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Globally helminth and protozoan parasites are one of the most serious public

health concerns with a widely distribution pattern in many countries and territories

particularly in tropical and subtropical developing countries and seen mainly in children.

Prevalence of intestinal parasitic diseases in each society considered as an indices of

health condition of region. Some personal (immunity condition, nutrition status, hygiene,

literacy, cultural habits, and etc.) and environmental factors like climate, geographical

position, poverty and socioeconomic status, poor sanitary conditions, and high density of

population may contribute to Intestinal parasites prevalence.

. Despite great efforts and improving the hygiene status in order to eliminate the

intestinal parasites, these infectious agents are still common in many areas throughout

the world. Pathogenesis, morbidity, and mortality of intestinal parasites are depending

upon species, climate, age, gender, immune system condition, nutritional status of the

host, and differ from person to person Intestinal parasitic infections remain as an

important public health problem in the Philippines. Numerous investigations in various

parts of the world have confirmed a direct correlation among the high rate of parasitic

infections and lower socioeconomic status of the area. Furthermore, poor sanitary and

environmental statuses are other critical epidemiological factors relevant with the

prevalence of these infectious agents

The effects of intestinal parasite infections vary according to species and burden

of infection. Studies indicate that parasitic infections cause malabsorption, diarrhea, and

other states of poor health. These parasites are commonly transmitted through ingestion

of contaminated food or water as a result of poor sanitation and hygiene. In some

instances, transmission occurs through close contact between infected and uninfected

individuals as in infected food handlers and consumers, respectively.

Food handlers are persons who have contact with food from the time of

preparation up to the time of serving of such to the consumers. A study conducted in

Malaysia showed that approximately 10-20% of food-borne disease outbreaks are due to

contamination by the food handlers. Proper screening procedure therefore may be

needed in order to diagnose food handlers, thus preventing possible morbidity and

protecting the health of the consumers.

The cross sectional study was done in the dietary section of a tertiary hospital in

Manila, where 102 food handlers are involved in preparation and serving of food to

patients and hospital staffs. The food handlers were screened by the local health unit

laboratory prior to clearance and issuance of health certificates. Permission was obtained

from the Hospital Director and the Chief of the Dietary Service of the hospital regarding

the conduct of the study.

The study has shown that intestinal protozoan infections among food handlers are

not uncommon with a rate of 42.4%. This finding is of particular significance since infected

food handlers may be at risk of developing illness themselves, and may pose a threat to

the health of consumers. All protozoans discussed in this study are transmitted via the

fecal-oral route. The pathogenic intestinal protozoans seen were Giardia lamblia (3.4%),

and coccidians (1.7%). Giardia has long been considered to cause diarrhea, and its

presence is typically associated with upper gastrointestinal symptoms. Patients suffering

from giardiasis often complain of periodic abdominal pain and recurrent or persistent

diarrhea. Intestinal coccidians cause transient, self-limiting infections, which may

manifest as mild diarrhea in immunocompetent individuals. However, in people who are

immunologically compromised, diarrheal episodes may be severe and prolonged.

Blastocystis hominis (40.7%), whose significance as a cause of human disease is still

uncertain, was seen in most of the infected study participants. This organism, in large

numbers, has been known to be associated with diarrhea; however, the pathophysiologic

mechanism for such remains unknown. Its presence has been reported in a wide variety

of intestinal disorders, such as bloating, flatulence, mild to moderate diarrhea, abdominal

pain and nausea.While Entamoeba coli (13.5%) and Endolimax nana (16.7%) are not

pathogenic, evidences indicates that when they are abundant, they may produce a mild

inflammation in certain regions of the large intestine, causing abdominal discomfort and

diarrhea. Although this last group of organisms is non-pathogenic, their presence among

the study participants may indicate that the food and water consumed are contaminated

with fecal material.

The absence of helminthic infections may be considered not unusual. Although

helminths such as Ascaris, Trichiuris and hookworm are considered to be the most

common helminths especially in developing countries. Similar results in a majority of

those who submit their stools for examination for pre-employment screening purposes

have been noted. It is possible that some of the study participants may have undergone

treatment with an anthelminthic drug before submission of stool specimens for

assessment. It is also possible that the obtained parasite rates were underestimated since

prior intake of deworming drugs was not considered.

Routine parasitologic examination of fecal material for intestinal parasites usually

includes examination of direct wet mounts prepared from fresh or preserved material and
examination of concentrated material. Direct wet mount examination of stool samples for

detection of common parasitic agents was less than half as sensitive as the examination

of concentrated material. Though the concentration technique was weighed down with

some shortcomings like cost of running the test, but still is reserved as the best method

for diagnosing intestinal parasites. There is a possibility of finding ova, cysts and larvae

among low excretes with concentration technique than direct smear method and it

exposes a higher percentage of infection missed by direct smear method. This will pave

a way in reducing the prevalence of intestinal parasites resulting from misdiagnosis.

Health personnel (laboratory technicians/scientists and clinicians) in developing

countries who rely on direct smear method should be aware that a person is not to be

classified as uninfected on the basis of a simple negative examination by the use of direct

smear. This study has shown that FECT has a higher detection rate compared with DFS

done once. Thus, FECT should be the technique used in screening stool samples of food

handlers. And should be adopted as a routine method in diagnosing intestinal parasites

or is incorporated with direct smear method, stool microscopy will continue as the most

important diagnostic method and at the same time reducing the traces of prevalence of

intestinal protozoan and helminth parasites ensuing from misdiagnosis.

The results also suggest the need to increase the awareness of food handlers and

responsible officials of food establishments on the importance of personal hygiene and

pre-employment / periodic health examination. Health education and improving facilities

environmental, especially in rural and semi-urban areas can be helpful. Along with those

epidemiological studies done for screening, determining the severity of infection and early

treatment of patients in order to adopting prevention program is necessary. It can be used

as basis for the improvement of the Operational Guidelines of the Sanitation Code so that

the public is not denied protection from possibly infected food handlers, and food handlers

are not deprived of an early diagnosis and treatment of intestinal parasites.