Prevalence and Risk Factors of Intestinal Helminth and Protozoa Infections in an Urban Setting of Cameroon: the Case of Douala

Thomas KUETE^1, , Fomefret Loic Sorel YEMELI¹, Emmanuel ESSONO MVOA², Therese NKOA², Roger MOYOU SOMO² and Albert SAME EKOBO^{1, 3}

¹Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon

²Faculty of Medicine and Biological Sciences, University of Yaoundé 1, Cameroon

³Laboratory of Parasitology, University Hospital Centre of Yaoundé, Cameroon

Cite this paper:
Thomas KUETE, Fomefret Loic Sorel YEMELI, Emmanuel ESSONO MVOA, Therese NKOA, Roger MOYOU SOMO and Albert SAME EKOBO. Prevalence and Risk Factors of Intestinal Helminth and Protozoa Infections in an Urban Setting of Cameroon: the Case of Douala. American Journal of Epidemiology and Infectious Disease. 2015; 3(2):36-44. doi: 10.12691/ajeid-3-2-4

Abstract

Intestinal parasitic infections remains a public health problem in rural areas of low-income and middle-income settings of tropical and subtropical zones however epidemiological evidence is scarce in urban areas. This study aimed to assess the extent of intestinal helminths and protozoa infections among residents of Douala city in Cameroon, and to identify risk factors of their transmission. A community-based cross-sectional study was carried out in 2013 on 428 residents from two quarters of Douala city by microscopic examination of a stool sample from each participant simultaneously as fresh wet mounts, Kato-Katz thick smear and smear from formol-ether concentration technique. All participants from the selected quarters were invited to provide a stool sample, and interviewed about demographic and socioeconomic characteristics, sanitary situation, hygiene behaviors, antihelminthic chemotherapy. The overall prevalence of intestinal helminths and protozoa infection was 15,2%. The infection rate was significantly different between quarters (p=0.003). Dwellers harbored helminths, protozoa or both infections. The prevalence of pathogenic intestinal protozoa, namely E.histolytica/E.dispar and G.intestinalis was 8.9% and 0.7% respectively. The prevalence of the non pathogenic protozoa E.coli was 1,6%. Prevalences of helminth namely A.lumbricoides, T.trichiura, S.stercoralis, H.nana and S.mansoni were below 5%. Polyparasitic infections occurred in 2.1% of the participants. The prevalence of intestinal parasites carriage were influenced by age, educational level, dwelling area, household clustering for all parasitic infections taken together, poor sanitation and hygiene behaviors. Intestinal helminth and protozoa infections were hypoendemic in Douala urban area. Amoebiasis, giardiasis, ascaridiasis, trichuriasis, strongyloidiasis hymenolepiasis, and mansoni schistosomiasis were the main infections identified mostly at low prevalent rates. All helminth infections recorded were of low intensity. Provision of health education, improving personal hygiene, potable drinking water supply as well as school based deworming should be the major focus area of all institutions in Douala.

Keywords:
helminth protozoa intestine risk factors urban area Cameroon

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Hotez PJ, Alvarado M, Basanez MG, Bolliger I, Bourne R et al. Interpretation and Implications for the Neglected Tropical Diseases. PLoS Negl Trop Dis, 2014 8(7): e2865.
[2]	Knopp S, Mohammed KA, Stothard JR, Khamis IS, Rollinson D, Marti H, Utzinger J. Patterns and risk factors of helminthiasis and anemia in a rural and a peri-urban community in Zanzibar, in the context of helminth control programs. PLoS Negl Trop Dis 2010, 4(5): e681.
[3]	Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet 2006, 367: 1521-1532.
[4]	Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J. Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis 2006, 6: 411-425.
[5]	WHO. Schistosomiasis and soil-transmitted helminth infections-preliminary estimates of the number of children treated with albendazole or mebendazole. Wkly Epidemiol Rec 2006b, 16: 145-164.
[6]	World Health Organization. Prevention and control of schistosomiasis and soil-transmitted helminthiasis: report of a WHO expert committee. WHO Tech Report 2002, Ser 912: 1-57.
[7]	Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Ehrlich Sachs S, et al.. Control of neglected tropical diseases. N Engl J Med,2007, 357: 1018-1027.
[8]	Hotez PJ, Bundy DAP, Beegle K, Brooker S, Drake L et al. Helminth infections: soil-transmitted helminth infections and schistosomiasis. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank; 2006. Chapter 24, pages 467-482.
[9]	Savioli L, Smith H and Thompson A. Giardia and Cryptosporidium join the ‘‘neglected diseases initiative.’’ Trends Parasitol 2006, 22: 203-208.
[10]	Utzinger J, Becker SL, Knopp S, Blum J, Neumayr AL, et al. Neglected tropical diseases: diagnosis, clinical management, treatment and control. Swiss Med Wkly 2012, 142: w13727.
[11]	Becker SL, Lohourignon LK, Speich B, Rinaldi L, Knopp S et al. Comparison of the Flotac-400 Dual Technique and the Formalin-Ether Concentration Technique for Diagnosis of Human Intestinal Protozoon Infection. J. Clin Microbiol 2011, 49(6): 2183-90.
[12]	World Health Organization. Preventive chemotherapy in human helminthiasis : coordinated use of anthelminthic drugs in control interventions : a manual for health professionals and program managers. WHO technical report 2006a, 74 pages.
[13]	World Health Organization. Soil-transmitted helminthiases: Eliminating soil-transmitted helminthiases as a public health problem in children: Progress report 2001-2010 and strategic plan 2011-2020. WHO technical report 2012.
[14]	Chan MS. The global burden of intestinal nematode infections: fifty years on. Parasitol Today 1997, 13: 438-443.
[15]	Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Ehrlich Sachs S, et al. Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Med 2006b, 3: e102.
[16]	Hotez PJ. Mass drug administration and integrated control for the world’s high-prevalence neglected tropical diseases. Clin Pharmacol Therap 2009, 85: 659-664.
[17]	Hotez PJ, Brindley PJ, Bethony JM, King CH, Pearce EJ, et al. Helminth infections: the great neglected tropical diseases. J Clin Invest 2008, 118: 1311-21.
[18]	Pullan R and Brooker S. The health impact of polyparasitism in humans: are we under-estimating the burden of parasitic diseases? Parasitology 2008, 135: 783-794.
[19]	Brooker S, Hotez PJ and Bundy DAP. Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis 2008, 2: e291.
[20]	Brooker S. Estimating the global distribution and disease burden of intestinal nematode infections: adding up the numbers - A review. Int J Parasitol 2010, 40: 1137-1144.
[21]	Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380: 2197-2223.
[22]	Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013, 380: 2197-2223.
[23]	Ezeamama AE, Friedman JF, Olveda RM, Acosta LP, Kurtis JD, et al. Functional significance of low-intensity polyparasite helminth infections in anemia. J Infect Dis 2005, 192: 2160-2170.
[24]	Dreyfuss ML, Stoltzfus RJ, Shrestha JB, Pradhan EK, LeClerq SC, et al. Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal. J Nutr 2000, 130: 2527-2536.
[25]	Hall A, Bobrow E, Brooker S, Jukes M, Nokes K, et al. Anaemia in schoolchildren in eight countries in Africa and Asia. Public Health Nutr 2001, 4: 749-756.
[26]	Walsh JA. Problems in recognition and diagnosis of amebiasis: estimation of the global magnitude of morbidity and mortality. Rev Infect Dis 1986, 8: 228-38.
[27]	Minenoa T and Avery MA. Giardiasis: recent progress in chemotherapy and drug development. Curr Pharm Des 2003, 9: 841-855.
[28]	Becker SL, Vogt J, Knopp S, Panning M, Warhurst DC, et al. Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests. BMC Infect Dis 2013, 13: 37.
[29]	Stanley SL. Amoebiasis. The Lancet, March 2003, 361(9362): 1025-34.
[30]	WHO. Preventive chemotherapy in human helminthiasis. Geneva: World Health Organization, 2006c. 71 p.
[31]	Hotez PJ, Fenwick A, Savioli L and Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 2009, 373: 1570-5.
[32]	Tchuem Tchuente LA and N’Goran EK. Schistosomiasis and soil-transmitted helminthiasis control in Cameroon and Cote d’Ivoire: implementing control on a limited budget. Parasitology 2009, 136: 1739-45.
[33]	Tchuem Tchuente LA, Dongmo Noumedem C, Ngassam P, Kenfack CM, Feussom Gipwe N et al. Mapping of schistosomiasis and soil-transmitted helminthiasis in the regions of Littoral, North-West, South and South-West Cameroon and recommendations for treatment. BMC Infectious Diseases 2013, 13: 602.
[34]	Joint Research Commission of the European Union, 2008. State of the World’s cities: Slum cities and cities with slums. Pp: 106-119.
[35]	World Health Organization. World health statistics 2014.
[36]	World Health Organization/UNICEF. Progress on sanitation and drinking-water - 2014 update. 78 pages.
[37]	UNFPA 2007 Report. State of world population 2007: 108 pages.
[38]	Katz N, Chaves A and Pellegrino J. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sa˜o Paulo 1972, 14: 397-400.
[39]	Martin LK and Beaver PC. Evaluation of Kato thick-smear technique for quantitative diagnosis of helminth infections. Am J Trop Med Hyg 1968, 17: 382-91.
[40]	Ouattara M, Silue KD, N’Guessan AN, Yapi A, Barbara M et al. Prevalence and polyparasitism of intestinal protozoa and spatial distribution of Entamoeba histolytica, E. dispar and Giardia intestinalis from pupils in the rural zone of Man in Côte d’Ivoire. Cahiers Santé 2008, 18(4): 215-222.
[41]	Glinz D, Silue KD, Knopp S, Lohourignon LK, Yao KP et al. Comparing Diagnostic Accuracy of Kato-Katz, Koga Agar Plate, Ether-Concentration, and FLOTAC for Schistosoma mansoni and soil-transmitted helminths. PLoS Negl Trop Dis 2010,4(7): e754.
[42]	Knopp S, Speich B, Hattendorf J, Rinaldi L, Mohammed KA, Khamis S, Mohammed AS, Albonico M, Rollinson D, Marti H, Cringoli G and Utzinger J. Diagnostic Accuracy of Kato-Katz and FLOTAC for Assessing Anthelmintic Drug Efficacy. PLoS Negl Trop Dis 2011, 5(4): e1036.
[43]	Curtale F, Pezzotti P, Sharbini AL, al Maadat H, Ingrosso P et al. Knowledge, perceptions and behaviour of mothers toward intestinal helminths in Upper Egypt: implications for control. Health Policy Plan 1998, 13: 423-32.
[44]	Curtale F, Pezzotti P, Saad YS, Aloi A. An analysis of individual, household, and environmental risk factors for intestinal helminth infection among children in Qena Governorate, Upper Egypt. J Trop Pediatr1999, 45:14-7.
[45]	Ostan I, Kilimcioglu AA, Girginkardesler N, Ozyurt BC, Limoncu ME, Ok UZ. Health inequities: lower socio-economic conditions and higher incidences of intestinal parasites. BMC Public Health 2007, 7:342.
[46]	Freeman MC and Clasen T. Assessing the impact of a school-based safe water intervention on household adoption of point-of-use water treatment practices in southern India. Am J Trop Med Hyg 2011, 84: 370-378.
[47]	Jia T-W, Melville S, Utzinger J, King CH and Zhou XN. Soil-transmitted helminth reinfection after drug treatment: a systematic review and metaanalysis. PLoS Negl Trop Dis2012, 6.
[48]	Bartram J and Cairncross S. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 2010, 7: e1000367.
[49]	Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, et al. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 2010, 39 Suppl, 1: i193-i205.
[50]	Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J and Freeman MC. Water, Sanitation, Hygiene, and Soil-Transmitted Helminth Infection: A Systematic Review and Meta-Analysis. PLoS Med 2014, 11(3): e1001620.
[51]	Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT et al. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Intern Health august 2014, 19(8): 906-916.