Intestinal Parasitic Infections in School Students in Malakal City, Upper Nile State, South Sudan

Abstract

Open Access Research Article the low and middle income nations affected 50% of the general population causing more than 100 000 deaths per year [4]. Giardia intestinalis, the protozoic causative agent of giardiasis, infects approximately 200 million people [2,5]. In this context, the population in South Sudan has been nearly completely evacuated over the course of the long civil war [6]. However, less information about parasitic infections in South Sudan is available and this paper tries to highlight the situation in the country. Diagnosis of intestinal parasitic infections is routinely based on microscopy. Preparation of stool samples for microscopy performed by the direct wet mount method or the concentration methods (sedimentation and flotation). Sensitivity of the direct wet mount method was shown to be low [7] but, this method is still used in low and middle income countries. The concentration technique has become a routine procedure in the ova and parasite examination and allows the detection of small numbers of organisms that may be missed by using only a direct wet mount [1]. The aims of this study were to determine the prevalence and distribution of intestinal parasitic infections among school students, and to compare between the wet mount method and the formalin-ethyl acetate concentration method in detecting intestinal parasites. Materials and Methods Area of study, population and sample collection The study was conducted in Malakal area, upper Nile state in South Sudan during the period from August-November 2010. The state has an area of 77,773 km 2 and an estimated population of approximately 1,400,000. Malakal School was located in Malakal city that is the capital of the state. The total number of the students in the Malakal school was 450 including 236 boys and 214 girls, with age range 7-22 years. The number of students studying in primary (7-15 years) and secondary (16-22 year) levels was 200 and 250 respectively. Abstract Intestinal parasitic infections affect billions of people worldwide. Low and middle incomes countries in the world are still using the wet mount method for the diagnosis in parasitology. The aims of our study were to determine the prevalence and distribution of intestinal parasitic infections among school students and to compare the wet mount method and the formalin-ethyl acetate concentration method for detecting intestinal parasites. Stool samples were collected from Malakal school students. 450 students aged 7 to 22 years in the Malakal Area in Upper Nile State, South Sudan. The samples were prepared by the wet mount and concentration methods and examined by microscopy. The overall prevalence of intestinal parasitic infections was 16.2% using the direct wet mount method and 18.6% by the formalin-ethyl concentration method. Both methods showed that Giardia intestinalis was the most predominant parasite followed by Hymenolepis nana, Entamoeba coli, Entamoeba histolytica/ E. dispar, Ascaris lumbricoides, Schistosoma mansoni and Trichuris trichiura. Double or multiple infection appeared in some cases as protozoa-protozoa or protozoa-helminths. Infections in males and primary level school students showed a higher prevalence than in females and those of secondary level. This study demonstrated that the formalin-ethyl acetate concentration method detects higher number of parasites than the direct wet mount method. G. intestinalis and H. nana are the most predominant parasites observed in school students in Malakal city. Formalin-ethyl acetate concentration method is recommended for the diagnosis of intestinal parasites.