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Fulltext Trichuris Dysentery Syndrome: evidence that it may be underdiagnosed in Kelantan

Noorizan AM, Mahendra Raj S

Med J Malaysia, 2001 Mar;56(1):53-7.
PMID: 11503297

The prevalence rate of trichuriasis in children in certain areas of Kelantan is high. However the Trichuris Dysentery Syndrome (TDS), a condition in children characterized by chronic diarrhoea, stunting and anaemia is said to be rare. A recent change in policy at our institution to lower the threshold for undertaking colonoscopy in children with chronic diarrhoea resulted in the detection of 6 cases of TDS in less than a year. The median age was 7 years (range 3-13) and the median duration of symptoms before diagnosis was 2 years (range 1-8). The insidious nature of TDS and the low level of awareness of this condition even among health care workers may result in considerable underdiagnosis.

Matched MeSH terms: Trichuriasis/epidemiology*
The prevalence of malnutrition and geo-helminth infections among primary schoolchildren in rural Kelantan

Zulkifli A, Anuar AK, Atiya AS, Yano A

Southeast Asian J. Trop. Med. Public Health, 2000 Jun;31(2):339-45.
PMID: 11127336

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.

Matched MeSH terms: Trichuriasis/epidemiology
Fulltext The prevalence of Trichuris, Ascaris and hookworm infection in Orang Asli children

Norhayati M, Zainudin B, Mohammod CG, Oothuman P, Azizi O, Fatmah MS

Southeast Asian J. Trop. Med. Public Health, 1997 Mar;28(1):161-8.
PMID: 9322301

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.

Matched MeSH terms: Trichuriasis/epidemiology*
Fulltext The effect of repeated chemotherapy on the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infection

Chan L, Kan SP, Bundy DA

Southeast Asian J. Trop. Med. Public Health, 1992 Jun;23(2):228-34.
PMID: 1439974

The prevalence and intensity of intestinal nematode infections were assessed during 3 anthelminthic interventions in an urban community in Malaysia. The prevalence levels of Ascaris lumbricoides at Interventions 1, 2 and 3 were 30.6%, 18.9% and 15.5%, respectively and the mean intensities were 1.9, 0.75 and 0.81 worms per person. For Trichuris trichiura, the prevalence levels at Interventions 1, 2 and 3 were 46.9%, 21.6% and 15.7%, respectively. The mean intensities for T. trichiura at Interventions 1, 2 and 3 were 3.30, 0.92 and 0.07 worms per person. No gender-related prevalence and intensity were observed for the two geohelminths in this community. Prevalences and intensity had convex age profiles. Although repeated chemotherapeutic intervention reduced both prevalence and intensity levels, intensity was a more sensitive indicator than prevalence. The results indicate that age-targetting treatment at school children of 7-12 years of age would be an appropriate strategy for this community.

Matched MeSH terms: Trichuriasis/epidemiology
The effect of repeated chemotherapy on age-related predisposition to Ascaris lumbricoides and Trichuris trichiura

Chan L, Kan SP, Bundy DA

Parasitology, 1992 Apr;104 ( Pt 2):371-7.
PMID: 1594301

This study examines the persistence of predisposition to Ascaris lumbricoides and Trichuris trichiura during repeated chemotherapy in an urban community in Kuala Lumpur, Malaysia. Significant predisposition was observed over 2 periods of reinfection with and without age-standardization of data. Analysis of different age groups indicated that predisposition was most strongly detectable in the younger age classes. The intensities of infection with both parasites were strongly correlated at each cycle of intervention, suggesting that individuals were similarly predisposed to both species.

Matched MeSH terms: Trichuriasis/epidemiology
Soil-transmitted helminthiasis: a critical but neglected factor influencing school participation of Aboriginal children in rural Malaysia

Ahmed A, Al-Mekhlafi HM, Azam MN, Ithoi I, Al-Adhroey AH, Abdulsalam AM, et al.

Parasitology, 2012 May;139(6):802-8.
PMID: 22310239 DOI: 10.1017/S003118201100237X

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.

Matched MeSH terms: Trichuriasis/epidemiology
Fulltext Protein-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor, Malaysia

Al-Mekhlafi HM, Azlin M, Aini UN, Shaik A, Sa'iah A, Fatmah MS, et al.

Asia Pac J Clin Nutr, 2005;14(2):188-94.
PMID: 15927939

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.

Matched MeSH terms: Trichuriasis/epidemiology
Prevalence of parasitic infections in Malaysian oil palm estate workers

Sinniah B, Sinniah D, Singh M, Poon GK

Southeast Asian J. Trop. Med. Public Health, 1978 Jun;9(2):272-6.
PMID: 725660

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.

Matched MeSH terms: Trichuriasis/epidemiology
Prevalence of intestinal helminths among patients admitted to the Balik Pulau district hospital on Penang island

Khan SM, Anuar AK

Southeast Asian J. Trop. Med. Public Health, 1977 Jun;8(2):260-4.
PMID: 918716

Faecal samples from patients admitted to the District Hospital in Balik, Pulau, Penang revealed high infection rates for Ascaris lumbricoides, Trichuris trichiura and hookworms. The prevalence rates were Trichuris trichiura 51.7%, Ascaris lumbricoides 31.9% and hookworm 37.2%. The overall highest infection is among the Malays (79%), the least being among the Chinese (61.1%). The prevalence of Ascaris lumbricoides was highest in the 11-20 age group. The prevalence of Trichura was highest in the 51-60 age group, Ascaris and Trichuris infections is higher among the males but hookworm infection is higher among the females. 72.6% of the patients were infected with at least one type of helminth and 32.9% of the patients were infected with at least 2 types of helminths.

Matched MeSH terms: Trichuriasis/epidemiology*
Fulltext Prevalence and risk factors of geohelminthiasis among the rural village children in Kota Marudu, Sabah, Malaysia

Lim-Leroy A, Chua TH

PLoS One, 2020;15(9):e0239680.
PMID: 32986746 DOI: 10.1371/journal.pone.0239680

Geohelminthiasis is a worldwide problem, especially in low-income countries. Children from rural areas and those living in poverty, lacking basic health amenities and having poor environmental sanitation are likely to be affected. Adverse effects such as anemia, protein malnutrition, colitis are common which can affect both the children's physical and mental growing development. A cross-sectional study on geohelminthiasis was conducted among children from 238 households in 13 villages in Kota Marudu of northern Sabah, East Malaysia. The study involved interviewing villagers using questionnaires to collect demographic and socio-economic data, getting faecal samples from the children, collecting soil samples and identifying parasite eggs with microscopy and molecular methods. A total of 407 children (6 months-17 years old) enrolled in the study. Geohelminthiasis was detected in the faecal samples of children from 54% (7/13) of the villages with mean prevalence of infection per village of 9.0% (0%-34.9%). On a household basis, 18% (43/238) of the households sampled had infected children, with mean prevalence rate per household of 11% (0%-43%). The prevalence was for Ascaris lumbricoides: 9.6% (39/407), Trichuris trichiura: 2.7% (11/407) and hookworms (Necator americanus and Ancylostoma sp.): 2.7% (11/407). The overall mean infection rate of the children examined was 14.3%. Significantly higher prevalence was recorded for the children of mothers who did not have any formal education (p = 0.003); household income of less than USD119 (RM500) (p<0.001); children from homes without proper sanitation facilities (p<0.001); children who usually go about barefoot (p<0.001) and not washing feet before entering the house (p = 0.017). Soil samples were found to have geohelminth eggs or larvae which could be due to unhygienic sanitation practices. This study shows the geohelminthiasis is prevalent in the villages, and the risk factors are lack of maternal education, low income, poor sanitation facilities and irregular deworming practice. Expanding deworming coverage in the study region may help reduce the worm infections in these communities, so that the mental and physical development of the children would not be affected by geohelminthiasis. The data on the prevalence of geohelminthiasis in this study would contribute to better public health monitoring and operation to reduce the infection in rural areas.

Matched MeSH terms: Trichuriasis/epidemiology*
Prevalence and distribution of soil-transmitted helminthiases among Orang Asli children living in peripheral Selangor, Malaysia

Al-Mekhlafi MS, Azlin M, Nor Aini U, Shaikh A, Sa'iah A, Fatmah MS, et al.

Southeast Asian J. Trop. Med. Public Health, 2006 Jan;37(1):40-7.
PMID: 16771211

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.

Matched MeSH terms: Trichuriasis/epidemiology*
Pattern and predictors of soil-transmitted helminth reinfection among aboriginal schoolchildren in rural Peninsular Malaysia

Hesham Al-Mekhlafi M, Surin J, Atiya AS, Ariffin WA, Mohammed Mahdy AK, Che Abdullah H

Acta Trop, 2008 Aug;107(2):200-4.
PMID: 18582430 DOI: 10.1016/j.actatropica.2008.05.022

Data on soil-transmitted helminth (STH) infections and reinfection among Orang Asli (aborigine) schoolchildren and their nutritional and socioeconomic status were analyzed to investigate the pattern and the possible predictors of STH reinfection. In this longitudinal study, 120 (60 males and 60 females) Orang Asli primary schoolchildren aged 7-12 years and living in remote areas in Pos Betau, Kuala Lipis, Pahang were screened for the presence of STH using modified cellophane thick smear and Harada Mori techniques. The overall prevalence of ascariasis, trichuriasis and hookworm infections were 65.8, 97.5 and 10.8%, respectively. After complete deworming with a 3-day course of 400mg/daily of albendazole tablets, children were re-examined at 3 and 6 months from baseline. The reinfection rate, by one or more of STH species, at 3 months after deworming was high (49.5%) while 79.6% of the children were reinfected at 6 months after deworming. Logistic regression analyses showed that females, stunted children and those living in houses without toilets had significantly higher reinfection rates than others at 3 months (P<0.05). At 6 months, maternal employment status emerged as another predictor where children of working mothers had significantly higher reinfection rates (P=0.026). In conclusion, reinfection rate of STH is high and thus necessitates frequent and periodic deworming among children. Public health personnel need to re-look at the current control measures and identify innovative and integrated ways in order to reduce STH significantly in the rural communities.

Matched MeSH terms: Trichuriasis/epidemiology
Intestinal parasitism in a Kampong on Pulau Pangkor, West Malaysia

Nawalinski T, Roundy LM

Southeast Asian J. Trop. Med. Public Health, 1978 Sep;9(3):440-1.
PMID: 749228
Matched MeSH terms: Trichuriasis/epidemiology
Intestinal parasitic infection among five interior communities at upper Rejang River, Sarawak, Malaysia

Sagin DD, Mohamed M, Ismail G, Jok JJ, Lim LH, Pui JN

Southeast Asian J. Trop. Med. Public Health, 2002 Mar;33(1):18-22.
PMID: 12118449

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%).

Matched MeSH terms: Trichuriasis/epidemiology
Fulltext Intestinal helminthiasis in relation to height and weight of early primary school children in northeastern peninsular Malaysia

Mahendra Raj S, Sein KT, Khairul Anuar A, Mustaffa BE

Southeast Asian J. Trop. Med. Public Health, 1997 Jun;28(2):314-20.
PMID: 9444012

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.

Matched MeSH terms: Trichuriasis/epidemiology*
Hookworm infection and protein-energy malnutrition: transverse evidence from two Malaysian ecological groups

Foo LC

Trop Geogr Med, 1990 Jan;42(1):8-12.
PMID: 2124397

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.

Matched MeSH terms: Trichuriasis/epidemiology
Fulltext Helminthic infections of urban and rural schoolchildren in Penang Island, Malaysia: implications for control

Rahman WA

Southeast Asian J. Trop. Med. Public Health, 1998 Sep;29(3):596-8.
PMID: 10437964

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.

Matched MeSH terms: Trichuriasis/epidemiology*
Helminthiases in peninsular Malaysia--prevalence and density of infestation of hookworm, Ascaris and trichuris in rural school children

Lo EK, Varughese J, Ghouse A, Noor M

Med J Malaysia, 1979 Dec;34(2):95-9.
PMID: 548726
Matched MeSH terms: Trichuriasis/epidemiology
Growth reduction among primary schoolchildren with light trichuriasis in Malaysia treated with albendazole

Tee MH, Lee YY, Majid NA, Noori NM, Raj SM

Southeast Asian J. Trop. Med. Public Health, 2013 Jan;44(1):19-24.
PMID: 23682433

We studied asymptomatic primary schoolchildren in northeastern Malaysia with light to moderate trichuriasis to determine the effect of albendazole treatment on growth rates and TNF-alpha levels. Thirty-seven schoolchildren aged 6-7 years with stool samples positive for Trichuris trichiura and negative for other geohelminths and protozoa were randomized to receive albendazole 400 mg or a placebo daily for 2 days. Anthropometric parameters at baseline, 3, 6 and 12 months were compared between the 2 groups. The placebo group had a significantly greater increase in height (p = 0.04) than the albendazole treatment group. There were no significant differences in urinary TNF-alpha levels (p = 0.8) between the 2 groups and no significant changes between baseline and 1 month post-treatment levels. Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.

Matched MeSH terms: Trichuriasis/epidemiology
Fulltext Geographical distribution of soil transmitted helminths and the effects of community type in South Asia and South East Asia - A systematic review

Silver ZA, Kaliappan SP, Samuel P, Venugopal S, Kang G, Sarkar R, et al.

PLoS Negl Trop Dis, 2018 01;12(1):e0006153.
PMID: 29346440 DOI: 10.1371/journal.pntd.0006153

BACKGROUND: Soil-transmitted helminth (STH) infections are among the most prevalent neglected tropical diseases (NTD) worldwide. Since the publication of the WHO road map to combat NTD in 2012, there has been a renewed commitment to control STH. In this study, we analysed the geographical distribution and effect of community type on prevalence of hookworm, Trichuris and Ascaris in south Asia and south east Asia.
METHODOLOGY: We conducted a systematic review of open-access literature published in PubMed Central and the Global Atlas of Helminth Infection. A total of 4182 articles were available and after applying selection criteria, 174 studies from the region were retained for analysis.
PRINCIPAL FINDINGS: Ascaris was the commonest STH identified with an overall prevalence of 18% (95% CI, 14-23%) followed by Trichuris (14%, 9-19%) and hookworm (12%, 9-15%). Hookworm prevalence was highest in Laos, Vietnam and Cambodia. We found a geographical overlap in countries with high prevalence rates for Trichuris and Ascaris (Malaysia, Philippines, Myanmar, Vietnam and Bangladesh). When the effect of community type was examined, prevalence rates of hookworm was comparable in rural (19%, 14-24%) and tribal communities (14%, 10-19%). Tribal communities, however, showed higher prevalence of Trichuris (38%, 18-63%) and Ascaris (32%, 23-43%) than rural communities (13%, 9-20% and 14%, 9-20% respectively). Considerable between and within country heterogeneity in the distribution of STH (I2 >90%) was also noted. When available data from school aged children (SAC) were analysed, prevalence of Ascaris (25% 16-31%) and Trichuris (22%, 14-34%) were higher than among the general population while that of hookworm (10%, 7-16%) was comparable.
CONCLUSIONS/SIGNIFICANCE: Our analysis showed significant variation in prevalence rates between and within countries in the region. Highlighting the importance of community type in prevalence and species mix, we showed that tribal and rural communities had higher hookworm infections than urban communities and for ascariasis and trichuriasis, tribal populations had higher levels of infection than rural populations. We also found a higher prevalence of ascariasis and trichuriasis in SAC compared to the general population but comparable levels of hookworm infections. These key findings need to be taken into account in planning future MDA and other interventions.

Matched MeSH terms: Trichuriasis/epidemiology*

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