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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1799-1804
Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria


1 Department of Hematology and Blood Transfusion, Faculty of Clinical Science, College of Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Haematology and Blood Transfusion, Ahmadu Bello University, Zaria, Nigeria
3 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
4 Department of Medical Microbiology, Ahmadu Bello University, Zaria, Nigeria
5 Department of Haematology and Blood Transfusion, Usmanu Danfodiyo University, Sokoto, Nigeria
6 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria

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Date of Web Publication11-Jan-2018
 

   Abstract 


Background: Nomadic pastoralists lack access to basic sanitary and health-care facilities mainly because their mode of life makes them a hard to reach group. In the Nigerian context, there is dearth of knowledge about the interplay between their lifestyle and health indices.Therefore, this study is aimed at determining the association between the prevalence of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Aim: The aim of this study was to assess the prevalence and pattern of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was conducted using questionnaires, physical examination, automated hemocytometry, enzyme-linked immunosorbent assay-based serum ferritin assay, and formol-ether concentration-based stool tests on 337 children(5–15years) at Ladduga grazing reserve, Northwestern Nigeria. Data were analyzed using SPSS version20.0. Results: The prevalence of parasitic infestation was 14.4%(49/337). The predominant parasites found were hookworm species, i.e., Necator americanus and Ancylostoma duodenale(46.9%) and Schistosoma mansoni(26.6%) while Ascaris lumbricoides, Hymenolepis nana, and Enterobius vermicularis accounted for 26.6%. Anemia was found in 40.4%(137/340) of the children with a statistically significant difference between younger(5–9years) and older children(10–15years; P<0.05). Of those with parasites in the stools, 53% of children had anemia. Iron deficiency anemia was found in only 8.1%(4/49) of children. Conclusion: The prevalence of anemia was high in the studied population, but iron deficiency was not a major cause despite hookworm infestation, thus necessitating the need for further studies to identify other causes of anemia among this group.

Keywords: Anemia, children, Fulani, iron deficiency, nomads, parasitic infestations

How to cite this article:
Bello-Manga H, Mamman AI, Suleiman H I, Olayinka A, Musa AU, Musa KA. Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria. Ann Trop Med Public Health 2017;10:1799-804

How to cite this URL:
Bello-Manga H, Mamman AI, Suleiman H I, Olayinka A, Musa AU, Musa KA. Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria. Ann Trop Med Public Health [serial online] 2017 [cited 2018 Aug 15];10:1799-804. Available from: http://www.atmph.org/text.asp?2017/10/6/1799/222723



   Introduction Top


Nomadism is a mode of life that enables humans to exploit resources that are widely distributed over space and time.[1] The nomadic Fulani have a migratory lifestyle that is often determined by the availability of pasture and water compelling seasonal migration between Northern and Southern parts of Nigeria. This lifestyle predisposes them to parasitic infestations as well as other health-related problems. They often have to travel hundreds of kilometers before they are able to access any form of facility that would cater for their health needs on either routine or emergency basis. The nomadic Fulani are described as “probably the most ignored major ethnic group as far as health issues are concerned in Nigeria despite their constituting about 5% of the country's population.”[2],[3]

It is estimated that about 1.5billion people(24% of the world's population) are infected with soil-transmitted helminthiasis(STH).[4] Over270 million preschool age and 600 million school-aged children in endemic areas are at risk of being infected.[4] In general, the diseases caused by these helminthes are considered nonfatal,[5] but are associated with increased morbidity due to nutrient depletion and gastrointestinal blood loss, causing iron deficiency and malnutrition with consequent impairment of growth and development of children.[6],[7],[8]

Reduced access to health promotion interventions such as environmental sanitation, vaccination, appropriate nutritional support, and potable water, coupled with a migratory lifestyle, accentuates the risk of helminthic infestation and consequent anemia. The paucity of data regarding the interplay between their lifestyle and health indices prompted this study which is aimed at assessing the prevalence and pattern of parasitic infestation and its association with anemia among nomadic Fulani children living in Northern Nigeria.


   Materials and Methods Top


Study setting

The Ladduga grazing reserve in the Ikulu Chiefdom of Kachia Local Government Area in Kaduna State, Northern Nigeria, is home to 8 villages, namely, Wuro Nyako, Nassarawa, Wuro Fulбe, Wuro Modi, Wuro Saleh, Tilɗe Bayero, Mayo Borno, and Ladduga. The tropical climate on the undulating plains with occasional rocky hillocks sustains the Guinea savannah vegetation. The reserve that is situated between 600 and 750m above sea level has as an area of 30,956 km 2. The arable land supports crop farming.

The whole grazing reserve has a human population of 18,000 and an animal population of 50,503 including cattle, sheep, goats, donkeys, and poultry. These numbers often diminish in the dry season due to Southward migration of the people and their animals in search for pasture.

Basic facilities provided at the reserve include earth dams, boreholes, community health clinic, community school, veterinary clinic, and milk collection center. The primary occupation of the population is cattle herding; this is often combined with farming especially during the rainy season, during which the need for outmigration is less. The men who are often followed by their adolescent male children usually do herding. Women and girls are usually engaged in household chores, craftwork, processing and selling dairy products, fetching water, firewood, and tending to the vegetable gardens.

Study population

The study was carried out on nomadic Fulani children of consenting parents and guardians between the ages of 5 and 15years living within the stated study setting. Children who were ill were excluded from the study.

Sample size and sampling technique

A sample size of 340 participants was arrived at using the formula for cross-sectional study. Cluster sampling method was used for selection of participants. The 8 villages within the grazing reserve were used as clusters. Four out of the eight villages were selected randomly, using the balloting technique. Participants, proportionate to the size of the population, were selected from each chosen cluster. Alist of all the households in each chosen cluster served as the sampling frame. The children were randomly selected from these houses, and the village head's(Ardo) house was used as the starting point. Subsequently, every second house on the right of the village head's house was selected until the required number of participants in each village was obtained. This was repeated for all the 4 villages selected.

Data collection process

Data collection included administration of structured questionnaires to participants with parents/guardians as respondents or witnesses depending on the participants' ages. The questionnaires assessed the pattern and effect of diet on iron status, physical examination, collection of blood, and stool and urine samples. Respectively on the blood samples, automated hemocytometry was performed using Sysmex KX-21N (Sysmex Corporation, Kobe, Japan), serum ferritin (SF) assay was done by solid-phase enzyme-linked Immunosorbent assay (ELISA) technique with microwell ELISA human Ferritin Enzyme Immunoassay test kit (Diagnostic Automation, Inc., USA). While formol-ether concentration based stool test was done for the stool samples.

Ethical consideration

The ethical approval of the ethical and scientific committee of the Ahmadu Bello University Teaching Hospital, Shika, Kaduna state, Northern Nigeria, was obtained.

A preliminary visit was conducted to the study area where a meeting, headed by the “Ardo”(i.e., district head), was held with the gatekeepers of the community and rapport was established. After this, the purpose of the study and the process of sample collection was explained to the gatekeepers and the parents of children and their children in the languages that they understood(Hausa and Fulfulde). They were also told that they could decline to be part of the study. Parents signed a written consent for their children's participation in the study.

All cost of the research was borne by the researcher.


   Results Top


A total of 340 participants between the age of 5 and 15years were enrolled. There were 150(44.1%) males and 190(55.9%) females. The participants were classified into 5–9years(54.7%) and 10–15years(45.3%). Educational status showed that 92.9% were in primary school, 4.5% were in secondary school, and 2.6% were not attending any formal school. Educational status of parents of participants showed that 10.6% of the parents had some form of formal education while 89.4% had nonformal education. The majority of parents were both farmers and herders(97.9%). Those who were either herders alone or farmers alone were 1.2% and 0.9%, respectively. The majority(52.6%) of the children came from a family of 10–15 people, while 30.6% and 16.8% came from families of<10 and>30 people, respectively[Table1].
Table 1: Sociodemographic characteristics of respondents

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Out of the 337 stool samples that were examined, parasites were present in 49(14.4%) of stool specimens. The parasites identified in the 49 stool samples include hookworm, Schistosoma mansoni, Ascaris lumbricoides, Enterobius vermicularis, and Hymenolepis nana. The distribution of parasitic infestation by sex and age of participants showed a female predominance and the older children(10–15) at 57.1% and 55.1%, respectively[Table2].
Table 2: Prevalence and pattern of Intestinal parasitic infection among nomadic children aged 5–15 years in Ladduga grazing reserve

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Anemia, defined by hemoglobin(Hb) level<11.5g/dl, was found in 40.3%, with an almost equal prevalence between females(20.0%) and males(19.7%), respectively. However, anemia affected more children in the 5–9years age group than children 10–15years(54.4% vs. 35.8%). There was a statistically significant relationship between anemia and age(P<0.05), but there was none between anemia and sex/gender. The prevalence of iron deficiency anemia based on low Hb and SF(<20 μg/L) was found in only 8.2% of the studied population, and the mean SF of participants with parasites in their stool was 90.18±100.07. However, up to 30% had microcytic anemia and 22% had hypochromic anemia, both of which occurred more in children in the 5–9years age group[Table3].
Table 3: Correlation of anemia with demographic characteristics and other hematologic parameters among children 5–15 years in Ladduga grazing reserve

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More than half of the children with parasites in their stool had concomitant anemia(53.1%). More females than males had both anemia and parasites in their stool but was not statistically significant. Results showed that children with parasites in their stool in the 5–9years age group had anemia compared to those in the 10–15years age group(56.2% vs. 43.8%).

On the whole, there is a statistically significant crude association (OR =1.822, 95% CI=0.987–3.363) between parasites in stool and anemia in this population of children. The adjusted models that significantly predict this association included sex (OR = 1.831, 95% CI = 0.990-3.385), age (OR=1.849, 95%CI=0.988-3.459) and number of cattle owned by the family (OR=1.927, 95%CI=1.036-3.587) [Table 4].
Table 4: Association between intestinal parasite infestation and anemia: Crude and adjusted models, odds ratio (95% confidence interval)

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   Discussion Top


The prevalence of parasites was 14.9%, with hookworm species being the highest parasite found. The prevalence was also found to be higher among females and the older children(10–15years). Previous studies have shown a much higher prevalence of intestinal helminthes in both nomadic and settled children where Okolo and John got a prevalence of 24.6% in Vom, Plateau State(North-Central, Nigeria)[9] and Adebara et al. 29.7%(South-Western Nigeria).[10] The prevalence obtained in this study is lower than previously reported, the reason for this could be because the Fulani have a wider area for disposing their waste which therefore leads to less human contact.

In our study, more females had parasites in their stools(57.1%) than their male counterparts. Asimilar pattern was seen by Adebara et al. in their study among school-aged children while Okolo and John found an almost equal sex prevalence rates.[9],[10] This finding may be due to the roles that females play in daily chores of the home like fetching water from the stream, tending to the vegetable gardens, which entails the use of animal dung as fertilizer, thus increasing their risk of contact with ova and larvae of STH.[11] Our study also found a higher prevalence of parasites in stool of children 10–15years(55.1%), which differs from the findings of Okolo and John who found a higher prevalence among the younger children(5–9years). In the studied population, adolescents, particularly boys, are also in the transition period from childhood to adulthood and this involves the allotment of tasks at either the community or family level which include herding, farming, and fetching water.[12] These responsibilities place these groups at risk of being infested by parasites, thus explaining the higher prevalence amongst them.

Infection with intestinal parasites has been recognized as a major contributor to anemia through mechanisms such as chronic blood loss, impaired nutrient absorption, as well as increased nutrient loss.[13]

The prevalence of anemia was high at 40.3%. This finding is similar to those reported by Asobayire etal. among settled rural school children in Côte d'Ivoire and Hashizume etal. in Kazakhstan, which were 46% and 49.8%, respectively.[14],[15] This figure is higher than the global prevalence for anemia in school-aged children, which is 25.4%.[16] A higher prevalence of 82.6% was reported by Onimawo et al.[17] in 2010 among settled school-aged children in Abia State, South-Eastern Nigeria.

There is a statistically significant association (OR=1.822, 95% CI=0.987–3.363) between parasites in stool of participants and anemia, with more than half(53.1%) of the children having both anemia and parasites in their stools. Adjustment for sex, age, and number of cattle ownership significantly influences this association(OR=1.980, 95% CI = 1.980–1.046–3.747). The association between intestinal parasites and anemia has been highlighted in some studies.[18],[19] Intestinal worm infestation was associated with anemia in up to 28% of the participants studied by Osei et al.[18] The higher prevalence rates found in females may be related to their roles in the community. Onset of menarche and growth spurt may be additional reasons for anemia among females.[20] The prevalence of hypochromic and microcytic was 22.3% and 30%, respectively. This finding is comparable to the figure reported by Fleming and Werblinska in Zaria, where they found hypochromia in 25% of the children they studied,[21] but lower than the figure reported by Adebara et al. in Ilorin, Nigeria, where they obtained a prevalence of 47.6%.[10] A study conducted by Hows et al.[22] showed that hypochromia and microcytosis are common findings in children and this is not always due to iron deficiency or hemoglobinopathies, they suggested that it is an intrinsic feature of erythropoiesis in children and its independent of iron status.[22]

Anemia associated with iron deficiency(SF, <20 μg/L) was found to be 2.9% in the studied population; however, there was no significant association between the level of SF and presence of parasites in stool, as all the values were within normal range(mean SF, 90.18±100.07; P=0.530).Although, iron deficiency anaemia is the major cause of anaemia worldwide affecting more than 1 billion,[19] especially in Sub-Saharan Africa,[23] but our study indicates otherwise. Reasons for this finding may be linked to the fact that nomadic children have access to other foods that are rich in iron such as chicken, green leafy vegetables, and also fruits in the wild that are rich sources of Vitamin C which can enhance the absorption of ferric iron(mostly found in cereals) from the intestines.[24],[25] A similar finding to our own was reported by El Hioui etal., where they found that the prevalence of anemia among school-aged children was 12.2% and only about 20%(of the anemic children) were associated with iron deficiency, giving a prevalence of iron deficiency anemia to be 2.5%.[26] They attributed this low prevalence of iron deficiency anemia to the fact that the study was conducted in a region with an abundance of fish, vegetables, fruits, and other cereals.


   Conclusion Top


Findings from this study show that nomadic Fulani children have a relatively high burden of parasitic infestation and an even higher burden of anemia, which is largely not due to iron deficiency as is seen in other populations. There is a dire need for health education on hygiene, especially with regard to proper waste disposal and use of protective footwear. Introduction of cost-effective, low technology agricultural interventions to boost food production to sustain iron levels in the community should also be encouraged. Other causes of anemia, such as hemoglobinopathies, folate, Vitamin B12, and other micronutrient deficiencies as well as human immunodeficiency virus(HIV) infection, were not assessed. The estimation of percentage transferrin saturation would have been beneficial in this study. Further studies on other possible causes of anemia such as screening for hemoglobinopathies, HIV, and other vitamin deficiencies should be carried out in the community to better define the cause of anemia in this population.

Acknowledgment

I would like to acknowledge the management and staff of the National Commission for Nomadic Education(NCNE) for their support. Special appreciation goes to Dr.Umar Ardo, Mallam Lawal Boro, Alhaji Haruna Garba, and Mallam Mannir.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Halima Bello-Manga
Department of Hematology and Blood Transfusion, Faculty of Clinical Science, College of Medicine, Kaduna State University, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_664_17

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