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February 1983, Volume 33, Issue 2

Original Article

Incidence of Intestinal Helminth Parasites of Man in the Twin Cities of Rawalpindi - Islamabad.

Riaz Ahmed Pal  ( Department of Biological Sciences, Quaid-i-Azam University Islamabad. )
Shahid Islam Rana  ( Department of Biological Sciences, Quaid-i-Azam University Islamabad. )

Abstract

A total of 8850 stool samples (Rawalpindi = 5360 and Islamabad = 3490) from seven hospitals of the twin cities of Rawalpindi-Islamabad were examined for intestinal helminths during September 1980 to September 1981 and the following parasites were recorded: Taenia saginata, Hymenolepis nana, Ascaris lumbricoides, Enterobius vennicularis, Trichuris trichiura, and Hookwonn. Of the total cases examined 43.90% from Rawalpindi and 30.34% from Islamabad carried helminthic infection. In both the cities T. s√£ginata had a very low incidence. Sex did not seem to play a role in the distribution of these parasites, and children had a higher incidence of infection than individuals in other age groups. It was noted that poor hygienic condition of the individuals, malnutrition, heavy faecal pollution of the premises, and large size of the family are mainly responsible for maximum infection cf these parasites. In general helminthic parasitosis was higher in Rawalpindi than in Islamabad (JPMA 33:33, 1983).

Introduction

Parasitic diseases constitute one of the major public health problems in the world. Incidence of intestinal parasitism is of paramount importance especially in the developing countries because of its direct contribution to malnutrition. The importance of the diseases due to intestinal parasitism is immense as they are unremittingly corrosive constituting a steady drain on the vitality of the host. Many descriptions regarding the incidence of intestinal parasites among human beings in various countries of the world are available (Kuntz and Moore, 1971; Biswas et al., 1978; Akinkugbe, 1980). In Pakistan, too, various surveys have been conducted in different areas (Saleem, 1961; Farooki, 1964; Ansari et al., 1968; Siddiqui and Bano, 1979) but little attention had been paid in this regard to the twin cities of Rawalpindi-Islamabad except for one report (Pal and Malik, 1979) which was on the incidence of intestinal parasites in the primary school children of Islamabad. These twin cities, although 12 Km apart show a wide range of difference in the education rate, socio-economic conditions and hygienic and sanitary facilities available to their inhabitants. It was, therefore, thought interesting and appropriate to study the incidence cf intestinal parasites in the populations of these cities and to note the differences, if any. The present report deals with the infection of intestinal lielminth parasites while protozoan parasitosis will be given in another communication.

Material and Methods

All stool specimens received for examination in seven hospitals of Rawalpindi and Islamabad aver a period of 12 months i.e. September 1980 to September 1981 were checked in the present investigation for helniinth parasites. This study involved a total of 5360 patients (females: 2450, males: 2910) from Rawalpindi and 3490 cases (females: 1690, males: 1800) from Islamabad. Each patient was asked to collect morning stool in a pill box. bearing name and age of the individuaL The stool specimens were collected between 0700 and 0800 hours and were examined in the hospital laboratories within one hour of their collection. At the time of stool collection each patient was asked to fill in a questionnaire requiring the following information: (1) list of all members of the family with sex and age, (2) observations on the faecal pollution of the premises, and its disposal, (3) size and condition of the house, (4) observations on the personal cleanliness of the individual, (5) physical condition of the patient, and (6) the type of drinking water source.
The stool samples were examined by direct smear method in normal saline and zinc sulphate floatation technique was also applied. One stool specimen was examined in each case. Microscopic examination conducted for at least 5 niinutes per sample. Ova were examined under 10 x objective lens.

RESULTS

Of the total patients examined 43.90% from Rawalpindi and 30.34% from Islamabad were found infected with helminths. Frequencies of specific infections are given in Table I.



Table II shows the prevalence of intestinal helminth parasites according to sex in Rawalpindi and Islamabad. In the former city 42,38% males and 43.88% females were found positive for helminths. The parasites showed minor degrees of differences in the two sexes. In Islamabad males and females showed 3030% and 30.17% helminthic infection respectively. Sex had little influence in the distribution of belminths in this city.
Table III shows the occurrence of intestinal helminths in different age groups of Rawalpindi and Islamabad. In the former city A. lumbricoides was the dominant pathogenic parasite varying in incidence from 3.09% in the 5.9 year age group to 0.52% in the 60 years and above age group. In Islamabad H nana proved to be the most common parasite with highest incidence (3.49%) in the 5-9 year age group. In both the cities T.saginata was the least common parasite having a very low rate of infection in the different age groups and with a higher percentage of infection in Rawalpindi than in Islamabad difference of infection between the populations of the twin cities could be due to the fact that in Islamabad



Tables IV and V show correlation between parasitological fmdings and the environmental conditions of Rawalpindi and Islamabad respectively. In both the cases poor hygienic conditions cf the individuals, malnutrition, heavy faecal pollution of the premises, and large size of the family were the factors responsible for maximum infection of these parasites.

Discussion

Two cestodes, H.naha and T.saginata, have been recorded from both the cities of which the former has shown higher incidence in Islamabad than in Rawalpindi. A similar high incidence for this cestode has already been reported from this city (Pal and Malik, 1979)9 This
people are comparatively more affluent as a whole, and consume bakery products where grocery shops have a fairly large murine population (Pal amd Malik, 1979). On the other hand, T. saginata is rare in both cities but shows a higher incidence in Rawalpindi than in Islamabad. Earlier Pal and Malik (1979) were unable to record this parasite from the primary school children of Islamabad owing to a small sample size as compared to that in the present study. Although beaf is thoroughly cooked in domestic preparations it appears that smoked beaf which is only partially cooked is responsible for maintaining this low infection. Whereas its high rate of infection in Rawalpindi indicates that here people take more smoked beaf than the residents of Islamabad. Ansari and Nasir (1956) conducted a survey of parasitic infections among the prisoners of Borstal Jail in Lahore and reported incidence cf Tsolium. It is likely that they have confused T.solium with T.saginata. The presence of Tjolium is highly doubtful in Pakistan due to the fact that pigs being the intermediate host of this parasite are not sold or eaten according to religious beliefs.
Of the nematodes, A.lumbricoides, T.trichiura and Hookworm show a higher level of infection of these parasites are varied and have been discussed in an earlier publication (Pal and Malik, 1979). It appears that Islamabad inhabitants are comparatively more educated and aware cf health hazards and enjoy better hygienic standards than the residents of Rawalpindi : Evermicularis infection is almost similar in both the cities. Beck and Barret-Connor (1971) have stated that less than 5% of positive cases of E. vermicularis ever show eggs in the faeces. In the present study more than 4% cases have been recorded which indicates a very high incidence of this parasite. The eggs of this parasite are present on the hands, clothing, bed linen,towels, washclothes, soap, tooth brush, door knobs, and many cther household articles but it appears that in Islarnabad and Rawalpindi, infrequert changing of bed linen, sharing of beds and over-crowding of families alsc contribute towards its infection.
According to the present findings sex does not appear to play a major role in the distribution of helminthic infections in both the cities although minor differences between the sexes are noted here for the city of Rawalpindi which cannot be explained on the basis of existing data. However, it seems certain that members of both the sexes within the respective cities are equally exposed to these infections inspite of a comparable education and hygienic background. Generally higher incidences of H0naha, A.lumbri­coides, E. vennicularis, T. trichiura, and hookworm in children has already been reported (Cameron, 1960; Beck and Barret-Connor, 1971)
A comparision cf the present results with those available for other areas of Pakistan (Lahore: Ansari et a!., 1968; Peshawar: Siddiqui and Bano, 1979; Karachi: Bilquees et al., 1982) reveals a greater incidence Of helminth parasites in Rawalpindi except for H.nana infection which was higher in Lahore and Peshawar, whereas the incidence of Ttrichwra was almost similar in Rawalpindi and Karachi. In general, helminthic parasitosis is comparatively higher in Rawalpindi than in Islamabad. Open drains, overflowing sewerage pipes, narrow dirty lanes, old fashioned dark houses arid ifi-planned new colonies around this city are mainly responsible for the high rate of infection. It is evident that the inhabitants are living in poor hygienic conditions and leading a substandard life. With the meagre resources of both the Government and the people it is very difficult to change the existing living standards, but at least, a focus can be drawn towards parasitic diseases This problem could be partially solved by educating the people and making them aware of the hazards cf helminthic diseases.

ACKNOWLEDGEMENTS

The authors are thankful to Prof. M.AJ-lafeez, Department of Biological Sciences, Quaid-i-Azam University, Islamabad for critically reading the manuscript. The assistance of the following persons in collecting stool samples from their respective hospitals is also gratefully acknowledged: Dr. Shamsul Arfeen, Central Government Polyclinic, Islamabad; Maj.Gen. Dr.MJ.Burney, National Institute of Health, Islamabad; Dr. Shaukat Mi Shah , District Headquarters Hospital, Rawalpindi; Brig. Dr.Chaudhary Safdar Mahmood T.I.(M), Combined Military Hospital, Rawalpindi and Lt.Col. DrSaleem Ahmad Khan, Cantonment General Hospital, Rawalpindi.

References

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