Parasitic infections in Kuwait: A study based on Primary Care Centers

Authors

Eiman M. Al-Nakkas, Sawaber Health Center;
Manal S. Al-Mutar, Dahya Abdulla Salem Health Center, Capital Health Region
Hussein M. Shweiki, Department of Laboratory, Al-Jahra Hospital Ministry of Health, Kuwait;
Prem N.Sharma, Health Sciences Computer Center, Kuwait University.
Shoukry Rihan, Sawaber Health Center.

Address for Correspondence:
Eiman Al-Nakkas
P.O. Box No. 68194 Kaifan
71962  Kuwait
2453053 (Fax)
Email: mmutar@doctor.com

Abstract
Objectives: To determine the prevalence of different types of parasitic infections among patients attending primary health care centers, from all the five health regions of Kuwait and to find if infection differs with socio-demographic factors.

Subjects and Methods: A cross- sectional sampling survey was conducted in five health regions of Kuwait, from December 2001 to August 2002, for all age groups. Four primary health care clinics were selected randomly  from each health region. One thousand questionnaires were distributed, and 912 completed questionnaires were received from the patients, who presented with gastroenteritis symptoms. The questionnaire included personal information with socio-demographic characteristics,  and results of stool examination. 

Results: A total of 912 participants in the study, comprised of 607 (66.6%) males  and 305 (33.4%) females. 354 (38.8%) were Kuwaitis. Based on stool examination, 255 (28%) subjects were found to be positive for different types of parasitic infections. There was no significant difference in the prevalence of parasitic infection among gender and nationality, but was significantly higher among children (p<0.001). Infection was significantly higher (p<0.001) among people with education up to intermediate or none, as well as, those with low or middle class income (p<016) and also among the unmarried patients. The highest prevalence of parasitic infection was found in Al-Jahra and Al-Ahmadi health regions, about 48%, and the least in  capital health region 15.8%.The most common type of parasite found was Enterobius vermicularis, 27.1% and was significantly higher (74.6%) among children (p<0.001). The E. histolytica and E.Coli was significantly higher among adults.   

Conclusion: Our study showed that the parasitic infections were more prevalent among population with  low socio-economic conditions. Hence, efforts are needed to increase prevention programmes and also to improve such conditions in the regions with high prevalence.  

Key Words: Parasites, prevalence, Enterobius vermicularis, Entamoeba histolytica, Kuwait.  

Introduction

Intestinal parasitic infection is considered one of the most common tropical diseases in developing countries [1] . There are over 30,000 living named species of protozoa. The protozoa that infected man, range from forms never pathogenic to those that cause major disease of tropical countries[2].The prevalence of parasitic infections in developing countries is high and ranges  between 30 and 60% [1]. Some helminthic and protozoal parasites have world wide distribution, but the majority occur in the tropics. The distribution of those parasites is considerably influenced by population mobility, but more importantly the pattern of distribution depends mainly on the availability of certain conditions that are required for certain parasites [3].  Kuwait is considered as a non-endemic country for most of the parasitic infections. The parasitic infection affects manpower in the Kuwait community, and it is important to screen the parasitic infections and find ways to prevent and control them.

The objective of this study was to determine the prevalence of different types of parasitic infections among patients attending primary health care clinics in Kuwait, and its prevalence in relation to various socio-demographic factors and variations in different health regions.

SUBJECTS AND METHODS

A cross-sectional sampling survey was conducted in five health regions, during  an eight- month period, from December 2001 to August 2002. Four primary health care centers were selected randomly from each health region.  

One thousand questionnaires were distributed, of which 912 were completed from patients who attended the clinic for gastrointestinal symptoms including abdominal pain, diarrhea, perianal itching and anemia .Since the majority of individuals from the developing countries generally may not present with any of gastrointestinal symptoms, thus the carriers have been excluded .The questionnaire included information on age, gender, nationality, marital status, level of education and family income, results of stool examination and type of parasitic infection. All stool specimens of 912 patients were submitted for routine Stool examination. All specimens were examined by the direct fecal smear with saline or Lugol’s iodine, formalin-ether concentration method (4) replacing ether with ethyl acetate and trichrome staining method which is the Wheatley modification of Gomoris's trichrome stain (5).

The patient’s age groups were divided into children (from 0 to 12 years) and  adults (more than 12 years). The data was transferred to the Statistical Package for Social Sciences (SPSS) software (PC version 11.0) for statistical analysis. Chi-square or Fisher’s exact test was used to establish any associations between the variables and  infection or to test the proportions. A probability level of p ≤0.05 was considered significant.

 

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