الفهرس 
Life cycle of G. lambliaOnly 14 pages are availabe for public view
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Abstract
Despite scientific and technological advances over the years, intestinal parasites still constitute a grave public health problem. This situation is characteristic, principally, of developing countries, in which actions to control enteroparasities are made more difficult by financial cost of technical measures (infra structure) and by lack of proper health educational projects. Allied with this are added low socio-economic and cultural levels and deficit habits of individual hygiene. G. lamblia is of a particular interest as being recognized as a re-emergent infection due to its association with diarrhea outbreaks in DCCs, water borne outbreaks and its wide spread infection in young livestock and infection harbored by pet dogs and cats and their potential of zoonotic transmission.
The growing use of DCCs and the elevated risk of acquiring G.lamblia infection in these settings, in either sporadic or epidemic forms, led to an important public health issue. At this vulnerable age, G. lamblia infection has many implications on the child health, growth, physical and psychosocial development. Thus, the aim of this study was to evaluate and compare the effectiveness of three different strategies for G.lamblia control in DCCs.
This study was carried out in four DCCs in Alexandria on 367 children (aged two to seven years, 200 males and 167 females) and their caregivers. The DCCs were a) Kamel badawy DCC, b) Anwar Shoukry DCC, c) Abnaa Ganyouty DCC and d) El-Mabara DCC.
A predesigned questionnaire to collect personal, socioeconomic and medical data was filled for each child and caregiver. Three stool samples every other day were obtained from each child, one stool sample was obtained from nine of the maids, samples were preserved in MF preservative and examined using MIFC technique for presence of G. lamblia cysts. Physical examination was done for each child.
An environmental study of each DCC was performed through filling an observational sheet and examining sweeping samples and door lockers and taps swabs.
Three different intervention programs were then implemented in three of the DCCs. Program one: Treatment of all G. lamblia diagnosed children (whether symptomatic or asymptomatic) was implemented in DCC A. Program two: Hand washing program was implemented in DCC B. Program three: Treatment of only G. lamblia symptomatic children was implemented in DCC C. The fourth (DCC D) was left as a control. Three months after the implementation of each program, G. lamblia percentage was reassessed, where stool samples were collected and examined in the same previous manner. Nearly 50% of the children in base-line phase participated in the follow-up test.
from the present study, the following results were obtained:
• The overall percentage of G. lamblia infection was 9.5%. It ranged from 8.1% in DCC (D) to10.5% in DCC (A).
• Protozoal infection was higher than helminthic infection with a total percentage of 13.9% versus 1.8% respectively. E. histolytica was diagnosed in 1.9% of the examined children, E. coli in 2.4%, A. lumbricoides in 0.8%, T. trichiuria in 0.5% and E. vermicularis in 0.5% of the examined children (which was much lower than expected as the technique used was not sensitive for its detection).
• The percentage of G. lamblia infection increased from 8.4% in the (2-4 years) age group to 10.5% in the older (4-7 years) age group, but the difference was not statistically significant.
• G. lamblia infection was slightly higher in males (10%) compared to females (9%), but the difference was not statistically significant.
• The percentage of G. lamblia among children with CI more than two was higher (14.3%) than among those whose CI was less than or equal to two (9.1%). However the difference was not statistically significant.
• As regards the source of drinking water, the percentage of G. lamblia was higher in those using tap outside house (11.1%) and who drank stored water (10.4%) compared to those with tap inside house (9.5%) and who did not drink stored water (5.7%). However, the difference was not statistically significant.
• In relation to presence of animals, G. lamblia percentage was higher among those who had animals inside the house (15.4%) compared to those who did not (9.3%), however, the difference was not statistically significant.
• The percentage of G. lamblia was higher in the asymptomatic children (10.5%) compared to the symptomatic children (8.3%), but the difference was not statistically significant.
• The percentage of G. lamblia was higher (9.7%) among those who did not receive previous anti-parasitic treatment compared to those with a history of anti-parasitic treatment (5.6%), but, the difference was not statistically significant. None of the children with chronic diseases had G. lamblia infection.
• The percentage of G. lamblia infection increased by the increase in time spent by the child in the DCC from 8.4% in those staying 4hrs/day in the DCC to 30% in those staying 8hrs/ day in the DCC, however, the difference was not statistically significant.
• A higher percentage of G. lamblia was found among those who were absent more than two days/ week (14.3%) and also among those who did not join a previous DCC (10.1%) compared to a percentage of 7.4% among those who did, none of these differences was statistically significant. The percentage of G. lamblia infection was nearly equal among those who had or did not have siblings in DCC (9% and 9.7% respectively).
• As regards DCC environmental conditions, a non-significant higher G. lamblia prevalence was found among children in DCCs with a building shared with other activities and that lack a playground compared to those in a DCC with a separate building and that had a playground (10% versus 8.1% respectively).
• G. lamblia prevalence was also higher among children in DCCs without a dining room (10.2%) compared to 9.3% among those in DCCs with a dining room, but, this difference was not statistically significant.
• A non significant higher G. lamblia percentage was found in DCCs with class CI more than or equal to 30 (10.2%) compared to a percentage of 9.3% in DCCs with class CI less than 30.
• As regards tap CI and toilet CI, the percentage of G. lamblia was higher in DCCs with tap CI and toilet CI less than 30 compared to DCCs with tap CI and toilet CI more than or equal to 30 (10.5% and 9.3% respectively), however, this difference was not statistically significant.
• A non significant higher G. lamblia prevalence was found in DCCs which presented hot meal only (10%) compared to that which presented both hot and dry meals (8.1%).
• As regards hand washing, percentage of G. lamblia infection was nearly equal among children who washed and who did not wash their hands before eating (9.4% and 9% respectively). This difference was not statistically significant.
• A non-significant higher G. lamblia percentage was found in DCCs where defecation and diaper changing took place in class compared to DCCs where they did not (10.5% versus 9.3% respectively).
• The percentage of G. lamblia infection was also higher among children attending DCCs not requiring entery stool analysis (10.2%) compared to those attending DCCs requiring entery stool analysis (9.3%) but, the difference was not statistically significant.
• The sanitary condition and degree of cleanliness of classes and toilets were nearly the same within the four DCCs.
• Regarding the DCC staff practices, the percentage of G. lamblia infection was higher among children in DCCs without regular physician’s visits than among those in DCCs with regular physician’s visits (10.3% versus 8.8% respectively). The percentage of infection was nearly equal in DCCs where the cook helped and did not help in cleaning (9.9% and 9.1% respectively). The percentage of G. lamblia infection was also higher in DCCs where the nany did not help the child after toilet compared to DCCs where she did (10% versus 8.1% respectively). However, none of these differences was statistically significant. Only nine of the DCC maids submitted one stool sample, all of which were negative for parasitic infections and G. lamblia.
• As regards contamination of taps and door lockers swabs with G. lamblia cysts, 5% and 5.5% of the swabs from (A) and (C) DCCs respectively were contaminated with G. lamblia cysts and these DCCs had higher G. lamblia prevalence of about 10% while no swabs from (B) and (D) DCCs was contaminated with G. lamblia cysts and these DCCs had lower G. lamblia prevalence (9.4% and 8.1% respectively).
• The results of the intervention programs revealed that treatment of all G. lamblia diagnosed cases resulted in reduction of G. lamblia infection by 66.7% from 15.4% to 5.1% and that treatment of only G. lamblia symptomatic cases resulted in reduction of G. lamblia infection by 57.1% from 17.5% to 7.5% and that hand washing program resulted in similar reduction in G. lamblia infection as that in the control group by 20% from 9.4% to 7.5% in the hand washing program and from 9.8% to 7.8% in the control group. These reductions in G. lamblia percentage were not found to be statistically significant
from these results, it could be concluded that control of G. lamblia in DCCs is a comprehensive process that requires treatment of cases, hand washing and health education programs and improvement of sanitary conditions in both the DCC and the child home environments. There should be engagement of the children’s parents in the control program where they should receive health education concerning modes of infection, complications, methods of prevention and control of G. lamblia with focusing on hand washing and personal hygiene.