Relationship of intestinal parasitic infections and malnutrition among school children in Makurdi, Benue State - Nigeria
E Amuta, T Olusi, R Houmsou
body, children, index, intestinal, malnutrition, mass, parasitosis
E Amuta, T Olusi, R Houmsou. Relationship of intestinal parasitic infections and malnutrition among school children in Makurdi, Benue State - Nigeria. The Internet Journal of Epidemiology. 2008 Volume 7 Number 1.
Malnutrition and intestinal parasitic infections are common public health problems of children in developing countries. Malnutrition is typically caused by a combination of inadequate food intake and infection which impairs the body’s ability to absorb or assimilate food. Anthropometric measurements with regards to W.H.O standard consisting of height and weight were taken using tape measure on a wooden stick and weighing scale respectively. The body mass index (B.M.I) was determined by dividing the weight in kilogram by the squared value of the height in metre. Examinations of stool specimens were done using direct smear examination and sedimentation and flotation techniques. The nutritional status and parasitosis was studied in 569 (272 male and 297 female) school children aged 10 to 18 years. 330 (57.99%) of the samples were found positive for various intestinal parasites with hookworm species accounting for the highest 173 (52.24%) and
Malnutrition and intestinal parasitic infections are common public health problems of children in developing countries . Malnutrition is typically caused by a combination of inadequate food intake and infection which impairs the body’s ability to absorb or assimilate food. An estimated global infection rate for some parasites has primarily been attributed to the appalling unhygienic and environmental conditions, poverty and over-dispersion of parasites. However, intestinal parasitic infections are especially problematic because they have negative life long health consequences; these infections can contribute to malnutrition which in turn can result in delayed growth as well as cognitive growth. It is well recognized worldwide that anthropometric measurements are indispensable in diagnosing malnutrition. It has now been well established that the body mass index (BMI) is the most appropriate variable for determining nutritional status among adolescents . However there is scanty information on the relationship of intestinal parasites and nutritional status of school children in Benue State. Thus, the present study was undertaken to find out the prevalence of intestinal parasites among school children, the relationship between intestinal parasites and malnutrition in school children and to be able to design a good programme that can improve the health status of Nigerian school children.
Materials and Methods
This study was carried out in Makurdi, the capital of Benue State which is located in the heart land of guinea savanna zone in central Nigeria. Makurdi lies between 7° (30’- 43’)N and 8º(30’- 35’)E, It also experiences typical tropical climate with two distinct seasons: the wet season which lasts from April to October and the dry season which begins from November to March.
This study focused on children attending primary schools. They are the most suitable study group because schools are easily accessible; disease occurrence and malnutrition are usually highest among this age group. The study was carried out between January and June 2006. A total of five hundred and sixty nine (569) school children were examined for intestinal parasites. Necessary approval was obtained from the school authorities prior to the commencement of the research.
Anthropometric measurements consisted of weighing children without shoes and with the least possible clothes, the measure precision was 0.1 Kg. Then a tape measure on a wooden stick was put vertically against the wall, the child stood up against the tape measure vertically without shoes, and height was measured with 0.5 centimetre precision. Height and weight were taken by one observer. Ages of the children were determined based on the questionnaire filled by their parents and body mass index (BMI in Kg/m²) is defined as the weight in kilogram divided by the square of height in meter.
The stool specimens collected from the children were taken to the Advanced Biology Laboratory of the University of Agriculture, Makurdi for examination of intestinal parasites. The faeces were first examined by direct wet preparations which consisted of emulsifying small quantities of the faeces in normal saline with Lugol’s iodine solution and examined microscopically under cover slip. Further examination of the faeces was done using the flotation egg technique. About one gram of faeces was placed in a tube of about 15ml, a few drops of saturated salt solution was stirred to make a fine solution, more salt solution was added until the tube nearly got full and the solution was stirred throughout and any coarse which floated up was removed. The tube was placed on a level surface. The final filling was done by a dropper until a convex meniscus was formed. A glass slide was carefully laid on the top of the container so that the centre was in contact with the fluid. The preparation was allowed to stand for 20 minutes after which the glass slide was quickly lifted, turned over smoothly as to avoid spilling of the fluid and examined under the microscope after putting a cover slip.
Comparisons were made between the sex and age groups of children using chi-square test. Differences were shown to be statically significant where P<0.05. Correlation was used to assess the association between intestinal parasitic infections and malnutrition in children.
The prevalence of intestinal parasites is shown in Table I. A total of 330 (57.99%) children were infected, hookworm (52.24%) recorded the highest prevalence rate followed by
Table II shows the prevalence of intestinal parasites by age groups. It is observed that infection was recorded among all age groups but with high prevalence in the lower ages
(10-13) and (13-15)
The profile of anthropometric measurements in infected and non infected children is shown in Table III. The prevalence of malnutrition i.e. those with body mass index (BMI < 18.5) is found to be higher in infected than uninfected children and this difference was not significant among these children. (X²= 4, P>0.05). Moreover the mean body mass index for those infected was 17.44 kg/m² with a range of 11.97 – 26.71, while those uninfected had a mean of 22.73 Kg/m² with a range of 12.36 – 37.30. The mean weight of infected children was 34.35 kg while the corresponding figure for uninfected children is 47.25 kg.
Table IV shows the pattern of infection and malnutrition between male and female children. Males recorded a high infection rate of 53.33% while female recorded a high malnutrition rate of 57.48%. However the association of intestinal parasitic infections and malnutrition (Fig 1) is found to be significant with a coefficient of correlation (r = 0.99, P<0.05).
Intestinal parasitosis is global though endemic in the tropics and subtropics for reasons attributable mainly to environmental conditions and poor hygiene causing significant morbidity such as anaemia, diarrhoea and dysentery, malnutrition, mental deficits and poor growth. The results of this report shows that hookworm,
Children below the age of 15 years appear to be more highly predisposed to intestinal parasitic infections than older ones. This indicates a coterminous behaviour and suscepbility for these age groups. Children of these age groups often spend more of their leisure time outdoors, playing and or foraging in garbage dumps and eating discarded food remains on the street. They are also more often in contact with sand and eat indiscriminately with unwashed hand. The lower infection rate observed in the 16-18 years age group may be due to their hygiene concern about their looks as compared to the lower age group and hence are able to avoid as much as possible what would lead them to one being infected.
The mean body mass index and mean weight showed a remarkable difference of nutritional status between infected and uninfected children. Children infected with intestinal parasites tend to be thinner than uninfected ones. Thus, there is no doubt that intestinal parasites may produce a remarkably and significant adverse effects on the weight gain inducing a significant contribution to the development of nutritional deficiencies in the group of children studied. The synergism observed between intestinal parasites and malnutrition in this study may be attributed to the fact that hookworm,
The prevalence of infections was higher among male than female this may be attributed to the fact that males are more often engaged in predisposing activities like playing football. The reasons of high rate of malnutrition recorded among females are far beyond the limits of this study and need more studies to be answered.
The study shows that a synergism exists between intestinal parasitic infections and malnutrition in school children in Makurdi. But it is important to stress that ‘association” does not equal ‘cause’. An example of this is the uncertainty about some other factors in the development of malnutrition. Therefore investment in education that it is not accompanied by investment in the health and nutrition of school children is a net loss for a country. If an improved health and amelioration of nutritional status in school children can be done, it will obviously contribute to high enrolments, better school attendance, lower rate of dropout, improved performance in academic work and to social equity and economic growth as healthy persons have the energy to work. However, to ameliorate the state of public health problem in school children in the nation, it is recommended that facilities for the physical maintenance of school health and nutrition and minimum health (first aid, etc) need to be in place where possible, regular medical check-ups could be undertaken. All schools must have adequate and clean toilets, clean drinking water. Future school designs should also take account of kitchen and minimum health facilities while school nutrition and health committees and food production units should be part of a new school environment.
The headmasters and teachers are thankfully acknowledged for their assistance and support during data collection. Thanks are also due to the pupils that participated in the study.