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Parasitism is any association in which a species depend upon another for its

existence. According to Wakelin, 1984: “For parasites, the host is the total environment.” It is

believed that even if the other reproductive stages of the parasite are able to survive in

the outside environment for various durations of time, this only depicts a part of the

parasite’s cycle or process of infection from one host to another.

Parasitic infections are continuing diseases experienced by a majority of people

especially those who live in unsanitary environments. Humans of all ages can get

infected but for young children, helminth infections are the most prevalent. Because of

the common knowledge that helminth infections are widespread amongst the young

and do not really cause fatality, only unpleasant side effects that may affect the child’s

health and happiness, the parents of these children commonly in the lower classes have

somewhat accepted this reality. They do not feel the need to learn proper hygiene habits

in their households because they have excused their families as immunes of this kind of

infection. Because of the parents’ lack of examples on proper hygiene habits, occurrence

of parasitic infections among their children is prevalent. But it is due to additional

environmental settings that primarily cause reinfection among them.

In Barangay Tabuc-Tubig, Dumaguete City, around 50% percent of the day care

children at Tabuc-Tubig Resource Day Care Center have been positively diagnosed with

helminth parasites. The reasons for the occurences of the infections are mainly pointed

to the unsanitary actions of the children like not washing their hands properly, not

wearing footwear while playing in the dirt, playing in the nearby contaminated river,

and such. But even though parents, teachers, and other health workers/personnel have
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tried to instill in them proper hygiene habits, the children still cannot escape from their

environment which possesses factors that are the primary causes for the continuing

reinfection of helminth parasites. Because the environment cannot easily be changed, it

is unavoidable especially for the children to not be affected by it even if they have been

taught proper hygiene practices. Thus, making the environmental setting of the day

care’s location as the main cause of Helminth Parasites reinfection among the

children enrolled at Tabuc-Tubig Resource Day Care Center SY 2016-2017.

Intestinal helminth worms grow in children who have ingested larva eggs,

typically from exposure to soil or surfaces contaminated with human feces. Three

common types of intestinal worm affecting children are Ascaris lumbricoides

(roundworms), Trichuris trichiura (whipworm), and Enterobius vermicularis

(pinworms) and together, they make up a group of parasites called helminths. While

none of the three conditions are usually fatal, it can lead to unpleasant side effects that

can affect the child’s daily practices and activities.

Ascaris lumbricoides are known as soil-transmitted helminths (parasitic worms).

It is one of the most common helminthic human infections worldwide. And also it is

highest prevalence in tropical and subtropical regions, and areas with inadequate

sanitation. The female worms are larger than the males and can measure 40 cm in length

and 6 mm in diameter. They are white or pink and are tapered at both ends. It is

estimated that more than 1.4 billion people are infected with Ascaris lumbricoides,

representing 25 percent of the world population. Transmission is enhanced by the fact

that individuals can be asymptomatically infected and can continue to shed eggs for
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years, yet prior infection does not confer protective immunity. It is most common in

children 2 to 10 years old, and prevalence decreases over the age of 15 years. Infections

tend to cluster in families, and worm burden correlates with the number of people

living in home.

Trichuris trichiura, known as whipworms, this species parasitizes humans and

monkeys. Two conditions are needed for spreading the Trichuris trichiura: poor

sanitation, and environmental conditions that are suitable for the worm’s development.

This includes a warm moist climate, low light, wet soil, and lots of rain. They are found

all over the world within temperate and tropical climates (Roberts and Janovy, 2000;

Smyth, 1994). Estimates of egg production range from 1,000 to 7,000 per day. After a

short period of development, it reenters the intestinal lumen and migrates to the

ileocecal area where it matures in about 3 months. Adults live for several years, so large

numbers may accumulate in a person.

Enterobius vermicularis, is commonly known as pinworm or seatworm. It is

parasitic only to humans. Enterobius vermicularis, measuiring 8 to 13 mm long by 0.4

mm wide, are characterized by the presence of winglike expansions (alae) of the body

wall at the anterior end, distention of the body due to the large number of eggs in the

uteri, and a pointed tail. Males, smaller in size, are 2 to 5 mm long and possess a curved

tail. Infection and reinfection occur when eggs containing the infective larvae are

ingested by the host. This may happen when eggs are picked up on the hands from

bedclothes or beneath fingernails contaminated with the host scratches the perianal

zone to relive itching caused by nocturnal migration of the female worms. However, the
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lightweight eggs are sometimes airborne and, therefore, can also be inhaled. The life

cycle of E. vermicularis spans about 2 months. Some evidence suggests that eggs can

remain viable for years under favorable conditions.

When the word ‘child’ comes to mind, we often link the word to youth and

innocence. Sometimes it comes with carelessness and stubbornness. A child’s need to

explore is endless and the only thing that could put a stop to this is their health. A

healthy child is a productive child, and being productive gives more learning. Adults

only serve as their protection and guide for them to be able to survive in this world. But

even something as simple as that, adults have no control over it completely. Children

play during their early years to learn and as day after day passes by, they slowly fill up

the empty spaces of their brain. As wonderful as self-learning sounds, it also has its

own setbacks because children are more vulnerable to getting diseases such as

parasitism because of their underdeveloped resistance and capacities of thinking to

the various, harmful microorganisms brought about by the environment.

The immune system is the body’s defense against pathogens and other foreign

microorganisms, and because they are not recognized by the body, the immune system

will immediately think of them as invaders that will cause disease. Through a process

called the immune response, the immune system attacks these organisms to prevent any

further damage that may be caused by them (Durani, 2015). The immune system is

made up of special cells, proteins, tissues, and organs that defend people against germs

and microorganisms everyday. In most cases, the immune system does a great job of

keeping people healthy and preventing infections. Although everyone’s immune

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system is different. Some people never seem to get infections, whereas others seem to be

sick all the time. As people get older, they usually become immune to more germs as

the immune system comes into more contact with more and more of them. That’s why

adults and teens tend to get fewer colds than kids because their bodies have learned to

recognize and immediately attack many of the viruses that cause colds.

As with all other organs and systems in the body, a child is not born with a fully

developed immune system, rather, their immunity grows and strengthens with time.

According to Presti, 2014 :

“A child’s immune system will start to develop on its own at about 2-3 months of age. At

this point the antibodies that the mother has conferred will start to decline. A baby’s immune

system begins to grow and develop when it comes into contact with bacteria, viruses and

fungi and can wage an attack against them. By 1 year of age, a baby will have developed its

immune system significantly, although not entirely. Some experts suggest an immune

system is not fully developed until a child is approximately 12-14 years of age, when they

finally reach adult levels of antibody formation.”

Because immunodeficiency is present, the children are not safe from getting

diseases. The surrounding environment is full of microorganisms that can easily defeat

the present and still progressing immunity of the child. But it is not advisable to deprive

the young of exposing themselves to the environment because a child adapts and learns

the moment they open their eyes and expose themselves to the setting of the

environment.
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The day care children are aged from 3-6 years old. Because they have not fully

developed their capacity to decide, they become somewhat ignorant to the roaming

infectious parasites that they will be able to possess if they do not practice proper

hygiene habits. “… they lack the developmental capacities to make decisions…”

(Martin, Gutierrez & Galang). According to Mrs Lazaro, the assigned midwife of the

local health center, “Wala kaayo sila [ang mga bata] kabalo nga hugaw diay nang ilang

gigunitan or ginahimo” (They [the children] do not know that what they are holding or

doing is unsanitary). She also said “… usahay bisag unsa nimog tudlo sa bata kung ang

iyang palibut daghang hugaw or unsa pa diha, dili jud malikayan na magkabitok usob ang kana

na bata. Apan maayo man pud ang pagtudlo sa ila ug proper hygiene pero mga bata pa biya sila,

ganahan sigeg lihuk-lihok ug dula-dula bisag unsa pa kahugaw ang ilang palibot kay usahay

man pud wala pa sila kabalo na hugaw diay na. Wala pa kayo na develop ilang way of thnking.”

(… sometimes, no matter how much you teach a child [proper hygiene], if his or her

surroundings is dirty or such, it cannot be avoided that the child will get reinfected by

parasitism. Although it is good to teach them proper hygiene but they are still young,

they also want to move and play no matter how dirty the setting is because they may

also not comprehend that it is indeed dirty. Their way of thinking has not yet been fully

developed). Since the environment is full of probable sources for infection, their

incapacity to fully decide or comprehend on things can really affect their health against

parasitism.

The day care children also become vulnerable to parasitism because of the

surrounding elements of the day care. Because it is here where they spend most of
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their time every week, the children are always exposed to these elements. According to

Mrs . Pagudsan, the assigned teacher of the said day care, “… kaning among day care

gipalibutan man ug mga balay-balay nya daghang mga iro ug iring galibot-libot tungod

mangalkal anang mga basura nga ipang bitay ra gali sa mga ubang tawo dira. Then we

also have a river sa likod. Makaingon ko na dili siya limpyo kay tungod makita man jud

nga daghang mga basura na galutaw-lutaw dira. Usahay mangadto ang mga bata didto

para magdula unya since bata pa sila ug murag naanad na pud sila ba, wala kayo sila

kabalo na makadaot diay sa panglawas ang kanang ilang pagdula-dula dira.” (… our

day care is surrounded by houses and there are a lot of cats and dogs roaming around

to scavenge on the garbage that are left and just hanged anywhere by the people. We

also have a river at the back. I can say that it is dirty because of the evident floating

garbage. Sometimes the children go there to play and since they are young and also

because of familiarity, they do not realize that playing there can be very harmful to the

body).

Bacteria, viruses and parasite larvae cannot be seen through the naked eye and it

can be found almost everywhere even in our own bodies. Most of the time children

touch what they see and even the most mundane things people use on a daily basis are

where many infectious microorganisms are found and children do not know this. By

putting things inside their mouths, they are more prone to infections, and that is only

one possible way of getting infected. The environment also plays a part in a child’s

health. For the day care children of Tabuc-Tubig, their day care’s location is surrounded
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by animals such as cats, dogs, ducks, and cows. These animals leave feces anywhere

they like and because of locomotive air, parasites residing in the feces could easily move

with the air and be inhaled by the children.

Just like what Mrs. Pagudsan stated, the river at the back of their day care could

also be a source of the continuing reinfection of helminth parasitism among the

children. Because it is flowing water and near residential homes with people and

animals, it could easily be infected with human and animal feces. And since children go

there and play, they too become infected.

The temperature and climate of the place is also a major influential factor of helminth

reinfection. “Many species of protozoa and of helminthes have been maintained

experimentally at abnormally high temperatures and they have consequently changed

their morphology as well as their physiological reactions to a marked degree. Helminths

sometimes go through more than a 60˚ C. change in temperature from host tohost

during the normal course of their life cycles.” (Noble & Noble, 1964). Since the

Philippines is a tropical country, we only experience dry and wet seasons. Most of the

year, a hot climate is usually experienced which contributes to the continuing survival

of helminth parasites. According to Hortez et. al(2008) “Climate and topography are crucial

determinants of the distribution of helminth infections.”

According to Weaver, (2010) “Climate change, from an environmental perspective, is

predicted to directly influence STHs through its effects on the free-living stages of parasites and
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have a direct impact on human host populations. Indirect influences on parasite abundances

include the effects of altered host nutrition and immunity.”

The act of health of teaching towards the children is not enough. Health

teaching is not enough to eradicate helminth infection. Because children don’t have any

idea what will be the effect if they got infected by the helminth infection, and they will

not cooperate because they are always playing without minding the infection. Children

get distracted easily that’s why making them voluntarily do certain things can be of

really great burden. But through the knowledge, perceptions and behavior of mothers

toward intestinal helminths in their child implications for control it can prevent

helminth infection. Children should learn proper hygiene at home first. And it is very

important for the parents to teach them the proper way to prevent infections of

helminth. Because lack of knowledge leads to a greater chance of risks and diseases.

According to Curtale, (1998):

Health education, besides encouraging mothers to refer their children to the health units

for treatment, should focus on improving hygienic behavior. While schools might be the best

channel to contact children, the use of informal channels of communication, such as television,

should be promoted to reach the mostly illiterate mothers. The research highlights the importance

of gathering information on mothers' perceptions and behavior in the design and implementation

of a community-based intestinal helminths control program. Good hygienic practices were

associated with a low prevalence of infection in the household. Practical recommendations were

formulated to design a helminth control program tailored to the local situation and to prioritize
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allocation of resources. A good level of knowledge was observed also for ways of preventing

infection.

Adults only serve as their protection and guide for them to be able to survive in

this world. A healthy child is a productive child, and being productive gives more

learning. But even something as simple as that, adults have no control over it

completely.

According to Louing, (2002) “In areas where human excreta are used as organic fertilizer,

people should be educated and motivated to use only the fully digested or properly composted

human excreta and not to apply the raw or partially digested excreta to the field. Fully digested

excreta are taken from a latrine pit where it has been sufficiently stored for one to two years.

During this period, disease pathogens and worms’ eggs have died out completely. It will not

pollute the soil or the environment as well as the vegetables grown in the field. An integrated

de-worming and WES program should also educate people about the proper method of

composting the human excreta for use as organic fertilizer.”

The above discussion shows that even if the children have been or will be taught

about proper hygiene, it is not enough to do so because the children, at a young age,

have not fully developed their immune system as well as their capacity to make

decisions. The environmental setting of the day care; the hot climate which contributes

to the survival of helminth parasites, and the residing animals whose feces could easily

infect the surroundings especially the river wherein the children play in; plays a very
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major role in the continuing cycle of helminth parasitism infection among the day care

children of Tabuc-Tubig Resource Day Care Center.

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References
Ascaris Lumbricoides In Parasites, In Humans. (2015) Retrieved from http://
www.parasitesinhumans.org/ascaris-lumbricoides-giantroundworm.html

Durani, Y. (2015, May). Immune System. The Nemours Foundation. Retrieved from
m.kidshealth.org/

Fraumann, R. (2003). Trichuris trichiura. Animal Diversity Web. Retrieved from

http://animaldiversity.org/accounts/Trichuris_ trichiura/

Lora, J. & Leder, K. & Weller’s P.F (n.d.) Ascariasis. Retrived from
http://web.stanford.edu/group/parasites/ParaSites2005/Ascaris/JLora_Pa
raSite.htmAscaris

Martin, R., Gutierrez, J. & Galang, J. (n.d.). Evaluating the Decision-Making Capacity
of Children: A Guide for Legal Practicioners. Retrieved from https://www.
law.umich.edu/centersandprograms/pcl/ljjohnsonworkshop/Documents/E
valuating%20the%20Decision-Making%20Capacity%20of%20Children%20
PDF.pdf

 Rett, D. (2003). Enterobius vermicularis. Animal Diversity Web. Retrieved from

http://animaldiversity.org/accounts/Ente robius_vermicularis/

Trichuris trichiura. (n.d.) Retrieved from https://smartsite.ucdavis.edu/access

/content/user/00002950/courses/nemas/trichuristrichiura.htm

Wakelin, D. (1984). Immmunity to Parasites. Great Britain: Edward Arnold Ltd.