International Journal of Research in Medical Sciences Faraji R et al. Int J Res Med Sci. 2015 Jul;3(7):1717-1720 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012
Research Article
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150258
Prevalence of Giardiasis among children in childcare centers
in Kermanshah, Iran
Reza Faraji1, Fereshte Ahmadian2, Gholam Reza Javadi3, Parisa Mohamadi Barshahi4*
1Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2Department of Clinical Biochemistry, International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 3Shahrekord University of Medical Sciences, Shahrekord, Iran 4Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran Received: 16 May 2015 Accepted: 05 June 2015 *Correspondence: Dr. Parisa Mohamadi Barshahi, E-mail: mohamadi_parisa63@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT Background: Giardia is a common and widespread intestinal protozoan parasite which occurs in of both humans and animals. The aim of this study is determining the prevalence rate of Giardiasis in children, Kermanshah childcare centers (2012). Methods: This cross-sectional study was performed on 632 children (330 were female and 302 were male) with an average of 0-6 years in children, Kermanshah childcare centers (2012). Three stool samples were obtained on three consecutive days and were tested for the detection of trophozoites, and/or cysts, using both direct laboratory methods and Formalin-Ether concentration. Informations were collected by a questionnaire. Results: Of the 632 cases in this study, the prevalence rate of gut parasite infection was 169 (26.74%), so that Giardia lamblia with 13.93%, Entamoeba histolytica with 3.48%, and Entamoeba coli with 2.53 were the most predominant isolate. The prevalence rate ranged in rural residents (15.67%) was more than urban residents (11.07%). The age group 4-6 years had the highest rate (14.24%) and 0-2 years the lowest (1.74%); boys with 16.29% had a higher rate than girls (10.45%). Parasitic infection was more prevalent in children whose parents had no high education (17.25). The maximum percentage of infections was in August with 5.86%. Conclusion: With attention to the above findings, it seems that in order to decrease, control and prevent of parasitic infection we should have the necessary public education to teachers and parents of children. Keywords: Intestinal disease, Giardia Lamblia, Children
INTRODUCTION
Giardiasis is a gastrointestinal and zoonotic disease that caused by protozoan parasites in the genus Giardia. Giardia can infect humans, sheep, cattle, dogs, cats, beavers, rodents, nonhuman primates, and other animals. But human is the most important source for infection. The parasite has two stages in its lifecycle; the cyst and the trophozoite. Trophozoite is active form and cyst is inactive form. Giardiasis is transmitted by the fecal-oral through direct person-to person contact or indirect through ingestion of fecally contaminated water or food.1-5 Therefore anyone can
get giardiasis, but it tends to occur more often in international travelers, daycare centers, insufficient water treatment, individuals who drink improperly, treated surface water and with institutional facilities such as nursing homes.6 All age groups are affected in epidemic areas but children are infected more frequently than adults.7-9 The protozoan genus Giardia (Family Giardiidae, order Giardiida) contains at least six species that infect animals and/or humans. These species are distinguished on the basis of the morphology and ultrastructure of their trophozoite. Giardia duodenalis (syn. Giardia intestinalis and Giardia lamblia), Giardia ardeae and Giardia psittaci, Giardia
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agilis, Giardia microti and Giardia muris that in mammals and humans, birds, amphibians, rodents, respectively.10-12 Giardiasis is an important unresolved health problem in developing countries and has worldwide distribution in warm and moist climates.3,13 The incidence rate is 2%-7% in industrialized countries and 20%-60% in developing countries.3,14-16 About 200 million people in Asia, Africa, and Latin America have symptomatic giardiasis with some 500,000 new cases a year.6 It's characterized by diarrhea, abdominal cramps, bloating, weight loss, and malabsorption. The prevalence of Giardiasis has been found to vary in different parts of the Iran, with 26.2% in Damghan1, 25.8% in south of Tehran17, 49% in Varamin18, 47.2% in Kerman19, 22.4% in Shahrekord.20 According to the data, in order to manage control and preventive programs, it seems that epidemiological studies are necessary for health care personal. Therefore we decided that to determine the prevalence rate of Giardiasis in the city of Kermanshah childcare centers, in the academic year 2012.
METHODS
This cross-sectional study was carried out during a one year period from March 2012 until February 2012 on 632 children, Kermanshah childcare centers. For each person was a questionnaire. The data collection form included information such as (age, sex, parent’s education, urban or rural residents). The clinical symptoms were not seen on all of the children. Three stool samples obtained on three consecutive days from each of these patients were examined for detection of trophozoites, cysts, oocysts and ova by using both direct laboratory methods and Formalin-Ether concentration (samples were collected in a sterile container and transported soon after to the laboratory for examination). For formed stool specimens, formol-ether sedimentation concentration technique was performed. The diagnosis of Giardia was based on parasite eggs, cysts and trophozoite.21,22
RESULTS
This cross-sectional study was performed on 632 children in Kermanshah childcare centers. Of the 632 cases, 302 (47.79%) were males and 330 (52.21%) were females. The mean age was 0±6 years (P=0.000). The most prevalence rate was reported in age groups 4 to 6 years, and the lowest prevalence was related to age group 0 to 2 years. The prevalence rate ranged in males (16.29%) was more than females (10.45%). Regarding educational level, 17.25% of parent's had a high school degree or illiterate, and 9.49% had college graduates. The prevalence rate ranged in rural residents and urban residents were 15.67% and 11.07%, respectively (Table 1). The prevalence rate of gut parasite infection was 169 (26.74%), so that Giardia lamblia with 13.93%, Entamoeba histolytica with 3.48%, and Entamoeba coli with 2.53 were the most predominant isolate. 463 (73.26%) of children haven’t infections (Table 2). The most contaminated cases were seen in August (5.86%) and July (4.44%) (Table 3).
Table 1: Frequency distribution of Giardiasis based
on variable type in child, Kermanshah childcare
centers, Iran (2012).
Table 2: Frequency of different gut parasite
infection isolated from child, Kermanshah
childcare centers, Iran (2012).
Table 3: Distribution of Giardia lamblia infection among children in Kermanshah city according to
months of the study (2012).
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DISCUSSION
Intestinal parasitosis represents have a relevant clinical problem in developing countries. Changes in socio- economic behavior, cultural, geographic, hygienic and nutritional factors may be reasons for the prevalence in the countries.23 Childcare centers as places where children are in contact with each other so that they can better parasitic infection transmission. Therefore children are more sensitive to Giardiasis, because weak immune system, and lack of the personal hygiene. In order to prevention of parasitic infection, treatment should be done in all patients and contaminated water used for sterilization and disinfection. Nowadays Giardiasis is a major public health problem among children in Iran and worldwide. Despite preventive measures but it is abundant in many parts of the worldwide.24 In our study, the prevalence rate of gut parasite infection was 169 (26.74%), so that Giardia lamblia with 13.93%, Entamoeba histolytica with 3.48%, and Entamoeba coli with 2.53 were the most predominant isolate. The prevalence of Giardiasis varies in different parts of Iran and worldwide. For example Heidari et al. reported the prevalence rate of the Giardiasis infection 26.2% in children resident in childcare centers in Damghan city, Semnan province, Iran.1 Mendoza et al. in their study reported the prevalence rate of the Giardiasis infection 54.6% in children resident in childcare centers in Havanan city.25 In another study which was done by Al-Saeed et al. on the children in Dohuk, northern Iraq, the prevalence rate of infection to Giardiasis was 38.5%.3 Also Newman et al. found 27.4% infection to Giardiasis in the north-east of Brazil in children resident in childcare centers.26 Giardia contamination was seen in 49% in Aminzadeh et al. study that performance on children in childcare centers in Varamin (Iran).18 These statistics show that different prevalence rates of Giardiasis in children resident in childcare centers are seen. Likely reasons for this difference could be related to, low socio- economic, cultural, climatic conditions, poor health hygiene and nutritional factors.3,8 In this study boys with 16.29% had a higher rate than girls with 10.45%. Like our study in Al- Saeed et al. study the frequency distribution of Giardiasis was higher among boys (41.6%) than girls (35.6%).3 Also in another study that carried out in Palestine and Mexico reported a higher rate of Giardiasis among male than females.27,28 It could be said that, may be boys have more relation to sources of parasites in social and environment.29 In this study the highest rate of infection was seen at 4-6 year-old age groups (14.24%), and the lowest rate was observed at 0-2 year-old age-groups (1.74%). In studies that performanced in Iraq, Saudi Arabia and Senegal, the infection rate was highest in the age group 10-12 years.3,30,31 Toilet use and avoiding from wash hands thoroughly with water are as two of the likely reasons which might lead to Giardia transmission in this group of children.3,32 In the present study, frequency of Giardiasis occurred among children whose parents had low level of education. In Heidari study parasitic infection was more prevalent in children whose parents had no high education (42.95).1 Also in another study that carried out by Machado children whose parents had low level of education have the most common
infections.33 It could be said that parents of children at high level of education provide better control on personal hygiene their children.1 In this study the prevalence rate ranged in rural residents (15.67%) was more than urban residents (11.07%). This result is in agreement with the findings of the study by Asmar.34 Increase prevalence of these parasites in rural residents may be related to high number of children, lack of health education and training, and low socioeconomic status in these rural residents. The maximum percentage of infections was in August and July with 5.86% and 4.44% respectively. Since the unfavourable temperatture for G. lamblia cyst is less than 5 ºC and 62 ºC 3,35 and According to, Kermanshah city have maximum temperature about 37-45 ºC in summer and 0 ºC or less to 5 ºC in winter. This could be considered as one of the likely reasons frequency distribution of Giardiasis in during the summer months.
CONCLUSSION
According to this study and other studies that carried out on children, the prevalence of Giardiasis and intestinal parasit infections in childcare centers could be due to the transmission of disease, and lack of awareness parents and teachers about the role of personal hygiene in controlling the disease. So by learning the basics of personal hygiene and conduct periodic examinations of children and staff in childcare centers, incidence of parasitic infections and giardiasis can be controlled.
ACKNOWLEDGMENTS
The authors are thankful of Kermanshah University of Medical Sciences for providing necessary funding of this study. It is also appreciated all the cooperation of personnel engaged in aforementioned childcare centers.
Funding: No funding sources Conflict of interest: None declared Ethical approval: Not required
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Cite this article as: Prevalence of Giardiasis among children in childcare centers in Kermanshah, Iran. Faraji R, Ahmadian F, Javadi GR, Barshahi PM. Int J Res Med Sci 2015;3:1717-20.
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