الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 129 |  |  |
| | | from | 129 | | |
Abstract
Intestinal parasites are considered as a major public health problem worldwide, they have been recognized as forming the greatest global causes of disease. In Egypt, different rates of parasitic infections were recorded. Elderly people could be the major victims of parasitic infections as a result of their physical disability and less effective self-care, institutionalized elderly residents represented an important group. So utmost focusing should be placed on the protection of this susceptible group from such infections.
The aim of the present work was to study the intestinal parasitic infections among the residents of elderly care homes in Alexandria. It was carried out on 275 residents at eleven elderly care homes (from February 2018 to December 2018), 105 males (38.2%) and 170 females (61.8); their age ranged between 50 years and over than 80 years.
Stool examination for intestinal protozoan parasites and helminths is one of the most frequently performed investigations in parasitological laboratories. Most of protozoan parasites usually excreted through stool in both cyst and vegetative stages. Also eggs, larvae or adult forms of helminths can be detected in stool specimens. So, a single fresh stool sample was collected from each resident, preserved in 10% formalin after the visual inspection then examined using: formol - ether sedimentation technique to identify intestinal parasitic stages and modified Ziehl-Nelssen staining technique to detect coccidian oocysts.
A specially designed interviewing questionnaire was completed for each resident to collect personal data, socio-demographic status, medical history data, symptoms and signs of the infection, knowledge about intestinal parasites, attitude towards it, practice to its prevention and evaluation of the hygienic condition of each resident. The environmental and sanitary condition in each care home was assessed through filling a pre-designed check list that included: the properties of floors, walls, windows of the bed rooms. Also the grades of ventilation, drinking water supply, the kitchen and the crowding index of the bed rooms were evaluated.
from the present work, the following results were obtained:
• Percentage of intestinal parasitic infections among the study sample according to their socio-demographic characteristics: Only 35.3% of the residents were identified as having one or more intestinal parasites with statistically significant difference among different institutions. The prevalence rate was significantly higher among the youngest residents than the oldest (68.4% and 25.7% respectively). Males represented a higher percentage of parasitic infections (38.1%) than females (33.5%).
Concerning infection in relation to educational level and duration of staying in the care home, the highest percentage of infection was recorded among illiterate individuals (53.0%) while highly qualified presented with the lowest percentage of infection (20.0%). Also the highest percentage of infection was detected among the residents who stayed more than 15 years (75.0%). All the previous results were statically significant. The current results showed that, there was no relation between intestinal parasitic infections and residence in urban or rural area before entering the care homes.
There was a significant difference between percentages of infection among governmental homes. Also the percentage of infection was significantly higher in governmental care homes (50.9%) compared to private (11.1%). Only intestinal protozoa were distributed among studied samples without any helminthic infections. The highest percentage was for Cryptosporidium spp.(14.9%) , followed by Microsporidia spp. 8.7%, then G.lamblia 7.6%. While E.histolytica and B.homonis represented the lowest percentage of infection (7.3% for each). The percentage of non-pathogenic parasite E. coli was 1.5%. The percentages of detected protozoa were lower among private care homes in comparison to the governmental.
As for the distribution of the most common intestinal parasites among study sample, no significant association were observed between E.histolytica infection and socio-demographic characteristics (P>0.05). The current study showed that, educational level was the only factor among the socio-demographic characteristics that had a statistically significant relation with G.lamblia and B. homonis infection (EFP=0.012), while educational level and residency were presented with a statistically significant association with Cryptosporidium sp. infection (P<0.05).
The current results proved that, age and educational level were considered as risk factors regarding Microsporidium spp. infection (P<0.05). No significant association was observed between E. coli infection and socio-demographic characteristics (P > 0.05).
The present study reported high significant correlation between multiplicity of intestinal parasitic infections and the studied care homes. Whereas, 24.7% of the participants harbored only one parasite. Those infected with two parasites presented with 9.1%, while 1.5% were infected with three parasites. Multiple infections were significantly higher among illiterate residents (P= 0.000).
• Percentage of intestinal parasitic infections in relation to environmental and sanitary determinants of health: from the designed check list and according to the score that obtained by each care home they were classified into three levels (bad, fair and good). Prevalence of infection was significantly higher among the residents who were living in either bad environmental or sanitary conditions (59.4% and 52.3% respectively) than those who were living in a good environment and sanitation (13.3% and 10.8% respectively). All private care homes had good living conditions, while the majority of governmental care homes had bad or fair levels.
The current findings recorded a significantly higher infection rate among participants who were living in tiles floor, lime coated walls, weak ventilation and rooms without wire on their windows. The safe collection of garbage inside the homes, tap drinking water, cleaning of water tank every month, presence of soap in the toilet and absence of flies in the kitchen were significantly associated with lower rates of intestinal parasitic infection (P=0.000). It was clear that, residents who share their rooms with one or more persons presented with significantly higher infection rate than those who live solely in a separate room.
• Percentage of intestinal parasitic infections in relation to residents, knowledge, attitude and practice (KAP): 63.6% of the participants did not hear about the intestinal parasites were infected representing the highest percentage. A high rate of infection was also recorded among individuals who don’t know types of intestinal parasites (54.0%). Regarding those don’t know signs and symptoms, ways of transmission and prevention presented with the highest percentages of infection (59.8%, 62.9% and 62.6% respectively). All previous results were statistically significant
(P = 0.000).
Regarding residents, attitude, the participants who were hesitant that intestinal parasites are harmful to people’s health, bath rooms are the most important source of parasitic infection and the possibility of avoiding infection presented with a significantly higher infection rates (67.9%, 67.9% and 62.8% respectively).
Concerning residents, practice, the percentages of parasitic infections among residents who mentioned rarely washing of their hands before eating or after defecation (66.7% and 100% respectively) were insignificantly higher than the percentages among those who admitted regular washing of hands. While a significantly higher infection rates were among individuals who did not cut their nails regularly (100%), and who were sometimes washing fruits and vegetables before eating (76.5%).
By asking about seeking any treatment after medical advice on feeling abdominal pain without doing any laboratory examination, the highest percentage of infection was among individuals who did (60.0%). Also the highest percentages of infection were among individuals who used other personal tools, did not keep their food from insects and those who have always eaten processed meat products.
The infection rate was significantly higher among poor residents, knowledge (50.9%) and intermediate residents, practice (57.1%). Also poor knowledge among both governmental and private homes, residents was significantly associated with high rates of intestinal parasitic infections (55.1% and 29.6% respectively).
Regarding associations of residents, knowledge with parasitic infections according to socio-demographic characteristic. Studying age, it was found that, the youngest age group represented the highest percentage of poor information accompanied by the highest percentage of parasitic infections (78.9% and 80.0% respectively). While the oldest age group presented with higher percentage of fair knowledge (52.9%) accompanied with a relatively lower percentage of infection (13.5%). A significantly higher infection rate among poor knowledge males and females (61.1% and 45.9% respectively). According to residents, educational level, duration of staying in care homes and staying before entering care homes those with fair knowledge showed lower percentages of infection in comparison to poor knowledge residents.
An observed insignificantly higher percentage of infection was detected among residents with intermediate behavior in both governmental and private care homes (61.1% and 33.3% respectively).
Concerning associations of residents, practice with parasitic infections according to socio-demographic characteristics. The youngest age group represented the highest percentage of intermediate practice (21.1%) with 50.0% infection rate. Higher percentage of infection was reported among intermediate behavior males and females (100.0% and 43.8% respectively) in comparison to those with good behavior of both sexes. Higher percentages of intestinal parasitic infections were found among different educational level categories with intermediate practice. Regarding duration of staying in care homes, also those with intermediate practice showed higher percentages of infection, the same results were recorded among those staying in the cities or countryside.
• In terms of risk factors associated with intestinal parasitic infections among the study samples: The youngest age group was at greater odds for parasitic infections by six times as compared to the oldest age group. The odds of parasitic infections in governmental institutions was estimated to be eight times the odds of infections in private institutions. Illiterate residents had four times the odds of having parasitic infections. The longer the staying in the care homes, the greater the exposure to the infection by 1.007 times per month. Individuals with poor knowledge were more likely to be infected by seven times. The residents with intermediate behavior were more susceptible to be infected by two times than those with good behavior. Those who reside in a bad environment were more likely to be infected by nine times. Participants within a bad sanitation were more likely to be infected by nine times.
On the other hand the current results revealed that, insignificantly lower odds (P = 0.442), (OR=0.820; 95% C.I = 0.494- 1.360) of having infection among females as compared to males.
.2. Conclusion
from the current results, it can be concluded that:
Intestinal parasitic infections are still prevalent among the residents of elderly care homes. The youngest and illiterate individuals presented with a high infection rate. The governmental institutions are among the most important risk factors that lead to increased infection due to their bad environment and sanitation. Overcrowding inside the home plays an essential role in the transmission of infections among the elderly. Knowledge, attitude and practice could be important underlying risk factors.
Recommendations:
from the current results, the following could be recommended regarding intestinal parasitic infections among elderly care home residents:
• More than one stool sample should be examined for any resident before entering the care home.
• Combination of more than one technique beside microscopy such as ELISA and PCR could give good results.
• Periodic health check-up, stool examination and regular treatment throughout their stay in the care home.
• Prevention strategies should be applied among the elderly to raise their awareness through the health education programs that focusing on the importance of personal hygiene regarding hand washing, cutting finger nails regularly and measures of safety food.
• Giving seminars inside the home to provide the elderly with sufficient information about intestinal parasites and raise their belief in the extent of the parasitic harmfulness and the possibility of avoiding them.
• Study the importance of intestinal parasitic infections on nutritional status of elderly in the care homes.
• Introducing financial support to the government care homes to improve the surrounding environment concerning properties of floor, walls, ventilation, presence of soap, drinking water supply and collecting of garbage.
• The government interest in building new governmental homes to solve the overcrowding problem.
• Increase the number of well educated, well qualified and well trained care giver for older group of residents.