PREVALENCE OF HELMINTHIC PARASITE INFECTION

AMONG THE CHILDREN (3-10 YEARS OLD) IN DIFFERENT

POPULATION OF QUETTA CITY.

By

Maira

A thesis submitted in partial fulfillment of the requirement for the degree of

BS in Zoology

Supervisor: Assistant Prof: Ms. Shahida Aziz

GOVERNMENT GIRLS POST GRADUATE COLLEGE

QUETTA CANTT DEPARTMENT OF ZOOLOGY
Session (2017-2021)
 i

AUTHOR’S DECLARATION

I Maira hereby state that my BS thesis titled Prevalence of helminthic

parasite infection among the children (3-10 years old) in different population of

Quetta city is my own work and has not been submitted previously by me for taking

any degree from this University UNIVERSITY OF BALOCHISTAN, QUETTA or

anywhere else in the country/world. At any time if my statement is found to be

incorrect even after my Graduate the university has the right to withdraw my BS

degree.

Name of Student

Date_
 ii

PLAGIARISM UNDERTAKING

I solemnly declare that research work presented in the thesis titled Prevalence

of helminthic parasite infection among the children (3-10 years old) in different

population of Quetta city. Is solely my research work with no significant

contribution from any other person. Small contribution/help wherever taken has been

duly acknowledge and that complete thesis has been written by me.

I understand the zero-tolerance policy of the HEC and UNIVERSITY

OF BALOCHISTAN, QUETTA towards plagiarism. Therefore, I as an

Author of the above titled thesis declare that no portion of my thesis has been

plagiarized and any material used as reference is properly referred/cited.

I undertake that if I am found guilty of any formal plagiarism in the

above titled thesis even after award of B.S degree and that HEC and the

University has the right to publish my name of the HEC/University Website on

which names of students are placed who submitted plagiarized thesis.

Student’s Signature:

Name: ______________
iii
 iv

ACKNOWLEDGEMENT

First of all, I would like to thank my Allah almighty, the most beneficent and
merciful without his graces and blessing, this research work would not have been
possible.

I would like to express my deep and sincere gratitude to my research

supervisor, Mam Shahida Aziz assistant professor of Govt girls post graduate college

Quetta cantt: She has taught me the methodology to carry out the research and to

present the research work as clearly as possible. It was a great pleasure and honor to

work and study under her guidance. I am extremely grateful for what she has offered

me. I would also like to thank her for her guidance, keen interest, value able

suggestion and great sense of humor.

I would like to express my Thanks towards our respected principal Ms Rahila

Ramzan principle and coordinator BS Ms Gulnaz Rasheed of Govt girls post

graduate college Quetta cantt. She arranges a study trip for our research work and

also, she give internet resources in digital library for research student. I would extend

my heartfelt gratitude to the whole department teachers who accepted me as a student

and whose constant encouragement, excellent guidance, enlightened advice, and

moral support, from the initial to the final level enabled me to develop an

understanding of the subjects.

Last but not least I want to say thanks to my parents and family members for their

endless prayers.

I thank you all from the core of my heart as without your contribution. I could never

have completed this dissertation. May Allah almighty bless you forever. This research

work becomes a reality with the kind support and help of many individuals. I would

like to extend my sincere thanks to all of them.

 v

CERTIFICATE FROM SUPERVISOR

This is certified that the Thesis title Prevalence of helminthic parasite infection

among the children (3-10 years old) in different population of Quetta city.

By Maira B.S Scholar in Zoology Department (2017-2021) Prima Facie is

worth examining both in terms of its contents and technical preparation according to

the standards specified in the University rules for the B.S Degree.

Research Supervisor

M.s Shahida Aziz Assistant professor

 vi

Table of contents

Chapter Title Page

No.
Title page
Plagiarism test
AUTHOR’S DECLARATION I
Plagiarism undertaking II

Certificate of Approval III

Acknowledgement IV
Certificate From Supervisor V
Table of content VI
List of table VIII
List of figure IX
Abbreviation X
Abstract XI
1 Introduction 1
1.1 Background of the study 1
1.2 Problem statement 9
1.3 Aims and Objectives 9
2 Literature Review 10

3 Research Methodology 17

3.1 Research design: 17

3.2. Study location 17
3.3. Sample size 17
3.4. Direct wet mount 18
3.5. Sedimentation: 18
3.6. Consistency 18
3.7. Microscopic examination: 19
3.8. Data statistical analysis 19
4 RESULT 20
 vii

4.1 Overall Prevalence of intestinal protozoan infection 20

4.2. Hymenolepis nana 21
4.2.1. Morphology 21
4.2.2 Mode of transmission 21
4.2.3 Pathology 22
4.3. Ascaris lumbricoides 22
4.3.1. Morphology 22
4.3.2 Mode of transmission 23
4.3.3 Pathology 23
4.4 Enterobius Vermicularis 24
4.4.1. Morphology 24
4.4.2 Mode of transmission 24
4.4.3 Pathology 25
4.5 Ancylostoma duodenale 25
4.5.1. Morphology 25
4.5.2 Mode of transmission 26
4.5.3 Pathology 26
4.6. Age wise prevalence of infection 27
4.7 Gender wise prevalence rates of Helminthic parasites. 28
4.8. Statistical analysis result for gender wise infection 29
DISCUSSION 31
CONCLUSION 34
Recommendations 35
References 38
 viii

LIST OF TABLES

Table Title Page

No. No

4.1 Overall incidence of intestinal parasites in stool samples. 20

4.6 Age group wise incidence of helminth parasite 27

4.7 comparison of Frequency in helminthic parasites and gender 28

 ix

LIST OF FIGURES

Figure Title Page

No No
4.1 Overall incidence of helminthic parasite 21
4.2 Egg & adult of H. nana 22
4.3 Egg & adult of A. lumbricoides 24
4.4 E. vermicularis eggs & adult worms 25
4.5 Eggs & adult of A. duodenale 26
4.6 Age group wise incidence of helminth parasite 27
4.7 Gender wise prevalence rates of Helminthic parasites 28
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ABREVATION

H. nana Hymenolepis nana

E. Vermicularis Enterobius Vermicularis
A. lumbricoides Ascaris lumbricoides
A. duodenale Ancylostoma duodenale
% Percentage
SAF Sodium acetate glacial acid and formalin solution
WHO World health organization
STHs Soil Transmitted Helminths
IPIs Intestinal Parasitic Infections
 xi

Abstract

The current study was shown in rural and urban areas of the Quetta District

from May to August.to estimate the incidence of intestinal helminthic parasites. The

current study aimed to find out the prevalence rate of intestinal helminthic parasite

infection in children as gender, age, and living in rural and urban areas of Quetta. A

total of 100 stool samples were collected from children of different age groups 3-4, 5-

7, and 8-10 years, from Benazir hospital Quetta city. The collected samples of stool

were microscopically observed through wet mount (saline solution, and iodine

solution).

Total 100 fecal samples were collected from children of different age groups.

Prevalence of helminths were observed in 3 age groups of children [(3-4 Years, n=22,

33.33%), (5-7 years, n=27, 40.91%), (8-10 years, n=18, 27.27%)]. Gender wise

infection rate was stated that n=40 (60.61%) females and n=26 (39.4%) males were

infested with helminths. In which the females were more infested than male children.

Four species of intestinal helminths were observed at different incidence rate of

infection. The highest frequency was observed as Enterobius Vermicularis n=35

(53.03%) out of 100 samples, Ascaris lumbricoides n=20(30.30%). Hymenolepis nana

n=10(15.15%) and least in Ancylostoma duodenale 1(1.52%).

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INTRODUCTION

1.1. Background of the study

Word "Helminth" comes from the Greek word "helmins", which means

"helminth" (worm). Intestinal parasites are worm-like pathogens that feed on and

protect a healthy host, allowing the host must become ill.

Several helminthes live in the abdominal tract of human and these are

nematodes (roundworms) such as Ascaris lumbricoides, Trichuris trichiura,

hookworms (Ancylostoma duodenale and Necator americanus) and Strongyloides

stercoralis, trematodes (flukes) (Odening, 1976).

A. lumbricoides, T. trichiura, and hookworms are the maximum widespread

intestinal parasites; they are referred to as soil spread helminths (Bethony et al.,

2006).

The existence of attachment organs, which define parasitic life, distinguishes

the alignments. Suckers, rostellum with hooks, oral and ventral suckers, lips, teeth,

filariform ends, and dentary plates are examples of attachment organs. The number,

form, and placement of such attachment organs vary between taxa, and their function

is sometimes unclear (Bethoney et al., 2006).

The helminths that are spread by soil are nematodes, commonly called to as

intestinal parasites. They include hookworms (such as Ancylostoma duodenale and

Necator americanus), whipworms (such as Trichuris trichiura), threadworms (such as

Strongyloides stercoralis), and roundworms (such as Ascaris lumbricoides). They are

particularly common in places with warm, humid weather combined with bad hygiene

and cleanliness. The socioeconomic conditions of afflicted populations as well as

human health are significantly impacted by soil-transmitted helminths. An

 2

epidemiological study has shown that although people of all ages can contain

parasites, children in rural tropical and subtropical places have the greatest incidence

(Bethoney et al., 2006).

The most widespread and significant soil-transmitted helminth is Ascaris

lumbricoides (Cheesbrough, 2005). This parasite is widespread as well as its spread is

mostly influenced by inadequate sanitation, which causes infected eggs to

contaminate the environment (Kightlinger et al., 1998). The prevalence of Ascaris is

cosmopolitan which affect the 1/4 population of world. More than 250 million people

face this chronic disease (Crompton and Savioli, 2007).

One of the most prevalent helminth diseases in humans is Trichuris trichiura

infection (trichuiriasis) (Edelduok et al., 2013). Trichuiriasis affects about one billion

individuals worldwide (Pearson, 2002).

Human habits and activity have been linked to worse soil-transmitted helminth

infection. Poverty, poor sanitation, a lack of access to healthcare, and overcrowding

are the most prevalent of these. In contrast, wearing bare feet and consuming unclean

fruits and vegetables are significant risk factors (WHO, 2002).

Pullan et al., (2014) Global estimates place about five hundred sixty-eight

million school kids and two hundred seventy million school youngsters in between the

almost 1.5 billion individuals worldwide afflicted with STHs. All of these affected

patients require treatment and preventative measures. Persons with low-intensity

infections are frequently asymptomatic, but people with high-intensity infections have

a high morbidity rate. Thus, the debilitating consequences of severely infected persons

include a variety of nonspecific and specific toxic effect such as insanity in kid

impaired development.
 3

Ngwese et al., (2020) as well as anemia and intestinal obstruction According

to recent estimates, four STHs, particularly hookworms four hundred eighty million

(N. americanus and A. duodenale), T. trichiura 508million, and A. lumbricoides700

million individual infected globally, correspondingly.

Children who attend school are more likely to become infected with intestinal

worms while playing on school grounds. When they put infected fingers in their

mouths, their hands become diseased after touching contaminated soil (Sah et al.,

2013).

Children in school age groups and expectant mothers are at a particularly high

risk for abdominal parasite contaminations. These illnesses are too referred to as

severe issues with sanitation due of the challenges such growth retardation in children,

anemia caused by a lack of iron, concerns with children's mental and physical health.

The potential for negative outcomes (Tulu et al., 2014).

Another important risk Influence amplification high STHs contamination

among children is behavioral in nature. Children are often quite active and like

playing with the environment's materials like dirt and items with little to no adult

supervision. Schools offer excellent chances for the implementation of control efforts

due to the incidence of helminthic infection in between school-aged kids, making this

subgroup a strong priority for helminth control efforts in the general population

(Ojurongbe et al., 2014).

STHs are a serious public health issue in the Philippines, especially within

school-aged kids; affected kids may suffer from severe abnormality such as anaemia

and starvation, slowed development, decreased strength, and intellectual disabilities

(hotez, 2009)
 4

Helminth worms’ infections were the most common neglected tropical

diseases (NTDs), with 24% of the earth's population believed to be affected by

helminthic spread from dust (WHO,2018).

Soil-transmitted helminths (STHs) it is a kind of parasitic worm that infects

people when they come into touch of infectious ova or larvae. Immature stages (eggs)

must develop in soil before becoming infective. Humans are usually affected by

ingesting infective forms of geo helminths through soil, raw fruits and vegetables, or

unwashed hands. STHs infections mostly affect children in both developing and

developed nations, and are related with stunted development, decreased physical

activity, and poor mental capacity (Drake et al., 2000).

The presence of ova in the soil's surface layer provides a possible public health

risk, particularly because these ova are exceptionally resistant to harsh weather and

chemicals. Thus, soil pollution appears to be the greatest direct predictor of STH

infection risk in the human population. As a result, several studies in recent years

have been carried out to evaluate incidence of geo-helminth ova in the soil of parks,

sandpits, seashore, enclosure and grounds, productive, as well as other urban and rural

places. The utilization of sewage, human or animal excreta in agriculture is a long-

standing and common procedure in underdeveloped nations, yet it has the potential to

harm human health (WHO, 2011).

Anemia in children is connected with a variety of health issues, including

growth retardation, delayed neurogenesis, low cognitive ability, and decreased

immunological response (Tapiero et al., 2001). Even in industrialised nations, despite

improved socioeconomic situations and higher living standards, it remains a public

 5

health concern (Kappus et al., 1994). Because of its gradual development, it is one of

the most overlooked illnesses (Okyay et al 2004).

The major causes of intestinal worm infection in children include a lack of

clean drinking water, a low socioeconomic status, inadequate sanitation, and low

literacy rates among parents, particularly women (Okyay et al 2004).

Low socioeconomic status, poor personal cleanliness, restricted access to

health care, inadequate sanitization procedures, and polluted drinking water are all

risk factors for intestinal parasite infections (IPIs) (Montresor et al., 1998). Anemia

and diarrhea in children are caused mostly by poor nutrition and frequent parasite

infection. Furthermore, they impede children's appetite, growth, and physical fitness,

as well as scholastic attainment, cognitive functioning, and economic development

(Drake et al., 2000). Intestinal parasite infections are common across the world,

affecting people of all ages and genders (Steketee et al., 2003).

Children with parasite infections have disability, emotional, and social health,

as well as poor work act and termination of work (Siddiqui et al., 2002). Poor

individuals in industrialised nations are vulnerable to reoccurrences of malnutrition

and continuous illnesses, which can lead to more than required disease transmission

from to the next creation (Mehraj et al., 2008).

Abdominal parasites are responsible for prolonged infections such as iron

shortage anemia, vitamin shortages, protein reduction, physical and mental health

issues, short development in kids, diarrheal diseases, and even curative problems such

as abdominal blockage and high exposure to other impurities mental damage, and

starvation (Quihui et al., 2006).

 6

Long/untrimmed nails, refusal before meals wash-down hands, naked

footedness, nail biting routine, and thumb extracting are all associated with parasite

infection in children (Kumar et al., 2014; Salam & Azam 2017). (Sah et al., 2013)

While playing on school grounds, students are more likely to become infected with

intestinal worms. When they put infected fingers in their mouth, their hands become

contaminated with infectious dirt and they become diseased.

Adults are also at risk as a result of consuming polluted water with worms that

invade the gastrointestinal system. Blitz et al., (2018) Children who consume tube-

well water have a considerably greater frequency of parasitic worms than children

who drink tap water (Tchakounté et al., 2018; Nxasana et al., 2013).

According to current estimates, at least 1/3 of the universe is affected through

abdominal parasites. Indeed, it is believed that around 3.5 billion individuals

worldwide are affected with abdominal parasites, with 450 million being unwell.

Globally, 16 million people die each year as a result of intestinal parasite illness.

(Keiser & Utzinge 2010).

Intestinal parasite infections are widespread across the world and have been

recognized as a leading reason of sickness and illness. Obesity, destitution, lack

sanitation, a shortage of resources drinkable liquid, and a warm and moist tropical

weather are all risk issues for abdominal parasite contaminations. Parasitic helminths

cause certain destructive and widespread human illnesses. (IPI) are a worldwide

fitness problem that cause scientific illness in 450 million individuals, several of

whom are ladies of breeding phase and kids in underdeveloped nations (Quihui, et al.,

2006).
 7

IPIs, primarily helminths related to an amplified danger of nutritional anaemia,

protein starvation, and development shortages in kids, as well as low weight during

pregnancy increase and uterine growth obstacle, which results in low birth mass

(Sackey et al., 2003; Rodríguez-Morales et al., 2006).

In India, like in other developing nations, abdominal parasite contaminations

are a serious sanitation concern. Previous research is low-income areas in and around

Chandigarh found a incidence of abdominal parasite infections extending from 14.6 to

19.3% (Bansal et al., 2004; Khurana et al., 2015). Just, it was revealed in among kids

from rural and urban parts of such Kashmir valley, India, that at least one

gastrointestinal helminth was discovered in 71.2% of the studied population. Ascaris

lumbricoides was the most common (68.3%), T. trichiura (27.9%), E. Vermicularis

(12.7%), and T. saginata (4.6%) surveyed (Wani et al., 2008).

Habtamu and Kloos (2006) In Ethiopia, parasitic helminthic contaminations

are the 2nd most prevalent reason for outpatient sickness. According to the Deribe et

al., (2012) reported, Ethiopia has the highest number of cases of Neglected Tropical

Diseases (NTD), followed by Nigeria and the Republic Of Congo. Ethiopia is

expected to have the second highest ascariasis load and the third largest hookworm

burden. Infections such as trichuiriasis are also frequent. Ascariasis affects one-third

of Ethiopians, trichiuriasis affects 1/4, and hookworm affects one in every eight

Ethiopians.

Who (1987) Helminth infections are extremely common and a major cause of

illness burden among kids in underdeveloped nations, particularly in Africa, South

Asia, and South America.

 8

The incidence rates in Bangladesh and Yemen are 80% and 50%,

correspondingly (Al-Ballaa et al., 1993; Hussain et al., 1997). A relatively high

incidence of Giardia has been observed in kids in Spanish due to endemic

study (Perez et al., 1997)

A lot of studies on the incidence of worm infection have been conducted in

Pakistan. Different incidence of worm infection is reported in various locations of the

nation due to variable living conditions. Similarly, worm infection is believed to be

23% in urban parts of Islamabad (Ghauri & Alam, 1992), 30.6% in the Baluchistan

province's Zhob district (Alsubaie et al.,2016) In Skardu, the prevalence was 54.9%,

which is compared to rural regions (Nishiura et al.,2002) in Abbottabad 85% (Ahmad

et al., 2003).

Helminth pollution is frequent in Pakistan, with variable distribution across

the country. Many additional researchers demonstrated in various sections of the state;

Dera Ismail Khan (Mirza et al., 2012), Banu (Alamir et al., 2013), Swat (Khan et al.,

(2015), N. Waziristan (Ahmed et al., 2015), Islamabad (Shakoor et al., 2018) and

Karachi (Arshad et al., 2019), Lower Dir (Ulhaq et al., 2021),Rawalpindi/Islamabad

(Qureshi et al., 1992), Punjab (Kosar et al., 2017), Swat (Khan et al., 2017), Peshawar

(Haider et al., 2018), Peshawar (Ilyas et al., 2018), Lahore (Ansari &Naru, 1968),

Sargodha (Ghauri & Alam, 19992) ,Northern Areas (Nishiura et al., 2002) and

Abbottabad (Ahmed et al., 2003).

The concentration in soil samples from various schools was 86.3% due to

Ascaris lumbricoides, 9.0% due to Trichuris trichuria, and 4.5% due to Taenia sp. The

percentage of Ascaris lumbricoides eggs was higher than the percentage of Trichuria

and Taenia species ova. The infection Trichuria ova ware low in earth samples from
 9

different institutes because the only female lays very few ova and they are certainly

smashed by dehydration. Taenia specie ova were few in amounts due to better

breeding conditions and farm animals. To ensure effective environmental health,

sanitary education, enforcement of basic hygiene rules, and deworming of study areas

in general and schools in particular are required to avoid helminth contaminations

(Zahir et al., 2020).

Helminthic parasite diseases remain public health concern globally, including

in the Quetta district of Baluchistan, Pakistan's urban and rural areas. The high

prevalence of these Helminthic illnesses is intimately linked to poverty, poor

environmental health, and disease prevention. Individuals in Pakistan have poor

personal hygiene. The toughest difficulty for parasitologist is watching the emergence

of helminths and parasitic worms.

1.2 Problem statement

The helminthic parasites A. lumbricoides (roundworms), T. trichiura

(whipworms), and N. americanus or A. duodenale are endemic in the Quetta

population (hookworms). These parasites are the most common source of infection in

children.

Poverty, illiteracy, poor sanitation, lack of knowledge, and low income are all

factors that contribute to the transmission and spread of these infections in Quetta

population.

1.3 Aim and Objectives

 To investigate the incidence of helminths between children of Quetta city

 To compare the age and gender population wise infection of Quetta city.

 To identify the incidence of infection rate of population in Quetta city.

 10

Literature Review

Khan et al., (2022) investigated Hazard issues related with abdominal

pathogenic worms in School children in of Malakand, Pakistan.184 stool specimens

were diagnosed. 82% Individuals were discovered to be infested with one type of

parasite, whereas 69.9% were infected with many species of worms. Hook worm was

the most common parasite (33.4%), closely by Taenia saginata (28.7%) A.

lumbricoides 27.7%, E. Histolytica 3.37%.

Aziz et al., (2020) Conducted study in abdominal parasite helminths in

youngsters from native residents of Quetta district. In kids, the general frequency was

43.80%., H. nana was discovered at the peak incidence of 48 (15.24%) in youngsters.

Females get infected at a greater rate than men. The age range of 6–10-year-old kids

(48.14%) had a higher incidence frequency than 11–15-year-old children (42.15%)

kids up to 5 years old (40.95%).

Zahir et al., (2020) Study was conducted that randomly selected samples of

The incidence of Helminthic worms was reported to be 86.3% in government and

private schools in Quetta, 9.0% in T. trichuria, and 4.5% in Taenia sp. The proportion

of A. lumbricoides eggs was higher than that of T. Trichuria as well as Taenia sp

eggs.

Elameen et al., (2019) the conducted study was Incidence of in Ombda,

Primary School-Aged Kids Have Abdominal Parasitic illness. Total of 210 stool

samples, 52 were positive. This resulted in an overall higher incidence of 24.8%, 29%

in men and 20.9% among women. The 6-8 year age groups had the maximum

incidence rate (35%) while the 12-14 year age groups had the lowest incidence rate

(10.3%). Giardia lamblia (16.6%), H. nana (6.7%), Taenia spp (0.5%),

A. lumbericoides (0.5%), & Entamoeba histolytica (0.5%) were the most common
 11

parasites found. Intestinal protozoa (17.1%) were more common than intestinal

helminthes (7.6%).

Abah & Awi-Waadu, (2018) Gastro-intestinal Helminthiasis among School

Kids in Gokana and Khana Local Government Areas of Rivers State, Nigeria. Total

633. The overall prevalence was 21.0%, the Gokana recording 24.3% and Khana

recording 17.4%. In Gokana, men had a higher sex-related prevalence (31.1%) than

females (18.5%), while in Khana; males had a 22.3% prevalence compared to 13.0%

for females. A. lumbricoides was the most common parasite found in Gokana (32.1%)

and Khana (45.5%), followed by hookworm (24.4%, 23.6%), T. trichiura (16.7%,

18.2%), and Strongyloides stercoralis (5.1%, 3.6%).

Ross et al., (2017) That Carried out cross-sectional prevalence survey in the

city of Northern Samar, Philippines, has 18 rural barangays. A total of 6976 people

done a health survey and gave a fecal sample for testing. Schistosoma aponicum

28.9%, A. lumbricoides36.5%, T. trichiura61.8%, and hookworm 28.4% incidence

rate were determined to be moderate to high, at and correspondingly.

Belachew et al., (2017) reported the cross-section study design as The

incidence and danger of abdominal helminth disease in between pupils in Tepi, south-

west Ethiopia. Each intestinal parasitic investigation included 380 researches. The

most common helminthes, A. lumbricoides (9.2%), was next by T. trichiura (5.8%),

with 94 (24.7%) being positive.

Bolaji et al., (2017) to determine the cross-sectional study Schistosoma

mansoni contaminations, and the associated hazard issues among schoolchildren in

Ifelodun, Kwara State. It included student ages 3 to 18 from three randomly selected

elementary schools in the Local Government Area. A single feces sample was tested

for geohelminths eggs. Ascaris lumbricoides was the only helminth shown to be
 12

prevalent (n=160). Overall, female students were infested at a higher rate 4.4%

(7/160) than male students (1.9% (3/160). 80 percent of the afflicted students had a

severe illness, while 20% had light infection.

Kosar et al., (2017) cross-sectional research was done to determine the

incidence and danger issues related through IPIs in school kids ages 3-15 in Mandi

Bahauddin, Pakistan. Total 1,434 kids examined. The total incidence of IPIs was

shown to be 33.3%. Helminths were more common (21.4%) as compare to protozoans

(17.9%). A. lumbricoides (17.5%), Giardia labia (9.8%), Entamoeba histolytica

(8.2%), H. nana (2.0%), and T. trichiura (1.3%) were the most common.

Amer et al., (2016) it is investigated that Hail General Hospital in North

Western Saudi Arabia worked on intestinal worms. 130 individuals (69 women and

61 men) took part in the study. The total number of parasite infection in the intestine

was 45.38%. (59 cases). Forty-four (33.84%) were determined to be infested

including one or more abdominal protozoa, five (3.84%) with helminthes, and ten

(7.69%) for both helminthes and protozoa.

Ali et al., (2016) Cross sectional survey was undertaken in region Zhob

Balochistan from April -2014 to Dec 2014. Worm disease was discovered in 30.6% of

the kids. The most common parasite found was Ascaris (15.3%), led by Giardia

(4.4%) and Hookworm (3.9%). 87% of worm-infested students were anemic.

Abah & Arene, (2015) it was investigated that in primary school students in

Rivers State, Nigeria. Overall, of 3,826 feces cases were taken from kids in 36

primary schools (1,828 men and 1998 females). In 1059 (27.66%) of the 3,826 fecal

analyzed samples, A. lumbricoides (51.78%), hookworm sp. (25.0%), T. trichiura

(15.18%), Strongyloides stercoralis (7.14%), Taenia sp. (0.89%), and E. Vermicularis

 13

(0.01%) were discovered. Men were found to be infected at a higher rate (57.60%) as

women (42.40%).

Abossie & Seid, (2014) From March to May of 2012, a cross-sectional survey

was undertaken on pupils from selected elementary schools in Chencha. Kids between

the ages of 5 and 15 were chosen. Total 422 samples and 400 provided complete

material for examination. The total frequency of abdominal parasitoids (81.0%) was

high. Infections with soil-transmitted helminths (STHs) were more common (63.0%)

than protozoa infections (23.5%). A.lumbricoides was the most common parasite

(60.5%), E.histolytica (16.25%), G. lamblia (11.7%), T. Trichuria (9.7%).

Ahmed, (2013) Estimated that Tanta youngsters from five elementary schools

participated in September 2010 and September 2011. Total 1520 fecal samples were

examined. Tanta schools varied from 6 to 12, with 820 (53.9%) students residing in

rural Tanta and 700 in urban Tanta. Four intestinal parasite species were detected,

with a total frequency of 22.43. The incidence was 14% in rural regions and 26% in

urban zones. Entamoeba histolytica (11.1%), E. Vermicularis (7.03%), Giardia labia

(4.46%), A. lumbricoides (0.19%), and Schistosoma mansoni (0.19%) were the most

common parasites. Men were infected at a rate of 46%, while women were infected at

a rate of 54%.

Auta et al., (2013) A conducted study A study on abdominal helminthes in

primary school students was conducted in Gwagwalada, Kaduna, Nigeria. Out of the

283 kids tested for infection, 190 (67.1%) tested positive. the highest infection found

A. lumbricoides (30.7%) T. trichiura (4.9%), E. Vermicularis (4.6%), Strongyloides

stercoralis (4.2), and H. nana (3.9%)

 14

Alo et al., (2013) study was investigated that. Total 325 students were

enlisted, with 140 men and 185 females. The total incidence of intestinal parasites in

the population investigated was 57.2% (186 of 325). A. lumbricoides (20.0%), E.

Vermicularis (17.8%) T. trichiura (12.9%) and A. duodenale (6.5%) were identified

from the primary school students' fingernails.

Asrat et al., (2013) cross-sectional study was estimated that Total 704 samples

were observed. Ten intestinal parasite species were detected, with a total 79.8% (562

of 704 children). Ascaris lumbricoides in n=338 (48%), Giardia lamblia

n=295(41.9%), Entamoeba histolytica/dispar n=192(27.3%), Schistosoma mansoni in

n=112 (15.9%), and Hookworm in n= 81 (11.5%). Of the total positive stool samples,

n=96 (13.6%) were single infections and n= 466 (66.2%) were mixed infections, with

n= 309 (43.9%) children having multiple infections.

Sehgal R et al., (2010) Study was investigated that incidence of abdominal

parasite infections in schoolchildren and pregnant women in a poor socioeconomic

area of Chandigarh, fecal specimens were collected from 360 kids and 87 pregnant

mothers. Infections caused by protozoans were significantly more prevalent than

infections caused by helminths.

Ullah et al., (2009) In Peshawar's rural region, cross-sectional research was

carried out (2009). 200 youngsters tested, 132 (66%) were positive. There were six

different kinds of helminths discovered. A. lumbricoides had the greatest prevalence

of 45.5% (91 cases). H. nana had a rather high rate of 8% (16 instances).

E. Vermicularis was discovered in 4% (16 cases), Hookworm 3.5% (7 instances).

Banke et al., (2006) it was investigated that incidence of gastro-intestinal

worms in school children. Fecal Specimens 580 understudies from 9 schools in

 15

Makurdi were analyzed. The schools' hygienic conditions were also mentioned. The

total prevalence rate was 54.13%. (11.89%) in A. lumbricoides, Strongyloides

stercoralis (1.89%), Schistosoma mansoni (1.55%), T. trichiura (4.65%), Tapeworm

(3.79%), E.histolytica (7.06%), and Entamoeba coli (2.41%)

Ahsan-ul-Wadood et al., (2005) conducted that Incidence of abdominal

Parasite affliction in children Hospital Quetta. Stool samples were extracted from 220

individuals who complained of recurring stomach pain. Therefore, 31% of the

population was infested. Hymenolepis nana (34%) was the most frequent pathogen,

surveyed by G. lamblia (32%). E. histolytica (29%) was found, A. lumbricoides (4%)

and A. duodenale (1%).

Bansal et al., (2004) Total 550 fecal cases were obtained from less

socioeconomic citizen of Chandigarh. Overall, incidence rate was 19.3%.

A. lumbricoides was the most common parasite and Giardia lamblia, which affected

51 (9.3%) and 33 (6.0%) people, respectively. The same parasite infected numerous

family members in 17 (22.7%) households, including A.lumbricoides (in

nine relatives), G. lamblia (in seven relatives), and H. nana (in one household).

Miller et al., (2003) It was estimated that total samples 301 Protozoan

infections were found in 21% of people with G. duodenalis, 1.0% with E.

histolytica/dispar, 4% with E. coli, 16% with Blastocystis hominis, and 89% with

Cryptosporidium parvum. Infection with A. lumbricoides 11%, T. trichiura was 10%,

Strongyloides stercoralis was 0.3%, and H. nana 1.3%.

Al-Ballaa et al., (1993 to determine total 8000 preschool children. Positive

samples were 18.4%. The most common parasite isolated was Giardia labia (14.5%),

Entamoeba histolytica (2.7%), Enterobius Vermicularis (1.4%), Ascaris lumbricoides

 16

(1.0%) and others. Out of the 1462 children positive for parasites, 183 (12.5%) had

mixed parasitic infections.

 17

RESEARCH METHODOLOGY
3.1. Research design:

A study was created and presented in order to fully describe the existing

situation and the factors that are linked to the high frequency of helminthic infection

at different places throughout the Quetta area. The present study was approved within

2 months in outdoor patients of Mohtarma Shaheed Benazir Bhutto General hospital.

The patient’s age ranged from 3-10 years. Certain parameters including name, gender,

age, area and disorders. The research study's foundation was the existing condition of

prevalence of helminthic parasite infection in the children of Quetta city.

3.2. Study location

The provincial capital and largest city of Balochistan is Quetta. Quetta City is

the only high-altitude major city in Pakistan because of its mountainous terrain and

normal altitude of 1,680 meters (5,510 feet) above sea level. (Census, 2017). The

weather in Quetta is windy, dry, and extremely cold (-7 to 15°C) in the winter and

rather warm in the summer.

3.3. Sample size:

Patients provided about 100 samples, which were collected in a wide-mouth

container. The name, date, location, time, gender and age of the patient were written

on the labels of these containers. Only fresh samples will be examined within one

hour of collection. Each of samples will be analyze and examine through direct

microscopy. Direct microscopy is most common used method all over pathological

laboratories and hospitals.

 18

3.4. Direct wet mount

For the discovery of parasitic elements like the mobile Strongyloides

stercoralis larvae, direct microscopy study of the faeces after wet preparation is

crucial. It is also employed for the detection of helminthes infections with large

concentrations of Ascaris lumbricoides eggs. At the time the fresh stool samples to

detect the ova, larva and adult helminths.

To find parasite species' eggs, larvae, and trophozoites, a light microscope is

used to analyse a thin smear of faecal sample. Identification of the intestinal

protozoa's oocytes and cysts also requires an iodine preparation. One drop of iodine

solution was added to a slide using the applicator stick and the identical techniques as

for saline solution, and a little quantity of faecal material was then placed in the

solution. Applicator sticks were used to break up the faeces, and a thin sufficient

smear was utilized to indicate the existence of helminths. The slide was then covered

with such a coverslip to prevent bubble creation during this procedure. The slide was

looked at with a microscope at high and low power for helminth eggs.

3.5. Sedimentation:

Using a solvent like ether or ethyl acetate to soften the lipids, 2 grams of

sediment has been utilized in the sedimentation method, which involves straining the

faeces to eliminate big particles. Following centrifugation, the mixture's residue was

analyses.

3.6. Consistency.

Consistency of stool specimens was classified as formed to check the color,

mucous, blood, semi-formed, semi-solid, and loos. With the aid of a hand lens,
 19

observations were also done to determine whether adult helminthic worms were

present.

3.7. Microscopic examination:

To find ova, larvae, and adult helminths, direct wet mount (saline, iodine)

microscopic tests were carried out. Excellent helminth infection diagnosis using

formal ether concentration. Faecal samples were kept in SAF (sodium acetate glacial

acid and 10% formalin solution) for more than an hour or so before being moved to a

research lab for additional analysis.

Helminth egg and larvae were detected and identified using high and low

power (40x, 10x) microscopes. The direct microscopic inspection of the faeces was

chosen since it's crucial to find parasite components like Trichuris trichiura larvae.

This is typically sufficient to detect helminth ova in dense concentrations, such as

Ascaris lumbricoides. The speed and low cost of this technology are its key benefits.

3.8. Data statistical analysis:

Age and gender were examined using the chi-square test to see if they would

be associated to helminthic infection of the gut. The Chi-square test algorithm was

( )
used to assess the data.
 20

RESULTS

Incidence rate of helminthic parasites in between the kids of different residents

of Quetta city. A total 100 cases were observed the prevalence of parasitic helminths

in children of various ages. Fecal samples were taken from different Hospitals of

Quetta like Benazir Hospital, mission hospital from May to August.

4.1 Over all prevalence of intestinal helminths infection

During the current research, A total of 100 fecal sample from three distinct age

groups of children were obtained and tested for the presence of helminthic parasites.

All fecal samples were obtained from different hospitals of Quetta like Benazir

Hospital, mission hospital. Out of 100 children 66 (66%) were positive with four

species of helminths. The different prevalence rate 53.03% (n=35) and 15.15% (n=10)

were recorded foe Enterobius Vermicularis and Hymenolepis nana, individually.

Other high amounts of prevalence consist of A. lumbricoides 30.30% (n=20) where

the lowermost incidence rate was reported in Ancylostoma duodenale of 1.52% (n=1).

The overall incidence of gastrointestinal parasites was 66 (66%) shown in table 4.1.

Table 4.1 Overall incidence of intestinal parasites in fecal samples.

Species Number of total samples (%)

Enterobius Vermicularis 35/ 66 53.03%
Hymenolepis nana 10/66 15.15%
Ascaris lumbricoides 20/66 30.30%
Ancylostoma duodenale 1/66 1.52%
Total 66/100 66%
 21

Figer 4.1 Overall incidence of helminthic parasite

44
positive 66
nagitive 44
66

4.2. Hymenolepis nana Bilharz, 1851

4.2.1. Morphology:

Since the identification of H. nana, a German parasitologist discovered it in

1851. T. Bilharz till the current day. H. nana, also known as “dwarf tapeworm” It is

the most common tapeworm in the universe and the tapeworm which can be

transferred from human to human.. This worm is transparent, scolex has retractable

rostellum armed with 20-30 hooks can be found. The scolex has 4 suckers.

Hymenolepis nana eggs are 40mm long and more than 1mm in diameter; the eggs are

spherical or slightly oval in form. The majority of eggs hatch in the duodenum and

move to the small intestine's microvilli. Humans, cats, dogs, and mice are all affected.

4.2.2 Mode of transmission:

If the eggs are eaten, the infection causes the majority of the infection caused

by Hymenolepis nana. Ova connects to the mucosa of the gut lining and develop in

the oil-based portion of the gut. And in adulthood, each has a unique set of mucosae

that grows in the oil-based section of the gut. Each class has its own set of

reproductive organs as well. The ova have two different membranes; the outer layer is
 22

thin, and the inner layer is encircled by an oncosphere with three sets of lancet-shaped

hook lets.

4.2.3 Pathology:

Most people who are infected do not have any symptoms. Those who have

symptoms may experience nausea, weakness, loss of appetite, diarrhea, and

abdominal pain. Young children, especially those with a heavy infection, may develop

a headache, itchy bottom, or have difficulty sleeping. Sometimes infection is

misdiagnosed as a pinworm infection.

Contrary to popular belief, a dwarf tapeworm infection does not generally

cause weight loss. You cannot feel the dwarf tapeworm inside your body.

Figure 4.2 (a): egg of H. nana figure4.2(b) Adult of H. nana

4.3. Ascaris lumbricoides: Linnaeus, 1758

4.3.1 Morphology:

Edward Tyson described A. lumbricoides for the first time in 1683. However,

it was recognized as Lumbricus teres at the time, not A. lumbricoides. Linnaeus was

the one who renamed Ascaris and gave its original title in 1758. Linnaeus gave the

roundworm the name Ascaris lumbricoides. The common name is round worms. It is
 23

world wide spread. Generally, nematodes have no colour but the Ascaris have reddish

tint caused by the presence of Hemoglobin. Males are 2-4mm in diameter and 15-30

cm in length. The male's back is curved ventrally and has a bluntly sharp tail. The

males are smaller than females. Females are 5mm wide and 20–49 cm long. The ova

laying ability of a developed Ascaris has been originate to be vast, releasing near

200,000eggs per day.

4.3.2. Mood of transmission:

Adult roundworms can be located in the gut. Every day, a female Ascaris

worm may produce up to 200,000 eggs, which are expelled in the stool. Depending on

the temperature, the ova mature into infective organisms in 18 days to a few weeks.

The larvae hatch after consuming infective eggs, breach the intestinal mucosa, and

then enter systemic circulation to the lungs. The larvae grow larger in the lungs (10 to

14 days), break the alveolar walls, ascend the bronchial tract to the esophagus, and are

eaten. They grow into adult worms once they reach the digestive system. Ovulation

occurs in the adult female between 2 and 3 months after consumption of the infective

eggs. Adult parasites are capable of living within one to two years.

4.3.3 Pathology

The infection caused by Ascaris lumbricoides is called Ascariasis. The

symptoms include abdominal discomfort and pain with diarrhea, vomiting and

temperature. They may block intestine, appendix, bile or pancreatic duct and interfere

with digestion. In some cases, they may injured the intestine and caused blood in

stool. In children where infection is more they stunt the growth.

 24

Figure 4.3(a)egg of A. lumbricoides figure 4.3 (b) adult of A.lumbricoides

4.4 Enterobius Vermicularis:

4.4.1 Morphology:

This parasite is commonly known as human pin worm due to female long and

pointed tail. It is also commonly known as thread worm and seat worm in some

countries. Epidemiologically it is worldwide distribution. Leuckart first worked out its

life cycle in1865. The adult female has sharply pointed posterior end. The female

measured as 8-13mm in length and 0.3-0.5mm widths. The male adult is considerably

smaller, thick and curved posterior end. The size of male adult has measured 2-5mm

in length and 0.1-0.2mm width. Position of the adult worms in cecum to peri-anal area

at night to deposit ova. The egg has a characteristic surface that can attach to any

object.

4.4.2 Mood of transmission:

Children are the most prevalent victims, and hereditary infection is regular.

Food and water contamination causes infection. Itching in the perianal causes people

to scratch the afflicted area, bringing infective eggs and larvae with them on their

hands and feet or nails. The eggs are transmitted to food that youngsters consume.

The larvae grow into small parasitic worms and adult worms that live in the colon and
 25

cecum. Female worms travel outside the anus at night and squirm on the epidermis of

the perianal region. Infection can cause anus, which is a relatively frequent habit in

youngsters.

4.4.3 Pathology:

Many children with Enterobiasis make show no symptoms. In some cases,

Nausea, loose of appetite, vomiting, involuntary discharge of urine at night, stomach

pain may occur. There may also be difficulty in sleeping and restlessness.

The major symptom is itching in anal area. The area which is constantly

scratched often developed alcers and secondary bacterial infection.

Fig4.4 E. vermicularis eggs. Fig 4.4 (b) E. vermicularis adult.

4.5 Ancylostoma duodenale

4.5.1 Morphology:

It is commonly known as old world hook worm. Distribution is Cosmopolitan.

It was first discovered in 1838 by a physician Angelo Dubini. A. duodenale worms

are colour is grey white. The head is slightly curved in respect to the rest of the body,

providing them their distinctive hook form. They have grown mouths containing two
 26

pairs of teeth. Size is about 8mm to 12.5mm in length. The eggs are oval or elliptical

in shape. Female can lay 10,000 to30, 000 eggs daily.

4.5.2 Mode of transmission:

Hook worm eggs develop in the faeces of sick youngsters. If they are

discharged into the atmosphere, they can grow into larvae that can pierce the skin.

When walking barefoot on contaminated ground. The infective larva infiltrates the

skin. The place is in the intestinal tract.

4.5.3 Pathology:

A light infection caused abdominal pain loss of appetite and geophagy( soil

eating habit), heavy infection causes severe protein deficiency anemia. The protein

deficiency caused dry skin and swelling, while iron deficiency cause mental dullness

and heart failure. In pregnant women this parasite is able to infect fetus and cause

complication such as low birth weight and infant mortality.

Figer4.5 eggs of A. duodenale figure 4.5(b) adult of A. duodenale

 27

4.6. Age wise prevalence of infection rate

The kids were divided into three age groups (3 to 4, 5 to 7, 8 to 10 years old).

The infection rate was higher in the 5-7 years age group at 40.91% (n=27) and then 8-

10 years age group 27.27% (n=18) and the prevalence rate was 33.33% (n=22)

between the age of 3-4 years. Infection rates by age exhibited comparable trends. The

dispersion of incidence by age group which is given in table 4.6

Table 4.6 Age wise prevalence of helminthic parasites

Age No. of H. nana E. A. A.

Group Examined Vermicularis Lumbricoide duodenale Total
66(66%) s
3-4
Years 22(33.33%) 1(1.52%) 8 (12.12%) 5(7.58%) 0 (00%) 14
(21.21%)
5-7
Years 27(40.91%) 6(9.09%) 16 (40%) 8(12.12%) 1 (1.52%) 31
(46.97%)

8-10 18(27.27%) 3(4.55%) 11(16.67%) 7(10.61%) 0 (00%) 21(31.82%)

Years

Total 66(66%) 10(15.15%) 35(53.03%) 20(30.30%) 1(1.52%) 66(66%)

Figure 4.6 Age group wise incidence of helminth parasite

14
21
3-4 years 14
5-7 years 31
8-10 years21

31
 28

4.7 Gender wise prevalence rates of Helminthic parasites.

The incidence percentage of abdominal helminth was meaningfully advanced

in females than males. Out of 100 stool samples were examined, the overall incidence

of helminthic infection was originated 66 (66%). The maximum infection level of

40(60.61%) was observed in the females than the male persons where the disease

incidence was 39.4% (26).

It shows the relationship between gender and the strength of helminthic

parasites table 4.7

Table.4.7 Gender wise prevalence rate of Helminths

Gender
Number (percentage)
Helminthic
parasites Male percentage Female Percentage

H. nana 4 (6.1%) 6 (9.1%)

Enterobius 14 (21.2%) 21 (31.8%)
Vermicularis
Ascaris lumbricoides 8 (12.12%) 12 (18.2%)
Ancylostoma duodenale 0 (00) 1 (1.52%)
Total 26 (39.4%) 40 (60.61%)

Fig 4.7 Gender wise prevalence rates of Helminthic parasites

26
Male 26
Female
40
 29

Expected values for intestinal parasites

Parasites Males Females

Hymenolepis nana 3.94 6.60
Enterobius Vermicularis 13.8 21.21
Ascaris lumbricoides 7.9 12.12
Ancylostoma duodenale 0.39 0.61

Observed values for intestinal parasit1es

Parasites Males Females Total Percentage
Hymenolepis nana 4 6 10 0.1511515
Enterobius Vermicularis 14 21 35 0.5303030
Ascaris lumbricoides 8 12 20 0.3030303
Ancylostoma duodenale 0 1 1 0.0151515
Total 26 40 66 0.66

4.8. Statistical analysis result for gender wise:

MS Excel 2016 was used to do statistical analysis on infected males and

females. In this study, females and males were matched to a total of 66 affected

patients. Males were altogether 26 and ladies were 40. The overall number of patients

infected with H.nana was ten (four men and six females, including 15.15% for each

gender). In all, 35 instances of Enterobius Vermicularis were recorded, with 14 males

and 21 females accounting for 53.03% of the total. People who are infected with

Ascaris lumbricoides totaled 20 (eight men and twelve females), with percentages

indicating that 30.30% of every gender is infected. The total number of Ancylostoma

duodenale cases detected was 01, with 0 males and 1 female infected at a rate of

1.51% for every gender. To get findings, expected values were subtracted from

observed values. The results of using the statistical tool (chi-square) in Excel show
 30

that the gained chi-square amount was 0.477, which is below 9.49(0.05), denoting that

there was no big variation in disease rates among male and female, implying that there

is insufficient evidence to disprove the null hypothesis.

 31

DISCUSSION:

In under developing nations like Pakistan, intestinal parasitic infections are

common health issues and have a varying distribution across the state. Helminths

were often found in the native population and were present in all ages of human with

varying incidence rate.

The current study provides evidence that the prevalence of helminthic

parasites is a major public health in the Quetta area of Pakistan. Although different

scientists and scholars have explored human intestinal parasites in Pakistan. All

helminthic parasites identified in this study could be associated to those reported

earlier, and no unexpected parasites were discovered. The relationship of helminth

parasitic infection to different factors such as gender and age, location and illiterate

parents were also considered.

According to Aziz et al., (2020) they discover the Incidence of intestinal

helminthic parasites between the children of the local population of Quetta District,

Balochistan. In their study the total numbers of stool samples were 315. The positive

helminthic parasites were 138(43.80%). Hymenolepis nana was detected at the

highest in kids. Gender wise infection was recorded higher in females (25.71%) than

males (18.09%). In another observation it indicates that intestinal parasites are higher

in females (51.29%) than males (48.08%) (Akhund, 1994).

In my research out of 100 patients, 66 children were found to have helminthic

parasite infection according to the current study on the prevalence of intestinal

parasite in children of different areas of Quetta district. Enterobius Vermicularis was

observed as highest 53.03% in children than other species. The children were divided

into 3 age categories (3-4, 5-7 and 8-10years old). The overall prevalence rate of
 32

helminthic parasites in my study was 66%. 66% in both male and female children

gender wise females n=40 (60.61%) were greater recorded than males n=26 (39.4%).

Elameen et al., (2019) another study was Prevalence of Intestinal Parasitic

Infections among Primary Schools aged Children in Ombda Locality. The highest

prevalence rate (35%) was reported among the 6-8 years age groups, while the lowest

prevalence rate (10.3%) was reported among 12-14 years age groups.

In my study the total 100 samples were collected and 66 were found positive

for prevalence of intestinal parasite. The similar result were stated that highest

prevalence rate n=31(46.97%) was investigated among 5-7 Years age group. while the

least prevalence rate was observed in 3-4 Years n=14 (21.21%).

Aziz et al., (2020) five species of intestinal helminths parasites were found at a

different prevalence rate of infection. The H. nana was found to be highest in 48

(15.24%) children followed by Enterobius Vermicularis in 38 (12.06%), then A.

lumbricoides in 32 (10.15%), S. stercolaris in 12 (3.80%) and least in A. duodenale 8

(2.54%).

In my study the 4 different types of helminths were observed in stool samples.

The highest frequency was observed as Enterobius Vermicularis n=35 (53.03%) out

of 100 samples, Ascaris lumbricoides n=20(30.30%). Hymenolepis nana

n=10(15.15%) and least in Ancylostoma duodenale 1.

. It is well-known about knowing the importance of perfection of hygiene in

grow up children was minimum infection of nematode. Mother’s education was an

important factor in influencing the incidence of parasites. Mothers are well aware of

the meaning of health hygiene and sanitation; they also manage to introduce a healthy

sense of hygiene in their children which results in less prevalence of parasites.

 33

In Pakistan, a number of researchers have been conducted on the incidence of

intestinal parasites range in nation. Due to the different living situation in the nation,

various cases of infection with intestinal parasites are found in different parts of the

county. Correspondingly, in rural zones where incidence was noted as 54.9% in

skardu (Nishiura et al., 2002), 85% in Abbottabad (Ahmed et al., 2003) compared to

urban areas, where the prevalence was noted as 23% in Islamabad (Ghauri & Alam,

1992), 30.6% in the Zhob district of Balochistan province (Ali et al., 2016).
 34

CONCLUSION

In the present study, a major association was observed between intestinal

helminthic infections. Four species of intestinal helminths were observed at different

incidence rate of infection. The highest frequency was observed as Enterobius

Vermicularis n=35 (53.03%) out of 100 samples, Ascaris lumbricoides

n=20(30.30%). Hymenolepis nana n=10(15.15%) and least in Ancylostoma duodenale

1(1.52%). The females were more infected than the males. The children of age group

5-7 years are extremely affected by intestinal parasites as compared to other age

groups. The individuals of Quetta were mostly infested by these parasites, due to low

income, lack of awareness, improper sanitation, and cleanliness.

 35

RECOMMENDATIONS

 A high prevalence of STHs, when combined with poor hygiene and malnutrition,

is an indicator of a country's future problems, indicating that priority is given to

destroying STHs worldwide.

 The world health organization (WHO) has recommended three interventions to

control morbidity due to STH infections: regular drug treatment of high-risk

groups for reduction of the worm burden over time, health education and

sanitation supported by personal hygiene aimed at reducing soil contamination.

 Regular drug treatment represents the main approach for infection control in

areas where infections are intensely transmitted, where resources for disease

control are limited and where funding for sanitation is insufficient.

 WHO recommended medicines –albendazole (400 mg) and mebendazole

(500 mg) – are effective, inexpensive and easy to administer by non-medical

personnel (e.g. teachers). They have been through extensive safety testing and

have been used in millions of people with few and minor side-effects.

 Both albendazole and mebendazole are donated to national ministries of health

through WHO in all endemic countries for the treatment of all children of school

age.

 Health education aims to improve health and increase hygiene awareness and to

change health-related behavior in the population. For diseases related to poverty,

such as STH infections, the suggested solution might not be available or might

be too expensive to adopt.

 Educational materials (posters, leaflets, radio and video messages) have been

traditionally used to transmit and disseminate health-related messages, but

 36

strategies imported from the private sector are increasingly being advocated for

their potential value in crafting and disseminating health-related messages.

 Reduction in the fecal contamination of soil can be achieved by recommending

the use of latrines, developing self-protection from re-infection, and promoting

personal/ family hygiene measures such as washing hands and proper food

preparation. The knowledge of, and motivation for, behavioral change must be

sustained by making available proper facilities for excreta disposal. Frequently,

in STH-endemic areas, latrines are not available or are not in sufficient numbers

to meet the needs of the population.

 Promotions of latrine maintenance and use, washing of hands and proper food

handling have benefits that go beyond the control of STH infections. From this

perspective, it is reasonable to include health education in all STH-control

programs, where in the health education message can be provided in a simple

and inexpensive way.

 Health education messages can be delivered by teachers in schools, thereby

fostering changes in health-related behavior in children, which in turn involves

their parents and guardians.

 The marketing of health education in order to create increased health awareness

and changes in habits of defecation are important when aiming to reduce STH

infections.
 37

Testing & observing of parasites in different Laboratories & hospitals.

 38

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school children in gokana and khana local government areas of Rivers State,
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Abossie, A., & Seid, M. (2014). Assessment of the prevalence of intestinal parasitosis
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Ahmed, A. K., Malik, B., Shaheen, B., Yasmeen, G., Dar, J. B., Mona, A. K., ... &
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Ahmed, F. A. (2013). Intestinal parasites among primary school children in urban and
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