Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online)

Sch. J. App. Med. Sci., 2015; 3(9C):3307-3310 ISSN 2347-954X (Print)

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Research Article
A study of the prevalence of Giardiasis in children of the kindergartens of Islam
Abad Gharb city, Iran
Naser Nazari1*, Meysam Fatahi2, Masoud Sadeghi2
1
Deparment of Parasitology and Mycology, Kermanshah University of Medical Sciences, Kermanshah, Iran
2
Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
2
Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

*Corresponding author
Naser Nazari

Abstract: Giardia Lamblia is a virulent protozoan parasite that is regarded as the most common intestinal pathogen
worldwide, particularly in developing countries due to its high prevalence. The aim of this study is to determine the
prevalence rate of the Giardiasis in children of the kindergartens of Islam Abad Gharb city, Iran in 2011. This
descriptive-analytic study was performed on 532 pre-school children (280 were female and 252 were male) in the
kindergartens of Islam Abad Gharb city with an average of 0-6 years. Using a questionnaire, data were collected. The
samples were randomly selected. Three samples of feces were taken alternately and then tested by two methods including
direct and formalin-ether. Statistical analysis was performed using the SPSS. In this study, 172 children (32.3%) were
infested with both pathogenic and non-pathogenic intestinal parasites. Infestation rate of intestinal protozoan was 29.8%,
of intestinal worms was 2.5% and of Giardiasis was 16.16%. Prevalence rate of Giardiasis in rural kindergartens was
9.59%. Given the prevalence of Giardiasis in children, the prevalence of such disease should be prevented by continuous
training of teachers, particularly rural kindergartens and the parents on the observance of the principles of personal
hygiene.
Keywords: Giardiasis, Giardia Lamblia, Children, Western Iran

INTRODUCTION [1]. Clinical symptoms of Giardiasis are highly variable

Giardiasis is one of the most common parasitic and often asymptomatic. The most common symptoms
infestations in children which are caused by a protozoan include acute and chronic diarrhea, anorexia, vomiting,
called Giardia Lamblia. The parasite is replaced in the failure to thrive, abdominal pain and weight loss [7].
upper part of small intestine (duodenum and jejunum) The most important adverse effects of this parasite
and sometimes the gallbladder and bile ducts, and it include mal-absorption disorders, weight loss and
lives there in two forms of trophozoite and cyst [1]. The reduced growth in children. In the severe infestations,
transmission of this parasite is done directly in a fecal- patients can suffer from fatty diarrhea, folic acid
oral way and indirectly through water, contaminated deficiency, gamma globulins and lack of fat-soluble
food, soil, as well as direct contact of person to person vitamins, also the shortage of elements such as zinc and
[2]. This organism is the most common intestinal iron [8]. The protozoan parasitic diseases in terms of
pathogen in the world [3]. This parasite infestation is morbidity and mortality in the world are regarded as the
more prevalent in developing countries and it is most important infectious diseases. In Iran, there is no
regarded as an agent of diarrhea in children in complete and accurate statistics on the incidence and
kindergartens [4, 5]. Based on cross-sectional studies the prevalence of parasitic protozoans. To know more
conducted in these countries, this organism is the most about the situation of this disease and taking action to
common factor known to be associated with diarrhea in control them it is necessary to perform accurate,
children in kindergartens [5, 6]. Kindergartens play comprehensive and coordinated studies. Regarding the
roles in the transmission of Giardia as an important parasitic worm diseases, intestinal worm infestation in
factor in the survival of the parasite in the community Iran had been developed at a very high level, which
[7]. The main route of transmission of the parasite is fortunately is now declining. Islam Abad Gharb city is
from person to person in kindergartens, but it can be one of the most vulnerable areas to the spread of the
transferred directly from food, water and toys as well disease and no study already has been conducted in this

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area on the prevalence of Giardiasis in children. The first provided and then the suspension was passed
present study attempts to determine the percent of the through the filter into centrifuge tube and then ether was
prevalence of Giardiasis in the children in a added to it, and the material inside centrifuge tube was
kindergarten according to variables such as age, gender, mixed and the tubes were centrifuged for a period of 1
etc. to 2 min with the rpm of 1500 to 2000. Then the outer
layer formed in the tubes was discarded and the
MATERIALS AND METHODS underside deposited layers ejected. Next, by the sterile
The type of the study was descriptive-cross pipette a drop of the deposit was put on the slide, one or
sectional and the sampling method was simple random two drops of Logel 5% added to it and we analyzed it
method. For data collection, a sampling was done on with a magnification of 40. In the case of the
532 children in the kindergartens of Islam Abad Gharb observation of parasites, larvae, trophozoite and cyst
city in a period of six months in 2011. A questionnaire were reported as positive cases [9]. The data collected
was designed for each participant. Some factors were were analyzed using SPSS software.
included in the questionnaire including age, sex,
education level, parents’ job, the habit of washing hands RESULTS
before meals and after defecation, and history of In this study, 532 children in Islam Abad
parasitic infestation. Three samples of feces were taken Gharb kindergartens were analyzed for a period of 12
from each sample and preserved in disposable plastic months. All the samples was in the age range of 0 to 6,
containers with lids. The containers were numbered and which 252 (47.3%) was male and 280 (52.7%) was
then transferred into parasitology laboratory. The female. 334 kids (62.8%) were in civil kindergartens
samples were tested by two methods including direct and 198 (37.2%) were in rural kindergartens.
method and formalin-ether method. To do a direct
microscopic test, two slides were prepared, which one The highest rate of prevalence (318) was
drop of Logel was added to one of the slides and one related to the age group of 4 to 6 years and the lowest
drop of physiology serum was added to another slide, rate related to age group of 0 to 2. The infestation rate
then they were examined by the magnification of 40. In of the kindergartens with the intestinal parasite was
the case of the observation of parasite eggs, cysts and 32.33% (Table 1). The prevalence rate of Giardiasis by
trophozoites were elected as the patient. To do two methods of direct and formalin-ether was 16.16%.
formalin-ether test, a suspension of the samples was

Table 1: The absolute and relative frequency distribution of the children under study in the kindergartens of
Islam Abad Gharb city in terms of affliction with intestinal parasites in 2011-2012
Test Result Number Percent
Positive (infested Persons) 172 32.33
Negative (Non-infested ones) 360 67.67
Total 532 100

Also, based on the results of the present study, higher than that of civil kindergartens (Table 2). After
the highest rate of the infection (101) was observed in Giardia Lamblia with 16.16% infestation, Entamoeba
the age group of 4 to 6. The male genus with 18.8% histolytica and Entamoeba coli caused the highest rate
infection was more dominant than females. Also, in the of infestation among the children by 3.75 and 3.20%
rural kindergartens, the infestation rate (48.17) was (Table 3).

Table 2: The absolute and relative frequency distribution of the children under study in the kindergartens of
Islam Abad Gharb city in terms of the type of the variable in 2011-2012
Variables Number of Positive Cases n(%) Number of Negative Cases
n(%)
Age Group (year)
0-2 1.7))9) 6.8))36)
2-4 11.6)62) 20.1)107)
4-6 19)101) 40.8)217)
Sex
Boys 8.8)100) 28.6)152(
Girls 13.5)72) 39.1)208)
Type of Kindergarten
Civil 85.24)79) 47.93)255)
Rural 48.17)93) 19.73)105)

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Table 3: The absolute and relative frequency distribution of the intestinal parasites and worms in the children of
the kindergartens of Islam Abad Gharb city variable in 2011-2012
Type of Protozoans and Worms Absolute Frequency Relative Frequency (%)
Entamoeba histolytica 20 3.75
Giardia lamblia 86 16.16
Entamoeba coli 17 3.20
Iodamoeba butchli 13 2.44
Endolimax nana 9 1.70
Blastocyst is hominis 14 2.63
Oxyure 7 1.31
Hymenolepis nana 4 0.76
Ascaris lumbricoides 2 0.38
taenia saginata 0 0
Trichocephal 0 0
No pollution 360 67.6
Total 532 100

DISCUSSION kindergartens, the prevalence of Giardiasis in girls was

In the present study, the infestation rate of higher than boys [11, 13]. These findings are different
Giardiasis was 16.16%, which it is different compared from our study findings in terms of sexual prevalence,
to the research done in other parts of Iran. In a study which probably it is due to the greater contact of boys
done by Saiari et al.; the infestation rate of Giardiasis in with peers and environment. The prevalence of
children over 2 years was 10.4%, which had the highest Giardiasis in the rural kindergartens was higher than
rate of prevalence compared to other intestinal parasites that of private ones in Islam Abad Gharb city, which
[10]. This rate was lower than our one, due to the this difference was significant statistically (p<0.05).
difference between age range of the participants and the The main cause of this difference can be lack of
size of the sample. In a study done in the kindergartens observance of hygienic issues and consequently an
and primary and secondary schools of Kashan city over increase in personal contacts and person to person
5 to 15 years old students, the infestation rate of transmission in the rural kindergartens, a difference
Giardiasis was 38.5%, which 17% of the cases lacked between social and economic situation of families and
clinical symptoms [11]. In the study of the infestation of also further supervision of teachers in private
parasitic infections in the kindergartens of Yasouj city, kindergartens to attract more families.
infestation rate of Giardiasis was 18.3%, accounting for
the highest rate of infestation among other protozoans The prevalence of Giardiasis in the
[12]. In the epidemiological study of Giardiasis in a kindergartens outside Qazvin city and also among the
kindergartens in Qazvin city, the prevalence of children living in suburbs is higher than that of Qazvin
Giardiasis was 13.5%, and in Bandar Abbas city was city, which is consistent with our study. In this regard,
17.23% [13, 14], that is almost consistent with our researchers have regarded the main causes of the
study. In a study in Havana city on the kids 1 to 5 years infestation as the number of family members, hygienic
old, the infection rate of Giardiasis was 54.6%, problems, and a difference in social and economic
introducing Giardiasis as the most common pathogen in situation [13]. In our study, there was a significant
the age range of 2 to 4 years old both in males and relationship between infestation rate and the place of
females [15]. In a study on a kindergarten in Houston living (city, suburbs and rural areas, probably due to the
State, the most common cause of the infestation during fact that our study was done in the kindergartens of civil
a year was Giardiasis, and the infection rate in this and rural areas. However the number of the children
kindergarten was 33%, that only 7% of it was living in rural areas and suburbs in civil kindergartens is
symptomatic [16]. less than the number of children living in city. In our
study, the prevalence of Giardiasis in the subjects with
In a study on a poor residential area in north degrees of high school and under of the mothers
east of Brazil, the infestation rate of Giardiasis in the education's level was higher than that over high school
children was 27.4%, which 7.6% of them were infested mothers education's level (P<0.05).
with acute diarrhea [17]. Probably, the main cause of
such high rate of infestation in these countries is In a study done in Sirjan city, there was a
geographical and economic situations. In our study, the significant relationship between educational level and
prevalence of Giardiasis among boys was higher than infestation rate of Giardiasis, and the maximum rate of
girls. In a study conducted in Kashan and Qazvin infestation was observed in the children under 6 years

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old and primary schools and the minimum rate was 5. Polis MA, Tuazan CU, Alling DW, Talmanis E;
related to the children over this year and educational Transmission of Giardia Lamblia from a day care
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