Despite a spectacular advance in the diagnosis and management of diseases, intestinal parasitic infections remain a major public health issue globally (Keiser and Utzinger, 2010). It is estimatedthat more than two billion people world wide are infected with atleast one species of intestinal parasite and over five billion peoplelive in countries where helminths and protozoa are endemic (Kucik et al., 2004). The risk of infection is particularly high in areas with poor sanitation because poor hygiene and the lack of adequate sanitaton facilities encourage the spread of food and waterbornediseases (Hotez et al., 2007). There are a number factors which facilitate the spread of parasitic infections both in the developingand the industrialized world; these include low socio economic status, mass migrations, and the presence of hosts in ecosystems (reservoirs of parasites) (Ali et al., 2014; Ojha et al., 2014). The spectrum of clinical symptoms in parasitic infections is extremelywide and may vary from asymptomatic cases through diarreas to cachexia leading to severe anemia (Korzeniewski and Kurpas, 2016). Microscopic examination is still the gold standard for the diagnosis of intestinal helminths and protozoa making it possible to detect parasites at their different developmental stages (cysts, trophozoites, larvae, ova) (Myjak et al., 2011). In Europe, high rates of parasitic infections are reported from the countries which are listed in the third and fourth quartile according to gross domestic product per capita (GDP $1 809 – $17 630) (Hotez and Gurwith, 2011); Kosovo ranks in the 4th quartile. The exact prevalence of parasitic infections in Kosovo is not clear because the country lacks organized epidemiological screening. In 2001, a study was conducted to establish the etiology of diarrhea in 45 Kosovar children (Kosovska Mitrovica). It revealed that 40 % of the diarrhea cases in the study group were associated with
The aim of this study was to assess the prevalence and distribution of species of intestinal parasites in the Balkans on the example of Kosovar and Serbian residents from the region of Gnjilane in eastern Kosovo, where the epidemiology of intestinal parasitic infections remains unknown.
In total, 840 asymptomatic school-children, aged 6 – 17 years, living in the region of Gnjilane in eastern Kosovo (including 530 Kosovars from the municipality of Kaçanik and 310 Serbs from the municipalities of Kamenica and Strpce) were screened for intestinal parasites in 2017 and 2018. The approval to perform the study involving Kosovar children had been given by the Head of Medical Service and Social Health Department Mrs. Diana Reka and the Head of Education and Culture Department Mr. Enver Kamishi and issued in the Kaҫanik municipality. The approval to perform a research study among Serbian children had been obtained from the Director of Medical Center for the Gnjilane region, Dr. Zoran Perić. Written informed consent was provided by parents or legal guardians of the children involved in the study (handwritten signatures on a collective list of all study participants). The details of the study were explained to the participants in patient information brochures written in the Albanian and Serbian languages.
Each patient provided two stool samples collected every second day at Kosovar and Serbian healthcare facilities and local schools. The specimens were fixed in SAF (sodium-acetate-acetic acid-formalin) preservative and 70 % spiritus vini, transported to the Department of Epidemiology and Tropical Medicine at the Military Institute of Medicine in Poland, and tested by light microscopy using three diagnostic methods: direct smear in Lugol’s solution, decantation with distilled water, and Fülleborn’s flotation (Clinical and Laboratory Standards Institute, 2005; Garcia et al., 2003; WHO, 1991).
The statistical analyses have been performed using the statistical suite StatSoft Inc. (2014) STATISTICA (data analysis software system) version 12.0.
The research project was approved by the Bioethics Committee at the Military Institute of Medicine in Poland (Decision No. 72/ WIM/2017) under the Declaration of Helsinki and in line with the EU provisions on
Following the microscopic examination of 1,680 stool specimens (two samples taken from each of the 840 subjects) by three different light microscopy methods we found that the total prevalence of intestinal parasites was 19.1 % in Kosovar (n=530) and 4.2 % in Serbian school-children (n=310). The study revealed that 101 Kosovar children were infected with pathogenic intestinal parasites; a total of 103 infections were detected (two cases of co-infections). The most frequently detected intestinal parasites included
Intestinal parasitic infections among 530 Kosovar school-children residing in Gnjilane region (Kaçanik municipality).
Intestinal parasites | No of infections (n=103) | % of infections | % of examined patients (n=530) |
---|---|---|---|
8 | 7.8 | 1.5 | |
hookworm | 8 | 7.8 | 1.5 |
3 | 2.9 | 0.6 | |
1 | 1.0 | 0.2 | |
2 | 1.9 | 0.4 | |
2 | 1.9 | 0.4 | |
79 | 76.7 | 14.9 | |
A total of 13 Serbian children were found to be infected with intestinal parasites.
Intestinal parasitic infections among 310 Serbian school-children residing Gnjilane region (Kamenica and Strpce municipality).
Intestinal parasites | No of infections (n=13) | % of infections | % of examined patients (n=310) |
---|---|---|---|
3 | 23.1 | 1.0 | |
1 | 7.7 | 0.3 | |
2 | 15.4 | 0.7 | |
1 | 7.7 | 0.3 | |
6 | 46.1 | 1.9 | |
Current epidemiological situation of intestinal parasitic infections (IPI) in Kosovo is unknown and presented study remains one of few analyses in the field of intestinal parasitology in this region. Population screening to assess the prevalence of intestinal parasites have been carried out in the neighboring countries, e.g. in Albania and Serbia. The study of Sejdini et al. (2011) involving 321 children (aged 7 – 16 years) living in the counties of Tirana and Elbasan in central Albania demonstrated the overall IPI incidence of 19.0 %, the most prevalent being
According to the research studies conducted in Serbia, the rates of infections with intestinal parasites in the local population are relatively low. A multicenter screening of 6,645 asymptomatic school-children, aged 7 – 11 years, from 115 settlements in 20 different regions of central Serbia (including Belgrade, Kragujevac, Lučani, Bor, Žagubica, Sjenica, Novi Pazar, Valjevo, Aleksandrovac, Pirot, Bosilegrad, Ivanjica, Golubac, Užice, Kladovo, Negotin, Kraljevo, Gornji Milanovac, Kruŝevac, and Čačak) found the overall prevalence of
Current epidemiology of intestinal parasites in Kosovo is unknown. The study involved asymptomatic Kosovar and Serbian school-children living in the same ecosystem of the Gnjilane region (eastern Kosovo) and demonstrated that the prevalence of intestinal parasitic infections in Kosovars is significantly higher in comparison to Serbian children, which may be the evidence of some differences in the quality of health care and sanitation as well as feed hygiene between these two communities.