Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine

Abstract

BackgroundIntestinal parasitic infections are common in rural areas with poor infrastructure and low socioeconomic status. The aim of this study was to estimate the prevalence of selected parasitic infections in marginalized rural areas in the northern part of the Palestinian West Bank Region, using conventional and PCR-based methods, and also to assess risk predictors of infection.MethodsA cross-sectional study was conducted on 104 individuals from three rural villages in the Jordan Valley. Stool samples were collected and examined by a battery of tests that included microscopy of wet fecal samples in normal saline with iodine, concentration by ethyl acetate sedimentation and also by zinc sulfate floatation, a conventional PCR and a real-time PCR (qPCR). Risk factors were assessed that included demographic, socioeconomic, and behavioral characteristics. Data on method performance was analyzed by kappa-statistic, Cochrane’s Q, and McNemar post hoc test. Mid-P exact test and odds ratio were used to discern association between outcome and risk predictors.ResultsThe overall prevalence of intestinal parasitic infections was 48% (49/102). The predominant parasites were Giardia lamblia at 37% (37/102) and Hymenolepis nana at 9% (9/102). To concentrate cysts and eggs, sedimentation can be used as an alternative to floatation with a loss of 1% of positive cases. The methods employing PCRs proved crucial as it increased the detected infection rate of G. lamblia approximately three-fold from 13% by the conventional methods to 37% by the qPCR. Multiple infections were present in 13% (13/102) of the study group, which included double (10%) and triple (3%) infections. Regarding the genus Entamoeba, E. dispar and E. coli were detected at rates of 2 and 8%, respectively. While none of the individuals were infected with the pathogenic E. histolytica, E. nana (4%) was detected for the first time in the area. Age was a risk predictor for infection (OR = 2.61, CI 95% 1.05–6.45, P = 0.038).ConclusionsThe increased prevalence of intestinal parasitic infections in children in marginalized rural areas in Palestine is worrying. The addition of PCR-based methods is important for the diagnosis of such infections as, with cautious interpretation, it increases proficiency and overcomes underestimation and misdiagnosis of cases. Control measures including education on personal hygiene and environmental sanitation, should be introduced to reduce the prevalence of the intestinal parasites and, thus, the infections they cause in this and other areas.

Prevalence and Associated Risk Factors of Human Intestinal Protozoan Parasitic Infections in Ethiopia: A Systematic Review and Meta-Analysis

“…Age (children up to 14 years) was significantly associated with the prevalence of intestinal protozoan parasitic infections. The result was supported by the studies conducted in Iran [ 59 ], Palestine [ 62 ], Ghana [ 63 ], Sudan [ 64 ], Cameroon [ 68 ], Libya [ 78 ], and Karachi [ 85 ]. This might be because children have weak immunity than adults.…”

“…The prevalence of HIPPIs in the present study was lower than that of Libya (85%) [ 14 ]; Shahura Health Center, Amhara region, Ethiopia (39.84%) [ 49 ]; Cambodia (53.9%) [ 58 ]; Senegal (32.6%) [ 60 ]; Thailand (37.8%) [ 61 ]; Palestine (39.21%) [ 62 ]; Ghana (42.9%) [ 63 ]; Sudan (54.2%) [ 64 ]; Tripoli, Kenya (56%) [ 65 ]; Kut city, Iraq (57.5%) [ 66 ]; Iraq (98.8%) [ 67 ]; Cameroon (74.3%) [ 68 ]; Malaysia (72.3%) [ 69 ]; Mexico (65%) [ 70 ]; Mexico (60%) [ 71 ]; and Burkina Faso (84.7%) [ 72 ]. The differences may be attributed to methodological, social, economic, demographic, hygienic, weather and climatic, environmental, and political factors.…”

Prevalence of Giardiasis and Entamoeba Species in Two of the Six Governorates of Kuwait

“…An estimation by the World Health Organization (WHO) stated that over three billion people are infected with IPI worldwide, yet only 450 million are symptomatic [5]. Two of the most common IPIs are giardiasis and amoebiasis, where their mode of infection is highly dependent on the fecaloral rout [6,7]. This mode of infection may be acquired by direct or indirect transmission whether by person-toperson or indirectly through the use of contaminated food or objects [8,9].…”

“…Amoebiasis is estimated to infect 480 million people globally, with elevated annual deaths ranging between 40 and over 100 thousand people, and nonetheless, giardiasis, while not life threatening, has an annual infection estimated at 280 million people worldwide [27][28][29][30]. According to the Global Burden of Disease Study 2010, the median global burden of giardiasis was estimated at 0.17 million, while the burden of amoebiasis was 0.5 million disabilityadjusted life years [6,31]. Some of the major risk factors involved in facilitating the spread of IPI are improper personal hygiene, feeble sanitary conditions, and deprived access to clean water supply [26,[32][33][34].…”

Anti-GiardiaDrug Discovery: Current Status and Gut Feelings

“…While Giardia parasites are ubiquitous, the world’s poor bear most of the burden, with prevalence rates being some 10-fold higher in developing countries (range 20–30%) as compared to developed countries (range 2–7% − ). However, rates of infection and disease vary considerably within regions, being highest in children and marginalized communities …”