Intestinal Parasitic Infestations in severely Malnourished Children admitted at the Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Title: Intestinal Parasitic infestations in severely malnourished children admitted at the Moi Teaching and Referral Hospital, Eldoret, Kenya.

Background: Malnutrition in children predisposes to diarrhea, infections and long term health problems. Intestinal parasite infestation is commoner than in eutropic children and is often symptomatic and severe. Though intestinal parasites and severe malnutrition frequently co-exist, the exact extent is unknown. The purpose of the study was to establish prevalence.

Objective: To determine the prevalence of intestinal parasites and associated clinical and demographic factors.

Methods: An 8-month cross-sectional study was carried out between Nov 2011 and June 2012 on severely malnourished children aged 6-59 months whose parents gave consent, and excluded those with known underlying malignant or metabolic disease admitted during the study period. Data was collected using a structured questionnaire. It included demographic, clinical, sanitation and nutrition histories of the subjects. Stool specimens were analysed using formol-ether concentration technique for presence of parasite ova and cysts. Data was processed by SPSS, STATA and variables compared by Chi Square and Fisher’s analytical tests.

Results: A total of 130 severely malnourished children were studied, median age was 25 months with a male to female ratio of 1:1.24. The subjects’ guardians had a median age of 26 years, 61% were unemployed, 53% were single parents, and 56% attained primary school education. Malnutrition types were marasmus 50%, marasmic-kwashiorkor, 32 and kwashiorkor 18%. Diarrhoea was significantly present in children with kwashiorkor and marasmic-kwashiorkor 78% (P-Value 0.0491). Chronic diarrhea was present in 49% of subjects with diarrhoea, stools were profuse and watery in 52%. There was a previous diarrhoeal episode in 79% and 22% had been dewormed prior commonly with Mebendazole. Tap water was a common source but subjects who used river water for daily use were 11 times more likely to be infested with intestinal parasite. Parasites were found in 24% of subjects, 77% of whom had diarrhoea. The parasites species that were isolated were protozoa 15% (Giardia lamblia 9(6.9%), Entamoeba hystolytica 4(3%), Entamoeba coli 4(3%), Chilomastix mesnilii 3(2.3%)) and helminths (9%) (Ascaris lumbricoides 4(3%), Strongyloides stercoralis 2(1.5%), Ancylostoma duodenale 2(1.5%), Taenia solium 2(1.5%), Taenia saginatum 1(0.8%).

Conclusions and Recommendations: Intestinal parasites, commonly protozoa, among malnourished children are associated with severe, chronic and recurrent diarrhea. Diarrhoea is a common presentation of parasite infestation. Malnourished children should be dewormed and given antiprotozoal agents as well. Use of River water in this region is associated with parasite infestation and should be treated before use.