Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine
Date
2019-12-11
Authors
Al-Jawabreh, Amer
Ereqat, Suheir
Dumaidi, Kamal
Al-Jawabreh, Hanan
Abdeen, Ziad
Nasereddin, Abdelmajeed
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Intestinal parasitic infections are common in rural areas with poor infrastructure and low
socioeconomic status. The aim of this study was to estimate the prevalence of selected parasitic infections in
marginalized rural areas in the northern part of the Palestinian West Bank Region, using conventional and PCRbased
methods, and also to assess risk predictors of infection.
Methods: A cross-sectional study was conducted on 104 individuals from three rural villages in the Jordan Valley.
Stool samples were collected and examined by a battery of tests that included microscopy of wet fecal samples in
normal saline with iodine, concentration by ethyl acetate sedimentation and also by zinc sulfate floatation, a
conventional PCR and a real-time PCR (qPCR). Risk factors were assessed that included demographic,
socioeconomic, and behavioral characteristics. Data on method performance was analyzed by kappa-statistic,
Cochrane’s Q, and McNemar post hoc test. Mid-P exact test and odds ratio were used to discern association
between outcome and risk predictors.
Results: The overall prevalence of intestinal parasitic infections was 48% (49/102). The predominant parasites were
Giardia lamblia at 37% (37/102) and Hymenolepis nana at 9% (9/102). To concentrate cysts and eggs, sedimentation
can be used as an alternative to floatation with a loss of 1% of positive cases. The methods employing PCRs proved
crucial as it increased the detected infection rate of G. lamblia approximately three-fold from 13% by the
conventional methods to 37% by the qPCR. Multiple infections were present in 13% (13/102) of the study group,
which included double (10%) and triple (3%) infections. Regarding the genus Entamoeba, E. dispar and E. coli were
detected at rates of 2 and 8%, respectively. While none of the individuals were infected with the pathogenic E.
histolytica, E. nana (4%) was detected for the first time in the area. Age was a risk predictor for infection (OR = 2.61,
CI 95% 1.05–6.45, P = 0.038).
Conclusions: The increased prevalence of intestinal parasitic infections in children in marginalized rural areas in
Palestine is worrying. The addition of PCR-based methods is important for the diagnosis of such infections as, with
cautious interpretation, it increases proficiency and overcomes underestimation and misdiagnosis of cases. Control
measures including education on personal hygiene and environmental sanitation, should be introduced to reduce
the prevalence of the intestinal parasites and, thus, the infections they cause in this and other areas.
Description
Keywords
Intestinal parasitic infection , Palestine-West Bank , PCR , Real-time PCR , Giardia lamblia
Citation
Al-Jawabreh, A., Ereqat, S., Dumaidi, K. et al. Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine. BMC Public Health 19, 1667 (2019) doi:10.1186/s12889-019-8024-2