الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
IPIs, which are among the most common infections worldwide, disproportionately affect children. Of particular concern, their associated disease burden is experienced during the period of life most critical for physical and cognitive development.
Accurate surveys of IPIs in children are inevitable to assess the prevalence, hence help implementation of successful MDA programs. There is limited information on this topic in Sohag, Egypt.
This cross-sectional study was performed to assess the prevalence of IPIs in stool and nail clipping samples among schoolchildren who attend 4 primary schools in Sohag governorate, Egypt, from January 2015 to December 2016. 200 children were included.
The age range was (6-12) years with (Age Mean ± SD = 8.9±1.9), (51.5%) were boys. Age was categorized into 2 groups: 59.5% were less than 10 years.
One fecal and one fingernail samples were collected per child and were examined by direct wet mount, FECT, and modified Z-N staining technique. Data relating to demography were also collected using a standardized questionnaire.
In total, (63.5%) of children harbored at least one type of intestinal parasite. Cryptosporidium spp., G. intestinalis and E. histolytica/ dispar were the most common parasites found, with prevalence rates of (34%), (14.5%) and (13%), respectively.
Unexpectedly, lower prevalences of intestinal helminths were found. Collectively, the whole helminthic infection prevalence was (10.5%). H. nana was the most prevalent (5%).
Polyparasitism with two protozoan parasites were found in (17.3%) of children. The most common dual infection was with E. histolytica/ dispar, Blastocystis spp. with a prevalence of (3.1%). In addition, 2.4% of children exhibited triple infections with E. histolytica/ dispar, G. intestinalis, Blastocystis spp.
Regarding symptoms, polyparasitzed children were more frequently symptomatized than monoparasitized ones. A statistical significance was found between diarrhea and the type of parasitism. P- value was 0.12.
Infection rates with G. intestinalis, E. histolytica/ dispar, E. hartmanni, I. butscilli, C. mesnilli, Cryptosporidium spp., Cyclospora and A. duodenale were more common in children < 10 years. However, no statistical significance was found.
On the other hand, children ≥ 10 years were more susceptible to infection with E. coli, Blastocystis, H. nana, A. lumbricoides. Moreover, E. vermicularis was equally distributed between the two age groups.
Girls were slightly higher susceptible to infection with E. histolytica/ dispar , E. coli, Iodameba, Blastocystis, A. lumbricoides where as infection with Giardia, E. hartmanni, C. mesnilli, H. nana and A. duodenale were more common among boys.
Only I. butscilli was affected by the child gender. All were Girls 5(100%). This was statistically significant, P value was 0.025.
Cryptosporidium and E. vermicularis harbouring children were affected by residence type. P value was 0.001 and 0.043, respectively. This was statistically significant.
Univariate and multivariate logistic regression models were performed to identify risk factors that were expected to be significantly associated with intestinal polyparasitism. According to our data, none of the age, gender, residence or family size were risk factors for polyparasitism.
The current study indisputably provided clues for some proposed questions and raised few more. Some questions that need answers and are suggested by the researcher as next points of research.
Of them, why S. mansoni was aside from the scene despite being endemic especially in such age group.
Another question is the above expectations prevalence of Cryptosporidium and which species is more prevalent. This needs implementation of molecular methodologies.
CONCLUSION
The findings of the present study revealed that IPIs are very common among schoolchildren in Sohag, Egypt. Cryptosporidiosis was the most common infection detected. Hence, there is an urgent need to implement an innovative and integrated control program to reduce the prevalence and intensity of these infections significantly and to save these children from their negative impacts.
Based on the findings, there is a great need for a proper health education program regarding good personal hygiene practices to enhance prevention and instill better knowledge on IPIs transmission and prevention in these communities. Moreover, sustainable school-based MDA campaigns, providing proper and adequate sanitation and safe water supply should be considered in the control program targeting this population.
RECOMMENDATIONS
This study represents a miniature of a survey which undoubtedly needs to be followed by extensive large-scale surveys. This requires intensive efforts and collaboration with the public health authorities.
1. Further studies should be performed accounting for the determination of infection intensity, which could reflect the transmission dynamics of such pathogens and their associated morbidity.
2. Other highly significant risk factors for IPIs in children are urgently in need to be thoroughly investigated. For example, access to safe drinking water, personal hygiene issues like handwashing after toileting and washing vegetables and fruits before eating.
3. Further studies should concentrate on the health impacts of IPIs on children regarding the anthropometric measures, anemia, cognitive functions and school performance.
4. Other parasitic infections are known to be common in schoolchildren were not included in our study. Of them, urinary schistosomiasis, scabies and pediculosis. These should be investigated also.
5. A point that we should not lose sight from it is the pre-school children in kindergartens and day care centers. They are also highly liable for IPIs. Hence, further studies are inevitable to assess the prevalence of IPIs among them.