SEMINAR

ON

PREVALENCE OF SOIL TRANSMITTED ROUNDWORM

INFECTION

BY
DORCAS PETER
1707671049

SUBMITTED TO THE DEPARTMENT OF APPLIED SCIENCE

OPTION MICROBIOLOGY, SCHOOL OF SCIENCE AND
TECHNOLOGY, ABDU GUSUA POLYTECHNIC, TALATA MAFARA,
ZAMFARA STATE.
IN PARTIAL FULFILLMENT FOR THE REQUIREMENT OF THE
AWARD HIGHER NATIONAL DIPLOMA IN MICROBIOLOGY,
ABDU GUSAU POLYTECHNIC TALATA MAFARA, ZAMFARA
STATE.

JULY, 2019

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 ABSTRACT

A study on the prevalence of infection caused by soil transmitted roundworms was

investigated among some schools, Nigeria. This infection using formal ether
concentration technique. Ascaris lumbricoides has a prevalence of 3 (7.5%) in relation
to the type of infection. Hookworm has a prevalence of 2 infected (5%) where as
trichuris trichura was 1 infected (2.5%). The distribution of infection among sexes, age
groups, income, number in household, source of water and toilet type used was also
recorded. However, these are the possible risk factors by the analysis of the infection
showed in the area. Eradication or reduction of this infection can be achieved by
promoting good sanitary conditions and promotion of social welfare.

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INTRODUCTION

Soil transmitted roundworms, the majority of this infection occurs in developing

countries where increased population density and urbanization, poverty inadequate
sanitation and poor health awareness contribute to the increasing prevalence of
infection (Abraham, 1994) Despite recent advance in epidemiological understanding of
parasite population behavior and cost effective control strategies.

Soil transmitted roundworms are parasitic nematode with a life cycle that involve no
intermediate host or vector. They infect many animals including humans, and are
transmitted by feacal contamination of soil, foods and water most species have juvenile
forms which move around the body of the host, but all species inhabit the intestine in
their adult stage and release their egg in the host’s feaces. The disease in human
ascaris lumbricoides (the large roundworm which cause ascariasis) trichuris trichiura
(the whiphworm which causes trichuriasis) and the blood feeding hookworms
ancylostoma doudenale and necator americanus (Chan et al, 1994; Montresor et al,
1998) are among the most common of all chronic human infections, accuring
predominantly in area of poverty and inadequate hygiene and sanitation in the
developing word. Unlike many other tropical disease, infection with these helminthes
does not typically result in clinical disease, and the majority of infected individuals
exhibit no signs or symptom. This is because pathology is strongly related to the
number of worms present (the intensity of infection), and most individuals harbor only a
few worms in the minority of individual who harbous a large worm burden, infection
result in anaemia and impaired growth cognition as well as overt clinical disease.

AIMS

The aim of this seminar is to determine the prevalence of soil transmitted round worms
infection

OBJECTIVES

The objectives are:

1. To determine the relationship between soil transmitted roundworm infection and
the ages of the participants in the area.

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 2. To examine the prevalence of soil transmitted round worm infection in he study
area.
3. To know the relationship between gender and soil transmitted roundworm
infection the study area.
4. To determine the risk factors of soil transmitted round worm infection.
5. To examine the degree of soil transmitted round worm infection in the study area.

STATEMENT OF PROBLEM

The study required proper introduction to the schools and formal identification. The
collected of samples needs urgent examination and the materials used are expensive.

JUSTIFICATION OF THE STUDY

Infections by soil transmitted round worms is among the chronic human infections, and
causes mortality in children within primary school age. Based on the above problems
this research was suggested to carry out so as to minimize the mortality rate and reduce
the infections in general.

HISTORY AND ORIGIN OF SOIL TRANSMITTED HELMINTHS

Some historians have identified references to helminth worms and their disease in the
Bible, but the relevant passages are open to several interpretations. Among the
Egyptian medical papyri the embers papyrus refer to intestinal worms, and these
records can be confirmed by the discovery of calcified helminthes eggs in mummies
dating from 1200Be. The Greek, particularly, Hippocrates (400 to 375BC) (Jones, W.H
et. al., 1948- 1953) knew about worms. Roman physicians including Celsus (25BC to
AD 50) (John , R.C, 1954) and Galen (Abraham of pergamon, AD 129 to 200) (Kuhn,
K. 1821- 1833) were familiar with the human round worms, Ascaris lumbricoides etc.

The 17th and 18th centuries following the re-emergence 'of science and scholarship
during the Renaissance period: Linnaeus described and named six helminths worms,
Ascaris lumbricoides is one of the six worms (Linnaeus, e. 1758). Ascaris lumbricoides
eggs have been found in human coprolites from Peru dating from 2277BC (Home, P.O.

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1985; Patrucco, R. et. aI., 1983) and Brazil from about 1660 to 1420BC (Ferreira, L.F.
et. aI., 1980; Ferreira, L.F. et. aI., 1983).

It was also discovered that hookworms originated from Asia and Africa. During the 18th
and 19th centuries, there were increasing numbers of record from West Indies and
South and Central America (Grove, DJ. 1990).

MODE OF TRANSMISSION

Ascaris Lumbricoides

Infections happen when human swallow water or food that contaminated with unhatch
juveniles. The juveniles hatch in the duodenum. They then penetrate the mucosa and
sub mucosa and enter venules or lymphatics. Next they pass through the right heart
and into pulmonary circulation. They then break out of the capillaries and enter the air
spaces. Acute tissue reaction occurs when several worms get lost during this migration
and accumulates in other organs of the body. The juvenile migrate from the lungs up the
respiratory tract to pharynx where they are swallowed. They begin producing eggs
within manure. It might seem odd that the worms end up in same place where they
began. One hypothesis to account for this behavior is that
Most diagnosis is made by identifying the appearance of the worm or eggs in feces.
Due to the large quality of eggs laid, physicians can diagnose using only one or two
fecal smears, (Dridelle 2009).
Life Cycle of Ascaris: Ascaris lumbricoides, a roundworm that infects human occur
when an ingested fertilized eggs becomes a larvae worm that penetrate the wall of the
duodenum and enters the blood stream. From here, it is carried to the liver and heart,
and enters pulmonary circulation to break free in the aveoli, where it grows and molt in
3weeks, the larvae pass from the respiratory system to be coughed up, swallowed, and
thus return to the small intestine, where they mature to adult male and female worms.
Fertilized eggs can now occur and the female produces as many as 200,000 eggs per
day for a year. These fertilized eggs become infectious after 2 weeks in soil, they can
persist in soil for 10 years or more. The eggs have a lipid layer which makes them
resistance to the effect of acids and alkalis as well as other chemicals. This resistance
helps to explain why nematode is such an ubiquitous parasite. (Robert et. al; 2009).

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Trichuris Trichura

Human can become infected with the parasite due to ingestion of infective eggs by
mouth contact with hands or food contaminated with egg- carrying soil. However, there
have also been rare reported cases of transmission of Trichuris Trachiura by sexual
contact. Some major outbreaks have been trace to contaminated vegetables (due to
presume soil contamination) (Dc, 2013).

Life Cycle: Unembryonated eggs (unsegmented) are passed in the feces of a previous
host to the soil. In the soil, these eggs develop into a 2cell state (segmented eggs) and
then into an advance cleavage stage. Once at this stage, the eggs embryonate and
then become infective a process that occurs in about 15 to 30 days next, the infective
eggs are ingested by way of soil-contaminated, hands or food and hatch inside the
small intestine, releasing larvae into the gastrointestinal tract. These larvae burrow into
a villus and develop into adults (over 2-3days). They then migrate into cecum and
ascending colon where they thread their anterior portion (whip-like end) into the tissue
mucosa and reside permanently for their year-long life span. About 60 to 70 days after
infection, female adults begin to release unembryonated eggs (Oviposite) into the
cecum at a rate of 3,000 to 20,000 eggs per day, linking the life cycle to the start.
(Bethony J. et. al.; 2006).

Hookworm

Life Cycle: The life cycle of the hookworm thrives in warm earth where temperatures
are over 180. They exist primarily in sandy or loamy soil and cannot live in clay or muck.
Rainfall averages must be more than 100mm (40 inches) a year for them to survive.
Only if these conditions exist can be eggs hatch infective larvae of Necator americanus
can survive at higher temperature, whereas those of ancylostoma duodenaIe are better
adapted to cooler climates. Generally, they live for a few weeks at most under natural
conditions, and die almost immediately on exposure to direct sunlight or desiccation.
(Brooker et. al; 2006).

Infection of the host is by the larvae, not the eggs, while Ancylostoma duodenale can be
ingested, the usual method of infection is through the skin, this is commonly caused by

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walking barefoot through area contaminated with fecal matter. The larvae are able to
penetrate the skin of the foot, and once inside the body, they migrate through the
vascular system to the lungs and from there up the trachea, and are swallowed. They
then pass down the oesophagus and enter the digestive system, finishing their journey
in the intestine, where the larvae mature into adult worms. (Fleming et. al.; 2008).

Once in the host gut, Necator tends to cause a prolonged infection, generally 1-5 years
(many die within a year or two of infection), though some adult worms have been
recorded to live for 15 years or more On the other hand, ancylostoma adults are short
lived, surviving on average for only about 6months. However, infection can be
prolonged because dormant larvae can be "recruited" sequentially from tissue stores
over many years, to replace expired adult worms. This can give rise to seasonal
fluctuations in infection prevalence and intensity (Hotez et. al.; 2005).

They mate inside the host, females laying up to 30,000 eggs per day and some 18 to 54
million eggs during their life time, which pass out in feces because it takes 5-7 weeks for
adult worms to mature, mate and produce eggs, in the early stages of very heavy
infection, acute symptoms might occur without any egg being detected in the patient's
feces. This can make diagnosis very difficult (Gasser et. al.; 2009).

METHOD OF DIAGNOSIS

Ascaris Lumbricoides

Most diagnosis are made by identifying the appearance of the worm or eggs in the
faeces. Due to the large quantity of eggs laid, physicians can diagnose using one or two
faecal smear. (Drideller, 2009).

Trichuris Trichura

Stool ova and parasites examination reveals the presence of typical whipworm eggs.
Typically, the form of ether techniques is used for identification of the Trichuris Trichiura
eggs in the stool sample. (Dube E, et. al.; 2008).

Although colonoscopy is not typical used for diagnosis, as the adult worms can be
overlooked, especially with imperfect colon, there have been reported cases in which

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colonoscopy can directly diagnose trichuris by identification of thread like form of worms
with an attenuated, whip-like end. Colonoscopy has been shown to be a useful
diagnostic tool, especially in patients infected by only a few male worms and with no
eggs presenting in the stool sample.

Trichuris can be diagnosed when Trichuris trichiura eggs will appear barrel- shaped and
unembryonated, having bipolar plugs smooth shell.

Rectal prolapsed can be diagnosed easily using defection program and is one of many
methods for imaging the parasitic infection. Sigmoidoscopy show characteristic white
bodies (Ziegelbauver, et. al.; 2012).

Hookworm

Diagnosis depends on finding characteristic worm eggs on microscopic examination of

the stools, although this is not possible in early infection. Early signs of infection in most
dogs include limbular limping and anal itching. The eggs are oval or elliptical, measuring
60 micro meter by 40 micro meter, colourless, not bile stained and with a thin
transparent hyaline shell-membrane. When release by the worm in the intestine, the
egg contains an unsegmented ovum. During it passage down the intestine, the ovum
develops and thus the egg passed in feces have a segmented ovum, usually with 4 to 8
blastomeres. As the eggs of both Ancylostoma and Necator are indistinguishable, to
identify the genus, they must be cultured in the lab to allow larvae to hatch out. If the
fecal sample is left for a day or more under tropical conditions, the larvae will have
hatched out, so eggs might no longer be evident. In such a case, it is essential to
distinguish hookworm from strongyloides larva, as infection with the latter has more
serious implication and requires different management. The larvae of the two hookworm
species can also be distinguish microscopically, although this would not be done
routinely, but usually for research purpose. Adult worms are rarely seen except via
endoscopy, surgery or autopsy, but if found, would allow definitive identification of the
species. Classification can be done based on the length of the buccal cavity, the space
between the oval opening and the buccal cavities whereas strongyloides rhabditoform
larvae have short buccal cavities. Recent research has focused on the development of
DNA-based tools for diagnosis of infection specific identification of hookworm and

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analysis of genetic variability within hookworm populations. Because hookworm eggs
are often indistinguishable from other parasitic eggs, PCR assays could serves as
molecular approach for accurate diagnosis of hookworm in feces (Markell, et. al.; 2009).

CONTROL MEASURES

Ascaris Lumbricoides

Prevention: Preventing any fecal-borne disease requires educated hygienic

habit/cultural and effective fecal treatment system. This is particularly important with
Ascaris because its eggs are one of the most difficult pathogen to kill (second only to
prion), and the eggs commonly survive 1-3 years. Ascaris lives in the intestine where it
lays eggs. Infection

Control of ascaris lumbricoides

1. Availability of water for use in personal hygiene.

2. Sanitation and education to promote using latrines.
3. Education on hand washing and washing of food.
4. Avoiding the use of un composted human feces as fertilizer.

Mass chemotherapy, modern anthelminthic such as mebendazole and albendazole,

administered in a single dose, are safe and relatively inexpensive and infective

TRICHURIS TRICHURA

Prevention: Limited access to essential medicine poses a challenge to the eradication

of trichuriasis world wide. Also, it is a public health concern that rates of post treatment
pre-infection need to be determined and addressed to diminish the incidence of
untreated re-infection. Lastly, with mass drug administration strategies and improve
diagnosis and prompt drug resistance should be examined. (Jamison Dean, 2006).

Improved facilities for feces disposal have decreased the incidence of whipworm. Hand
washing before food handling and avoiding ingestion of soil by through washing of food
that may have been contaminated with egg-containing soil are other preventive
measures. Mass drug administration (preventive chemotherapy) has had a positive
effect on the disease burden of trichiuriasis in east and West Africa, especially among

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children, who are at highest risk for infection. Improvement of sewage and sanitation
system, as well as improved facilities for feces disposal have helped to limit defecations
feces from bodily contact. A study in Brazil urban centre demonstrated a significant
reduction prevalence and incidence of geohelmith infection, including trichiurasis
following implementation of a city-wide sanitation program. A 33% reduction in
prevalence of trichiurasis and a 26% reduction in incidence of trichiuriasis was found in
the study performance on 890 children ages 7-14 years old within 24 different sentinel
areas - chosen to represent the varied environmental conditions throughout the city of
Salvador, Bahia, Brazil. Control of soil fertilizer has helped eliminate the potential for
contact with human fecal matter in fertilizer in soil.

Infection can be avoided by proper disposal of human feces, avoiding fecal

contamination of food, not eating diet and avoiding crops fertilized with night soil. Simple
and effective proper hygiene such as washing hands and food is recommended for
control (Fenwick A, 2012).

CONTROL

 Availability of water for use in personal hygiene

 Sanitation and education to promotes using teaches
 Education on hand washing and washing of food
 Avoiding the use of un compos ted human feces as fertilizer

Mass chemotheraphy: modern anthelminthies such as mebendazole and albendazole,

administered in a single dose, are safe and relatively inexpensive and infective for
several months. Although ascariasis is not eradicable it can be better controlled if the
above measures are implemented in area of high prevalence (Crompton D.W.T 2001).

Hookworm

Prevention: The infective larvae develop and survive in an environment of damp dirt,
particularly sandy and loam soil. They cannot survive in clay or muck. The main lines of
precaution are those dictated by sanitary science. -
1. Do not defecate in places other than latrines, toilets etc.

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 2. Do not use human excrement or raw sewage or untreated night soil as
manure/fertilizer in agriculture.
3. Do not work barefoot in known infected areas
4. Deworm pet dog- canine and feline hookworms rarely develops into adulthood in
humans (ancylostoma caninum, the common dog hookworm, occasionally
develop into an adult to cause eosinophilic enteritis in people), but their invasive
larvae can cause an inch rash called cutaneous larvae migrants (Brooker et. al.;
2006).

Control

 By wearing shoes when walking about especially in areas that mighty have feces
in the soil.
 In areas where hookworm is common proving sanitation can help to reduce the
number of infection. These include using better sewage disposal system and
reducing human defecation at occurs in the house.
 Some developing nations practice preventive treatment. This involves treating
group 0 people who are at a higher risk of having infections. These include
- Young children
- Women of childbearing age
- Pregnant women etc

Disease: Hookworm (n.d) centre for disease control and prevention (2012).
In a study conducted to determine the prevalence of intestinal worm infection among
primary school children in Kenya, the four intestinal worms investigated constituted a
total prevalence of 12.9%.
Findings from a study by Brookers et. aI., (2000) in Busia district, Kenya showed that
91.6% of the children were infected with Ascaris lumbricoides, Trichuris trichura and
hookworm. No significant relationship between host age and infection prevalence was
observed for the other helminth species.
According to the study by Mengistu and Berhanu (2004) overall prevalence of intestinal
parasites among school children in a rural area close to the south east of lake Langano,
Ethiopia was 83.8%.

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In a study conducted to determine hook worm species distribution among children in of
Asendabo Jimma zone, south west Ethiopia a total of 100 school children with mean
age 12.9 were included in the study. The overall intestinal parasitosis among the study
participant was 70.9% (66/93) hookworm (40.8%) Ascaris lumbricoides (10%) and
Trichuris trichiura (7.50%) (Fekadu et. aI., 2008).
A study carried out by Albonico et. aI., 2002) showed that in sub-saharan Africa alone,
there are 41 million hookworm infected school age children.
In a research carried out by Alborico et. aI., (2002), the burden of disease associated
with worm infection is enormous. (School age children (0-15 years of age) harbor heavy
intestinal parasites and thus are a good study group. They are the group most
responsible for contaminating the environment and transmitting these infections.
The most serious consequences of soil transmitted roundworm infection infections stem
from chronic infection during the vulnerable years of childhood. It has been estimated
that Necator americanus is responsible for a mean (±SD) blood loss of 0.031 0.012ml
per day. Similarly, Ancylostoma duodenale has been estimated to cause a mean blood
loss of about 0.081 0.02ml per day (Awogun et. aI., 1995; WHO 1994). These
measurements of feeding activity explain the pathogenicity of hookworm and account
for deficiency (hypochromic) anaemia.
An increasing number of studies of helminth epidemiology have shown that it is
common for individuals to be infected with more than one species of helminth
(Crompton et. aI., 1999, Fleming et. aI., 2006). Infection of soil transmitted roundworm
infection has been reported to be associated with higher levels of anaemia compared to
an independent infection of helminth parasites (Ezeamama et. aI., 2008).
Soil transmitted roundworm infections can cause intestinal bleeding and protein loss
which could result in iron deficiency and anaemia (Van Ejik et. aI., 2009). It has been
documented that iron deficiency and anaemia resulting from helminthiasis infection in
preschool children are associated with developmental delays and this has been
attributed partially to low cure rate of anthelmintic drug (Stoltztus et. aI., 200 I).
Infections with helminths (e.g Ascaris lumbricoides, Hook worm, Trichuris trichiura etc)
are closely linked with conditions of poverty, unsafe water, sanitation and hygiene
(Cairn et. aI., 20 I 0).

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RISK FACTORS ASSOCIATED WITH SOIL TRANSMITTED ROUNDWORM INFECTION
Soil transmitted roundworm infection is the second leading cause of mortality in children
6 years of age in Africa (Giles H.M 1996). The infection is promoted by:

1. Poor hygienic habits: This include indiscriminate disposal of human and animal
faeces. In Nigeria, a considerable amount of human and animal waste is
discharged into the soil daily leading to the seeding of the soil with pathogenic
organisms. Such habit permits contact of faeces and its accompanying microbial
load including soil transmitted roundworm infections eggs with soil (Caimcross S
et. aI., 20 I 0).
2. Lack of safe water source: According to Abraham, et. aI., 2003, children who
sourced drinking water from ring-wells have a greater prevalence and intensity of
trichuris infection than those who have access to running top water. Water that
has been contaminated with the eggs of some nematodes such as Ascaris
lumbricoides increase the risk of soil transmitted roundworm infection infections
especially in primary school children.
3. Overcrowding: When children are overcrowded in an environment the rate at
which they infect one another is higher compared to an environment of lesser
crowd, this is because most of these soil transmitted roundworm infection
infections are transmitted by contact with the eggs or larvae and this can easily
be transferred from one child to another in a crowded environment through
contact. (Ailello et. aI., 2008)
4. Poverty: Inability of parents to provide foot wear for their children, lack of good
and clean drinking water and lack of functional toilet facilities encourage the
children especially boys to defecate in nearby bushes. All this increase the risk of
children to soil transmitted roundworm infection infection (Caimcross S et. aI.,
2010).
5. Geophagia: this is the practice of eating earthy or soil-like substance such as
clay and chalk. It exists in human most often in rural communities especially
among children and pregnant women. Although the consumption of dirt is of
health benefit in some aspect, there are obvious risks in the consumption of earth
that is contaminated by animal or human faeces, in particular, parasite eggs,

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 such as round worm, that can stay dormant for years can present a problem.
Tetanus poses a further risk. Nevertheless, these risks are generally well
understood by most tribal populations that engage in geophagia hence "clean"
earth from below the surface level is sought out. Children's predilection to
engage in geophagia makes them more susceptible to worm infection. Other
dangers associated with geophagia include damage to tooth enamel, the
ingestion of variety of bacteria, various forms of soil contamination, and intestinal
obstruction. (Peter Abrahems et. aI., 2003).
6. Failure to wear foot wear: Most of the nematodes are transmitted by contact of
skin with soil contaminated with eggs or larva (coetaneous prostration of larva).
Many of the primary school children moves around bare footed there by exposing
their skin and when they come in contact with soil that has been contaminated
with egg or larvae of this nematodes they become infected, thereby increasing
their risk of susceptibility to soil transmitted roundworm infection infections.
(Abraham et. aI., 2004).
7. Having pools of water/sewage around houses: Most of the eggs and larvae of the
namatodes requires a conducive environment to develop into the next stage
pools of water/sewage around houses facilitate this process thereby increasing
the risk of infection among children since they play around. (Nokes et. aI., 2008).

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CONCLUSION

This study has shown the overall prevalence of 15% Ascaris lumbricoides had (7.5%)
and hookworm (5.0%), while trichuris trichura though is part of the targeted parasite but
was found two point five percent (2.5%) of infection out of the examined,

I conclude that this particular infections is mainly distributed in children of primary

school age and mostly children between the age of 5-7 have the highest prevalent and
risk of contamination.

RECOMMENDATION

Based on the findings of this study, the following recommendations can be made.

1. Since most of the nematodes are transmitted by contact of skin with soil
contaminated with eggs or larvae (cutaneous penetration of larvae) parent should
always ensure frequent use of shoes of their children.
2. Further studies should be carried out and this should be coordinated with and
integrated epidemiology research so that, the maximum benefit would be
derived.
3. Government should establish a bi-annual de-worming campaign programme to
help reduce the intensity and prevalence of the infection.
4. Education regarding the geophagia prevention should be integral component of
the control programme. This will reduce the worm burden, reduce contamination
of the environment by these children and enables the pupils perform better in
schools.
5. Preventive measures for safety of available drinking water and spreading
awareness related to sanitation. Related behavior, be adopted to minimize the
prevalence of worm infestation.

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 REFERENCES
Abraham, L. A., Pam, C. D., Szlachetba. R. (1996). Clinical patterns and outcome in
children with acute severe Plasmodium falciparum malaria at Jos University
Teaching Hospital, Nigeria. East African Medical Journal, 73: 823 - 826.
Adeyeba, O. A. and Akinlabi A. M. (2002): Intestinal parasitic infections among school
children in a rural community, southwest Nigeria. Nigerian Journal O.
Parasitology, 23: 11 -18.
Albonico, M., RANSA, M., WRIGHT, V. JAPE, K., HAJI, H.J TAYLOR, M., SA VIOLl, L.
and BIEKLE (2002) Treatment in Mafia Island school children. Annals of Tropical
medicine and parasitology, 96 (7): 717-726.
Anosike JC, Zaccheaus VO, Adeiyongo CM, Abanobi OC, Dada EO, Keke IR,
Uwaezuoke JC, Amajuoyi OU, Obiukwu CE, Nwosu DC, Ogbuju FJ (2006).
Studies on the intestinal worm (Helminthiasis) infestation in Central Nigeria Rural
Community, J. App!. Sci. Environ. Manage. 10(2): 61-66.
Arekul, Pannatat; Jongwutiwes (February 2010). Trichuris vulpis and Trichuns trichina
infections among school children of rural community in north western Thailand;
the possible role of dogs in disease transmission.
Awogun, IA; Okwerekwu, F.E, Oyawoya, O.A. and Bello A.B (1995). Helminthic
infection and anaemia among pregnant women attending antenantal cline in
Illorin Nigeria. Biosciences research communication, 7:14-45.
Bahu Sj, Shibuya Ty, Meleca RJ, Custody CM, Gratha CZ and mangaili AR (2001)
Hepatosiliary and Pancreatic complicating at Acariasis in children: Journal of
pediatric Gastroenterology and nutrition 33, 271-275.
Bethony J, Brooker S, Albonico M. et al; (May 2006) soil- transmitted helminth
infections; Asceriasis, Trichuriasis and hookworm
Bethony, J; Brooker S; Albonico, M; Geiger, SM; Loukas A,Diemert, D; Hotez, P; (March
6, 2006). Soil-transmitted helminth infection, ascanasis, trichuriasis and
hookworm.
Brooker S Moulin A, Luoba D, Bundy, M. Kremer D. (2000). Epidemiology of single and
multiple species of Helminth infections among school children in Busia Distric,
Kenya. East African medical journal 77 (3) - 168.
Brooker S, clements A,C Bundy DA (2006). Global epidemiology, ecology and control of
soil transmitted helminth infections.
Brooker, S. and Michael, E. (2000). The potential of geographical information systems
and remote sensing in the epidemiology and control of human helminth
infections. Advance Parasitology, 47: 245 - 287.

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