Prevalence of Intestinal Parasites, and its Association with Severe Acute Malnutrition Related Diarrhoea

Abstract

Intestinal parasites contribute to undernutrition with or without overt diarrhoea and diarrhoea remains one of the commonest illnesses leading to high mortality rates in children with severe acute malnutrition (SAM). The objective of this study was to determine the prevalence of intestinal parasites and its association with diarrhoea in children admitted with SAM. This cross-sectional study enrolled severely acute malnourished children 6-59 months. SAM was diagnosed basing on a very low weight for height (below -3 z scores of the median WHO growth standards) or mid upper arm circumference below 11.5cm (MUAC<11.5 cm) or presence of bilateral pitting edema based on WHO definition of SAM. From each child, fecal samples were also collected and screened for presence of intestinal parasites using direct microscopy and modified Ziehl-Neelsen methods. Bivariate and multivariate logistic regressions were used in data analysis. The overall prevalence of intestinal parasites was 32.8%. The prevalence of protozoa (20.9%) was higher than and helminth (13.9%) infections (p=0.354). Giardia lamblia had the highest prevalence at 15.4% followed by hookworm at 9%. All other intestinal parasites like Entamoeba histolytica, Cryptosporidium species, Entamoeba coli, and Isospora species, Ascaris lumbricoides, Hymenolepis nana, Schistosoma mansoni, Trichuris trichura, Strongyloides stercoralis and Taenia species had a prevalence ranging from 2.5 to 5%. Adjusted logistic regression analysis showed that children presenting with Giardia lamblia were 3.53 times most likely to present with diarrhoea (95% CI: 4.15-142.3, p<0.0001) and 19.8 times at risk of having chronic diarrhoea (95% CI: 7.3-53, p<0.0001) after controlling for age, sex, HIV status and fever. All other parasites were not significantly associated with any diarrhoea. Children with fever were 2.12 times likely to present with diarrhoea in adjusted logistic analysis (95% CI: 1.1 - 4.0, p= 0.02). The results suggest that intestinal parasitic infections are highly prevalent in SAM, and giardiasis is associated with SAM related diarrhoea, chronic type in particular. This implies that successful routine intestinal parasite screening could increase the diagnostic rate of parasitic diarrhoea and improve the treatment and prevention strategies of diarrhoea in SAM children.

Keywords: Severe acute malnutrition, diarrhoea, intestinal parasites