Research Article: Neglected Intestinal Parasites, Malnutrition and Associated Key Factors: A Population Based Cross-Sectional Study among Indigenous Communities in Sarawak, Malaysia

Date Published: January 17, 2017

Publisher: Public Library of Science

Author(s): Yamuna Rajoo, Stephen Ambu, Yvonne Ai Lian Lim, Komalaveni Rajoo, Siew Chang Tey, Chan Woon Lu, Romano Ngui, Emmanuel Serrano Ferron.


Intestinal parasitic infections (IPIs) have been recognized as one of the most significant causes of illness among disadvantaged communities. Many studies have been conducted on the prevalence of IPIs in Malaysia. However, these studies mostly focused on the indigenous groups in Peninsular Malaysia. The present study was conducted to provide the current baseline data on prevalence of IPIs, anaemia, malnutrition and associated risk factors among the indigenous communities in Sarawak, situation at northwest Borneo island of Malaysia. A cross sectional study was conducted among the longhouses communities. Stool samples were obtained and examined for the presence of IPIs using microscopy technique. Haemoglobin measurement was done using a portable haemoglobin analyzer. Malnutrition (i.e., stunting, underweight and wasting) was assessed using the WHO Anthro software. Statistical analysis was carried out using SPSS software. A total of 341participants took part in this study. The overall prevalence of IPIs was 57.5%. Multivariate analysis indicated that the absence of toilets (OR = 1.6; 95% CI = 1.1–2.7; p = 0.002) and close contact with animals (OR = 1.8; 95% CI = 1.3–2.9; p = 0.027) as significant predictors for IPIs. The incidence of anaemia was 36.4%. The incidence of underweight, wasting and stunting were 22.2%, 5.6% and 35.4%, respectively. Multivariate analysis demonstrated that low level of parental education attainment (OR = 1.9; 95% CI = 1.2–3.0; p = 0.006) was identified as significant predictor for anaemia. The incidence of wasting was significantly associated with mild anaemia (OR = 1.2; 95% CI = 0.9–1.7; p = 0.024). Low household income was identified as significant predictor for stunting (OR = 2.1; 95% CI = 9.8–22.2; p = 0.001) and underweight (OR = 1.9; 95% CI = 5.6–18.7; p = 0.037), respectively. Essentially, the present study highlighted that intestinal parasitic infections, anaemia and malnutrition are still prevalent among rural indigenous community in Sarawak. Improvement of socioeconomic status, periodic mass deworming, iron supplementation and health education program should be included in the control and prevention of public health strategies.

Partial Text

Intestinal parasitic infections (IPIs) are among the most widespread health maladies in the developing world and on the World Health Organization (WHO) list of neglected tropical diseases (NTDs) [1]. IPIs are most prevalent among the poorest people [2–7], contributing to economic instability and social marginalization that can persist from generation to generation [1]. Ascaris lumbricoides, Trichuris trichiura and hookworms, collectively referred as soil-transmitted helminths (STHs) are the most prevalent of intestinal parasites. Approximately 24% of the world’s population is infected with at least one of species with an estimation of 135,000 deaths annually [8]. Giardia lamblia, causing giardiasis, is the most prevalent intestinal protozoan worldwide with an estimated prevalence rate ranging between 2 to 7% and 20 to 30% in developed and developing countries, respectively [9]. Another common intestinal protozoan is Entamoeba histolytica, causing amoebiasis which often leads to chronic intestinal infection and dissemination to the liver causing amoebic liver abscess (ALA) [2,5]. The opportunistic protozoan such as Cryptosporidium spp. are commonly reported among immunocompromised individuals with significant mortality and morbidity [2,5].

Intestinal parasitic infections (IPIs) remain a major public health problem among the Malaysian indigenous population where poor environmental and sanitation, improper hygiene, overcrowding, low education attainment and poverty are common. The findings of the present study showed a high prevalence of IPIs with 57.5% of participants was infected with at least one species. These findings in a state in Borneo Malaysia were relatively consistent to the report from previous study among indigenous groups in Peninsular Malaysia with prevalence rates of 50% and above [2,4,7,19–21]. Similarly, the results were also consistent with previous local study conducted among other indigenous community in Saratok Division which reported high prevalence of IPIs (67.6%) [28]. However, these findings were contrary to earlier studies conducted among various indigenous groups in Kapit and Serian Division with low prevalent rate (below 50%) [22,23]. This variation may be due to differences in the sampling population, sample size, socioeconomic status(SES) of the participants and environmental sanitation.

This study provided baseline data on the intestinal parasitic infections (IPIs), anaemia and malnutrition among indigenous community in rural areas in Sarawak, Borneo Malaysia. Generally, the IPIs, anaemia and malnutrition are still public health problems among this indigenous community. IPIs were found to be significantly associated with anaemia. Meanwhile, the incidence of malnutrition (i.e., stunting, underweight and wasting) was higher among infected children with IPIs. Absence of toilets and close contact with animals was identified as significant predictors for IPIs. No parental formal education was significantly associated with anaemia. As for malnutrition, low household income was identified as a significant predicator for both stunting and underweight. This data strongly support the need for implementing health program aimed at improving nutrition, anaemic conditions and reducing the prevalence of infections, with potentially beneficial effects on cognitive and educational outcomes particularly among children. With effective control measures in place, these children will have a greater opportunity for a better future in terms of health and educational attainment, which will eventually put them on par socially and economically with other communities in Malaysia.




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