Prevalence of Intestinal Parasites among Expatriate Workers in Al-Ain, United Arab Emirates
1993; King Faisal Specialist Hospital and Research Centre; Volume: 13; Issue: 2 Linguagem: Inglês
10.5144/0256-4947.1993.126
ISSN0975-4466
AutoresOsama M.G. Ibrahim, Abdulbari Bener, Abdulgadir Shalabi,
Tópico(s)Travel-related health issues
ResumoOriginal ArticlesPrevalence of Intestinal Parasites among Expatriate Workers in Al-Ain, United Arab Emirates Osama M.G. Ibrahim, MBBCh, MSc, MD Abdulbari Bener, and PhD, FRSS Abdulgadir ShalabiMBBch, DPH Osama M.G. Ibrahim From the Imported Disease Control Centre, Department of Preventive Medicine, Ministry of Health, Al-Ain, United Arab Emirates. Search for more papers by this author , Abdulbari Bener Address reprint requests and correspondence to Dr. Bener: Associate Professor, United Arab Emirates University, Department of Community Medicine, Faculty of Medicine and Health Sciences, P.O. Box 17666, Al-Ain, United Arab Emirates. From the Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates. Search for more papers by this author , and Abdulgadir Shalabi From the Director of Preventive Medicine, Ministry of Health, Al-Ain Medical District, Al-Ain, United Arab Emirates. Search for more papers by this author Published Online:1 Mar 1993https://doi.org/10.5144/0256-4947.1993.126SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractA retrospective study was conducted among expatriate workers in Al-Ain City, United Arab Emirates (UAE), to determine the prevalence of pathogenic parasitic infestation. The study was based largely on expatriates arriving from India, Pakistan, Bangladesh, Iran, Philippines, Sri Lanka, and other Arab countries and mainly employed as food handlers, housemaids, baby sitters, and private drivers. This group represents 45.7% of the total number of new arrivals of expatriates during the period between 1 January 1985-31 December 1988. Stool specimens were examined in 60,268 screened individuals, of which 14,010 were found to be positive with pathogenic intestinal parasitic disease. Overall parasitic prevelance was 23.1%. The most common parasites found included: Ancylostoma species (6.7%), Ascaris lumbricoides (6.6%), Trichuris trichiura (6.2%), and Giardia lamblia (2.4%). The distribution of intestinal parasites among expatriates was different for all nationalities. The results showed that Giardia lamblia was more prevalent among Iranians (54.7%) and Pakistanis (42.2%). Ancylostoma species was found to be more prevalent among Sri Lankans (33.3%) and Indians (39.6%). Ascaris lumbricoides was more prevalent among Bangladeshis (33.1%), and Trichuris trichiura was more prevalent among Filipinos (40.2%).IntroductionThere has been rapid economic growth in the United Arab Emirates (UAE) which has resulted in an enormous increase in the number of expatriate workers. Expatriates in the United Arab Emirates arrive largely from India, Pakistan, Sri Lanka, Philippines, Iran, and other Arab countries. The existence of such workers remaining in the UAE may present a potential health hazard to the local community. Many of these people may be infested with various types of parasites and other bacterial and viral diseases. Moreover, a substantial percentage of expatriates may be carriers of such microbes. The situation is aggravated by the peculiar type of environmental conditions in which these people live.The prevalence of almost all intestinal parasites depends on climatic and socioenvironmental conditions. In Saudi Arabia, a neighboring country of the UAE, 7.6% of food handlers working in restaurants located in Dammam and Al-Khobar were found to be infested with parasites and a very low percentage had Entamoeba histolytica (3.2%) and Giardia lamblia (3.1%) infection [1]. In Yemen, 53% of the stool specimens were found positive for intestinal parasites [2]. The prevalence rate varied in expatriates working in Riyadh, Saudi Arabia [3]; 55.7% of whom were infested with parasites [4]. In another hospital-based study conducted in Riyadh, Saudi Arabia, 22.9% of patients had pathogenic parasites and many more commensals [5]. The prevalence rate of intestinal parasites was found to be higher in expatriates from home countries such as Bangladesh [6], India [7], and Pakistan [8].In the UAE, all expatriate workers are subjected by law to have clinical examinations and laboratory investigations for various' communicable diseases. With the awareness and efforts directed toward control of tropical and communicable diseases, expatriates are required to submit medical examination certificates prior to the start of employment.However, in the UAE, there remains limited information regarding the epidemiological aspects of parasitic infestation among natives and expatriates. The present study was aimed at determining the current situation of intestinal parasites among expatriate workers in Al-Ain City, UAE, which may reflect a clearer image of the situation in other areas of the country.MATERIAL AND METHODSThe present study was based on a retrospective survey of intestinal parasitic infestations among expatriates in specific jobs (food handlers, baby sitters, house maids, private cooks, and private drivers) arriving to work in Al-Ain, United Arab Emirates during the period between 1 January 1985-31 December 1988. The age of expatriates ranged from 20 to 45 years. The monthly income of expatriate workers ranged from 400 to 2500 UAE Dirhams (Dh) (1 US $ = 3.68 UAE Dh). Fresh fecal specimens were obtained from 60,286 individuals at the laboratory of Al-Ain Preventive Medicine Department. These specimens were examined by light microscopy of wet smears in normal saline and Lugol iodine solution within one hour of collection [9]. The specimens were received in the laboratory in wide mouth, watertight plastic containers with tightly fitted lids. Periodic random re-examination was carried out throughout the entire period of investigation using the formalin concentration method [10]. Data were entered, recorded, and analyzed on the IBM mainframe of the UAE University. The Statistical Package Program SPSSx was used for statistical computation [11].RESULTSThe prevalence of various pathogenic intestinal parasitic infestations among expatriates in Al-Ain is shown in Table 1. The overall prevalence was 23.1%. The most common parasites encountered during the period of study were Ancylostoma species with a prevalence rate of 6.1%. Ascaris lumbricoides ranked second with a prevalence rate of 6.6% followed by Trichuris trichiura (6.2%). The least common parasite found was Entamoeba histolytica (0.1%). Ancylostoma species infection was more common during 1985 and Ascaris lumbricoides infection was more common during the period between 1986-1988.Table 1. Prevalence of common parasitic infections among expatriates in Al-Ain, United Arab Emirates (UAE).Table 1. Prevalence of common parasitic infections among expatriates in Al-Ain, United Arab Emirates (UAE).The distribution of parasitic infestations among various nationalities are shown in Figure 1. Sri Lankans represented the majority of positive cases (29.9%) followed by Indians (22.9%), Bangladeshis (20.0%), Filipinos (16.3%), Pakistanis (8.3%), Arabs (8%), Iranians (0.5%), and others (0.2%). The most common parasitic infestations distributed according to nationality in Al-Ain during the period of study are noted in Table 2. The findings revealed that Giardia lamblia was more prevalent among Iranians (54.2%), Pakistanis (42.2%), and other Arabs (25.9%). Ancylostoma species was more prevalent among Indians (39%) and Sri Lankans (33.3%). Ascaris lumbricoides was more prevalent among Bangladeshis (33.1%) and finally, Trichuris trichiura was found to be more prevalent among Filipinos (40.2%) and other nationalities (33.3%).Figure 1. Distribution of intestinal parasites among various nationalities from 1985-1988 in Al-Ain, United Arab Emirates (UAE).Download FigureTable 2. Comparison of common parasitic infections distributed according to nationality in Al-Ain, United Arab Emirates (UAE).Table 2. Comparison of common parasitic infections distributed according to nationality in Al-Ain, United Arab Emirates (UAE).DISCUSSIONThe aim of this study was to determine the prevalence rate of intestinal parasitic infestation among new expatriates such as food handlers in Al-Ain, UAE. The overall prevalence rate was 23.1% and the major parasites found were Ancylostoma species, Ascaris lumbricoides, and Trichuris trichiura. The findings demonstrated that there was a gradual decrease in the numbers as well as the prevalence rates for the total intestinal parasitic disease from year to year throughout the period of investigation (1985-1988). These gradual decreases are noted in the Ancylestoma species, Entamoeba histolytica, and Hymenolepis nana. The low prevalence of Giardia lamblia and Entamoeba histolytica was remarkable. The rates were found to be higher in other Arab countries [1,5]. In addition, the high prevalence rate of intestinal parasites in Bangladesh [6], India [7], and Pakistan [8] are well documented. In southeast Asia, the infestation rate of intestinal parasites was found to be 80.1% in the coastal areas and reached 94.4% in the highland regions [12]. Among Filipinos, the most common parasites found were hookworms 44%, Schistosoma japonicum 16%, and Trichuris trichiura 12% [13]. In studies conducted on expatriates living in Saudi Arabia, 55.7% revealed single-parasite infestations and 10.5% of the expatriate population were found to be infested by more than one parasite [14]. Among the Saudi population, the prevalence rate was found to be comparatively low at 9.3% [3] and prevailing parasites were Giardia lamblia, Schistosoma mansoni, and Entamoeba histolytica[15]. But in the southern region of Saudi Arabia there was a relatively low infestation rate with intestinal parasites [16]. In the western region of Saudi Arabia, Entamoeba histolytica was found in 9.6% of the stool samples examined, followed by Giardia lamblia at 4.5% [17]. A study recently conducted by Ali et al [8] in Medina demonstrated that approximately 14% of 13,216 individuals harbored potentially pathogenic parasites in which the most common parasite was Giardia lamblia (33%) and the highest incidence of parasitic load was found to be among Sri Lankans (40.7%) [18].In the present study, we obtained a relatively low prevalence rate of intestinal parasites among expatriates working in the UAE when the results were compared with the expatriates' home countries [6–8,12]. However, this may be attributed to the concept that the UAE is considered to be an enticing place to work for workers seeking to improve their personal living conditions, especially those coming from socioeconomically poor countries. For these workers, the competition for employment is high, with employers selecting only the healthiest employees. Moreover, all expatriates have been subjected to medical examinations and laboratory investigations in their home countries prior to their arrival in the UAE.In conclusion, the present investigation demonstrates that the infestation rate remains a compromising health problem, especially when it has been noted that 96.8% of all detected types of parasites are transmissible and could easily be transmitted without the need of the vectors of transmission, animal reservoir hosts, or animate or mobile intermediate hosts. The highest prevailing parasites (Ancylostoma species, Ascaris lumbricoides and Trichuris trichiura) representing 84.4% of all positive cases are defined as “geohelminths.” All that is needed for transmission is inanimate soil [19]. Other less frequent parasites (Giardia lamblia, Entamoeba histolytica and Hymenolepis nana) are known to be infective through fecal-oral route. Thus, the actual possibility of spreading such diseases throughout the community may be a potential risk. It is recommended that expatriate workers be checked and treated if necessary on arrival in the UAE and examined upon returning from their annual home leave vacations. This policy must be strictly monitored, particularly for caterers and domestic workers.ARTICLE REFERENCES:1. Khan ZA, Al-Jama AA, Madan I. "Parasitic infections among food handlers in Dammam and Al-Khobar, Saudi Arabia" . Ann Saudi Med. 1987; 7 (l): 47–50. Google Scholar2. Farag HF. "Intestinal parasitosis in the population of the Yemen Arab Republic" . Trop Geog Med. 1985; 37: 29–31. Google Scholar3. Abu Al-Saud AS. "A survey of the pattern of parasitic infection in Saudi Arabia" . Saudi Med J. 1983; 4: 117–22. Google Scholar4. Abdel-Hafez MA, El Kady N, Noah MS, et al. "Parasitic infestation in expatriates in Riyadh, Saudi Arabia" . Ann Saudi Med. 1987; 7 (3): 202–6. Google Scholar5. Qadri SMH, Khalil SH. 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