|Year : 2017 | Volume
| Issue : 2 | Page : 48-51
Prevalence and risk factors associated with Entamoeba Histolytica infection among children in Sebha, Libya
Rugaia Mohammed Abdulgader ESalem, Seham Abobaker Ali Gahgah, Aisha Salih Hamza Ali, Samah Abdaladhem Rahmma Al Shrief
Department of Zoology, Faculty of Science, Sebha University, Sebha, Libya
|Date of Web Publication||10-Jul-2017|
Rugaia Mohammed Abdulgader ESalem
Department of Zoology, Faculty of Science, Sebha University, Sebha
Source of Support: None, Conflict of Interest: None
Background: The protozoa parasite Entamoeba histolytica is an important cause of human morbidity and mortality worldwide besides malaria and schistosomiasis. Prevalence of E. histolytica in Sebha, Libya has been scantily studied and risk factors associated with this parasite are unavailable in Libya. Aims: A cross-sectional study was aimed to provide the first data on the prevalence and epidemiological risk factors associated with E. histolytica infection among school children in Sebha, Libya. Subjects and Methods: A total of 150 stool samples randomly were collected (during period from April 2017 to May 2017) from school children residents of Sebha and examined by direct smear microscopy (in normal saline and iodine smears) for the detection of E. histolytica infection. Results: Of one hundred fifty children, six children (4%) were found to be infected with this parasite. Boys were more significantly (P < 0.5) infected with E. histolytica than girls. A higher prevalence rate (6.66%) was found among 8 to 11 years old age group. There was no significant difference of E. histolytica infection among different age groups (P > 0.05). It has been noted that those who had large family size have significantly (P < 0.05) higher risk of being infected with E. histolytica. A significant (P < 0.05) association was found between education level of children's parents and E. histolytica exposure among children. No, significant correlation was found between monthly income of family and the presence of E. histolytica infection among children. Conclusions: Prevalence of E. histolytica among school children is low and this parasite may play a minor role in causing morbidity in this population in Sebha, Libya. Large size of families and education of parents of children were significant predictors of this parasite. In addition, more studies are needed to provide data on epidemiological risk factors of E. histolytica to improve health education and environmental sanitary conditions to protect children from the infection of this parasite in Libya.
Keywords: Children, Entamoeba histolytica, Libya, Sebha
|How to cite this article:|
ESalem RM, Gahgah SA, Ali AS, Al Shrief SA. Prevalence and risk factors associated with Entamoeba Histolytica infection among children in Sebha, Libya. Dent Med Res 2017;5:48-51
|How to cite this URL:|
ESalem RM, Gahgah SA, Ali AS, Al Shrief SA. Prevalence and risk factors associated with Entamoeba Histolytica infection among children in Sebha, Libya. Dent Med Res [serial online] 2017 [cited 2019 Jan 16];5:48-51. Available from: http://www.dmrjournal.org/text.asp?2017/5/2/48/210122
| Introduction|| |
The protozoa parasite Entamoeba histolytica is an important cause of morbidity and mortality worldwide., Infections with E. histolytica are common and are one of the major health problems in developing countries., Humans are the host of E. histolytica and there are no other known animal reservoirs of this parasite. The clinical spectrum of E. histolytica infections varies from asymptomatic infection to hemorrhagic colitis and extraintestinal disease. Most persons infected with E. histolytica are carriers. Infection with E. histolytica is responsible from a considerable number of cases of prolonged diarrhea in travelers. In addition, infection with E. histolytica may lead to the development of life-threatening abscess in lungs  or liver, brain. Transmission of E. histolytica occurs in areas with poor sanitation by contamination of drinking water or food with human feces. Water-associated outbreaks of E. histolytica disease have been reported. Transmission of E. histolytica can also be sexual.
The reviewed data of Ghenghesh et al. suggest that E. histolytica may play a minor role in Libya and showed prevalence rates of 0.8%–36.6% (mean 19.9%) and 0.8%–16.3% (mean 8.3%) for E. histolytica among the children with gastroenteritis and without gastroenteritis, respectively. The review also indicated that prevalence of E. histolytica was significantly higher in children than adults in Libyan population. High prevalence rates for E. histolytica were reported mainly from the city of Sirt. Recently, a study from Al-khoms found a significantly higher prevalence rate of E. histolytica among foreign workers, mainly from Egypt and other African countries, than among Libyan individuals.
Amebic infections mostly affect children below 15 years of age, with a significant increase in those aged 5–9 years.
The microscopic examination of stool specimens remains the backbone of the diagnosis of intestinal protozoa, particularly in developing countries. In recent years, several enzyme immunoassays (EIAs) that detect antigens of E. histolytica in fresh or frozen stool specimens with 85-100% sensitivity and 93-100% specificity have become commercially available. In Libya, most of the studies on intestinal parasites are based on hospital-based study and used microscopic examination of stool samples for the detection of cyst of E. histolytica. To the best of our knowledge, this is the first available research describing the prevalence and risk factors for E. histolytica in Libya.
The objectives of the present study were to investigate the prevalence of E. histolytica by stool examination (direct smear microscopy) among school children in Sebha, Libya. We also aimed to investigate possible risk factors for this parasite among children.
| Materials and Methods|| |
A total of 150 random stool samples were collected (during the period from April 2017 to May 2017) from primary school children, Sebha city. As soon as stool samples collected, they were processed for the detection of E. histolytica infection using direct smears microscopy in normal saline and iodine stain.
The questionnaire was completed by interviewing each child with their parents on demographic data (gender, age, size of family, education level of parents and socioeconomic status of family or monthly income of households).
As soon as stool samples collected, they were processed for the detection of E. histolytica infection using direct smears microscopy in normal saline.
Microscopic examination of stool
Each sample was processed and examined immediately after collection, by routine direct fecal smear microscopy using normal saline preparation to record the prevalence of E. histolytica among children residing in Sebha city.
Direct saline wet preparation
The direct saline smear was prepared by mixing a small amount of feces with a drop of normal saline (0.85%). These mixtures provide a uniform suspension under 22 mm coverslip. The entire coverslip area was examined using low power (×10) and then high power objective (×40).
Chi-square test was calculated for between infection of E. histolytica and risk factors associated with this parasite among children. P <0.05 was considered as statistically significant.
| Results|| |
The results of direct smear microscopy for the detection of E. histolytica among children are presented in [Table 1]. The overall prevalence of this infection was 4%. Gender-wise infection of E. histolytica is shown in [Table 2]. Boys (6%) were more infected than girls (3%) and the difference them was statistically significant (χ2 = 6.456, P = 0.011). Age-wise infection of E. histolytica among children is presented in [Table 3]. A higher (6.66%) and lower (2.56%) infection of E. histolytica was found among 8–11 and 12–15 years of age groups, respectively. No significant (χ2 = 3.037, P = 0.081) correlation was found between infection of E. histolytica and age groups of children.
|Table 3: Prevalence of Entamoeba histolytica among children according to age groups|
Click here to view
[Table 4] shows the results between E. histolytica infection and risk factors associated with this parasite among school children. The data confirmed that large-sized family was significantly (χ2 = 6.423, P = 0.001) associated with infection of E. histolytica among children. It also further confirmed that education level of parents was also a risk factor (χ2 = 44.30, P = 0.000) associated with infection of E. histolytica among children. Socioeconomic status (monthly income of family) was not significantly (χ2 = 1.22, P = 0.748) associated with infection of this parasite.
|Table 4: Epidemiological risk factors associated with Entamoeba histolytica among children|
Click here to view
| Discussion|| |
Amebiasis, an infection caused by the protozoan parasite E. histolytica, is globally considered as a leading parasitic cause of human mortality besides malaria and schistosomiasis. The results of previous studies in Libya showed prevalence of E. histolytica varies from 1.2% to 6.6% in different cities of this country.
The results of the present study showed an overall prevalence rate of 4.0% of E. histolytica among school children. This result almost agrees with other studies, who reported prevalence of E. histolytica in some parts of Libya, as it was 4.4% in adult population in Benghazi, 3.6% in Sebha among patients attending Central Laboratory, 3%–4% in school children in Tripoli, and 3.1% in primary children in Zawia. A slightly higher prevalence of 11.8% was found among children in Zliten, 6.6% among primary school children in Derna District, 9.5% in adults and children in Brak, Wadi Al-Shati, and 12.1% in school-aged children and adults in Al-Khoms city.
Moreover, a lower prevalence rate of amebiasis (1.2%) has also been reported in random school children of Wadi Al-Shati province. The results of the present findings contradict the high prevalence rates of E. histolytica reported in other studies from Libya, using direct smear microscopy as it was 16.3% in Sirt among children without gastroenteritis, 36.6% in Sirt in children with gastroenteritis, and 21% in Nalout city among adults and children with gastroenteritis.
In the present study, boys (6%) were significantly (P < 0.05) more infected with E. histolytica than girls (3%). A similar observation has been reported in Sirt city, where boys were more infected with E. histolytica than the girls. However, Sadaga and Kassem  and Kassem et al. reported no significant difference in the prevalence of E. histolytica among boys and girls in Derna and Sirt city of Libya, respectively.
The results of this study showed that there are no significant differences in the prevalence of E. histolytica among the different age groups of school children. Higher infection (6.66%) was reported among 8–11-year-old age group. Abdel-Magied and Elahwel  also reported higher prevalence of E. histolytica in 7–10-year-old school children in the Sirt city of Libya.
The results of this study showed that significantly higher prevalence of E. histolytica was reported among participants (P = 0.010) of large households (more than seven persons) compared to small size of families (seven or less persons). This finding is similar to the study in Derna city, Libya, who reported that infection of intestinal parasites was higher in large family size. Similarly, exposure of E. histolytica was positively associated with overcrowding at home or more household members in the family in Orang Asli Ethnic Group in Malaysia  and in general population in Mexico. Moreover, overcrowding in the families supports the dissemination of intestinal parasites in Argentina. However, Gelaw et al. and Nath et al. reported that infection of E. histolytica was independent to the size of family or household members in Ethiopia and India, respectively. The results of present study indicate that children belonging to large size families (≥ 7 members) might be favoring the transmission of E. histolytica among children due to crowding in the vicinity of homes in Sebha, Libya.
In the present study, prevalence of E. histolytica among school children in Sebha, showed significant association (P = 0.000) with the education of parents. The results are similar to the studies of Sadaga and Kassem  and Ben Mousa, who reported the prevalence of intestinal parasites was related to the education of family in the city of Derna and Tripoli, Libya, respectively. Similarly, Alvarado-Esquivel et al. and Nath et al. reported significant association between prevalence of E. histolytica and the education of family members in Mexico and India, respectively. However, contrary to the studies from Derna and Tripoli city of Libya, Abdel-Magied and Elahwel  observed statistically significant higher prevalence rates of E. histolytica among children with noneducated mothers than those with educated mothers in the Sirt city of Libya. Moreover, Shahrul Anuar et al. observed that exposure of E. histolytica was not significantly associated with the education of family in Malaysia.
The finding of the present study showed that household monthly income of parents was not significantly associated (P = 0.748) with E. histolytica infection among children in Sebha. Similar observations were reported by others as Shahrul Anuar et al. in Malaysia, Gelaw et al. in Etiopia, Alvarado-Esquivel et al. in Mexico, and Nath et al. in India, who found that income of the family did not play a significant risk factor for E. histolytica in the general population and children. However, Sadaga and Kassem  reported that prevalence of intestinal parasites was significantly associated with socioeconomic level of families among school children in Derna city, Libya.
In conclusion, the present study showed low prevalence of E. histolytica among school children in Sebha, Libya. Crowding at home and education level of children's parents were significant predictors associated with the exposure of E. histolytica among this population. Health information about how to prevent this infection in children should be provided to the parents of children.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
van Hal SJ, Stark DJ, Fotedar R, Marriott D, Ellis JT, Harkness JL. Amoebiasis: Current status in Australia. Med J Aust 2007;186:412-6.
Choudhuri G, Rangan M. Amebic infection in humans. Indian J Gastroenterol 2012;31:153-62.
Mortimer L, Chadee K. The immunopathogenesis of Entamoeba histolytica
. Exp Parasitol 2010;126:366-80.
Ralston KS, Petri WA Jr. Tissue destruction and invasion by Entamoeba histolytica
. Trends Parasitol 2011;27:254-63.
Tengku SA, Norhayati M. Public health and clinical importance of amoebiasis in Malaysia: A review. Trop Biomed 2011;28:194-222.
ChacÍn-Bonilla L. An update on amebiasis. Rev Med Chil 2013;141:609-15.
Nair GV, Variyam EP. Noninvasive intestinal amebiasis: Entamoeba histolytica
colonization without invasion. Curr Opin Infect Dis 2014;27:465-9.
Slack A. Parasitic causes of prolonged diarrhoea in travellers – Diagnosis and management. Aust Fam Physician 2012;41:782-6.
Petri WA, Haque R. Entamoeba histolytica
brain abscess. Handb Clin Neurol 2013;114:147-52.
Marie C, Petri WA Jr. Amoebic dysentery. BMJ Clin Evid 2013;2013. pii: 0918.
Karanis P, Kourenti C, Smith H. Waterborne transmission of protozoan parasites: A worldwide review of outbreaks and lessons learnt. J Water Health 2007;5:1-38.
Showler AJ, Boggild AK. Entamoeba histolytica
. CMAJ 2013;185:1064.
Ghenghesh KS, Ghanghish K, BenDarif ET, Shembesh K, Franka E. Prevalence of Entamoeba histolytica
, Giardia lamblia
, and Cryptosporidium
spp. in Libya: 2000-2015. Libyan J Med 2016;11:32088.
Alsirieti SR, Elahwel AM, Elamari AA. Intestinal Protozoa in Libyan patients in Sirt. Jamahiriya Med J 2006;6:59-61.
El-Ammari NE, Nair GA. Critical evaluation of the intestinal Protozoan parasites among Libyan and other African residents of Al-Khoms, Libya. J Entomol Zool Stud 2015;3:42-6.
Ximénez C, Morán P, Rojas L, Valadez A, Gómez A. Reassessment of the epidemiology of amebiasis: State of the art. Infect Genet Evol 2009;9:1023-32.
McHardy IH, Wu M, Shimizu-Cohen R, Couturier MR, Humphries RM. Detection of intestinal protozoa in the clinical laboratory. J Clin Microbiol 2014;52:712-20.
Chessbrough M. District Laboratory Practice in Tropical Countries. 2nd
ed. Cheesbrough: Cambridge University Press; 2004. p. 191-9.
World Health Organization. World Health Organization/Pan American Health Organization/UNESCO report of a consultation of experts on Amoebiasis. Wkly Epidemiol Rec 1997;72:97-100.
EI-Ammari NE, Nair GA. Occurrence and prevalence of intestinal protozoan parasites in male and female Libyan nationals residing in Benghazi, Libya. Rev Iber Parasitol 2003;63:47-54.
Al-Fellani MA, Abdulrahman OM, Khan AH, Abousaif AA. Prevalence of intestinal parasites in Sebha, Libya. Garyounis Med J 2005;22:56-60.
Ben Musa N, Sehari A, Hawas A. Intestinal parasitic infections among school children in Tripoli, Libya. J Egypt Soc Parasitol 2007;37:1011-6.
El-Said MM, Shaktur Al, El-Said SM, EL-Alem MD, Traish KO, Kahbar F. Prevalence of intestinal protozoa in primary schools in Zawia City, Libya. Nat Sci 2014;12:67-71.
Ali MB, Ghenghesh KS, Aissa RB, Abuhelfaia A, Dufani M. Etiology of childhood diarrhea in Zliten, Libya. Saudi Med J 2005;26:1759-65.
Sadaga GA, Kassem HH. Prevalence of intestinal parasites among primary schoolchildren in Derna District, Libya. J Egypt Soc Parasitol 2007;37:205-14.
Mergani MH, Mohammed MA, Khan N, Bano M, Khan AH. Detection of intestinal protozoa by using different methods. Dent Med Res 2014;2:28-32. [Full text]
Saada GS, Khan A, Ajaili A, Abdulsalam AM, Al-Shebani M, Kubti Y. A study of prevalence of human intestinal parasites in Wadi Al-Shati region. Sebha Med J 2009;8:51-8.
Abdel-Magied AA, Elahwel AM. Factors associated with intestinal parasitic infection among school children in Sirt, Libya. Benha Med J 2006;23:821-32.
Al Kilani MK, Dahesh SM, El Taweel HA. Intestinal parasitosis in Nalout popularity, Western Libya. J Egypt Soc Parasitol 2008;38:255-64.
Kasssem HH, Zaed HA, Sadaga GA. Intestinal parasitic infection among children and neonatus admitted to Ibn-Sina Hospital, Sirt, Libya. J Egypt Soc Parasitol 2007;37:371-80.
Shahrul Anuar T, M Al-Mekhlafi H, Abdul Ghani MK, Osman E, Mohd Yasin A, Nordin A, et al.
Prevalence and risk factors associated with Entamoeba histolytica
infection among three Orang Asli ethnic groups in Malaysia. PLoS One 2012;7:e48165.
Alvarado-Esquivel C, Hernandez-Tinoco J, Sanchez-Anguiano LF. Seroepidemiology of Entamoeba histolytica
infection in general population in rural Durango, Mexico. J Clin Med Res 2015;7:435-9.
Soriano SV, Barbieri LM, Pierángeli NB, Giayetto AL, Manacorda AM, Castronovo E, et al.
Intestinal parasites and the environment: Frequency of intestinal parasites in children of Neuquén, Patagonia, Argentina. Rev Latinoam Microbiol 2001;43:96-101.
Gelaw A, Anagaw B, Nigussie B, Silesh B, Yirga A, Alem M, et al.
Prevalence of intestinal parasitic infections and risk factors among schoolchildren at the University of Gondar Community School, Northwest Ethiopia: A cross-sectional study. BMC Public Health 2013;13:304.
Nath J, Ghosh SK, Singha B, Paul J. Molecular epidemiology of amoebiasis: A Cross-sectional study among North East Indian Population. PLoS Negl Trop Dis 2015;9:e0004225.
Ben Musa NA. Intestinal parasites in school aged children and the first case report on amoebiasis in urinary bladder in Tripoli, Libya. J Egypt Soc Parasitol 2007;37:775-84.
[Table 1], [Table 2], [Table 3], [Table 4]