Study on Intestinal Helminth Parasites in School Children of Rangeli Municipality of Morang District in Eastern Nepal

This study was accomplished on school children with the objective to define the prevalence of intestinal helminth parasites. A total of 3000 of stool samples were randomly collected from children of five schools in Rangeli municipality and were examined by a routine by saline and smear techniques. 83.3% stool samples were infected with helminth parasites. The prevalence rate of intestinal parasites was Ascaris lumbricoides (50.92%); Ancylostoma duodenale (44.56%); Trichuris trichiura (1.96%); Enterobius vermicularis (1.44%); Hymenolepis nana (1.12%). The lack of safe drinking water, food, poverty, unhygienic practices and poor environmental condition were found to be contributing factors in the maintenance of high prevalence rate of intestinal parasites infections. Parasites control programs with hygienic practice and improvement of environmental conditions along with the treatment of infected peoples may be helpful in reducing the burden of helminth intestinal parasites in children. Hygienic conditions benefit people at personal and community level and, ultimately contributes to promoting the health status of people.


Introduction
Intestinal parasites infections are common in the world responsible for considerable morbidity and mortality [1][2][3].
As of now people earning less than two US dollars per day in developing regions of Asia, sub-Saharan Africa, North America and South America are mostly infected with one or more helminth [4]. It is estimated that approximately 2 billion people are infected with soil-transmitted helminths worldwide. More than 880 million children need treatment for these helminthic parasites [5]. While comparing all the age group, school-aged children, and preschool children be likely to harbor the largest numbers of helminth and the reasons for it is not well understood. Because of such condition, children develop growth stunting, impaired memory and cognition [6]. Around 450 million school children are clinically infected with intestinal parasitic infection [7]. The world has 800-1000 million cases of Ascaris, 700 to 900 million cases of hookworm infections and 500 millions of Trichuriasis [8]. Intestinal parasitic infections are estimated to infect roughly 50% of children and adolescents nationwide [9]. The common mode of transmission of the gastro-intestinal infections is faecal-oral. Infection is more frequently in younger children in the urban areas [7].
The poor environment, unsafe human waste disposable system, lack of safe water supply, and poverty have contributed to the main causes of a high prevalence of intestinal parasitic infections [10]. Climate and topography determine the distribution of helminth infections while heterogeneity of the same helminth is an epidemiological occurrence [11,12]. Soil-transmitted helminths are highly affected by soil type and surface temperature along with altitude and rainfall [13,14]. Evidence of clustered housing of infected people exists for ascariasis and trichuriasis [15].
The average intensity of infection of Ascaris lumbricoides and Trichuris trichiura rises in children aged 5-15 years and declines in intensity and frequency in adulthood [16] while hookworm often displays a firm rise in the intensity of infection with age which peaks up in adulthood [17].
Only a few drugs -albendazole, oxamniquine, praziquantel, ivermectin, together with diethylcarbamazine and mebendazole -are developed to treat the most common disease in the world "helminthiases" [18,19].
In Nepal, very few studies are available only covering few focus areas. Keeping all these in mind, the present study is helpful to control measures for the prevalence of intestinal parasitosis and suitable for the eradication of parasitic infection throughout the country covering school students of urban and rural areas. Many workers have studied the helminth parasitic infections of human [20][21][22][23][24][25][26][27].

Study Area
Takuwa, Battarbari and Kasijan area under Rangeli Municipality of Morang district in eastern Nepal was selected as study area. It lies in the Koshi zone. At primary schools of Takuwa and Battarbari, a total of 3000 children of 5-10 years of age from a poor socio-economic status with low levels of nutrition were studied.

Materials and Methods
This study was conducted during January to June 2016. A total of 3000 stool samples were randomly collected from children of 3 primary schools covering Rangeli municipality and were examined.
Direct smear method technique was employed for the stool examination. A saline preparation was done and few drops of saline (0.9%) was taken on a slide and a match head of fecal material by means of the disposable applicator was taken on saline water. The stool samples were mixed with saline and placed on the slide with a cover slip and were observed under a microscope.

Result
Over the 6 months from January to June 2016, a total of 3000 samples were studied among school children from different primary schools of Rangeli municipality in Morang district of eastern Nepal. Out of 3000 samples, 2500 (83.3%) fecal samples were infected with helminth parasites. Among the specific helminth parasites, infection is shown in the Table 1.  The prevalence rate of total infections was higher in males (54.72%) as compared to females (45.28%). Thus, with respect to sex, in the case of the prevalence rate of infestations with helminth parasites in male was higher (54.72%) than females (45.28%). Helminth infection and gender were found to be independent of each other with χ 2 stat (5.164) < χ 2 crit (9.488) at p=0.05 and df = 4.

Discussion
This study was carried out to find the present prevalence of  Rai, et al (1993), Vaidya and Acharya (1998), Sherchand et al (1998), Rijal et al (2001). Analysis of the Tribhuvan University Teaching Hospital record from 1985 -1992 revealed that the prevalence rates of the intestinal parasites were 29.1 to 43% and the higher prevalence was found in children [28]. The high prevalence rate in this study might be due to poor socioeconomic condition, climatic and environmental conditions of the area, a poor personal hygienic condition which could be more favorable for intestinal parasites, along with unsafe water supply, contamination of food, soil and vegetables and sanitation facilities [29]. This high prevalence rate of parasites infection is prevailing health problem of the country.

Conclusion
The high rate of parasitic infections of the gastro-intestinal tract may account for a high proportion of death in infants with low hygiene and nutrition. This study has observed that the lack of sanitation knowledge and hygienic practice among school going children and poverty were the main cause. Consequently, there has been a need for parasitic control program with wide participation from local NGOs and community for the control of helminth parasite infections. Soil-transmitted helminths weaken the infected and sometimes cause death. Such infections decrease school performance. Sometimes surgical intervention is needed when intestinal obstruction and rectal prolapse occur. Since 83.33% of the student population in the school is infected with these parasites, such area needs a bi-annual treatment as per WHO recommendation. Along with antihelminthics, people at risk should be educated for improvement in sanitation and health education as control measures.