Prevalence of G airdia lamblia and Entamoeba histolytic /Entamoeba dispare infections among Children in AL-Shulaa and AL-khadimya –Baghdad-Iraq

The prevalence of Giardia lamblia and Entamoeba histolytica/E.dispare were screened among 513 children aged less than 12 years in Al-Shulaa and Al-Khadimya - Baghdad, to evaluate the relationship of some factors (gender, age, grade and type of drinking water) with the prevalence of these two intestinal protozoal parasites, this study was done during the period from the beginning of April 2009 till the end of March 2010, in human.The study revealed that the total rate of ( G.lambli a and E. histolytica / E.dispare ) infection was (13.64%), the infectivity rate of G.lambli a was higher than the infectivity rate of E.histolytica / E.dispare as their rate was (10.72%) and (2.92%) respectively, and there was no significant relation (p≤0.05) between infectivity rate of these parasites and each of gender, age and grade (school and preschool) while there were very high significant relation between the type of drinking water and infectivity rate of both ( G.lambli a and E. histolytica / E.dispare ) the maximum infectivity rate of ( G.lambli a, E.histolytica / E.dispare ) was observed in patients who consumed tap water (17.56%) while patient who consumed the other kind of drinking water showed the minimum infectivity rate which was (3.49%) .


Introduction
Intestinal protozoan parasites are widely prevalent causing considerable medical and public health problem in developing countries [1]. Malabsorption, diarrhea, blood loss, impaired work capacity, and retarded growth can be associated with these intestinal infections [2], some infections occur focally in school and preschool age children [3,4]. Giardia lamblia and Entamoeba histolytica/ E.dispare, are among the major intestinal parasitic agents [5], both of G.lamblia and E. histolytica/ E.dispare are frequently transmitted via contaminated food or drinking water, but may also be spread from person to person through fecaloral contact [6].Approximately 10% of the world's population is infected by either E.histolytica or E.dispar of which 50 million people have invasive disease due to E.histolytica [7].The annual death of 40.000-100.000 is due to E.histolytica /E.dispare, place amoebiasis as the second leading cause of death from the parasitic disease worldwide [8], while 5-10% of population is at risk of giardiasis[9].
In Iraq literatures showed different incidence level of Giardia lamblia and E. histolytica/ E.dispare infection [10,11,12] in all age group well as some papers focus on sex related, occupation related prevalence [12] and age related especially in children [13,14], although we need more descriptive data to update our knowledge about these two parasites especially in children.

Materials and Methods
This study was conducted in: AL-Noor primary health care center, AL-Noor General Hospital, AL-Khadimya Teaching Hospital and AL-Khadimya Hospital for children / Baghdad, during the period from beginning of April 2009 till the end of March 2010.
Faecal samples were collected from 513 diarrheal and non diarrheal patients of both gender at age less than 12 years old, each sample was put in a clean screw cap container used for collecting stool samples, labeled with the number and date of collection. A special form of information was filled for each patient, which include source of drinking water and the grade (school , preschool).
The samples were concentrated by formalinether method. A drop was taken from each deposit by P-ISSN 1991-8941 E-ISSN 2706-6703

Journal of University of Anbar for Pure Science (JUAPS)
Open Access 2011,(5), (2 ) :06-12 pasture pipette and was smeared on a glass slide and then was examined by light microscope with × 100 objectives [11].
Experimental data were presented in terms of observed numbers and percentage frequencies, and then analysed by Statistical Package for Social Sciences (SPSS 10.01) using the Chi square: P value ≤ 0.05 was considered statistically significant.

Results and Discussion
The prevalence of Giardia lamblia and Entamoeba histolytica was studied among children in two locations, in north of Baghdad (AL-Shulaa and ALkhadimya), the results showed that the total rate of parasitic protozoan infection (G.lamblia, E.histolytica/ E.dispare) was (13.64%), the infectivity rate of G.lamblia was higher than the infectivity rate of E.histolytica/ E.dispare as their rate was 10.72% and 2.92% respectively figure (1), these result were differ from the result done by Sa'el,2009 [12] which showed high prevalence of E.histolytica/ E.dispare (28.4%) comparing with G.lamblia (12.9%), while it was in agreement with Atia, 2009 [11] who recorded high infectivity rate of G.lamblia (48%) comparing with less infectivity rate of E.histolytica/ E.dispare (33.8%). The differences between prevalence of these intestinal parasites from one study and other may due to different factors such as: Environmental, nutritional, socio-economic, geographical conditions, demographic and health-related behavior as well as number of patients samples in screening study and diagnostic method used [11, 13,14]. histolytica among children Gender related prevalence of both G.lamblia and E.histolytica/ E.dispare was screened and the result showed that there were no significant differences (p≤0.05) between male and female as their rate of infection were 12.28% and 15.35% respectively, results also showed that the prevalence of G.lamblia in both male (9.82%) and female (11.84%) were higher than the prevalence of E.histolytica/ E.dispare in both male (2.46%) and female (3.51%) table (1). This result was in agreement with Shrestha, 2001 [15] and Tasawar et al. 2010 [16] who showed that the infection with intestinal parasites was not associated with particular gender, while these results were disagreed with Al-Saeed & Issa, 2006 [17], who showed that there were significant differences between male and female infected with G.lamblia. Although clinical studies of humans and field studies of nonhuman animals are suggestive, several factors, including exposure rates, social behavior, habitat, and diet cannot be held constant and could contribute to the observed differences between male and female in parasite infection [18].  (2), and the low infectivity rate in age group less than three years , perhaps because parents are responsible for their hygiene [19] while the infection rate was higher in other age groups, this may be because this group of children are more involved in outdoor activities which might lead to parasites transmission [20] But statistical analysis of the current study showed that there was no significant relation (p≤0.05) between age and infectivity rate of both parasites in children. These results agreed with Kia et al.,2008[21] and Mohammed et al.,2009 [22] who illustrated that there were no significant differences between age groups,while it was disagreed with Sa'el,2009 [12], Al-Saeed & Issa, 2006 [17] and Ouattara et al.,2010 [23] who showed that the infection was significantly associated with age. The prior results of the current study were confirmed by the result of grade (preschool and school) related prevalence of children which examined in this study, high but no significant infectivity rate (G.lamblia & E.histolytica/ E.dispare) were seen in school children followed by preschool children as their rate of infection 18.64% and 12.15% respectively, while statistical analysis showed less significant differences between school and preschool children, high prevalence were observed in school children infected with G.lamblia 16.94% and E.histolytica/ E.dispare 3.29% when it compared with preschool children infected with G.lamblia 8.68% and E.histolytica/ E.dispare 1.69% table (3). Because of low sanitary levels, in developing countries, infection with some intestinal parasites occurred mostly in the first years of the life, but in developed countries the infection can be linked and easily transmitted in nurseries, day care centre and schools [24]. Contaminated water is a high risk factor for G.lamblia and E.histolytica infection, so prevalence of these parasites were screened child related with tab water and other kind of drinking water (boiled, filtered and bottled water), the maximum infectivity rate of (G.lamblia, E.histolytica) was observed in patients who consumed tab water (17.56%) the priority of infectivity rate was for G.lamblia followed P-ISSN 1991-8941 E-ISSN 2706-6703

Journal of University of Anbar for Pure Science (JUAPS)
Open Access 2011,(5), (2 ) :06-12 by E.histolytica as their rate was 13.78% and 3.78% respectively while patient who consumed the other kind of drinking water showed the minimum infectivity rate which was (3.49%), the priority of infectivity rate was for G.lamblia followed by E.histolytica as their rate was 2.79% and 0.7% respectively table (4). Statistical analysis showed that there was very high significant relation (p≤0.05) between the source of drinking water and the prevalence of these parasites, these results agreed with Hadi & Faraj,(2008) [25] who showed that the contamination rate of some parasites in tap water reach to 17.2%.
Giardia and E.histolytica cysts have the greatest potential for transmission through drinking water because: human infective cysts are widely distributed in the environment, cysts can penetrate physical barriers in water treatment processes and are disinfectant resistant [26,27] and each of Giardia and E. histolytica has a low infectious dose for humans [28].
From the previous results we conclude that both gender and age were not significantly associated with Giardia and E. histolytica, while drinking water can consider high risk factor .