ABSTRACT

This Study sought to determine the species and prevalence of intestinal parasites in
a representative sample among farm workers children in Ikwerre local government
Area, Rivers state. The aim of this study was to investigate the prevalence of
intestinal parasites in a representative sample among farm workers children in
Ikwerre local government Area, Rivers state. The research work was carried out in
three communities randomly selected, Elele, Isiokpo and Aluu which formed a
population sample for the study area. Faecal samples was collected from 100 farm
workers children using a sample container, the sample containers were numbered
and distributed with the questionnaire.The standard method of stool examination as
described by WHO was adopted for the study. All the samples were concentrated
using formal ether concentration technique. The deposit was examined using the
10x and 40x objectives for the presence of cyst or eggs of parasite. The overall
prevalence of intestinal helminth infections encountered in the study was 18
(18.0%). 100 samples were collected from the local farmers children in three
different communities Elele, Aluu and Isiokpo all in Ikwerre local government
area, Rivers state. Elele, Isiokpo and Aluu had prevalence values of 24.0% (12 out
of 50), 12.0% (3 out of 250 and 12.0% (3 out of 25) respectively (P<0.05). Out of
the total number 58 were males and 42 were females. The total number of infected
Children was 18(18%) with males 11(19.0%) and females 7 (16.7%). The two
major intestinal helminths observed were Ascaris lumbricoides 16(16%) and
Entrobius vermicularis 2 (2%), the result shows that there is a significant
difference (P=0.00 at p<0.005). The study was able to show the intestinal
Helminths infections are prevalent among children of rural/local farmers workers
in Ikwerre local government Area Rivers state, Therefore, good toilet facilities pipe
borne water, education through enlightenment programmes and improved sanitary

1
conditions be provided since the infection is by no means caused by lack of good
water and poor sanitary conditions.

CHAPTER ONE

INTRODUCTION

1.1Background to the Study

According to the International Labour Organization, agriculture is the second

greatest source of employment worldwide, with over one-third of the world’s

workforce (1.3 billion people) depending on agriculture. In most are industrialized

countries, agricultural workers comprise 9% of the workforce, and this rate reaches

60% in developing countries (Ximenezet al.,2011). In Eastern Europe, 20% and in

Latin America, 25% of all workers are employed in agriculture. About 63% of all

about 2 million people die every year due to diarrhoeal workers in Africa and 62%

of all workers in Asia are employed in agriculture, compared to only 5.2% in the

European Union. Similarly, in Turkey, 24.6% (6,143,000 people) of the labour

force are employed in the agriculture sector. Agricultural work is different from

other sectors from the point of view of the working environment and facilities.

While working in fields, agricultural workers are infected with many waterborne

and foodborne pathogenic agents, including bacteria, viruses, and protozoa, which

may cause diseases that vary in severity from mild gastroenteritis to severe, and
2
sometimes fatal, diarrhoea related to the lack of sustainability of water supply and

sanitation services, poor hygiene behaviours, and lack of priority given to the

agricultural sector’s healthy living arrangements.

Helminths and protozoons are in endemic areas for children. Infections that are of

major public health importance are widely distributed in tropical and subtropical

areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas,

China, and East Asia. Infected children are physically, nutritionally, and

cognitively impaired because of the malabsorption of nutrients. In addition, some

protozoon and helminths also cause loss of appetite, and therefore a reduction in

nutritional intake and physical fitness. (Alruzug,Alhanoot,2016).

Parasitic infections, caused by intestinal helminths and protozoan parasites, are

among the most prevalent infections in humans in developing countries. In

developed countries, protozoan parasites more commonly cause gastrointestinal

infections compared to helminths. Intestinal parasites cause a significant morbidity

and mortality in endemic countries (Gilles and Hoffman,2002). Helminths are

worms with many cells. Nematodes (roundworms), cestodes (tapeworms), and

trema- todes (flatworms) are among the most common helminths that inhabit the

human gut. Usually, helminths cannot multiply in the human body. Protozoan

parasites that have only one cell can multiply inside the human body. There are

four species of intestinal helminthic parasites, also known as geo-helminths and

3
soil-transmitted helminths: Ascarislumbricoides (roundworm), Trichiuristrichiuria

(whipworm), Ancylostomaduodenale, and Necatoramericanicus (hookworms).

These infections are most prevalent in tropical and subtropical regions of the

developing world where adequate water and sanitation facilities are lacking (1,2).

Recent estimates suggest that A. lumbricoides can infect over a billion, T. trichiura

795 million, and hookworms 740 million people. Other species of intestinal

helminths are not widely prevalent. Intestinal helminths rarely cause death. Instead,

the burden of disease is related to less mortality than to the chronic and insidious

effects on health and nutri- tional status of the host. In addition to their health

effects, intestinal helminth infections also impair physical and mental growth of

children, thwart educational achievement, and hinder economic development.

The most common intestinal protozoan parasites are: Giardia intestinalis,

Entamoebahistolytica, Cyclosporacayetanenensis, and Cryptosporidium spp. The

diseases caused by these intestinal protozoan parasites are known as giardiasis,

amoebiasis, cyclosporiasis, and cryptosporidiosis respectively, and they are

associated with diarrhoea. G. intestinalisis the most prevalent parasitic cause of

diarrhoea in the developed world, and this infection is also very common in

developing countries. Amoebiasis is the third leading cause of death from parasitic

diseases worldwide, with its greatest impact on the people of developing

countries(Haque,2007).

4
1.2Statement of the Problem

The ability of intestinal helminths to survive in tropics and subtropics has made it

one of the most prevalent infection in humans and other animals.The farm

workers’ children walk on the ground without shoes and play on soil that contains

parasite cysts and mature forms. The infectious stages of parasites have the ability

to easily enter their host, usually through the mouth as a contaminant of food,

water, or fingers, while the next generation leaves the body in faeces through the

anus in the form of spores, cysts, eggs, or larvae. There are exceptions: a few

parasites of the gut enter the body through the skin, notably the larvae of

hookworms and Strongyloidesstercoralis. Sometimes, infected people put others at

risk of infection, such as by defecating in the open, so that the infectious stages are

spread through the environment.

1.4Aim and Objectives

The aim of this study was to determine the species and prevalence of intestinal

parasites infection in a representative sample among farm workers children in

Ikwerre local government Area, Rivers state.

The objective of this study was to

5
 1. To determine the species and distribution of intestinal parasites infection

amongst farm workers children.

2. To determine and compare the sex and age related parasite prevalence.

3. To determine prevalence of intestinal parasite in relation to source of

drinking water

4. To evaluate the prevalence of intestinal parasites in relation to wearing foot

wears.

1. 3 Justification of the Study

Results from this study will help create awareness of the pre-existing infectious

helminths. This will enhance proper disposal of faeces, proper personal hygiene,

handwashing after coming in contact with the soil and , positive health behavior

and provision of health care infrastructure in the community. This will help

decrease the rate of incidence of intestinal helminth infections among farm workers

children.

6
 CHAPTER TWO

LITERATURE REVIEW

2.1 Brief Overview

Parasite are organisms that rely on a host for food and nutrients. They live in or on

the host at the host’s expense. Intestinal parasites live in the digestive tract in the

intestines. Most of the time humans are accidental hosts in the parasite life cycle.

Intestinal parasite infection spreads via the oral-fecal route. This includes infection

through contaminated water, food, or surfaces such as toilet handles. These

parasites can also spread through person-to-person contact, such as changing

diapers or other anal or fecal contact (Nyantekyiet al,2010). Intestinal parasites are

parasites that populate the gastro- intestinal tract. They are larger than bacteria and

viruses but some of them are so small that one cannot see them without a

7
microscope. Intestinal parasitic infections have been described as constituting the

greatest single worldwide cause of illness and diseases. Numerous studies have

shown that the incidence of intestinal parasites may approach 99% in developing

countries.

Four major groups of intestinal parasite exist; they include single celled parasites

(Protozoa),flukes (Trematoda), tapeworms (Cestoda) and roundworms

(Nematoda). Each of these groups of parasites can infect the digestive tract, and

sometimes two or more can cause infections at the same time. Parasites get into the

intestine through the mouth from uncooked, improperly cooked, unwashed food,

contaminated water, hands or by skin contact with larvae infested soil. Infection

with intestinal parasite could be through oral sex. When the infective stage of the

parasites are swallowed, they move into the intestine where they can develop and

cause disease.

Intestinal parasites have accounted for most of the clinical manifestation of many

unhealthy people. Such features as asthma, arthritis, nausea, hypertensions,

intestinal blockage, fever, oedema, sore, ulcers, etc. from the available literature

reviewed, one should know that intestinal parasites is a health problem in many

part of the world including Nigeria in over rural areas, they pose health, social and

economic problems which have for reaching effects on the Nigeria economy

especially in reducing the productivity labour force Absence of pipe-born water

8
and modern sewage disposal facilities coupled with our socio-cultural

characteristics conditions favour the survival and transmission of the free living

stages of the parasites (Nwosu and Udonsi, 2011).

Silva et al., (2013); Brooker et al., (2011) Stated that the global prevalence of

intestinal parasitic infections rate are highest in children living in sub-Sahara

Africa, followed by Asia and then Latin America and the Caribbean. According to

Brookeer (2012) in sub-Sahara Africa, it was estimated that approximately a

quarter of the total population was infected with one or more helminthes, typically

the nematodes worms which are the most prevalence of all gastrointestinal

parasites. The 2010 estimates propose that of the then 181 million school-aged

children in sub-Sahara Africa, almost half (89 million) were affected by one more

of these parasitic worm he further added.

The burden of diseases caused by intestinal worms is a major public health

problem. Indeed, it has been estimated that children aged 5-14 years in low income

countries, intestinal worm infection account for 12% of total disability adjusted life

years (DALYs) lost due to communicable disease among school children as a

result of intestinal nematodes. The public-health and socio-economic consequence

of intestine helminthes are of considerable global concern especial in the children

health and development where it causes malnutrition, which compromise their

learning capabilities in their formative years (Absaret al., 2010). In Sub-Sahara

9
Africa, intestinal helminthes are the most common and diseases with a very higher

negative public health and socio-economic impact (Enimienet al., 2014).

The transmission of this intestinal parasites infection has behavioral,

environmental and biological bases (Michael et al., 2010). For instance children

tend to be more active in infected environment and rarely employ good sanitary

behaviour; also these potential carriers are crowded together for a long period of

time (e.g. in school, orphanage or slum); in addition helminthes are masterful

immune-regulator and able to elicit a complex and mixed Th1/Th2 respond that

both ward off and subverts an immune response from the host.

The disease burden caused by these parasitic worms is similar to liver cancer and

higher than prostate cancer (WHO, 2018). A study carried out by Usipet al.,

(2017), observed that out of 216 primary school children examined for intestinal

parasites, 66(30.5%0 were infected with A. Iumbricoides, 27(12.5%) with A.

Iumbricoides,and 5(2.3%) with T. trichiuria. (Abah and Awi-Waadu, 2018) in a

research on Gastro- intestinal Helminthiasis among School Children in Gokana and

Khana Local Government Areas of Rivers State, Nigeria, found that the frequency

of parasites identified showed that AscarisIumbricoides has the highest frequency

32.1% in Gokana and 45.5% in Khana LGAs. This observation agrees with

previous studies by Hassan et al., (2018) on a Survey of human intestinal parasites

in communities within Ibadan, Southwestern, Nigeria and also Abah and Arene
10
(20160 research on intestinal parasitic infections in three geographical zones of

Rivers state, Nigeria. This may be attributed to the capacity of the embrocated eggs

to withstand harsh environmental conditions for long periods.

2.2 Global Distribution and Prevalence

Globally, more than 1.5 billion people, or 24% of the world population, are

infected with soil-transmitted helminth infections worldwide (Pullan et al., 2014

and WHO, 2018). Infection are widely distributed in tropical and subtropical areas,

with the greatest numbers occurring in sub-Saharan Africa, the Americas, China

and East Asia (Hotezet al., 2014). Cumulatively, helminth infections result in

approximately 12 million disability-adjusted life years (DALYs) worldwide (Hotez

et al., 2014). 568 million school-aged children live in areas where these parasites

are intensively transmitted and are in need of treatment and preventive

Interventions.

2.3 Ascarisiumbricoides

AscarisIumbricoides is a soil-transmitted large round worm which causes

Sscariasis. It transmitted by accidental ingestion of eggs present in human feces

that contaminate food, soil, and water in areas of poor hygiene (WHO, 2017). Like

other neglected tropical diseases, it is indicative of a poor socioeconomic status,

Hygiene and sanitation in a given population. The adult worm is cylindricalshaped,

11
white or pinkish in colour and tapered at both ends. The female adult can reach up

to 20 cm to 30 cm in length and are thicker with straight rear end while adult male

are up to 15 cm to 20 cm with a more slender, ventrally incurvated rear end with

two retractile copulatory spicule.

2.3.1 Life Cycle

Adult worms live in the lumen of the small intestine (fig 2.1). A female may

produce approximately 200,000 eggs per day, which are passed with the feces.

Unfertilized eggs may be ingested but are not infective. Larvae develop to

infectivity within fertile eggs after 18 days to several weeks, depending on the

environmental conditions (optimum: moist, warm, shaded soil). After infective

eggs are swallowed, the larvae hatch, invade the intestinal mucosa, and are carried

via the portal, then systemic circulation to the lungs. The larvae mature further in

the lungs (10 to 14 days), penetrate the alveolar walls, ascend the bronchial tree to

the throat, and are swallowed. Upon reaching the small intestine, they develop into

adult worms. Between 2 and 3 months are required from ingestion of the infective

eggs to oviposition by the adult female. Adult worms can live 1 to 2 years.

12
Fig 2.1 Life Cycle of Ascarislumbricodies

(Source: Centre for Disease Control)

13
2.4 TrichurisTrichiura

The whipworm derives its name from its characteristic whiplike shape.

Trichuristrichiura is a member of the nematode super family Trichuroidea, and

therefore related to theTrichinellaspiralis. T. trichiura causes a parasitic disease

known as trichuriasis. The adult worm is prinkish-white in color and

approximately 30 to 50mm long with whip-like shape. The female is larger than

male (i.e., approximately 35 to 50 mm long compared to 30 to 45 mm). Both sexes

have a long, whip-like anterior end. Adults reside in the large intestine, caecum

and appendix of the host. They both bury their thin, threadlike anterior half into the

intestinal mucosa and feeds on tissue secretions not blood. This relative tissue

invasion causes occasional peripheral eosinophilia. The caecum and colon are the

most commonly infected sites, although in heavily infected individuals, infection

can be present in more distal segments of the gastrointestinal tract such as the

descending colon and rectum. Trichuris is also notable for its small size compared

with Ascarislumbricoides. Vitamin A deficiency has been seen in patients with

Trichuriasis and transmission is associated with poor hygiene and children are

especially vulnerable helminthes that flourish under similar conditions a common

pathogen being A. lumbricoides. The characteristic egg is brown in color and

barrel-shaped with plug at each pole. A fertilized egg is un-segmented when passed

through faeces.

14
2.4.1 Life Cycle

Unemberyonated eggs are passed with the stool. In the soil, the eggs develop into a

2-cell stage, an advanced cleavage stage, and then they embryonate; eggs become

infective in 15 to 30 days. After ingestion (soil-contaminated hands or food), the

eggs hatch in the small intestine, and release larvae that mature and establish

themselves as adults in the colon. The adult worms (approximately 4 cm in length)

live in the caecum and ascending colon. The adult worms are fixed in that location,

with the anterior portions threaded into the mucosa. The females begin to oviposit

60 to 70 days after infection. Female worms in the caecum shed between 3,000 and

20,000 eggs per day. The life span of the adults is about 1 year.

15
Fig 2.3 Life cycle of Trichuristrichiura

(Centre for Disease Control)

16
2.5 Hookworms

Hookworms are nematodes belonging to the family Ancylostomatidae, a part of the

super family Strongyloidea. The two major species that affect humans

areNecatoramericanus (new world hookworm) andAncylostomaduodenale ( old

world hookworm). Both species can be differentiated by the presence of oral

cutting organs in the adult stages. The adult worm is small, cylindrical, fusiform

and grayish white in color. The female (i.e., 9 to 13 mm) is larger than male (i.e., 7

to 11 mm). The egg has blunt rounded ends and a single thin transparent hyaline

shell. The adult worm usually resides in the small intestine. The egg hatches in soil

within 24 to 48 hours under optimal condition and prevalent throughout the tropics

and subtopics. Initially, itching and a rash may occur at the site of infection. The

infection is usually asymptomatic, however, those with heavy worm burden may

experience abdominal pain, diarrhea, weight loss, and tiredness. The mental and

physical development of children may be affected and Anaemia may result (CDC

2017).

2.5.1 Morphology

A.Duodenale worms are grayish white or pinkish with the head slightly bent in

relation to the rest of the body. This bend forms a definitive hook shape at the

17
anterior end for which hookworms are named. They possess well-developed

Mouths with two pairs of teeth. While males measure approximately one

centimeter by 0.5 millimeter, the females are often longer and stouter.

Additionally, males can be distinguished from females based on the presence of a

prominent posterior copulatory bursa.

N. americanus is very similar in morphology to A. duodenae but generaly smaller

then A. duodenale with males usually 5 to 9 mm long and females about 1mm

long. Whereas A duodenale possesses two pairs of teeth, N. americanus possesses

a pair of cutting plates in the buccal capsule. Additionally, the hook shape is much

more defined in Necator than in Ancylostoma.

2.5.2 Life cycle of hookworm

Eggs are passed in the stool, and under favorable conditions (moisture, warmth,

shade), larvae hatch in 1 to 2 days. The released rhabditiform larvae grow in the

feces and/or the soil, and after 5 to 10 days (and tw3o molts) they become

filariform (third-stage) larvae that are infective. These infective larvae can survive

3 to 4 weeks in favorable environmental conditions. On contact with the human

host, the larvae penetrate the skin and are carried through the blood vessels to the

heart and then to the lungs. They penetrate into the pulmonary alveoli, ascend the

bronchial tree to the pharynx, and are swallowed. The larvae reach the small

18
intestine, where they attach to the intestinal wall with resultant blood loss by the

host. Most adult worms are eliminated in 1 to 2 years, but the longevity may reach

several years. Some A. duodenalelarvae, following penetration of the host skin, can

become dormant (in the intestine or muscle). In addition, infection by A. duodenale

may probably also occur by the oral and transmammary route. N americanus,

however, requires a transpulmonary migration phase.

19
Fig 2.5 Life Cycle of Hookworm (source: centre for disease control)

20
2.4Enterobiusvermicularis

Enterobiusvermicularis is commonly called the thread worm, pin or seat worm. It

causes an intestinal parasitic infection called enterobiasis (anal itching) that occurs

commonly in children. Adult worm (gravid females) live in the caecum and

vermiform appendix of human, where they remain until the eggs are developed.

They generally remain on the surface of the mucosa and may occasionally encyst

in the submucosa layer.

The adult worm is small, white in color, more or less spindle shaped and resembles

a short piece of thread.They are visible to the naked eye,True buckle capsule is

absent.A pair of cervical alae (wing like expansions) is present as the anterior

extremity.The posterior end of the oesophagus is dilated into a conspicuous

globular bulb/ a double- bulb oesophagus which is a characteristic feature of this

nematode.The oral end has three lips with a dorso-ventral bladder like expansion of

the cuticle.

2.4.1 Life cycle

The life cycle of E. vermicularis is simple and is completed in single host (Human
host).i.eNo intermediate host is required.Human acquires infection by ingestion of
the embryonated eggs attached to their nails during scratching of the perianal
area.The egg shells are dissolved by digestive juices and the larva escape in the
small intestine then they migrate to the caecum and vermiform appendix, where
21
they develop to adult worms within 15-30 days of infection.Male use spicules to
hold female during copulation. The male dies immediately after fertilizing the
female.The gravid female then migrates to the perianal skins at night, stimulated
by a dropin body temperature of the host.It will only lays eggs on the perineum,
because air acts as stimulant for laying eggs.The ejection of eggs is so forceful that
the eggs can be spread out over the perianal area.After oviposition the female often
dies.Eggs trapped in perianal folds may hatch out the larva and may enter intestine
directly via the anus. This process is known as retro-infection.Occasionally larva
may enter the vulva and infect the vagina of women.Whole life-cycle completes
within in 2-13 weeks.

22
Fig. 2.6 Life cycle ofEnterobiusvermicularis:

Center for Disease control)

23
2.5 Clinical Manifestation

Clinical manifestation of intestinal helminth infections are usually asymptomatic,

however the clinical manifestation generally can be categorized into two features;

first, the acute clinical symptoms resulting from early larvae migration through the

human skin and viscera and second, the acute and chronic symptoms associated

with the intestinal parasitism by adult worm.

2.5.1 Early larvae migration

Early larvae migration in the early larvae stage of Ascaris to the lungs can cause

respiratory symptoms. Ascarislumbricodes larvae that die during migration through

lungs can cause eosinophilic granulomas. Classically, heavy infection may also

result in verminous pneumonia (i.e., Loeffler s syndrome), a condition which is

usually associated with wheezing dyspnea, non-productive cough and fever with

blood-tinged sputum. In contrast to A.lumbricoides, E. vermicularis life cycle does

not involve any pulmonary migration and thus, no pulmonary symptom occurs.

(Hotezet al., 2010)

2.5.2 Intestinal Parasitism by Adult Worm

During the late phase (i.e., intestinal phase) of intestinal helminth infections,

gastrointestinal symptoms occur typically due to the mechanical effect of high

parasite loads. In A. lumbricoides infection, the most severe manifestations are the
24
physical obstruction in intestinal tract by adult worms and migration of adult worm

into the biliary tree. Hepatobiliary and pancreatic ascariasis (HPA) occurs when

adult worm in the duodenum enter and block bile duct, leading to biliary colic etc.

chronic A. lumbricoides infection also has impacts on their host nutritional status

such as increased fecal nitrogen loss, reduction in the ability to digest lactose (i.e,

lactose intolerance) and vitamin A malabsorption. In most case of the chronic

infections especially among children, they may experience abdominal pain and

nausea.

2.6 Diagnosis

Intestinal helminthes infections are most often diagnosed by finding and

identifying eggs and/or juvenile nematodes when examining fecal specimens under

the microscope. Either fresh or preserved specimen may be used for diagnosing an

infection. Identifying an egg found but not readily recognized often presents a

problem for the laboratory worker and may require looking in several reference

sources before identification can be made.

The size shape, structure, and stage are key used in identification. If an appropriate

reference source is not readily available, identification may take several days or

sometimes longer. Sophisticated tests such as serological assays, antigen tests and

25
molecular diagnosis are also available (Lustigmanet al., 2012). However, they are

time-consuming, expensive and not always reliable.

2.7 Prevention and Control

1. Disrupting the cycle of the worm will prevent infestation and re-infestation.

2. Prevention of infection can largely by achieved by addressing the issues of

wash-water, sanitation and hygiene (UNICEF, 2015).

3. The reduction of open defecation and stopping the use of human waste as

fertilizer (Strunzet al., 2014).

4. Further preventive measures include adherence to appropriate food hygiene,

wearing of shoes, regular deworming.

2.8 Treatment

Helminthiasis can be treated using Anthelmintic Medications

1. Broad-spectrum benzimidazoles (such as albendazole and mebendazple) are

the first line treatment of intestinal roundworm and tapeworm infections.

2. Macrocyclic lactones (such as ivermectin) are effective against adult and

migrating larval stages of nematodes.

3. Oxamniquine is also widely used in mass deworming programmes. Pyrantel

is commonly used for veterinary nematodiasis.

26
4. Mass deworming in regions where helminthiasis is common, mass

deworming treatments may be performed, particularly among children in

rural areas, who are a high-risk group.

Deworming programs can improve school attendance by 25 percent.

Although deworming improves the health of an individuals, outcomes from

mass deworming campaigns, such as reduced deaths or increases in

cognitive ability, nutritional benefits, physical growth, and performance, are

uncertain or not apparent.

5. Surgery can be done if complication of helminthiasis, such as intestinal

obstruction occur, emergency surgery may be required. Patients who require

non-emergency surgery, for instance for removal of worms from the biliary

tree, can be pre-treated with the anthelmintic drug albendazole.

27
Figure 3.1 Map of Ikwerre Local government Area

28
 CHAPTER THREE

MATERIALS AND METHODS

3.1Study Area

Ikwerre is a Local Government Area in Rivers state, Nigeria it has a total land

area of 530sqmi(1,380km2). Having a population of over 265,400 (projected with

3.46% growth rate by NPC from the 2006 census of 188,930), with a given

population density of 405.2/km2. The Ikwerreland lies roughly within the

coordinatesof4°:50N5°:15N,6°:30E7°:15E. (Fig 3.1) The geology and

geomorphology of the area are intimately associated with that of the Niger-Delta

which was created in the Holocene by the process of erosion and sedimentation,

(Harrison, et al., 2018).

This research work was carried out in three randomly selected, communitiesElele,

Isiokpo and Aluu(all in Ikwerre Local Government Area of Rivers State Nigeria).

In the study area has a tropical rainforest vegetation and climate with constant

temperature and pressure; the rainy season fall between April and October while

the dry season lasts between November and March; the relative humidity of the

area is also very high and this encourages the development and survival of

infective stages of parasites. The inhabitants of the study area consist mostly of

people from all walks of life, including civil servants farmers and traders, (farming

29
and trading are the predominantly occupation of the adults and their children are

also known to participate in these occupation). These children walk about in farms

and at home on bare foot and they do not boil their water before drinking. Also,

toilets and “water closet” are more expensive and many families cannot afford

them. Hence, they use bush and pit as their toilet system.

3.2 Study Population

The study population comprised of 100 (58 males and 42 females)farm workers’

children in the selectedcommunities within the age range of 2- 16years.

3.3Study Design

The study was a cross sectional randomized study conducted in selected

community of Ikwerre,Rivers State from May to August,2021. Oral or coritten

consents were obtained from the parents/puardians of all study participants.

3.4Sample Collection

Faecal samples was collected from 100 farm workers children using a sterile

sample container;each sample containers was numbered and distributed with a

questionnaire. Respondents were instructed to provide their early morning faecal

specimens (not contaminated with urine) and these were collected between 8-10am

in the morning with the questionnaire. The questionnaire provided information on

30
personal data (sex, age, source of drinking water, study participants who could not

fill the questionnaires themselves were assisted. type of toilet facility and wearing

of footwears) from each respondent; Specimens were flooded with 10% formalin

on collection and were taken to Department of Animal and Environmental

Biology, Parasitology Laboratory for microscopic examination.

3.5Examination of Samples

The standard method of stool examination as described by WHO was adopted for

the study. This includesmacroscopy andmicorscospic(formal ether concentration

techniques) examination.

3.5.1 Microscopy

The stool samples were examined for the following;

 Colour: The colours observed were brown, dark brown, yellow and

greenish-brown

 Presence of blood: this was done to check out for the presence of blood and

there was none. Bloody stool is suggestive of Amoebic dysentery

 Consistency: The stool samples were mostly formed and a few were semi

formed and three watery sample.

31
  Presence of mucous: this was done to check out for visible mucous and there

was none. Presence of adult worms or segment.

3.5.1 Microscopy Formol-ether sedimentation technique0

The fecal samples were processed using formol-ether concentration technique as

described by Cheesbrough, 2006. Using a rod stick 1gram (pea-size) of faces was

emulsified in about 7ml of 10% formalin contained in a screw-cap bottle. The

emulsified faces was sieved using a guaze and funnel into a beaker. The filtered

suspension was transferred into a centrifuge tube and was centrifuged for 2000

r.p.m for 5 minutes. 7ml of Formol-saline was added to the tube, mixed by shaking

vigorously and was centrifuged for 5 minutes. 2ml of Ether was added mixed and

centrifuged for 3 minutes. After centrifuging the sample separated into layers with

Ether at the top (a colourless clear fluid), a plug of debris (dark brown and thick)

formol-saline (colourful fluid with suspended debris and the sediment (with the

parasites at the bottom of the tube using an applicator stick, the layer of faecal

debris was loosened from the side of the tube. The tube was inverted to discard the

ether, faecal debris and formalin. The bottom of the tube was tapped to resuspend

and mix the sediment and a drop was placed on a glass slide, a drop of lugol’s

iodine was added and was covered with a cover slip. The preparation was

32
examined microscopically using the x10 objective with the condenser iris closed

sufficiently to give a good contrast. X40 objective was used to examine the eggs.

3.6 Identification of Parasites

The Parasites were identified using a key or guide from Monica Cheesbrough

2006. Positive specimen was identified on the basis of microscopy.

3.7 Statistical Analysis

All data obtained were deistically analyzed using chi-square test and prevalence

were expressed in percentage. A p-value less than 0.05 (P<0.05) was considered

significant.

33
 CHAPTER FOUR

RESULTS

4.1 Overall Prevalence of intestinal parasites

An overall prevalence of 18.0% (18 out of 100) was recorded in this study in this
study (P<0.05). Elele, Isiokpo and Aluu had prevalence values of 24.0% (12 out of
50), 12.0% (3 out of 250 and 12.0% (3 out of 25) respectively (P<0.05) (table 4.1).

Table 4.1: Overall prevalence of intestinal parasites

Study area Numbers NoUninfected Noinfected P- Value

Examined (%) (%)

Elele 50 38(76.00 12(24.0)

Isiokpo 25 22(88.0) 03(12.00 0.00

Aluu 25 22(12,0) 03(12.0)

Total 100 82(82.0) 18(18.0)

There is significant differences between those infected and uninfected at p<0.05

34
4.2: Sex-related overall prevalence of intestinal parasites

According to sex, overall prevalence values of 19.0% (11 out of 58) and 16.7% (7
out of 42) were recorded for males and females respectively (P>0.05) (table 4.2).
Males in Isiokpo (15.4%) and Aluu (13.3%) had higher prevalence than females
but females in Elele (25.0%) had a higher prevalence than males (P>0.05) (table
4.3).

Table 4.2: Overall sex-related prevalence of intestinal parasites

Sex Number Number Number P-value

examined Unfected (%) Infected (%)

Males 58 47(81.0) 11(19.0)

Females 42 35(83.3) 7(16.7)

Total 100 82(82.0) 18(18.0)

There is no significant difference between those infected and uninfected at P>0.05.

35
4.3 Age-Sex Related Overall Prevalence of Intestinal Parasites

According to age overall parasite prevalence values of 20.)% (4 out of 20), 23.5%

(8 out of 34) and 13.0% (6 out of 46) were recorded for age groups 2-6years,

7-11years and 12-16years respectively (p 0.05) ( table 4.3)

Table 4.3a Age Related overall prevalence in the study area

Age (years) Number Number Number P-value

examined Uninfected infected (%)
(%)

2-6 20 16(80.0) 04(20.0)

7-11 34 76 (76.5) 08(23.5)

12-16 46 40(86.9) 06(13.0)

Total 100 82(82.0) 8(18.0)

36
Table 4.3b: Sex-Related prevalence in relation to studies communities

Sex Elele Isiokpo Aluu

Number Number Number Number Number Number

Examined Infected (%) Examined Infected(%) Examined Infected(%)

Males 30 07(23.3) 13 02(15.4) 15 02(13.3)

Females 20 05(25.0) 12 01(8.3) 10 01(10.00

Total 50 12(24.0) 25 03(12.0) 25 03(12.0)

Table 4.3c: Age–Related prevalence in relation to studies communities

Age Elele Isiokpo Aluu

(years) Number Number Number Number Number Number

Examined Infected (%) Examined Infected(%) Examined Infected(%)

2-6 08 02(25.0) 05 01(20.0) 07 01(14.2)

7-11 11 06(50.0) 11 01(9.1) 12 01(8.3)

12-16 31 04(8.0) 09 01(11.1) 06 01(16.6)

Total 50 12(24.0) 25 3(12.0) 25 3(12.0)

37
4.4 Distribution and Species Intestinal Parasites

In this study, only two parasites were observed and they were Ascarisis
lumbricoides(16.0%) and Enterobius vermicularis(2.0%) (table 4.6). Elele
recorded the highest number of both parasites with prevalence values of 20.0% and
4.0% for Ascarislumbricoides and Enterobiusvermiculeris respectively (table 4.6).

Table 4.4:Distribution and Most common Helminthes Species Intestinal

Parasites in the study Area

Study area Numbers Prevalence of Parasites (%) Total

Examined prevalence
AL (%)EV(%)
(%)

Elele 50 10(20.0) 02(4.0) 12(24.0)

Isiokpo 25 03(12.0) 0(0.0) 3(12.0)

Aluu 25 03(12.0) 0(0.0) 3(12.0)

Total 100 16(16.0) 2(2.0) 18(18.0)

KEY

Al = Ascarislumbricoides

EV = Enterobiusvernicularis

38
 4.5 Prevalence of intestinal parasites in relation to source of drinking
water

According to drinking water sources, children who drank water from tap, wells
and boreholes had parasite prevalence values of 12.8% (5 out of 39), 33-3% (2
out of 6) and 20.0% (11 out of 555) respectively (table 4.7).

Table 4.5 Prevalence of intestinal parasites in relation to source of drinking

water

Drinking Number Number Number

water
Examined Unifected (%) Infected (%)
source

Tap 39 34(87.2) 05(12.8)

Wells 06 4(66.7) 02(33.3)

Borehole 55 44(80.0) 11(20.0)

Total 100 82(82.0) 18(18.0)

39
 4.6Prevalence of Intestinal parasites in relation to wearing of footwaears

According to frequency wearing foot wears children who rarely, never and
constantly wore footwear had parasite prevalence values of 20.0% (14 out 70)
20.0% (1 out of 5) and 12.0% (3 out of 25) respectively (table 4.6)

Table 4.6 Prevalence of Intestinal parasites in relation to source of

drinking water

Frequency Number Number Number

of wearing
Examined Unifected (%) Infected (%)
footwear

Rarely 70 56(80.0) 14(20.0)

Never 25 04(80.0) 01(20.00

Constantly 25 22(88.0) 03(12.0)

Total 100 82(82.0) 18(18.0)

40
 CHAPTER FIVE

5.1DISCUSSION

The study revealed an An overall prevalence of 18.0% (18 out of 100) was

recorded in this study in this study (P<0.05).

Table 4.1 shows percentage prevalence of intestinal parasitic infection in the study
area. Elele has the highest percentage prevalence with 24.0% (12 out of 50)
(P<0.05) Prevalence obtained in this study is in line with the reports of Odugbemi
et al..,(2015) who recorded 11.6% in Lagos state, Adaeze (2018) also reported
12.1% prevalence among primary school children in Obio/Akpor local government
Area, Rivers state.

Table 4.2 shows percentage prevalence in relation to sex prevalence values of

19.0% (11 out of 58) and 16.7% (7 out of 42) were recorded for males and females

respectively (P>0.05) (table 4.2). Males in Isiokpo (15.4%) and Aluu (13.3%) had

higher prevalence than females but females in Elele (25.0%) had a higher

prevalence than males (P>0.05). This may be as a result of the males always

accompany their parents to farm on walking on barefoot and also for the females

as aresult of their involvement in domestic activities around homes and therefore

come in direct contact with polluted environment and consequently less infected.

Agi (2010) stated that in the case of toilet facilities used, people who used pit toilet

41
facility have a high infection rate (100.0%) while those who used water closet have

(31.0%).

Table 4.3 shows the Age-Sex overall parasite prevalence with the age bracket of

(7-11) years having the highest prevalence value 23.5% (8 out of 34). Which could

be attributed to their ignorance to personal hygience because of their litttle age.

Table 4.3b and 4.3c revealed that females in Elele had the highest frequency

percentage prevalence of intestinal parasites with a value of (5 out of 20) which

gives 25%. This is due to the fact that the females according to the observation of

the researcher assist their parents more in some domestic activities which exposes

them more to germs from unclean environment. for that of the age prevalence in

relation to study communities the study also revealed that children within the age

bracket of (7-11) in Elele had the highest prevalence with a value a percentage

value of 50% ( 6 out of 11).

Table 4.4 shows the distribution and prevalence of each parasites species which
indicated Ascarisis lumbricoides as the highest with a percentage of (16.0%) and
Enterobius vermicularis (2.0%). Elele recorded the highest number of both
parasites with prevalence values of 20.0% and 4.0% for Ascaris lumbricoides and
Enterobius vermiculeris. Respectively Some workers have observed similar
finding. (Agi, 2009) stated that high prevalence of Ascaris lumbricoides could be

42
attributed to environmental fouling of fecal materials which could contamination
of water in the area, followed by hookworm. He added that the presence of
Enterobius vermiculeris can be attributed to the people agricultural involvement in
farming since they lack personal hygiene. Hookworm is a soil transmitted
helminthes parasites and can easily infect people especially children that walk with
bare foot. Agi, (2009) also reported that Ascaris lumbricoides occurred more
frequently in Bonny island of Rivers State. Brownson (2011) equally reported a
high occurrence of the three named helminthes in Isiokpo community and that
Choba village he observed that out of 125 faecal samples examined 73(66.4%)
were positive for Ascaris lumbricoides. However the low prevalence of
Entrobiusvermicularisrecorded in this study could be attributed to personal
hygiene, Health education, the use of Anthelmintic drugs, wearing of foot wears,
and drinking of clean water as observed in the questionnaire administered to the
respondents.

Table 4.5. shows the Prevalence of intestinal parasites in relation to source of

drinking water, where it was revealed that children who drank water from wells
had the highest prevelance of 33-3% (2 out of 6) and followed by those that drank
from Bore-Holes 20.0% (11 out of 555). This maybe as result of the fact that well
waters are mostly used by the poor local farmers of the study area, since the areas
are mostly wetlands and their top soils are close to the water table thereby making
it easy for wells to be dug as a major source of water. The study is also is also in
line with (Odugbemi et al .,,2015) who revealed that Intestinal parasites infections
are endemic in the tropics and subtropics for reasons attributive mainly to
environmental conditions, poor Hygiene and lack of access to clean and portable
water causing significant morbidity such as Anamia, diarrhea, malnutrition, mental
deficits, poor growth and in severe intestinal obstruction.

43
Lastly table 4.6 shows the prevalence of intestinal parasites in relation to wearing
of foot wears from the percentage estimated frequency for wearing of foot wears
children who rarely and never wore footwear had the highest parasite prevalence
values of 20.0% (14 out 70) 20.0% (1 out of 5) while those that constantly wear
footwares had value of 12.0% (3 out of 25). This is in line with the researcher who
discovered that, The farm workers’ children walk on the ground without shoes and
play on soil that contains parasite cysts and mature forms, which makes them
vulnerable to being infected.

This practice is a product of under development and shows lack of personal and

community hygiene, it is a major source of soil and water pollution and responsible

for the high incidence of soil transmitted helminth parasites in Nigeria. Most of the

entire population drinks from the well. Those that drink from the well are allowed

defecating indiscriminately around houses and compounds. Domestic animals such

as goats, fowls, ducks, and dogs drink freely with the least restriction. Whenever

there is heavy rainfall the polluted water is washed easily to the wells because they

are not properly covered. Children are found during rainy season playing under the

rain with their legs inside this polluted water making it easier for parasites to

44
penetrate their feet most times, they go to streams to bath in the polluted water.

Therefore the habit of defecating in bushes, bathing contaminated water, walking

barefoot to farm and on contaminated grounds contributed to the high rate of

intestinal infection.

Table 4 shows the percentage prevalence in age Range, ages 7 and 8 had the

highest prevalent percentage (75.6). This is due to the fact that these group walk

barefooted around homes and when going to school and even swim continuously in

the contaminated streams. This is followed by ages 13 and 14 (67.7%) and age

bracket 11 and 12 (60.6%). Erokosima (1984) had 6(9.09%) out of 150 faecal

samples examined. Poly parasitism in the infected individuals are important feature

in the epidemiology of the parasites, this is because the acquisition of a single

infection produces a different effect from acquisition of large number of different

worms. The most prevalent of these combinations was Ascaris lumbricoides and

Trichuris trichuria.

5.2 CONCLUSION

45
This research work, through preliminary acts as a spring board for further studies,

on the prevalence and its associated impact of intestinal parasites amongst farm

workers children in the rural study area which is hoped may lead to better

understanding of the disease. From the research work it was observe that majority

of the people were infected not necessarily because of poverty but because of

ignorance as a result of lack of education, good environmental sanitation (through

proper waste disposal system and personal hygiene), lack of pure and portable

drinking water and not wearing of footwear. Therefore, good toilet facilities pipe

borne water, education through enlightenment programmes and improved sanitary

conditions be provided since the infection is by no means caused by lack of good

water and poor sanitary conditions.

5.3 RECOMMENDATIONS

This study has shown the intestinal Helminths infections are prevalent among
children of rural/local farmers workers in Ikwerre local government Area Rivers
state.

Thus the following are Hereby recommended;

1. Economic implications and public Health necessarily should be provided

because children tend to have higher intensities of infections.
2. Improvement in habitation, sanitation access, health service and appropriate
available health infrastructure are also important factors for decreasing the
prevalence of parasitic infections.

46
 3. Regular De-worming program of children.
4. Health Education about causes of intestinal Helminths infections, it’s
clinical features and ways of diagnosis; treating and preventing the infection
should be an integral part of the Curriculum of all schools in areas in which
the school age population is at risk of the infection.
5. Government should close endeavors to provide a primary Health center
infrastructure in the communities.

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APPENDIX

51
Plate 1: Egg of AscarisLumbricoides

52
Plate 2: Egg of EnterobiusVermicularis

53
 Plate 3: Laboratory Analysis of sample

AN EXPERIMENTAL QUESTIONNAIRE

Instruction: please answer the following questions sincerely and objectively to

ensure statistical validity of the instrument.

1. Name: ……………………………………………………………………….

2. Age:………………………………………………………………………….

3. Sex: Male Female

4. Parents occupation:…………………………………………………………..

54
5. Type of toilet system: (a) Pit Toilet (b) Water System (c) Bush (d) Bucket

6. Source of drinking water: (a)Tap (b) Stream (c) Well (d)Borehole (e) Rain

7. Do you put on footwear: (a) All the Time (b) Occasionally (c) Never

8. Have you passed out worm through anus, nose or mouth before? (a) Yes (b)

No

9. When last did you take an anthelminthic medication?..................................

55