A cross-sectional study of the nutritional status of schoolchildren aged 7-10 years from the Kuala Betis Resettlement Scheme in Gua Musang, Kelantan was done. A total of 291 schoolchildren were examined but only 183 (62.9%) fecal samples were returned for geo-helminth infection analysis. The prevalence of stunting was 40.4% and underweight was 28.4%. A total of 127 schoolchildren (69.4%) were positive for at least one of the 3 geo-helminth infections. The most common geo-helminth was Ascaris lumbricoides (62.8%), followed by Trichuris trichiura (38.9%), and hookworm infection was relatively low (12.6%). All the anthropometric indices measured were lower in the geo-helminth infected children compared to the uninfected childen, except for the weight-for-height z-score. However the differences were insignificant Geo-helminth infections may not be a significant factor in malnutrition of these schoolchildren. However, with the availability of safe, efficacious and cheap broad spectrum anthelmintics, regular mass treatment should be given in selected areas where the prevalence of geo-helminth infections is still high, so that these schoolchildren will be able to achieve their growth potential during their school years.
Soil-transmitted helminthiasis (STH), among the most common neglected tropical diseases, is a major public health problem in Malaysia with a possible impact on the nutritional status and school participation of rural children. This study was carried out among Aboriginal schoolchildren, living in an endemic area for STH in Malaysia, to determine the possible relationship between intestinal helminthiasis and school absenteeism. We also evaluated whether successful treatment of the infection will affect school attendance among the subjects. Stool analysis revealed that more than 90% of the subjects were infected with at least 1 helminth species, with Ascaris lumbricoides and Trichuris trichiura infections being most prevalent. Infection of moderate-to-heavy worm burdens, low level of fathers' education and anaemia were identified as the significant predictors of high absenteeism among the subjects (P<0·05). Following treatment of the infected children, it was found that school absenteeism was reduced significantly (P<0·01). In conclusion, STH continues to have significant impacts on public health, particularly in rural communities with a negatively significant effect on the school participation of Aboriginal children. A school-based de-worming programme should be introduced and incorporated in the current educational assistance targeted towards the Aboriginal communities, under the auspices of the government.
The gastrointestinal helminth infection status of 1574 children living in a slum area of Kuala Lumpur, Malaysia was assessed by quantitative coprology. Almost two-thirds were infected with Trichuris trichiura, 49.6% with Ascaris lumbricoides, and 5.3% with hookworm. Infection prevalence rose rapidly to a stable asymptote at 7 years of age, and the age-intensity profile was convex with maximal values in the 5-10 year age classes. This pattern was the same for males and females, but differed markedly between different ethnic groups. The frequency distributions of A. lumbricoides and T. trichiura were highly overdispersed (k values were 0.21 and 0.27, respectively), and age-dependent over the 0-8 year age classes. This suggests that the force of infection with these nematodes is lower in infants than in older children.
Stool specimens of 104 primary schoolchildren (mean+/-SD age = 8.2+/-0.3 years) were examined for helminth eggs and for occult blood to investigate the possibility that trichuriasis causes occult intestinal bleeding in the absence of the overt Trichuris dysentery syndrome. A commercially available guaiac test was used to detect fecal occult blood. Sixty-one children had Trichuris infection, 11 of whom had heavy infections (> 10,000 eggs per gram of feces [epg]), and 53 had Ascaris infections. No hookworm infection was detected. Baseline screening yielded only one weakly positive occult blood test result in a child with a light (800 epg) Trichuris infection. Serial stool occult blood testing on the 11 subjects with heavy trichuriasis and 8 uninfected controls yielded a single weakly positive result in the control group. The results provide no evidence that trichuriasis predisposes to significant occult gastrointestinal bleeding in children in the absence of the dysenteric syndrome.
The intestinal parasites of schoolchildren from an urban and a rural area on Penang island, Malaysia were compared. Examination of stool samples for helminth eggs showed that helminths found were Trichuris, Ascaris and hookworms. The results indicate that there is no significant difference (p<0.05) between rural and urban schoolchildren as regards to the prevalence of the three species of helminths. An extensive control program targetted at schoolchildren to monitor the helminth problem on the island is suggested.
Trials using albendazole and mebendazole, as single 400 mg dose treatments, against soil-transmitted helminths, were carried out in 7-9 and 10-12 years-old schoolchildren living in urban and rural environments in Penang, Malaysia. Both drugs were equally effective in treating trichuriasis and ascariasis in both age groups and environments. However, mebendazole is not so effective in the treatment for hookworms when compared to albendazole. It is suggested that albendazole should be considered the drug of choice for mass chemotherapy for Penang.
Intestinal parasitic infection among five interior communities at Bakun Valley, upper Rejang River, Sarawak, Malaysia, was investigated as part of a public health impact assessment of the proposed US$ 3 billion Bakun Hydroelectric Project. Coproparasitological examination of 355 stool samples from 7 of 16 villages representing 5 of 7 tribes in the area revealed infection rate of 41%. A higher infection rate was found among the settled Kayans (56%) than the seminomadic Penans (29%). Infection rate was high (68%) among children less than 14 years old. Trichuris trichiura accounted for more than 90% of all infections; less common were Ascaris lumbricoides, hookworms and Strongyloides stercoralis. Polyparasitism was found in 8% of the individuals surveyed with dual infection due to T. trichiura and A. lumbricoides being more common than dual infection with T. trichiura and hookworm. Women had higher infection rates (57%) than men (33%).
A survey of workers and families resident in an oil palm estate in Malaysia revealed high incidence of parasitic infections. The commonest parasites are T. trichiura (56%), A. lumbricoides (52%), hookworm (28%), Entamoeba coli (11.3%) and Giardia lamblia (11.3%). Mixed infections by two or more parasites was seen in 46% of the subjects. Anaemia was present in 70% of children with hookworm infection. Eosinophilia was observed in 69% of subjects. One each of Hymenolepis nana and Hymenolepis diminuta infection was detected. This is the first report of Hymenolepis diminuta infection in man in Malaysia.
This study aims to determine the prevalence of protein-energy malnutrition and its association with soil-transmitted helminthiases in Orang Asli (Aborigine) children in Selangor, Malaysia. The results obtained from 368 children aged 2-15 years showed that the overall prevalence of mild and significant underweight was 32.1% and 56.5% respectively. The prevalence of mild stunting was 25.6% while another 61.3% had significant stunting. The overall prevalence of mild and significant wasting was 39.0% and 19.5% respectively. The overall prevalence of ascariasis, trichuriasis and hookworm infection were 61.9%, 98.2% and 37.0% respectively and of these 18.9%, 23.5% and 2.5% of the children had severe infection of the respective helminthes. The overall prevalence of giardiasis was 24.9%. The present study vividly shows that stunting and underweight are highly prevalent among Orang Asli children and therefore of concern in this community. In this population intestinal parasitic infections, especially severe trichuriasis and giardiasis, were identified as the main predictors of stunting and wasting respectively, in addition to age between 2 to 6 years.
Vitamin A deficiency and malnutrition are still considered public health problems in rural areas of developing countries, including Malaysia. A cross-sectional exploration study was carried out on 281 Orang Asli (Aborigine) children aged between 2 and 15 years in Selangor, Malaysia. The overall prevalence of low serum retinol (<70 micromol/l) and hypoalbuminaemia (<35 g/l) were 25.2 and 7.8%, respectively. Univariate analysis showed that severe ascariasis, significant stunting and giardiasis were significantly associated with low concentration of serum retinol. As well as intestinal parasitic infections, low socio-economic status was a significant predictor of hypoalbuminaemia. Logistic regression analysis identified severe ascariasis and significant stunting as predictors of low serum retinol, while mixed intestinal parasitic infection and low household income were predictors of hypoalbuminaemia. In conclusion, control measures for intestinal parasitic infections should be included as one of the strategies for the prevention and control of malnutrition and vitamin A deficiency in this population.
Soil-transmitted helminthiases are a public health problem in rural communities. A cross-sectional study of the prevalence and distribution of Ascaris lumbricoides, Trichuris trichiura and hookworm was conducted in 281 Orang Asli children (aborigines) aged between 2 and 15 years, from 8 Orang Asli villages in Selangor, Malaysia. All the children were infected with soil-transmitted helminthes, with 26.3% of the children infected either with A. lumbricoides, T. trichiura or hookworm and 72.6% having mixed infection. The overall prevalences of A. lumbricoides, T. trichiura and hookworm were 61.9, 98.2 and 37.0%, respectively. Approximately 19.0, 26.0 and 3.0% of the children had severe infection of ascariasis, trichuriasis and hookworm infection, respectively. The prevalences and mean egg per gram (epg) counts for A. lumbricoides and T. trichiura were not significantly dependent on age, therefore age-dependent convexity was not seen in this study. However, the results of this study reveal an age-dependent prevalence and mean epg count in children with hookworm infection. We conclude that ascariasis, trichuriasis and hookworm infection are still prevalent and therefore a public health concern in Orang Asli communities. Severe ascariasis and trichuriasis may lead to other health and medical problems.
A study to determine the effect of antihelminthic treatment on growth and nutritional status was undertaken on 103 children in the second grade of primary school, 71 of whom were found to be infected with Ascaris lumbricoides or Trichuris trichiura. The median Ascaris and Trichuris intensities in the infected group were 19,600 (range; 0-488,000) and 2,800 (range; 0-84,600) eggs per gram of feces respectively. Forty-three children harbored both types of worm. Fourteen weeks after two 400 mg doses of albendazole were administered to infected children, the increases in weight, height, weight for age, height for age and weight for height were significantly higher among infected children than controls who were uninfected at baseline. The observed gains were independent of sex and socioeconomic status. Decrease in log transformed Trichuris intensity correlated with increases in weight (r=0.24; p=0.02) and weight for age (r=0.20; p=0.06) but decrease in Ascaris intensity did not correlate with increases in any of the anthropometric parameters. The results suggest that antihelminthic treatment has beneficial short-term effects on growth and nutritional status of a modest magnitude among early primary schoolchildren in the area.
Stool examination, height and weight measurements were undertaken on 249 early primary school children at two schools in North-eastern Peninsular Malaysia. Helminth infected children were treated and follow-up anthropometric measurements and stool examination undertaken on all (n = 100) children at one of the schools 16 months later; to observe the relationship between acquisition of infection and growth. Baseline Ascaris prevalence rates at the two schools were 16.0% (23/144) and 47.6% (50/105) respectively whilst Trichuris rates were 33.3% (48/144) and 52.4% (55/105). Hookworm infection was uncommon. There was no difference in weight or height for age between infected and uninfected children at any time. Acquisition of worm infection over the initial 16 month follow-up period was not associated with significant decreases in growth rates. However the small subsets of children with heavy Ascaris infection were consistently lighter and shorter at all evaluation times. They also gained significantly less weight and tended to have reduced linear growth rates between measurements. Further interventional studies are required to determine if this association is one of cause and effect or largely incidental.
A cross-sectional study was conducted to provide comprehensive data on the patterns and associated risk factors of soil-transmitted helminth (STH) infections among five Orang Asli subgroups in Peninsular Malaysia. The overall prevalence of STH infections was 59.9% (95% confidence interval [CI] = 56.1-63.7%). Trichuris trichiura (54.3%; 95% CI = 50.4-58.2%) was the predominant species followed by Ascaris lumbricoides (26.7%; 95% CI = 23.3-30.1%) and hookworm (9.1%; 95% CI = 6.9-11.3%). This study showed diversity for STH infections by subgroup with poverty and personal sanitary behavior as important risk factors for infection. Risk profile analyses indicating that Orang Kuala subgroup who has a generally well-developed infrastructure and better quality of life had a low rate of infection. There is a need for poverty reduction and promotion of deworming programs along with mass scale campaigns to create awareness about health and hygiene to reduce STH infections.
This study examines the persistence of familial aggregation and familial predisposition to Ascaris lumbricoides and Trichuris trichiura infection over 2 periods of treatment and reinfection, in an urban community in Kuala Lumpur, Malaysia. Both parasite species were shown to be aggregated (assessed by the variance to mean ratio) within families at all 3 interventions, although no consistent trend in aggregation was observed over the period of the study. Associations between mean A. lumbricoides and T. trichiura infection levels of families, at all 3 interventions, were highly significant (P < 0.0001), suggesting persistent predisposition at the family level.
Anthropometric and parasitological data from cross-sectional studies of two groups of primary school children (Group I of Indian origin, 325 boys and 259 girls, age = 7 years; Group II of Malay origin, 284 boys and 335 girls, age = 7-9 years) from two different ecological settings in Peninsular Malaysia were examined for epidemiological evidence of an association between hookworm infection and protein-energy malnutrition. In both ecological groups, significant weight, height and haemoglobin deficits were observed in children with hookworm infection after adjustment for covariables including Ascaris and Trichuris infection intensities and other child and family characteristics. The deficits were related to the intensity of infection based on egg counts. These findings suggest that hookworm may be an important determinant of chronic protein-energy malnutrition, as well as anaemia, in areas where diets are generally inadequate in protein, energy, and iron. Well-controlled intervention studies are needed to confirm these observations.
A community study on the age and sex related prevalence, intensity infection and frequency distribution of Ascaris, Trichuris and hookworm was carried out in 205 Orang Asli (Aborigines) children (95 boys, 110 girls) aged 1-13 years. The overall prevalence of Ascaris, Trichuris and hookworm was 62.9%, 91.7% and 28.8%, respectively. Almost two-thirds of the children were infected with moderate and severe intensity infection of Trichuris, 46.3% had moderate to severe intensity infection of Ascaris. However only 1.5% had moderate intensity of hookworm infection. The prevalence and mean intensity infection (measured by eggs per g) of Ascaris was age-dependent; lower in age group 1-4 years reached peak and stable at age group 5 years and above. The prevalence of Trichuris was high in all age groups and it fluctuated with age; the mean intensity of infection of Trichuris (measured by eggs per g) was age-dependent. Hookworm infection also rose with age and reached peak at 5-6 years, following that the prevalence declined. The frequency distributions of Ascaris, and hookworm were overdispersed. A strong positive correlation (p < 0.001) were observed between Ascaris and Trichuris and between hookworm and Trichuris. A positive correlation (p < 0.01) were also observed between Ascaris and hookworm.