School Children at Kuala Kubu Bharu, Selangor
NORADILAH SA, MOHAMED KAMEL AG, ROBIAH M & FADLUL AZIM FMABSTRACT
Trichuris trichiura is the most common soil-transmitted helminth affecting communities of the tropical regions.
Living in places with lack of hygienic lifestyle, the aborigines were reported to have the highest prevalence of trichuriasis especially among children. A total of 159 aboriginal school children from a semi urban area in Kuala Kubu Bharu, Selangor were recruited in this study. Stool specimens collected from the school children were examined for Trichuris trichiura ova using direct stool smear and formalin-ether concentration technique. Trichuriasis is prevalent among the aboriginal school children (44.0%). The aboriginal school children aged 9 years old showed the highest prevalence of infection at 63.2%. There were no significant differences in the prevalence of trichuriasis according to gender between male (44.9%) and female students (43.3. From this study, it was found that despite living in a semi urban area with better sanitation and hygiene at school, trichuriasis was still prevalent among the aboriginal school children in Kuala Kubu Bharu.
Keywords: Trichuris trichiura; aboriginal school children, semi urban INTRODUCTION
Trichuris trichiura is one of the most common cause of intestinal helminthiasis in man. Light or moderate trichuriasis causes morbidity through nutritional and cognitive impairment (Shield et al.
2015). The whipworm infection causes chronic abdominal pain, diarrhoea, weight loss and others (Sunkara et al. 2018). In chronic trichuriasis, rectal prolapse, severe anaemia, physical growth retardation and delayed or impaired cognitive development usually occurs among the infected individuals (Sipayung et al. 2016). High prevalence rate has been associated with poverty, lack of treated water supply, poor environmental conditions and poor waste disposal. Being commonly reported in the tropical countries, rural communities are at high risk to contract such infection. In Malaysia, the prevalence rate is high among children of the disadvantaged communities especially the aborigines (Sinniah et al. 2012). Although studies across regions in Malaysia reported a decline in geohelminths infection over the years, the exact status of Trichuris trichiura infection especially among the aboriginal children living in a semi urban area is yet to be reported.
MATERIALS AND METHODS Subjects and study area
A cross-sectional study was performed at an aboriginal primary school at Kuala Kubu Bharu, in 2011 among the 159 students aged 7-12 years old.
The study area and study subjects have been described elsewhere (Noradilah et al. 2019). Stool containers were distributed to the students after obtainment of informed consent.
Stool examination
All stools collected were subjected to direct stool smear and formalin-ether concentration technique.
RESULTS
Trichuris trichuria was positive in 70 (44.0%) aboriginal school children. The aboriginal school children aged 9 years old showed the highest rate of Trichuris trichiura infection (63.2%; 12/19), followed by students aged 10 years old (60%;
15/25), 11 years old (52.4%; 11/21), 8 years old (50.0%; 13/26), 12 years old (29.2%; 7/24) and 7 years old (27.3%; 12/44).Of all the school children participated in this study, female students showed higher prevalence of trichuriasis (24.5%; 39/159) as compared to the male students (19.5%; 31/159).
10
TABLE 1 : Trichuriasis among the aboriginal school children at Kuala Kubu Bharu, Selangor according to age Participants age Number of samples Number of positive Prevalence (%) (years) examined samples
7 44 12 27.3
8 26 13 50.0
9 19 12 63.2 10 25 15 60.0
11 21 11 52.4
12 24 7 29.2
TABLE 2 : Prevalence of Trichuris trichiura infection among the aboriginal school children at Kuala Kubu Bharu, Selangor according to gender
Gender Number of examined Number of positive Prevalence (%) samples samples
Males 69 31 44.9
Females 90 39 43.3
DISCUSSION
Trichuriasis is an important intestinal geohelminthic infection which is related to lack of hygiene and unsanitary environmental condition (Mohd- Shaharuddin et al. 2019). Although the prevalence of geohelminths have declined in Malaysia, it is still a problem especially among the rural communities with poverty and having unhygienic lifestyle especially the aborigines (Anuar et al. 2014).
Trichuriasis was reported to be age-dependant where the infection declines with age. School-aged children had higher rates of infection (Anuar et al 2014; Mengistu et al. 2007). This was also evidenced by the result of this study, where trichuriasis was still prevalent among the aborigines, particularly the children. The prevalence rates of trichuriasis in the current study (44.0%) was in agreement with previous studies performed in Malaysia which ranged from 26% to 98.2%
(Hanjeet et al. 1991; Kan & Poon 1987). The high prevalence of trichuriasis in various studies was suggested to be due to the resistance towards anthelminthic drugs (Norhayati et al. 1998;
Rajeswary et al. 1994).
It is interesting to note that, although the aboriginal school children in this study went to a
semi urban school which was equipped with good sanitation with proper toilets, treated tap water and clean school environment, the infection rates were still relatively high. It was postulated that the aboriginal school children may have contracted the infection while they went back to their home during school holidays. Unfortunately, this study did not collect stool samples from the aboriginal community living nearby the school where the school children stayed during the school holidays.
Observations were made by Anuar et al. (2014) where young children usually played in groups outside the houses and ate unwashed vegetables and fruits which may have been contaminated with soil.
Children were more prone to practise open defaecation and played in the areas where stool were dispersed.
In terms of gender, there were contradictory findings where some studies reported higher prevalence of trichuriasis in females in comparison to male (Tefera et al. 2017; Sharif et al. 2010;
Ngrenngarmlert et al. 2007) while others reported the opposite finding (Ginandjar & Saraswati 2017;
Nasiri et al. 2009; Quihui et al. 2006). Several studies reported no gender predilection for trichuriasis (Anuar et al. 2014). In this study, trichuriasis showed no gender predilection as the
11
prevalences in male as well as female students were almost equal. The female students may have spent more time during the school holidays at their houses and perform daily activities such as washing, cleaning and other activities than the male students.
Routine domestic activities among the aborigines are usually associated with the environment; the aborigines usually go to the river or wells to wash clothing, collect water for cooking and others, as well as collecting herbs and vegetables. Because of the exposure towards the sources of infection in the environment including the area around their houses, both male and female students in this study are equally exposed.
Provision of improved or treated water supply, proper disposal of excreta, and health education regarding open defaecation and personal hygiene should be provided (Campbell et al. 2016).
Implementation of a continuous and long-term efforts towards better sanitation and safe water supply are hoped to reduce the prevalence of trichuriasis within the aboriginal children and community.
CONCLUSION
This study concluded that the prevalence of Trichuris trichiura infection is still moderately high among the aboriginal school children. Despite living in a semi urban area with better facilities, the school children still have the high risk to contract trichuriasis. A systematic and long-term strategies targeted at the community level should be applied to reduce the prevalence of trichuriasis among the aboriginal school children in Malaysia.
ACKNOWLEDGEMENT
This study was supported by the Universiti Sains Islam Malaysia (USIM), Research Grant Code : PPP/PSK-1-15011. We thank the headmaster of the school, Pn. Rosidah binti Mohamed Ahyar, teachers and school children from SK Tun Abdul Razak, Kuala Kubu Bharu, Selangor for their great support and assistance during our field work.
REFERENCES
Anuar, T. S., Salleh, F. M., & Moktar, N. (2014). Soil- transmitted helminth infections and associated risk factors in three Orang Asli tribes in
Peninsular Malaysia. Scientific Reports, 4(1), 1- 7.
Campbell, S. J., Nery, S. V., McCarthy, J. S., Gray, D. J., Magalhães, R. J. S., & Clements, A. C. (2016).
A critical appraisal of control strategies for soil- transmitted helminths. Trends in Parasitology, 32(2), 97-107.
Ginandjar, P., & Saraswati, L. D. (2017). Soil- Transmitted Helminth Infection in Elementary School Children: An Integrated Environment and Behavior Case Study in Bandungan Sub- District, Semarang District. Advanced Science Letters, 23(4), 3565-3568.
Hanjeet, K., Lai, K. P. F., Mathias, R. G., & OwYang, C.
K. (1991). Soil-transmitted helminthiases in squatter populations around Kuala Lumpur by ethic distribution. Tropical Biomedicine. 8, 33–
37.
Kan, S. P., & Poon, G. K. (1987). Prevalence, distribution and intensity of soil-transmitted helminthiases among Malaysian children. Public Health. 101, 243–251.
Mengistu, A., Gebre-Selassie, S., & Kassa, T. (2007).
Prevalence of intestinal parasitic infections among urban dwellers in southwest Ethiopia. Ethiopian Journal of Health Development, 21(1),12–17.
Mohd-Shaharuddin, N., Lim, Y.A.L., Hassan, N., Nathan, S., & Ngui, R. (2019). Molecular characterization of Trichuris species isolated from humans, dogs and cats in a rural community in Peninsular Malaysia. Acta Tropica, 269-272.
Nasiri, V., Esmailnia, K., Karim, G., Nasir, M., &
Akhavan, O. (2009). Intestinal parasitic infections among inhabitants of Karaj city, Tehran province, Iran in 2006–2008. Korean Journal of Parasitology, 47(3), 265–268.
Ngrenngarmlert, W, Lamom, C., Pasuralertsakul, S., Yaicharoen, R., Wongjindanon, N., Sripochang, S., Suwajeejarun, T., Sermsart, B., &
Kiatfuengfoo, R. (2007). Intestinal parasitic infections among school children in Thailand.
Tropical Biomedicine, 24, 83–88.
Noradilah, S.A., Mohamed Kaeml, A.G., Zatul-‘Iffah, A.H., Robiah, M., & Fadlul Azim, F.M. (2019).
Ascariasis among Orang Asli school children at Kuala Kubu Bharu, Selangor. Buletin Sains Kesihatan, 3(1),18-21.
Norhayati, M., Peggabean, M., Oothuman, P., & Fatmah, M. S. (1998). Prevalence and some risk factors of Giardia duodenalis infection in rural communities in Malaysia. Southeast Asian Journal of Tropical Medicine and Public Health, 29, 735–738.
12
Quihui, L., Valencia, M.E., Crompton, D.W., Phillips, S., Hagan, P., Morales, G., & Diaz-Camacho, S.P.
(2006). Role of the employment status and education of mothers in the prevalence of intestinal parasitic infections in Mexican rural schoolchildren. BMC Public Health, 6, 225–
232.
Rajeswary, B., Sinniah, B. & Hasnah, H. (1994).
Socioeconomic factors associated with intestinal parasites among children living in Gombak, Malaysia. Asia Pacific Journal of Public Health, 7, 21–25.
Sharif, M., Daryani, A., Asgarian, F., & Nasrolahei, M.
(2010). Intestinal parasitic infections among intellectual disability children in rehabilitation centers of northern Iran. Research in Developmental Disabilities, 31, 924–928.
Shield, J., Aland, K., Kearns, T., Gongdjalk, G., Holt, D., Currie, B., & Prociv, P. (2015). Intestinal parasites of children and adults in a remote Aboriginal community of the Northern Territory, Australia, 1994-1996. Western Pacific Surveillance and Response Journal, 6(1), 44.
Sinniah, B., Sabaridah, I., Soe, M.M., Sabitha, P., Awang, I.P.R., Ong, G.P., & Hassan, A.K.R.
(2012). Determining the prevalence of intestinal parasites in three Orang Asli (Aborigines) communities in Perak, Malaysia. Tropical Biomedicine, 29(2), 200–206.
Sipayung, N. P., Arrasyid, N., & Pasaribu, A. P. (2016).
Comparison of Hemoglobin Concentration Before and After Trichuriasis Treatment with Albendazole among Primary School Children. Indonesian Journal of Medicine, 1(3), 201-208.
Sunkara, T., Sharma, S.R., & Ofosu, A. (2018). Trichuris trichiura-An unwelcome surprise during colonoscopy. American Journal of Tropical Medicine And Hygiene, 99(3),555-556.
Tefera, E., Belay, T., Mekonnen, S. K., Zeynudin, A., &
Belachew, T. (2017). Prevalence and intensity of soil transmitted helminths among school children of Mendera Elementary School, Jimma, Southwest Ethiopia. The Pan African Medical Journal, 27.
NORADILAH SA*
ROBIAH M
FADLUL AZIM FM
Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia,
55100, Pandan Indah, Kuala Lumpur
MOHAMED KAMEL AG Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Jalan Raja Muda,
Kuala Lumpur
*Corresponding author: [email protected]; [email protected]
