Annexures
MASTER CHART
The study was carried out over three months from 1st January to 31st march 2012. Those who had intestinal parasitic infection were treated appropriately.
52 CHAPTER FOUR RESULTS
4.1 Socio-demographic characteristics of the study population Table 1 Sociodemographic characteristics of study subject.
Characteristic Number of participants Percentage Gender:
Male 85 27.4 Female 225 72.6 Male Female Total (%) Age group (yrs) :
<=20 0(0.0) 2(100.0) 2(0.6) 21-30 3(5.7) 50(94.3) 53(17.1) 31-40 27(19.7) 110(80.3) 137(44.2) 41-50 40(44.4) 51(56.6) 91(29.4)
51-60 12(52.2) 11(47.8) 23(7.4) 61-70 3(75.0) 1(25.0) 4(1.3)
Residence
Rural 39(33.9) 76(66.1) 115(37.1)
Urban 46(23.6) 149(76.4) 195(62.9) Education:
None 0(0.0) 14(100) 14(4.5)
Primary 23(23.7) 74(76.3) 97(31.3) Secondary 26(27.4) 69(72.6) 95(30.5)
Tertiary 36(34.6) 68(65.4) 104(33.7) Source of water
Safe 58(29.0) 142(71.0) 200 (64.5) Unsafe 27(24.5) 83(75.5) 110 (35.5)
Occupation:
Farmers 16(35.6) 29(64.4) 45 (14.5) Others 69(26.0) 196(74) 265(85.5)
Toilet facility
Water cistern 39(24.5) 120(75.5) 159(51.3) Pit latrine 36 (35.6) 65(64.4) 101 (32.6) Bush 10 (20.0) 40(80.0) 50 ( 16.1) Contact with animal
Goat 21(38.2) 34(61.8) 55 (17.7) Pig 6(25.0) 18(75.0) 24 (7.7)
Both 3(27.3) 8(72.7) 11 (3.6) None 55(25) 165(75.0) 220 (71.0)
Table 1 continued
53
Characteristics Male(%) Female (%) Total Hand washing
All the time 58(26.7) 159(73.3) 217(70.0) Sometime 24(28.9) 59(71.1) 83(26.8) Rarely 3(30.0) 7(70.0) 10(3.2)
Table 1 showed that out of three hundred and ten (310) respondents, 225 (72.6%) were females while 85 (27.4%) were males, giving a male to female ratio of 1:2.7.This table also showed that 192 (61.9%) were less than forty years, comprising the younger age group while the remaining 118 (38.1%) were more than forty years of age, comprising the older age group.
This table also showed that there were fewer people living in the rural area (37.1%) . Farmers constituted 14.5% of the study population while artisans, students, civil servants, traders, security men and unemployed, who were categorized as “others”, constituted 85.5% of the study population. Among the farmers, majority of them were females (64.4%). All the study subjects who hadn’t any form of formal education were females (100%) which constituted 4.5% of the study population. All the subjects who did not have any form of formal education were women (100%). This table also showed that majority of the study subjects (64.5%) had access to safe drinking water and most of the study subjects who drank unsafe water were females (75.5%). The female study subjects accounted for the highest proportion of those who defeacated in bushes (80%). Majority of study subjects (70.0%) washed their hand all the time after using the toilet facility.
54 Table 2 Mean age of study population.
Mean±SD frequency Males 44.1±7.9 85 Females 36.3±7.9 225
Total 38.5±8.6 310
This table showed that the mean age of the study population was 38.5±8.6 years with an age range of 19 to 68 years. Male sex had a higher mean age of 44.1±7.9 years compared to their female subjects who had a mean age 36.3±7.9 years. This means that the female population were much younger than the male population.
Table 3 Distribution of clinical features and treatment regimen among the study subjects
Characteristics No. of participant Percentage
55 Symptoms:
Abdominal pain 7 2.2 Vomiting 3 1.0 Both 0 0.0 None 300 96.8 Body mass index (kg/m2):
< 18 6 1.9 >18 304 98.1 Current CD4 count (cell/mm3):
<200 39 12.6 >200 271 87.4 cotrimoxazole prophylaxis:
Yes 118 38.1 No 192 61.9 HAART regimen
First line 260 83.9 Second line 50 16.1 Current CD4 Males Females
<200 10(25.6%) 29(74.4%) 39(12.6%)
>200 75(27.7%) 196(73.3%) 271(87.4%)
This table showed that most of the study subject had CD4 >200cell/mm3 while a high proportion of those who had severe immune deficiency were female subjects (74.4%). Majority of study subjects (83.9%) were on first line antiretroviral drugs while only 16.1% were on second line ART.
Furthermore, most of the study subjects (61.9%) were not on cotrimoxazole (Septrim) prophylaxis.
This study shows that very few study subjects (3.2%) had either abdominal pain or vomiting while most subjects did not complain of either symptom. Most of the study subjects (98.1%) were well nourished.
56
Table 4 Proportion of intestinal parasite infections among study subjects Isolated parasite Frequency Percentage A.lumbricoides 21 6.8
E.histolytica 17 5.5
Hookworm 7 2.3 S. stercoralis 4 1.3
Others 5 1.6 No parasite 256 82.5 Total 310 100
Table 4 showed that of the 310 stool sample examined among the study subjects, 54 (17.4%) subjects had intestinal parasite isolated from their stool samples. Out of these, 21 (6.8%) had Ascaris lumbricoides, 17 (5.5%) had Entamoeba histolytica 7 (2.3%) had hookworm, 4 (1.3%) had Strongyloides stercoralis, 5 (1.6%) had other parasites (Giardia lamblia, Hymonolepis nana,Schistosoma mansoni) and the remaining 256 (82.6%) did not have any parasite in their stool samples.
57
Figure 1 Prevalence of intestinal helminths and protozoa infection among the study subject
Figure 1 showed that among the 310 stool samples were examined, at least one intestinal parasite was isolated from the stool sample of 54 study subjects, giving a prevalence of 17.4% of intestinal parasitic infection among the study subject. It also showed that helminths account for 10.3% (32) and protozoa account for 7.1% (22) of all the intestinal parasitic infection.
.
10.3
7.1
82.6
prevalence of intestinal helminthes and protozoans infection
helminths protozoa no parasite
58
Figure 2 Distribution of helminths and protozoa among 54 study subjects
Figure 2 demonstrated the distribution of different classes of intestinal parasites among the study subjects. Among 54 study subjects, intestinal helminths were isolated from 32 (59.3%) study subjects and protozoa were isolated from the stools of 22 (40.7%) clients.
59.3 40.7
Proportion of helminths and protozoas
Intestinal helminths Protozoa
59
Figure 3 Pattern of intestinal helminths among 32 study subjects.
Figure 3 shows that out of the 32 study subjects who had at least one helminths isolated from the stool sample, 21 (65.6%) had Ascaris lumbricoides, 7 (21.9%) had hookworm and 4 (12.5%) had Strongyloides stercoralis.
65.6 21.9
12.5
pattern of intestinal helminths
Ascaris lumbricoides hookworm
S.stercoralis
60
4.2 Relationship between immune status of study subjects and helminths infection Table 5: Relationship between CD4 count and intestinal helminths infection
Current CD4 count Total no.tested Total no. infected Fisher’s exact <200 39 8(20.5) 0.03237
>200 271 24(8.9)
Severe immune deficiency (<200cell/mm3) was significantly associated with intestinal helminths infection(Fisher’s exact =0.03237) .
Table 6: Relationship between CD4 count and specific isolated helminths.
Specific isolated helminthes Current CD4 count(cell/mm3) Total Fisher’s exact <200 >200
Ascaris lumbricoides 5(23.8) 16(76.2) 21 0.0025 Strongyloides stercoralis 2(50.0) 2(50.0) 4
Hookworm 1(12.5) 6(87.5) 7 Others 7 (20.0) 15(80.0) 22 No parasites 24 (10.4) 232(89.6) 256
Table 6 shows that Strongyloides stercoralis was the most prevalent intestinal helminth (50.0%) among those who had severe immune deficiency followed by Ascaris lumbricoides (23.8%) and the least was hookworm (12.5%).
61
4.3 Relationship between sociodemographic factors and intestinal helminths infection among the study subjects.
Table 7: Relationship between sociodemographics and intestinal helminths infection
Risk factors Total no. tested Total no. infected (%) X2 P-value Gender
Male 85 5(5.9) 3.982 0.5520 Female 225 27(12.0%)
Age
<=20 2 0(0.0) 8.9456 0.2100 21-30 53 4(7.5)
31-40 137 16(11.7) 41-50 91 6(6.6) 51-60 23 6(26.1) 61-70 4 0(0.0) Residence
Rural 115 16(13.9) 8.9458 0.0818 Urban 195 16(8.2)
Occupation
Farmers 45 12(26.7) Fisher’s exact 0.0001 Others 265 20(7.5)
Education
Not literate 14 3(21.4) Fisher’s exact 0.1118 Primary 97 11(11.3)
Secondary 95 13(13.7) Tertiary 104 5(4.8)
62 Table 7 continued
Risk factors Total no. tested Total no. infected X2 P-value Source of water
Safe 200 10(5.0) 17.25 0.00002 Not safe 110 22(20.0)
Contact with animals
Goat 55 5(9.1) 2.011 0.5701 Pig 24 4(16.7)
Both 11 2(18.2) None 220 21(9.6) Toilet facility
Water cistern 159 13(8.2) 14.66 0.0481 Pit latrine 101 9(8.9)
Bush 50 10(20.0) Hand washing habit
All the time 217 13(6.0) 14.66 0.0007 Sometimes 83 17(20.5)
Rarely 10 2(20.0)
The influence of sociodemographic characteristics on the prevalence of intestinal helminths infection among the study subjects are as shown in the table above. Generally, the female gender (12.0%) were more infected with intestinal helminths compared to their male counterpart (5.9%).
This table also showed that age, and place of residence had no significant effect on helminths intestinal parasitic infection (P=0.2100, P=0.0818). Those who resided in the rural areas had a higher rate of helminths infection (13.9%) compared to clients from the urban community (8.4%).
Farmers (26.7%) were significantly affected (P-value=0.0001) with helminths infection while other workers such as artisan, businessmen/businesswomen, security personnel and students were
63
least affected (7.5%). Those who were not literate or had primary education harboured more intestinal helminths (12.6%) compared to those with tertiary education (4.8%). However, those with secondary education had the highest prevalence of intestinal helmiths infection (13.7%). The patients whose sources of drinking water were streams, rivers or surface water (20.0%) were significantly affected with helminths infection (P-value=0.00002). The rate of helminths infection among study subjects who had contact with animal ranged from 16.7% in pigs to 9.1% in goats, while those who had no contact with animals accounted for 9.6%. The highest prevalent was observed among those who reared both pigs and goats (18.2%). Defaecating in nearby bushes (20.0%) resulted in a significantly increased (P=0.0481) prevalence of helminths infection among them. Similarly, the client who washed their hands sometimes or rarely were significantly affected (P-value = 0.0007) by helminths infection.
64
Table 8: Relationship between cotrimoxazole prophylaxis, clinical features and helminths infection
Characteristic Total no. tested Total no. infected X2 P-value Cotrimoxazole
Yes 118 11 (9.3) Fisher’s exact 0.4015 No 192 21(10.9)
Symptoms
Abdominal pain 7 2(28.6) Fisher’s exact 0.0003 Vomiting 3 3(100.0)
None 300 27(9.0) BMI
<18 6 1(16.7) 43.3811 0.9234 >18 304 31(10.2)
This table showed that the clients on cotrimoxazole prophylaxis had less helminths infection (9.3) compared with those who were not on cotrimoxazole (10.9%). Vomiting was significantly associated intestinal helminths infection (Fisher’s exact=0.0003) in that all clients (100%) who were vomiting were infected. There was a higher rate of helminths infection among those with malnutrition (16.7%) compared to those who had good nutritional status (10.2%). This was not statistically significant ( P-value =0.9234).
65 4.4 Predictors of intestinal helminths infections
Table 9: Predictors of intestinal helminths infection in the study subjects
Terms OR 95% C.I Coeffecient S.E Z-stat P-Value CD4 count 0.1836 0.0724 - 0.4654 -1.6949 0.0445 -3.5718 0.0004 (<200cell/mm3)
Hand washing 2.4424 1.0373 - 5.7509 0.8930 0.4369 2.0437 0.0410 (sometimes)
Occupation 0.2807 0.1015 - 0.7897 -1.2618 0.5233 -24112 0.0159 (farmers)
Constant * * * 0.6811 1.2425 0.5482 0.5836 The predictors of intestinal helminths infection among the study subjects were CD4 count less than 200 cell/mm3 (OR= 0.1836, P= 0.004), farming as an occupation (OR= 0.2807, P=0.0159) and infrequent hand washing habit (OR =2.4424, P=0.0410). This table also shows that those who washed their hand occasionally were 2 times more likely to have intestinal helminths infection than those who washed their hand all the time. The statistically significant association of sources of drinking water, certain clinical features and types of toilet facility with intestinal helminths infection was lost after logistic regression. Implying that when other predictors are held at a constant, types of toilet facility, clinical features and sources of drinking water will not be significantly associated with intestinal helminthes infection in these study subjects.
66 CHAPTER FIVE 5.1 DISCUSSION
Three hundred and ten (310) patients were enrolled for this study. More female subjects 225(72.6%) were enrolled compared to their male counterparts 85(27.4%) with a ratio of 2.7:1. This agrees with previous studies carried out in Sao Jose Brazil, South-western Ethiopia and Benin city, Nigeria among HIV-positive patients in which more female subjects were enrolled.33,34,35 Female subjects were at higher risks of acquiring HIV through unprotected sexual intercourse with an infected person because of the anatomical nature of their genital system. This might explain the resultant higher female population in this study. Furthermore, women have a better health seeking behavior and as such seek medical help at the slightest sign of ill health. This might be the reason why more female clients were enrolled in this study.
The female subjects had a lower mean age (36.3±37.9yrs) compared to their male counter parts (44.1±7.9yrs). Previous reports by WHO and NACA in 2010, agree with the observation made in this study.,10,12 Most female subjects, who were of the child bearing age (aged between18-45 yrs), were usually recruited during routine antenatal clinic visit which ensure that they had access to Antiretroviral Therapy earlier in life than the male subjects.10, This may explain the reason why most women were of a younger age group.
The study site was situated at an urban area (Jos North LGA) at the heart of Jos city. Since it is a state government owned establishment, its health services are cheaper than that of surrounding private and federal government owned teaching hospitals. This may explain the reason why most of the study subjects were of low socioeconomic status. This agrees
67
with a previous study done by Assefa et al in Ethiopia which reported that a large proportion of those who accessed free antiretroviral drugs at Dessie Hospital had a low socioeconomic status.50 This was because, being a government owned hospital, healthcare services were cheap and therefore within the reach of the poor who expectedly had poor educational background.
In this study, most study subjects (62.9%) lived in the urban community. This may explain why a higher proportion of respondents (51.3%) had standard toilet facilities and a good source of drinking water (64.5%). This may also explain why most study subjects did not keep domestic animals (71.0%). These findings agree with other previous studies done by Bachur et al, Assefa et al and Akinbo et al in Brazil, Ethiopia and Nigeria respectively, in which most patient from the urban areas had standard toilet facilities and good source of drinking water.33,34,50 Most people who lived in urban Nigerian cities had relatively better access to basic amenities compared to their counterpart in the rural areas because development was concentrated in the cities. This may be the reason for the finding in this study.
Antiretroviral therapy is known to reduce the prevalence of intestinal helminths infection among those who are on HAART. 33,50, 52,53 This was confirmed in the present study in which the prevalence of intestinal parasitic infection was 17.4%. The prevalence observed in this study was lower than what was reported in previous studies done among HIV-positive patients before the commencement of HAART which ranged between 24-79.3%.
33, 47-49 HAART has been reported to improve immune status, thereby preventing the occurrence of opportunistic parasitic infection.33 Antiretroviral therapy is circumspect,
68
comprehensive and holistic in operation. Apart from provision of drugs, other measures such as education on improvement of sanitation, boiling drinking water and washing of hands were taught. This was coupled with regular follow-up, use of prophylactic cotrimoxazole and provision of water sanitizing agent (waterguard). All these measures reduced intestinal parasitic infection and may explain the lower prevalence observed in this study compared to that among those who were not on HAART.
The 17.4% prevalence of intestinal parasitic infection observed in this study among patients on HAART correlates with studies by Pavie et al in Paris, France and Assefa in Dessie hospital, Ethiopia. 50, 51 The report in this study was lower than that reported in Sao Jose, Brazil and Jimma, Ethiopia in which 24.4% and 39.0% prevalence were reported respectively. 33, 52 The difference observed in this study and the study in Brazil and Ethiopia might be due to the smaller sample sizes, the use of Zeihl-Neelsen stain in stool sample examination and the use of a non-probability sampling technique in both Brazil and Ethiopian studies. Conversely, a study done in Benin City, Nigeria, observed a 5.3%
prevalence of intestinal parasitic infection among HIV – patients on HAART. 53 The Benin study did not use the conventional direct wet mount preparation before stool samples were subjected to the concentration technique. This might have led to a missed chance of detecting some cyst and eggs which may be destroyed by concentration method and thus the lower prevalence seen in the Benin study.
Ova or cyst of intestinal parasites were isolated from stool samples of 54 study subjects during stool sample examination on wet mount preparation and Formol-ether concentration in the present study. Ova of Ascaris lumbricoides was seen in 21 (6.8%), cyst of
69
Entamoeba histolytica in 17(5.5%), Ova of hookworm species in 7(2.3%), ova of
Strongyloides stercoralis in 4(1.3%) and the cyst of other protozoa which were
categorised as “others” in this study and include Giardia lamblia , Hymonolepis nana and Schistosoma mansoni constituted 5(1.6%). This pattern is similar to previous studies done in Brazil, Ethiopia and Benin city, Nigeria in which Ascaris lumbricoides, Strongyloides stercoralis, hookworm and Entamoeba histolytica were the parasites
isolated from stool samples of patients on HAART. 33, 50, 53 Moist soil, humid condition and unhygienic practices are some of the factors that Ethiopia and Benin City shared in common with Jos and environment. Accidentally, these factors encouraged the survival of these parasites and may explain the findings observed.
In the present study, it was observed that 10.3% of the respondents had intestinal helminths isolated from their stool samples. This represents the highest proportion of intestinal parasites in this study. Previous studies done by Bachur et al and Akinbo et al in Brazil and Benin city, Nigeria also observed that intestinal helmiths were the largest proportion of intestinal parasite seen in HIV-patients. 33,34 Intestinal helminths are more prevalent in the developing countries where poor hygienic practices and scarcity of safe drinking water was a constant feature. These encouraged the spread of these parasites and may explain why these parasite still strive in human despite ART among AIDS patients.
Ascaris lumbricoides 21(6.8%) was the most prevalent intestinal helminths encountered
during stool examination in this study. This agrees with a study done by Babatunde et al in Ilorin, Nigeria among HIV positive patients in the pre-HAART era.32 In the era of HAART, a previous study in Benin city, Nigeria observed a 4.2% prevalence of Ascaris
70
lumbricoides among HIV –positive patient which makes it the most prevalent intestinal
helminth.53 Jos metropolis and environment has a relatively moist soil which encourages the growth and survival of the ova of Ascaris lumbricoides. Since most people in the rural areas were predominantly farmers who use human faeces as local manure, contact with this parasite was more likely. This may be the reason why this parasite was more prevalent among the study subjects. That Ascaris lumbricoides was the most prevalent parasite did not agree with previous study done by Bachur et al in Sao Jose, Brazil which had Strongyloides stercoralis as the predominant parasite among HIV – positive patients on
HAART.33 There was a high rate of homosexual behaviour among the Brazilian study population which encouraged auto infection of strongyloidiasis.33
This study revealed that Hookworm species was the second most predominant intestinal helminths (2.3%). The observation made in this study was in agreement with what was observed in Osun State Nigeria. 49, This may be because Osun and Jos share certain demographics. In contrast, a 7.8% prevalence was observed Ilorin, South-western Nigeria among those who had not commenced ART.32 The patients on HAART are on routine follow-up visits where health education and good hygienic practices are emphasized after commencement of HAART. This may explained the lower prevalence of hookworm infestation observed in this study compared to the Ilorin study.
In the present study, the prevalence of Strongyloides stercoralis was 1.3%. This finding agreed with a study done by Akinbo et al in Benin city, Nigeria which had almost similar finding (1.6%).53 This study also showed a marked decrease in the prevalence of Strongyloidiasis among patient on HAART compared to 11% prevalence observed among
71
HIV positive Italians who were not on HAART.98 Strongyloides stercoralis was believed to be an opportunistic intestinal parasite because of its predominance when CD4 Count falls below 200cell/mm3. 98 Data from this study showed that only 12.6% of the study subjects had CD4 count less than 200cell/mm3.This might be a reason for the decreased prevalence of strongyloidiasis in this study group. In contrast, 11% prevalence was observed among HIV-positive patients who were on HAART by Bachur et al in Brazil.33 Strongyloidiasis has been associated with homosexual behaviour which was a predominant practice among HIV-positive patients in Brazil.33 This might explain the higher prevalence of strongyloidiasis seen among Brazilians compared to what was observed in the present study.
Other helminths such as Trichuris trichiuria and Enterobius vermicularis were not seen in this study. However, previous studies in Benin City reported the occurrence of these parasitic infections among HIV positive patient before and after commencement of HAART.34, 53
This study revealed that CD4 count had a significant effect on prevalence of intestinal helminths infection (Fisher’s exact = 0.03237). It was observed that those who had severe immune deficiency (CD4 <200cell/mm3) had a higher proportion of intestinal helminths (20.5%) compared to those who had CD4 more than 200 cells/mm3 (8.9%). This finding was consistent with study done by Shimelis et al in Gondar, Ethiopia among HIV-positive patients before the era of HAART.46 A similar work done in Dessie Hospital among those who were on HAART had similar finding.50, In Nigeria, a work done by Akinbo et al in Benin City, observed that CD4 count was significantly associated with helminths
72
infections. 53 Previous studies had demonstrated a marked decrease in the prevalence of intestinal parasite among patients who were on HAART.38 However, HIV-positive patients who are on HAART with CD4 count <200c/mm3 are still prone to intestinal parasitic infection.33,52 HIV is known to destroy cellular immunity (including CD4) thereby depleting CD4 cell counts.38 Since cellular immunity is the major defense against intestinal parasites, immunodeficiency predisposes HIV-positive patients to these parasites despite commencement of HAART. This may explain why these parasites were still common among patient who had commenced HAART.
Strongyloides stercoralis was the most prevalent intestinal helminth (50.0%) isolated from stool samples of those whose CD4 was less than 200 cell/mm3. This organism has been tagged as “opportunistisc helminth” because of its increased prevalence among AIDS patients.33 This may explain the finding in this study. This agrees with a previous study done in Sao Jose, Brazil among patient on HAART which observed a high prevalence of Crysptosporidium parvum, Isospora belli and Strongyloides stercoralis among clients who
had CD4 less than 200 cell/mm3.33 Cryptosporidium parvum and Isospora belli are known opportunistic parasite that thrive at CD4 less than 200 cells/mm3. However, a specialized and relatively more expensive staining technique is needed to isolate them. This was not routinely done in our centre because of cost and other logistics. This may be the reason why Cryptosporidium species and Isospora species were not detected among those whose CD4 count was less than 200cell/mm3 in this study despite being on cotrimoxazole prophylaxis.
73
The gender of the study subjects did not significantly influence the prevalence of intestinal helminths infection (p=0.5520). A similar study in Baringo, Kenya agrees with the findings of this study.57 In this study, it was observed that female subjects (12.0%) had more intestinal helminths infection compared to their male counterparts (5.9%). The increase prevalence in female subjects might be connected to domestic activities which include sanitation, child care and constant contact with contaminated water than men, hence are more vulnerable to parasitic infection. Conversely, Okodua et al in Abeokuta, observed a significant difference in prevalence of helminths infections among the two genders in that women were more prone to these infection compare to their male counterparts.48
The age of the study subjects had no significant effect on the prevalence of helminths infection in this study(X2=8.94, p=0.21000). Previous study done by Assefa et al in Ethiopia also observed this lack of association.50 In this study, the prevalence of intestinal helminths infection rose to 11.7% among the age group 31-40. This may be because this age group constituted the working class which increases their contact with environment where helminths strive. The present study also observed that the age group 51-60 years habours more intestinal helmiths than any other age group. This may be because of deteriorating immunocompetence and reduced vigilance on food and hand hygiene as they grow old. Conversely, a study among children in Karachi, Pakistan observed a significant increase in helminths infection as the age of the study subject increased.14 This was mainly due to the adventurous nature of most children as they grow up. Moreover, children are likely to move around barefooted, defeacate in bushes and drink water from questionable source
74
Residing in the rural area is known to increase the risk of contracting helminths infection.
However, in this study the place of residence had no significant effect on prevalence of intestinal heminths infection (X2=8.9458, P= 0.0818). The lack of association observed in this study might be as a result of comprehensive healthcare most study subjects received at ART clinic. This finding was in contrast with previous study done by Assefa et al in Ethiopia which observed that those who resided in the rural area were twice more likely to have helminths infection than those who reside in urban community.50 A study of 3 communities in Benue state, Nigeria also demonstrated this significant association.58 Those who reside in rural area, who are mainly of low socioeconomic status, have little or no access basic amenities and this may increase their susceptibility to helminths infection.
The occupation of the study subjects was noticed to have had a significant effect on helminths infection (P = 0.0001). This study shows that farmers had higher proportion of intestinal helminths infection (26.7%) compared to other categories of workforce (7.5%).
This suggested that farmers where more susceptible to these infections than merchants, artisans, student and security personnel. Previous study by Akinbo et al in Benin city, Nigeria observed similar significant association between type of occupation (artisan and farmers) and intestinal helminths infection among HIV – infected patient before the era of HAART.34 A study done by Shimelis et al in Gondar, Ethiopia observed similar significant association with farmers.46 Farmers may be more exposed to intestinal helminths infections because of their frequent contact with soil and human faeces during farming activities.
They are likely to eat food and drink water from questionable source as they carry out their job. They also have poor educational background and to a large extent poor hygienic