Infections with gastrointestinal helminths are associated with deficient sanitary facilities, unsafe human waste disposal, inadequate and lack of safe drinking water, and low socioeconomic status [1]. More than 2 billion people may be infected with helminths, mainly in the developing world [2]. At highest risk of morbidity are preschool and school-aged children, and pregnant women [3]. Negative effects of helminth infections include diminished physical fitness and growth retardation, and delayed intellectual development and cognition [2, 3]. Helminthiasis is of considerable public health importance in Iraq and throughout less developed Asia [4-7]. However, the geographical distribution and regional burden remain to be determined and updated regularly. The aim of the present study was to assess the prevalence of some helminths among Iraqi people depending on the database of communicable diseases control centers of the Ministry of Health in Iraq.
This retrospective survey consisted of a spatial and temporal analysis of reported cases of helminths using an available surveillance database from January 2013 to December 2013 taken by the Iraqi Communicable Diseases Control Center (CDC). Data included all provinces of Iraq. The number of patients examined was 2,761,990. The parasites studied and included were divided in to two categories: Nematoda: (
Data for each parasite were arranged according to sex of patients, and seasonal variation from January to December. Data for each parasite were arranged according to age groups as follows: group 1 <1 year old; group 2, from 1 to 4 years old; group 3, from 5 to 14 years old; group 4, from 15 to 45 years old; and group 5, >45 years old. We examined differences in prevalence among sexes, age, and region with a chi square test using the Statistical Package for the Social Sciences (SPSS Inc, Chicago IL, USA).
The overall prevalence of gastrointestinal helminthiasis was 1.39%. The number of infected individuals was 38,547 of 2,761,990 examined.
The distribution of helminths infections among 18 districts surveyed
Number of positive cases (%) among districts | |||||||
---|---|---|---|---|---|---|---|
Province (Governorate) | |||||||
Ninevah | 0 | 0 | 0 | 0 | 2,205 (6.01) | 29 (2.39) | 3 (5) |
Ta’mim | 34 (6.59) | 5 (3.1) | 0 | 0 | 1,371 (3.73) | 7 (0.71) | 0 |
Suleimaniyah | 0 | 10 (6.1) | 0 | 0 | 101 (0.28) | 0 | 0 |
EM | 4 (0.78) | 0 | 0 | 0 | 332 (0.90) | 13 (1.31) | 12 (16) |
Dohuk | 83 (15.90) | 8 (4.9) | 0 | 7 (70%) | 713 (1.94) | 466 (47.00) | 1 (1) |
Baghdad | 51 (9.88) | 0 | 57 (34.1) | 1 (10%) | 3,183 (8.67) | 48 (4.48) | 21 (28) |
Anbar | 37 (7.17) | 63 (38.4) | 0 | 0 | 4,014 (11.2) | 0 | 0 |
Diyala | 2 (0.39) | 0 | 0 | 0 | 4,066 (11.1) | 0 | 0 |
Salahuddin | 0 | 7 (4.3) | 0 | 0 | 744 (2.03) | 2 (0.20) | 1 (1) |
Babil | 0 | 4 (2.4) | 0 | 0 | 728 (1.98) | 138 (13.90) | 0 |
Karbala | 2 (0.39) | 0 | 1 (0.6) | 0 | 797 (2.17) | 68 (6.86) | 0 |
Najaf | 120 (23.30) | 0 | 4 (2.4) | 0 | 1,223 (3.33) | 33 (3.33) | 4 (5) |
Qadisiyah | 43 (8.33) | 2 (1.2) | 0 | 2 (20%) | 1,382 (3.76) | 35 (3.53) | 7 (10) |
Muthanna | 0 | 0 | 20 (12.0) | 0 | 1,164 (3.17) | 13 (1.31) | 3 (4) |
Wasit | 90 (17.40) | 0 | 78 (46.7) | 0 | 2,516 (6.85) | 0 | 0 |
Dhi-qar | 3 (0.58) | 1 (0.6) | 0 | 0 | 2,752 (7.50) | 60 (6.05) | 11 (15) |
Misan | 0 | 0 | 0 | 0 | 2,016 (5.49) | 2 (0.20) | 0 |
Basrah | 48 (9.30) | 64 (39.0) | 7 (4.2) | 0 | 7,317 (19.90) | 77 (7.77) | 11 (15) |
The distribution of helminth infections among the four surveyed regions
Region | Infected | Total examined | Prevalence % |
---|---|---|---|
Northern | 5,404 | 670,217 | 0.80 |
Middle | 12,297 | 1,135,051 | 1.08 |
Middle Euphrates | 5,793 | 253,646 | 2.28 |
Southern | 15,053 | 703,076 | 2.14 |
Total infections | 38,547 | 2,761,990 | 1.39 |
The distribution of helminth infections according age groups and sex
<1 | 0 | 0 | 0 | 0 | 799 | 0 | 0 |
1-4 | 26 | 17 | 19 | 3 | 6,605 | 121 | 19 |
5-14 | 208 | 63 | 61 | 6 | 11,004 | 309 | 20 |
15-44 | 179 | 47 | 53 | 1 | 10,916 | 362 | 24 |
>45 | 104 | 37 | 34 | 0 | 7,300 | 199 | 11 |
Male | 311 | 91 | 94 | 4 | 16,453 | 422 | 39 |
Female | 206 | 73 | 73 | 6 | 20,171 | 569 | 35 |
The seasonal distribution of helminths infections among the surveyed population
Month | Number of positive cases | |||||||
---|---|---|---|---|---|---|---|---|
Total | ||||||||
January | 34 | 0 | 0 | 5 | 2,393 | 50 | 6 | 2,488 |
February | 40 | 33 | 2 | 0 | 3,115 | 47 | 6 | 3,243 |
March | 14 | 0 | 4 | 2 | 2,781 | 45 | 3 | 2,849 |
April | 53 | 17 | 40 | 0 | 2,714 | 37 | 3 | 2,864 |
May | 126 | 10 | 6 | 0 | 3,001 | 66 | 3 | 3,212 |
June | 35 | 21 | 3 | 0 | 2,875 | 42 | 5 | 2,981 |
July | 32 | 13 | 39 | 3 | 2,974 | 35 | 6 | 3,102 |
August | 25 | 5 | 61 | 0 | 3,456 | 36 | 3 | 3,586 |
September | 55 | 6 | 10 | 0 | 3,697 | 198 | 7 | 3,973 |
October | 41 | 15 | 2 | 0 | 2,843 | 154 | 21 | 3,076 |
November | 25 | 19 | 0 | 0 | 3,761 | 146 | 5 | 3,956 |
December | 37 | 25 | 0 | 0 | 3,014 | 135 | 6 | 3,217 |
The overall presence of helminthic infections in this survey was 1.39%, this prevalence is considerably lower than previous reports from other surveys in Asia [8]. The prevalence of gastrointestinal helminth infections varies according to geographical location, education, use of raw salads and vegetables, age of patients, socioeconomic criteria, nutritional status, immunological status, and personal hygiene [9]. The most common helminth infections in this survey was Enterobiasis, followed by Hymenolepiasis.
The overall prevalence of intestinal parasitosis is greater among 5-14 year olds. This is because at such age school children indicate changes in exposure to conditions that favor the transmission of the infective stages of most of the helminths especially geohelminths; other investigators showed that handwashing habit of the this age group is very poor [17]. This finding is consistent with the result of Arinola and Fawole who showed that the prevalence and intensity of some intestinal helminths were predominant in the same age group [18]. Although there was no significant relationship between sex and helminth infection, most infections were seen in male individuals, this is probably because males are more exposed to unhygienic conditions in fields during outdoor activity [19], especially in a country like Iraq. High prevalence of Enterobiasis is seen in female individuals, also Hymenolepiasis and Strongyloidiasis and this inconsistent with findings by Al-Qadhi et al, who showed that prevalence of