Anthropometric status, anaemia and intestinal helminthic infections in shantytown and apartment schoolchildren in the Sanliurfa province of Turkey.

OBJECTIVE: To study anthropometric status, anaemia and intestinal helminthic infections of schoolchildren living in better and worse socio-economic and environmental conditions in the Sanliurfa province of Turkey. DESIGN: Cross-sectional school-based survey. SETTING: The sample was selected using a multistage random cluster sampling technique. The urban area of the province is stratified into two strata on the basis of environmental conditions: shantytowns and apartment areas. A total of 12 schools in the shantytown areas and five schools in the apartment areas were randomly selected based on probability proportional size in the two strata. A third class (including 9-10 y-old children) was randomly selected in each school and all children in this class were selected for the survey. SUBJECTS: A total of 806 children, 572 of them from shantytown schools and 234 from apartment schools, took part in the surveys. Height for age, weight for age and weight for height were calculated by New Anthro software using the NCHS/WHO international reference values. The haemoglobin concentration was measured by the cyanmethaemoglobin method. Stool samples were examined by the semiquantative Kato-Katz technique. RESULTS: Evidence of chronic ill health was common due to undernutrition, anaemia and helminthic infections in shantytown schools. Both male and female children in shantytown schools had higher stunting rates than those of apartment schools. Underweight was significantly associated with the sex of the children in shantytown schools in that the boys had a significantly higher underweight rate than girls (P: 0.04), but this rate did not differ between sexes in apartment schools. Wasting was significantly associated with the type of settlements; the girls in apartment schools had a significantly higher wasting rate than those of shantytown schools (P: 0.02). The children in shantytown schools had significantly higher anaemia rates (45%) than those of apartment schools (15%) (P: 0.01). The prevalence of intestinal helminthic infections was significantly higher in shantytown schools (63%) than apartment schools (37%) (P < 0.0001). Ascaris lumbricoides was the most prevalent helminth and followed by Trichuris trichiura, Hymenolepis nana and Taenia species in both the study areas. Infection in children was significantly related to stunting in shantytown schools (multiple R = 0.147; P: 0.005) and in apartment schools (multiple R = 0.171; P: 0.02). CONCLUSION: These results indicated that the prevalence of stunting, anaemia and intestinal helminth infections constitutes an important public health problem among shantytown schoolchildren. School health programmes including deworming, feeding and micronutrient iron supplements through health education have a potentially beneficial effect on the health and education of schoolchildren.

Demographic and socio-economic factors affecting the physical development, haemoglobin and parasitic infection status of schoolchildren in Sanliurfa province, Turkey.

A cross-sectional population-based survey was undertaken to evaluate the relationship between nutritional status and parasitic infections of schoolchildren and demographic, socio-economic factors in Sanliurfa province, southern Turkey. Nine hundred and eight schoolchildren took part in the survey: 57.2% boys and 42.7% girls. The children's mean z scores were as follows: height for age-0.8 (+/-1.0) and weight for age-1.0 (+/-0.9). The mean haemoglobin concentration was 123 g/l (+/-2.1) and the prevalence of parasitic infections was 55.1%. In total, 50.2% of children were hungry when they arrived at school and 13.4% worked after school. Over 70% (70.4%) of mothers and 18.1% of fathers were illiterate, 16.1% of fathers were unemployed and 46.3% of fathers were engaged in low-income labour. The mean number of children in each family was 5.4 (+/-2.5), and the mean number of children from each family who attended school was 2.1 (+/-1.1). The school-attendance ratio was 0.4 (+/-1.0). Data indicated that older children had significantly lower mean z scores of height (P < 0.0001) and weight for age (P < 0.0001) than younger children, and boys had significantly lower mean z scores of height for age than girls (P < 0.0001). Children living in shantytown areas had significantly lower mean z scores of height for age (P < 0.0001) and weight for age (P < 0.0001), lower mean haemoglobin concentrations (P : 0.003)and a worse parasitic infection status (P < 0.0001) than those living in apartment areas. Children who were hungry when they arrived at school had significantly lower mean haemoglobin concentrations than those who had eaten (P : 0.04). Multiple regression analyses indicated that mean z scores of height for age were significantly related to maternal (multiple R = 0.183; P < 0.0001) and paternal illiteracy (multiple R = 0.216; P : 0.004). Mean z scores of weight for age were significantly related to maternal illiteracy (multiple R = 0.154; P < 0.0001), as was parasitic infection status (multiple R = 0.261; P < 0.0001 ) and the number of children in the family (multiple R = 0.267; P : 0.005). Hunger status was significantly related to maternal (multiple R = 0.095; P : 0.016) and paternal illiteracy (multiple R = 0.104; P : 0.005), as was belonging to a large family (multiple R = 0.104; p: 0.009). These findings indicate that school health programmes may improve the nutritional and health status of schoolchildren. The participation of the local community, which such a programme would entail, may help to increase maternal awareness regarding the feeding of their children before sending them to school. School health programmes may also motivate parents to send their daughters to school, thus increasing maternal literacy in the future. In turn, better levels of maternal literacy will positively affect the socio-economic development of society.

Erythrocyte antioxidative enzyme activities and lipid peroxidation levels in patients with cutaneous leishmaniasis.

Although cutaneous leishmaniasis (CL) is a local infection, the cellular immune response against the disease is systemic, and reactive oxygen intermediates (ROIs) are an important part of cellular immune response involved in killing the parasite. However, whether these intermediates cause oxidative damage in host is unknown. In this study, the metabolism of ROIs were investigated in patients with CL, and compared with healthy subjects. Erythrocyte lipid peroxidation was determined, as an index of oxidative damage, by measurement of malondialdehyde (MDA) levels. Erythrocyte MDA levels and SOD activities were found to be significantly higher in CL patients than in control subjects (p < 0.01 and p < 0.01, respectively). However, CAT and GSH-Px activities were significantly lower in the CL group (p < 0.05 and p < 0.01, respectively). There was a tendency to decreased hemoglobin (Hb) levels, but values did not reach statistical significance. These findings suggest that changes in antioxidant enzyme activities may amplify the leishmanicidal effect in patients with CL. However, these changes may not only cause the killing of parasite but also may cause oxidative damage in the other cells or tissues.

Environmental pollution with soil-transmitted helminths in Sanliurfa, Turkey.

Soil transmitted helminth (STH) infection are endemic in developing countries. A study was carried out of sewage farms, streams and vegetables to determine the sources and routes of STH infection in Sanliurfa, Turkey. Stool samples from farmhouse inhabitants as well as soil and vegetable samples from the gardens were collected and examined. In addition, water samples from streams and vegetable samples from the city market were collected and examined. One hundred and eighty-seven (59.5%) of a total of 314 samples, including 88.4% of the stool samples, 60.8% of the water samples, 84.4% of the soil samples and 14% of the vegetable samples, were found to be positive for STH eggs. These results indicate that the water, soil and vegetables are heavily contaminated, and suggest a vicious circle between humans and the environment. Improving environmental sanitation is imperative for the control of soil-transmitted helminthiasis in Sanliurfa.

Diagnostic performance characteristics of rapid dipstick test for Plasmodium vivax malaria.

We compared the diagnostic performance characteristics of newly developed method, the rapid dipstick test, which provides colorimetric determination by developing antibody to the lactate dehydrogenase enzyme of parasites, with conventional standard thick-blood film examination. For the rapid test, OptiMAL commercial kits were used. The results were also evaluated with clinical findings from patients. The parasites were determined by microscopic examination of thick-blood films from 81 patients with vivax malaria from southeastern Anatolia, Turkey. The OptiMAL test results were found to be negative in five patients who were diagnosed clinically and through thick-film testing as having vivax malaria. There was no false positivity observed with the OptiMAL test. We concluded that this rapid malaria test has a lower level of sensitivity than the classical thick-blood-film test for malaria, but that these methods have equal specificity.

Oxidative stress of platelets and thrombocytopenia in patients with vivax malaria.

Oxidative stress and antioxidative capacity of platelets and the relationship with thrombocytopenia were determined in patients with vivax malaria and compared with those of healthy subjects. Whole blood thrombocyte count, platelet superoxide dismutase and glutathione peroxidase activities of patients with vivax malaria were lower and platelet lipid peroxidation levels were higher in patients than those of healthy subjects. There was an important negative correlation between whole blood thrombocyte count and platelet lipid peroxidation level. The antioxidative mechanisms of thrombocytes were insufficient in malaria patients and caused oxidative stress. The oxidative damage of thrombocytes might be important in the ethiopathogenesis of thrombocytopenia occurring in malaria.

A comparative study on the different staining methods and number of specimens for the detection of acid fast bacilli.

The presence of acid fast bacilli in multiple specimens was investigated comparatively with Ziehl-Neelsen (ZN) and fluorescence microscopy (FM) staining in order to determine sensitivity in detecting tuberculosis (TB). A total of 465 specimens obtained from 295 patients were analysed at Harran University Medical School Hospital between March 1998 and March 2000. The culture was employed as the reference method. Sixty-eight patients (23.1%) were diagnosed as having TB by culture. The ZN and FM staining sensitivities were 67.6% (46/68) and 85.2% (58/68) respectively. Two hundred and one patients (68.1%) submitted one specimen to the laboratory. TB positivity was detected in 42 (20.9%) of these patients by culture. The sensitivities of ZN and FM stains were found to be 61% and 83% in these patients. However, in 18 patients (6.1%) who submitted two specimens to the laboratory, the TB was positive in six of them (33.3%) and ZN and FM sensitivities were 66% and 83% respectively. When three specimens or more were collected from the patients (76 patients, 25.8%), TB positivity was determined in 20 of them (26.3%) and the sensitivities were 80% and 92% in the ZN- and FM-stained smears, respectively. Our data indicate that in the diagnosis of TB, FM has greater sensitivity than ZN. In particular, in the case of a single specimen, the diagnostic value of FM is quite significant. It is, therefore, possible to conclude that both ZN and FM staining can be used for the diagnosis of TB when there are more than two specimens. However, if only one or two specimens are available, FM staining is preferable.

Efficacy of cryotherapy and intralesional pentostam in treatment of cutaneous leishmaniasis.

Forty-two CL patients with 60 lesions were treated with cryotherapy using liquid nitrogen twice for two months. Another group of fifty-five CL patients. With 73 lesions were treated with intralesional pentostam with pentostam, 67 of 73 lesions (92%) and with cryotherapy 47 of 60 lesions (78%) healed or markedly improved at the end of three months follow-up. This study shows that intralesional pentostam injection was effective than cryotherapy. However, both lines of treatment were well tolerated by the patients. They showed no severe side effects and no significant changes in laboratory values. It is suggested that cryotherapy is an alternative to intralesional pentostam injection.