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Chapter I Introduction and Background of the Study

Introduction

The existence of parasitism has brought about tremendous dilemma in human lives. The occurrence of it has widened dramatically. On global basis, parasitic infections affect approximately 50 million persons each year resulting in nearly 40-100 thousand deaths (Dhawan, Vinod, K.M.D). Thats why this is one of the major problems in developing countries where there is a deprived condition characterized by lack of clean water, clean food and sanitized environment.

Parasitism is referred to as the presence of organisms that take place up their abode temporarily or permanently on or within other organisms for the purpose of procuring food and shelter. It is caused by various parasites that are very injurious to humans. These parasites inhabit the human body either externally such as on the skin or internally such as the intestines, muscles, blood and the like. Moreover, the distribution of parasites depends on the presence of suitable host , the more susceptible host coming in contact with the parasites the more disseminated the parasites will be.

Actually, environmental condition and sanitation greatly affect intestinal parasitism which is caused by the invasion of soil transmitted intestinal parasites taking

up their abode in the human intestine. Specifically, Ascaris lumbricoides, Trichuris trichiura and Hookworms are the one involved in intestinal parasitism or helminthiasis.

According to World Health Organization Western Pacific Region, which covers East Asia and the Pacific, intestinal parasitism remains as a leading public health problem, affecting millions of children. In poor countries and communities, with inadequate sanitation and hygiene, it is common to find 90% of children infected with at least one parasite such as hookworm or roundworm. In addition, scavengers, garbage collectors and garbage truck drivers are also some group of individuals that are vulnerable in acquiring parasites because of the nature of their work. Several effects could be observed to them such as poor mental ability especially in children, poor health status and certain disease, intestinal parasitism specifically.

Consequently, intestinal parasitism is a worst disease since it is one of the neglected diseases. It is considered as a disease of poverty. They represent the most common diseases among 2.7 billion people including 610 million people living in Asia Pacific Region. They can basically be treated by means of cost-effective, safe interventions, yet most have been largely invisible to the public health community. Thus, policies to control and prevent these diseases are not in place in many countries. Furthermore, intestinal parasitism is not subjected to compulsory reporting resulting in insufficient data. It actually ranked higher than malaria and tuberculosis (disabilityadjusted life years-DALYs). In conjunction, since poverty affects it greatly, more and more individuals are parasitized. It is because millions of people are still stuck in poverty

and poor health with no sign of being able to breach the barrier to better medical care. For example, how can be cased of intestinal parasitism be lessen in areas where poor environmental sanitation is existing due to poverty and lack of education of course. Take for instance those who are living in and settling near dumpsites. With the fact that dumpsite is a dirty area, mere exposure to the soil is already a predisposing condition towards the acquisition of intestinal parasitism. Thus they really and hardly needed to be recognized and be declared under intestinal parasitism danger zone. They should be known to be vulnerable group from intestinal parasitism.

Thus, this way they can be given attention by the government and the public health community and be given some sorts of help. Health Education dissemination per se, then to be followed with interventions needed, the possible treatments, controls and preventions primarily.

They could be given the control measures and be extended with remedies from the government programs via the Department of Health. Like for example Garantisadong Pambata Programs being conducted twice a year nationwide. In conjunction, with the said program pursuing the advocacy, proper hand washing, and proper food preparation, proper footwear practices and human waste disposal could be shared too to them in the form of seminars or information education campaign. That way, they would become aware that living near dumpsite is simply putting their health at risk.

Given with such kind of focus, intestinal parasitism could be possibly reduced or even eradicated.

Statement of the Objectives

Generally, this study aimed to determine the prevalence of intestinal parasitism at Tuguegarao City dumpsite. Specifically, it aimed to: 1. Determine the intestinal parasites harbored by the residents of Tuguegarao City dumpsite as well as those garbage collectors and garbage truck drivers working in the dumpsite. 2. Determine if there is association on the parasites isolated and the degree of parasitism when grouped according to: a.) Sex b.) Educational Attainment c.) Marital Status d.) Livelihood 3. Identify intestinal parasites present in soil samples taken at Tuguegarao City dumpsite and from the vicinity of the residents. 4. Asses if the intestinal parasites harbored by the respondents are the same with those isolated from the soil samples.

Hypotheses Ho: 1) There is no association in the intestinal parasites harbored by the respondents with the species identified from the soil sample taken from the dumpsite and from the vicinity of the residents. 2) There is no association in the intestinal parasite isolated from the respondents when they are grouped according to: a. Gender b. Educational Attainment c. Marital Status d. Livelihood

Scope and Delimitation

This study restricted itself on the determination of the prevalence of intestinal parasitism among garbage collectors, garbage truck drivers and the entire residents settling near the dumpsite located at Carig Norte, Tuguegarao City. The parasites of concerned were Ascaris lumbricoides, Trichuris trichura and hookworm either in their ova or larvae forms. Information education campaign (IEC) was conducted by the researchers on July 5, 2010 simultaneously with the orientation (on how to properly collect stool samples and when to collect them). An interview to the respondents was also conducted in coordination with the dumpsite personnel.

The study analyzed stool specimen coming from the 47 respondents (20 from the residents and 27 from the garbage truck drivers and garbage collectors) and 30 soil samples (15 samples were taken at the dumpsite area and 15 samples were taken at the vicinity of the residents beside the dumpsite). Stool cups were used as containers for the specimens. Furthermore, the collection of stool specimen was conducted on July 11, 2010 to July 27, 2010 respectively. The collection of stool specimens was done once in every respondent and there was no replication or another trial conducted. It was accomplished in several consecutive dates because of the difficulty in collecting the stool specimens due to the poor compliance of the respondents. After the collection of stool specimen the stool specimens were preserved using 10% formalin and immediately transported in the laboratory together with the soil sample. The soil samples were not preserved since it was not necessary. Moreover, Formalin Ether Concentration Technique (FECT) was the laboratory procedure utilized in both the stool specimens and soil samples. After which, microscopic examination was performed in the identification of intestinal parasites present in the specimen with the help of an expert Parasitologist. All the laboratory testing was conducted at Cagayan State University, Andrews Campus, College of Allied Health Sciences, Clinical laboratory.

Significance of the Study

The result of the study was useful and beneficial to the following individuals and agencies:

The study was deemed beneficial to the Department of Health (DOH) specifically the DOH region 02 for they could use this study to strengthen their ongoing projects regarding parasitism such as the Garantisadong Pambata Program and any other projects related for that matter, for the upliftment of the health status of the people concerned.

The study was also a great help on the City Council of Tuguegarao and other Local Government Units for, this served as an eye opener for the real situation of the people who are in contact to the dumpsite. On the other hand, this could be a driving force for the government officials to give more priority and exert more effort to combat the problem regarding parasitism, such as providing protective suits and materials to the people at the dumpsite.

Furthermore, the respondents of this study were mainly benefited since they were informed and already aware on their health status specifically the presence or absence of intestinal parasites within them. They were also had a free fecalysis and being educated on the prevention, control and treatment of intestinal parasitism invasion.

This study, in a way, was a good source of help to the future researchers. This served as a useful material for reference purposes where insights collaborate and ideas take place for a much better research. Moreover, this research study was the researchers help and a valuable contribution in eradicating the problem on intestinal parasitism primarily at Tuguegarao City dumpsite.

Definition of Terms

Dumpsites isolated area where garbage coming from the people of Tuguegarao City including the municipality of Iguig is being disposed. Parasites intestinal parasites like Ascaris, hookworm and Trichuris that mainly resides in the intestine. Formalin Ether Concentration Technique (FECT) laboratory technique used in the determination of the prevalence of intestinal parasitism at Tuguegarao City dumpsite employed via fecalysis and soil analysis. Fecalysis stool processing used in the analysis of the stool from the respondents. Marital Status status of the respondents whether they are married, single or widow. Gender either the respondent is a boy or a girl. Educational Attainment highest degree in education the respondents attained. Livelihood source of living of the respondent either scavenging, garbage collecting or garbage truck driving.

THE PARADIGM Input Process Formalin Ether Concentration Stool specimen And Soil sample Technique Microscopic identification of parasites Output

Figure 1.1 The paradigm showing the relationship between the input and output.

Conceptual Framework

Parasitism is one of the basic problems in third world countries like Philippines specifically, intestinal parasitism. It is a widespread problem affecting many people in areas with poor environmental sanitation wherein people are not educated on its effects. Intestinal parasitism is commonly caused by three main species of soil transmitted intestinal parasites which include Ascaris lumbricoides, Trichuris trichura and hookworm. These parasites are commonly called the unholy three because of the bad effects on their host and with the assumed possibility that having even just one of the three species may mean also a tendency of harboring one of the other two or the other two per se . They abode into the intestine which can cause poor mental ability especially in children, poor health status and certain disease which is intestinal parasitism like ascariasis and trichuriasis.

Here in Tuguegerao City, the residents near the dumpsite who are scavenging including the garbage collectors and garbage truck drivers are the ones usually prone to have intestinal parasite thats why they are considered to be the vulnerable group. It is hard to avoid the direct contact of these people with the garbage and the soil in the dumpsite because of the nature of their work.

In order to know if they have acquired such parasites, studying their stool and soil from the dumpsite is very essential to determine the specific parasites present. 10% Formalin-Saline was used as a preservative for the stool specimens in order to prevent rapid decomposition. Moreover, Formalin-Ether Concentration Technique was used as a laboratory technique because it is excellent for concentrating both cyst and ova and possesses the added advantage that may apply to formalin-preserved specimens (Markell et al.).

Furthermore, microscopic examination was then conducted, this is so to determine the presence of parasite with the help of an expert Parasitologist.

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Chapter II Review of Related Literature and Studies Soil-transmitted infections persist in areas where personal hygiene and environmental sanitation practices are poorly carried out and where cases remain untreated and become continuing sources of infections. A high prevalence of intestinal parasitism is also generally associated with areas that are basically agricultural and low in the economic and human development scale. The three major causes of intestinal parasitism in the Philippines are ascariasis or roundworm infection, trichuriasis or whipworm infection, and hookworm infection. Thus, in order prevent such parasitic infection, proper sanitary practices must be strictly followed. Factors Affecting Intestinal Parasitism Sanitation Sanitary habits such as hand washing, toilet flushing and use of human manure, cleanness of drinking water and also the educational level of the parents are some factors affecting intestinal parasitism. The term Hygiene suggests set of practices associated with preservation of health and living a healthy life. Hygiene correlates with personal and professional care practices followed at every aspects of healthy living. Hygiene could be of many types such as medical hygiene, body hygiene, dental hygiene, domestic hygiene at every level is necessary for healthy living, sanitary hygiene is something that is promoting health by avoiding human contact with the hazards of waste. The term sanitary is derived from the word sanitation.

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The term sanitation is applied to a particular concept, aspect, strategy or location for basic sanitation, on site sanitation, food sanitation, environmental sanitation and ecological sanitation. A good sanitary habit includes following hygienic practices. Poor sanitary habits can create health problems and the spread of diseases. A good sanitary habit can only be followed if the individual is supplied with proper sanitary supplies. Sanitary supplies are necessary in a crisis situation. There are hygiene supplies available in market that supports you even when you are without water as a cleansing source for several days. Hygiene and sanitary supplies are the primary tools for achieving good where elementary cleanliness is the basic criterion. Neglect of hygiene and sanitary issues resulted into problems and diseases of which we sometimes were not even aware of. Everybody part demands attention at regular intervals, as far as cleansing them is concerned. Sometimes we complain about conditions that disturb our daily regimen appearing as a threat to personal hygiene. Some health conditions that can be controlled by improving personal hygiene include intestinal parasites like roundworms. There are sanitary supplies readily available in market that can well be used for both in crisis situations and also in daily hygiene. A good hygiene is the only method of preventing infections. One most effective method of preventing ourselves from illness is practicing good personal hygiene. Sanitary and hygiene is a wide concept which includes practices such as bathing, washing hair, brushing teeth and cleaning clothes.

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Poverty In relation to sanitation poverty could also be a factor. For instance a sizable chunk of the population lives in squatters areas where environmental sanitation is poor and the surroundings harbour the parasites. Parasites reside in warm moist soil and dirty surroundings. The poor population does not have the capacity to go to school so they are not aware of the mode of transmission of parasitic agents. Being unaware of these, they would not take precautions. Those who were found out to be infected could not go for treatment because of financial constraints. The lucky ones who were able to sometimes lack the financial capacity to buy needed medicine or when they have money, the medicine is scarce. There are not enough health centres and health professionals to conduct efficient health services. Socio-economic Status In conjunction, poverty greatly affects socio-economic status of a place, thus socio-economic status could also be a factor towards the risk of intestinal parasitism. The socio-economic conditions prevalent in third world cities differ markedly from those in industrialized countries. Third world cities are experiencing rapid urbanization brought about by fast population growth as well as high immigration rates. Urbanization often takes place as the expansion or creation of new slum areas and squatter settlements. Their rapid expansion and the lack of resources to provide them with the necessary infrastructure and urban services translate into insufficient collection of the wastes generated, as well their improper disposal on the streets, of their operational budgets on

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waste management, third world cities only collect between 50 and 80% of the refused generated. Consequently, in third world cities, sometimes the rural areas are unattended because of the lack of personnel and medical equipment. Due to several people with parasitism, re-infection occurs and when auto infection parasitism keeps recurring because of the inability to live in clean, comfortable and healthy environment. The presence of secondary hosts are more common in third world countries because families tend o place their poultry and pigpen for example near their abode because of lack of space and ignorance of diseases and parasites of these animals could pass on to humans. Soil Transmitted Intestinal Parasites There are three main intestinal parasites that are soil transmitted. They are commonly known as the members of the unholy tree. Ascaris lumbricodes

Figure 2.1 Ascaris lumbricoides Ova First, is Ascaris lumbricoides or the giant roundworm is one of the most common, if not the most common helminth infecting our young population. It lives in the small intestine, and found worldwide but is more prevalent in warm moist regions of the world. It is also one of bigger-sized worms with adult males 15 31 cm long by 24 mm and

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adults female 20 35 cm long by 3 -6 mm. Males have a curved a tail, while females have a straight brown in color and have mammilated, thick shell. They are in the onecelled stage when passed in feces. In certain, instances, the outer albuminoid, mammillated layer may be absent, and as such, they are called decorticated eggs. Infertile eggs are elongate, 85 90 um by 43 47 um, and have thin shells with the mammillated layer varying from grossly irregular mammillations. Its content is typically a mass of disorganized, highly refractive granules. Females worms lay eggs and are therefore called oviparous. Unembyonated eggs in feces pass on the soil, where they undergo further development for 2 3 weeks. Each will contain an infective second stage larva. When infective eggs are ingested, larvae emerge in the small intestine and undergo an obligatory migration for about 8 9 days through the lives and the lungs. In the lungs, they undergo considerable growth to reach a length of 1 mm. after which they return to the small intestine where they were grow to maturity in about 2 months. When the worm causes disease during the phase of larval migration, it is called Ascaris pneumonitis or some references would call it loefflers syndrome. The erratic migration of adult worms to extra intestinal locations, in the liver for example, makes the presence of even one worm a potentially serious danger to the human host. This worm is very important is very important cause of abdominal pain among infected individuals. When a form is passed out with feces, it is easily recognizable because of its relatively large size. In fact, it is probably the most commonly seen and recognized worm in endemic communities. When this happens, it is likely that other worms remain inside. In the laboratory ascariasis is diagnosed by demonstration of characteristic eggs in feces.

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Ascaris eggs are produced in such large numbers such that even with a single pair of worms present. The eggs are easily detected by direct fecal smear. Infertile eggs maybe missed if only a flotation concentration procedure is done for fecal examination. Infertile eggs may also pose diagnostic problems if the outer mammillated layer is totally absent or if egg assumes a typical shape. Fertile eggs concentrate well by sedimentation or flotation concentration procedures. Trichiuris trichura

Figure 2.2 Trichiuris trichura Ova Secondly, is Trichiuris trichura or whipworm which lives in the large intestine, cecum or appendix. Like Ascaris, it is found worldwide, but more especially in warm, moist regions of the world. Males have a called posterior end and measure 35 50 mm. Adults worm have a long, slender, whip-like anterior end. And a thicker, short posterior end. The esophagus consists of a thin-narrow tube surrounded by a column of glandular cells called stichocytes which are collectively referred to as the stichosome. Whipworm eggs are 5055 um by 22-24 um and barrel shaped. They have a yellow-brown color with a thick shell, and clear, mucoid plugs at each end. They are unembryonated when passed.

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Like ascaris, trichuris females are oviparous. Eggs pass on to soil where they undergo development for 2-3 weeks, after which they contain an infective first stage larva. When infective eggs are ingested, larvae emerge in the intestine and migrate to the large intestine where they develop to maturity. The prepatent period is about 3 months. This worm is quite sturdy and may not be expelled easily by the best deworming drug available. Adult worms may live for up to 10 years or more. Whipworm infant is diagnosed by demonstration of characteristics eggs in feces. The eggs are easily recognizable although in light infants, they maybe difficult to find in fecal preparations, unless concentration techniques are used. In patients treated with antihelminthics, distorted eggs maybe passed in feces.

Hookworm

Figure 2.3 Hookworm Ova Third and lastly is the Hookworm, which has variety of species like Necatur americanus and Ancylostoma duodenale. In the Philippines, the former is encountered more frequently than the latter. Hookworms inhabit the small intestine and they are an important cause of chronic anemia of the microcytic- hypochromic type.

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Necatur males measure 5-9 mm by 0-3 mm and are bursate, with two spicules that fuse at their distal end. Females are 9-11 mm byo-4 mm. adults have a buccal capsule containing cutting plates rather than teeth. Eggs are thin-shelled and colorless, measuring 60-75 um by 36-40 um. They are usually in early cleavage when passed in feces. First stage rhabditoid larvae that hatch from eggs are 250-300 um long by 17um. They have a long buccal canal and their genital primordium is small and difficult to see. Infective third stage platiform larvae are 500-600 um long. They have a pointed tail and a ratio of esophageal to intestinal length of 1:4. The sheath about the larvae is conspicuously striated. Ancyslostoma males measures 8-11 mm by 0.4-0.5 mm. (Adults have) and are also bursate, with two spicules that do not fuse at their distal ends. Females measure 1013mm by 0.5-0.7 mm. Adults has a buccal capsule containing two pairs of teeth. Eggs are thin-shelled and colorless, measuring 55-65 mm by 36-40mm. First stage habditoid larvae hatch from eggs are 250-350 um long by 17 um. They a long buccal canal and their genital primordium is small and difficult to see. Infective third stage filariform larvae are 600-700 um long. They have a pointed tail and a ratio of esophageal to intestinal length of 1:4. Unlike Necatur, the sheath is not as conspicuously striated. Hookworms are oviparous. As in the previously describe soil transmitted helminthes, eggs are shed in feces on to soil where they embryonate and hatch approximately 24 hours. Larvae reach the infective first stage in about a week. Human infections are acquired by skin penetration by these larvae. For ancylostoma, human infection is also obtained by mouth. Larvae undergo further development in the lung prior to migration to the small intestine. The prepatent period is about 5-6 weeks. The usual

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life span of necatur is between 3-5 years, while that of ancylostoma is between 5-10 years. Necatur adults may live up to 15 years. Eggs of necatur are indistinguishable from those of ancylostoma. If hookworm eggs hatch in feces because of a delay in examination, the first stage larvae must be differentiated from those of strongyloides. At first stage, larvae hookworm has a long buccal canal and an inconspicuous genital primordium, while the larvae of strongyloides have a short buccal canal and a prominent genital primordium. Stool specimens must not be refrigerated before attempting to culture larval stages since necatur is especially sensitive to cold.

Formalin-Ether Concentration Technique Concentration procedures are used to concentrate the parasites in a specimen and increase the likelihood of detecting the parasite while decreasing the amount of fecal debris. Fresh or formalin-fixed specimens maybe concentrated by sedimentation or floatation techniques. A common sedimentation technique is the Formalin-Ether Acetate Method. This method retrieves sediment of parasites such as helminthes ova and protozoan oocyst using centrifugation. With various sedimentation methods, eggs and cysts which are heavier than the suspending fluid become concentrated in the bottom of a tube. The Formalin-Ether Sedimentation technique is excellent for the concentration of both cyst and ova and possesses the other advantage that may be applied to formalin preserved specimens. After centrifugation, the diagnostic material is transferred to a

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microscope slide. It is well to make a habit examining completely every concentrated preparation with low power objective of the microscope. Related Studies Intestinal Parasitism Parasitic infection caused by intestinal helminthes and protozoan parasite, are among the most prevalence infection in humans in developing countries, protozoan parasite more commonly cause gastrointestinal infection compared to helminthes. Intestinal parasite causes a significant morbidity and mortality in endemic countries. According to Nada A. Abahussian, PhD in her study entitled prevalence of intestinal parasites among expatriate workers in Al-Khobar, Saudi Arabia. The prevalence of parasitic infection is 31.4% - 22.3% are single infection and 9.1% with multiple infections (double and triple and quadruple). Hookworm, Trichuris trichura, and Ascaris lumbricoides were the most common infections in all nationalities. Parasites were found to be more prevalent among Indians followed by Indonesians, Filipinos then Sri Lankans. In addition, the prevalence rate found in this study was high enough to merit a spotlight on it as a problem. Health education should be then increased to raise awareness of the society about such a health problem. Consequently, Simmona Penizzi, Chiara Gorrini,Gionanna Piccolo, Adriana Calderaro, Giuseppe Dettori, Carlo CHezzi stated in their study that 148 patients

(13.24% were affected by intestinal parasitosis. Among the 951 Italians, 96 (10%) were infected, while out of a total of 166 foreigners 52 had intestinal parasitosis (31%). Moreover, we found that 113 infections were caused by only one parasite while 35 were mixed infections. In addition, intestinal parasitosis represents a remarkable cause of

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gastrointestinal disease and our study demonstrates that these infections are quite common in our area, affecting both Italians and non European citizens from developing countries. Moreover, according to I. Jamaiah and M. Rohela Department of Parasitology. Faculty of Medicine University Malaya, Kuala Lumpur, Malaysia entitled prevalence of intestinal parasites among members of the public in Kuala Lumpur, Malaysia. The overall infection rate was 6.9% (17 out of 246), with Trichuris trichiura being the most common parasite (4.5%), followed by Ascaris lumbricoides (0.8%), Clonorchis sinensis (0.8%), hookworm (0.4%), and Entamoeba histolytica (0.4%). None of these participants showed any clinical symptoms. The highest infection rate was in the age group 16-30 years, which was 9% (6 out of 67). While, according to Fadel A. Sharif entitled prevalence and seasonal fluctuations of common intestinal parasites in Khan Younes, 1996-2000. Of the 5,704(32.14%) were found to be positive. The overall prevalence of the common parasites was: Entamoeba histolytica (54.08%), Giardia lamblia (22.84%), and Ascaris lumbricoides (20.21%). The overall monthly incidence of parasites showed significant seasonal fluctuations. Peak incidence of intestinal parasites occurred during the summer season (June to August), and the lowest was during the winter season (December to February). The prevalence of intestinal parasites has dropped significantly over the reviewed years from 42.87% in 1996 to 23.86% in 2000 (p<0.01). Prevalence of Ascaris lumbricoides decreased from 28.38% to 7.64%. Furthermore, according to the study entitled prevalence of intestinal parasitic infestation in school children in the Northeastern part of Kathmandu Valley Nepal by

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Batu Krishna Sharmal, Shiba Kumar Rail, Diyo Ram Rai2 and Deepali Roy Choudhuryl. The overall prevalence of parasitosis was 66.6% (395/533) with no significant difference between boys and girls (p<0.05). Tibeto-Burman children had a non-significant higher prevalence, compared with Indo-Aryan and Dalit children (p<0.05). Half (53.8%; 191/355) of the children had multiple parasitic infections. Altogether, nine types if parasites were recovered. The recovery rate of helminthes was higher (76.9%) than protozoa (23.1%). Trichuris trichiura was the most common helminth detected, followed by hookworm, Ascaris lumbricoides and others. In addition, according to the study entitled detection and prevalence of intestinal parasites in patients in Abeokuta, South-western, Nigeria by I.O. Okonko, F.A Soleye, T.A. Amusan, O.K.Mejeha, E.T. Babalola and O.A. Adekolurejo. The overall prevalence was 6.6% and mostly in females (7.1%) than in males (6.4%). More parasites were detected in stool samples collected in 2002 (23.6%) than other years studied, there was also significant difference in the years under study (P=0.05). The parasites include: Ascaris lumbricoides [57(38.8%)] and Schistosoma Mansoni [4(2.7%)] and

trophozoites/cysts of Entamoeba histolytica [76(51.7%)]. There were cases of multiple infection of Ascaris lumbricoides and E. histolytica [10(6.9%)]. Likewise, according to the study entitled Intestinal Obstruction due to Ascaris by Jesus Miguel Galiano Gil. More than a billion people worldwide are infected with one or more species of intestinal nematodes. The ascariasis is one of the roundworm parasites more commonly seen of human being and it is calculated that the world populations fourth part is infected. Although that the clinical pictures of this illness courses mostly with silent form or chronic symptomatology, the massive infestation in children can give

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place to serious complications that required emergency surgical treatment with a favorable evolution.

Cross, J.H., Alquiza, G. and Ranoa, C. of San Lazaro Hospital, Manila, Philippines, also said in their study that intestinal parasitic infections are not unique to the Philippines and a number of reports are published on prevalence rates dating back to the beginning of the century. Cabreral in 1971 reviewed data from 1908 to 1970 and recently Cross and Basaca-Sevilla (1984) published a report on stool examinations conducted among many of the Philippine Isalands. In these surveys of urban and rural populations, over 30,000 single stools were examined and 86% were found to have one or more intestinal parasitic infections. In 1980, the U.S. Naval Medical Research Unit No.2 (NAMRU-2) initiated a variety of studies in collaboration with the staff at San Lazaro Hospital. Most patients involved in these studies submitted stool specimens that were examined by the NAMRU Parasitology laboratory. This report presents the result of those examination performed from 1980 until 1984.

Finaly, Baldo, E.sT., Belizario, V.Y., et.al., stated in their study entitled Infection status of intestinal parasites in children living in residential institutions in Metro Manila, the Philippines, a small scale survey was performed to know the infection status of intestinal parasite in children of the residential institutions and street communities in Metro Manila, Philippines. A total of 284 stool samples from 11 institutions and 3 street communities were examined by the formalin-ether concentration method. The scotch tape anal swab was adapted to 121 children to investigate the infection status of Enterobius

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vermicularis. It was found out that 62.0% of the children examined were positive for one or more intestinal parasites. Multiple infections were observed in 34.2% of the children. Among 172 children who gave detail information, the prevalence for Ascaris lumbricoides, Trichuris trichiura, and hookworm was 36.0%, 44.8%, and 7.0% respectively. Of the children examined, 47.7% were found to be harboring parasitic protozoans such as Entamoeba histolytica, Giardia lamblia, and Blastocystis hominis. The most prevalent of these protozoans was B. hominis with an infection rate of 40.7%. The prevalence of these infections among children living in institutions was relatively high. More efforts should be made to implement anthelminthic programs including biannual follow-up treatments.

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Chapter III Methodology

Research Design

The research design utilized in the study was experimental post-test design. This is so because the stool specimen coming from the respondents and soil samples taken from the dumpsite and at the vicinity of the residents near the dumpsite were examined just after the specimen collection process via Formalin Ether Concentration Technique followed by a microscopic examination. In addition, analysis and interpretation of the results were done after.

Time and Locale of the Study

The study was conducted at the 10.6 hectare dumpsite located in Carig Norte, Tuguegarao City, between the municipality of Iguig and Tuguegrao including its nearby residential area. Moreover, microscopic examination was performed in Cagayan State University, Andrewss campus, Tuguegarao City, Clinical Laboratory.

It was conducted from June to September 2010. The specific dates were the following:

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First, ocular observation and meeting with the dumpsite personnel was done on June 28, 2010. It was followed by the orientation and Information Education Campaign (IEC) as well as an interview to the respondents on July 5, 2010. After which the simultaneous collection of soil samples and stool specimens were done. It was conducted from July 11, 2010 to July 27, 2010. Dissemination of the results to the respondents was next on September 2, 2010.

Research Instrument

Administration of microscopic examination was needed in the study which was used to gather the necessary data in the determination of the prevalence of intestinal parasites harbored by the respondents via stool specimens as well as the identification of parasites presents in the soil samples. The following materials, equipment and solution were utilized: microscope, glass slides, stool cups, cotton, cover slips, applicator sticks, dropper/pipette, centrifuge tubes, gauze, graduated cylinder, weighing balance, beakers, alcohol, ether/ethyl acetate, 10% formalin, .85% Normal Saline solution, and parafilm.

Respondents and Sampling Procedure

The respondents of the study were all the residents near the dumpsite who are scavengers. In addition, garbage collectors, and garbage truck drivers were also included.

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Sampling was done with regards to the gender, educational attainment, marital status and livelihood of the respondents. Slovins formula was utilized to determine the specific number of respondents needed.

Collection and Processing of Data

The researchers asked permission from the two officers-in-charge at the dumpsite and at the same time the researchers did an ocular observation. After permission was granted, the researchers conducted an orientation, and an Information Education Campaign (IEC) among the respondents regarding the research study, the presence of intestinal parasites in the area, mode of transmission, parasitic infections and interventions as well as the proper collection of stool specimens and when the proper time to collect. After which, they also conducted an interview to illicit the respondents name, educational attainment, marital status and livelihood. These parameters were further correlated to the result of microscopic examination. At the scheduled time of submission of the stool specimen, the researchers collected the specimens including soil samples and immediately transported them into the college of Allied Health Sciences, Clinical Laboratory. When the researchers had arrived at the laboratory, stool specimens were preserved with 10% formalin prior to processing. The soil samples were not preserved unlike the stool samples. After that, they performed Formalin Ether Concentration Technique. This laboratory procedure was done both on the stool and soil samples however, in the processing of stool sample, the sediments were

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used and the supernatant was discarded whereas in the processing of soil samples it was vise versa. The following chronological procedures of the said technique shall follow which was followed by the researchers:

1. The researchers thoroughly comminute approximately 1.0 to 1.5 g of fresh stools in 10ml 10% formalin in a suitable container. They stand for 30 minutes or longer to achieve adequate fixations for very loose or watery stool samples. They used 5 to 6ml of material. 2. They strained the suspension through two layers of wet gauze and they poured into 15 ml conical centrifuge tube. 3. They fill the tubes with NSS, they centrifuged at 400 500 g for 1 2 minutes. 4. They discarded the supernatant if cloudy; they resuspended the sediments then centrifuge again using NSS. They proceed to the next step only after the supermarket was clear. 5. They resuspended the sediment in 10% formalin to a volume of 10 ml; added 3 ml of ether then shaked vigorously for 30 seconds. 6. They centrifuged at 400 500 g for 2 3 minutes. When tests was removed, they saw four layers: (a) a to layer of ether (b) a plug of debris adhering to the walls (c) a layer of formalin and (d) sediment for examination. They inserted an applicator stick with cottoned tip to ring and loosend the plug of debris and then eventually decanted it.

28

7. They did wet mount preparation and then microscopic examination with the help of an expert parasitologist. Iodine was utilized for ease and better viewing.

29

Asking permission by the researchers to the officer-in-charge at the dumpsite Ocular observation

Orientation and IEC, and Interview Collection of stool specimen and soil sample Preservation of stool specimen Fecalysis (Formalin Ether Concentration Technique (FECT) and soil analysis Microscopic examination Validation (by an expert Parasitologist) Analysis and Interpretation of Data

Figure 3.1 the flow chart

30

Statistical Tools for Data Analysis Test for correlation was utilized in correlating the microscopic results as to gender, educational attainment, livelihood, and marital status. It was further statistically analyzed using Chi-Square test of independence. In addition, Chi- Square goodness of fit was then utilized to determine the significant association between the parasite identified in the stool specimen and the parasites present in the soil samples.

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Chapter IV DATA PRESENTATION, DISCUSSION AND INTERPRETATION

The succeeding presentations revealed the results obtained in the statistical determination of the prevalence of intestinal parasitism at Tuguegarao, City dumpsite.

Table 4.1 Gender and Individual Parasite Count Cross tabulation. Result Gender Male Female Total Chi-square test NOPS 27 4 31 Value 2.105a Ascaris lumbricoides 11 3 14 Df 2 Hookworm 1 1 2 P value 0.349 Total 39 8 47

This table shows the frequency count of specific soil-transmitted intestinal parasites with regards to respondents gender. Based on the result of the Chi-square test of independence, at 5% level of significance, thus there was no association between gender and the parasites isolated from the respondents (Pvalue=0.349). However, there was a violation of the assumption of chi-square test of independence so categories from the column of parasites were combined to make the chisquare result more reliable.

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Table 4.2 Gender and Parasite Count Cross tabulation Gender Male Female Total Chi-square Test Result NOPS Parasite 27 12 4 4 31 16 Value Df 1.0939 1

Total 39 8 47 Fisher Exact Test Value 0.416

This table shows the frequency count of all the soil transmitted intestinal parasites with regards to the respondents gender. Based from the result of the chi-square test of independence with a fisher exact value of 0.416 at 5% level of significance there was really no significant association. Meaning, species of parasites isolated from the respondents has no bearing with gender of the respondents.

Table 4.3 Educational Attainment and Individual Parasite Count Cross tabulation. Educational Attainment Result Ascaris Lumbricoides 0 8 4 2 14 df 6 Hookwor Total m 1 7 1 23 0 13 0 4 2 47 P value 0.436

NOPS

Not yet studying 6 Elementary graduate/level 14 High school graduate/level 9 College Graduate/level 2 Total 31 Chi-square test Value 5.8909

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This table shows the frequency count of specific soil-transmitted parasite with regards to educational attainment of the respondents. Based on the result of the chi-square test of independence with a P value of 0.436 at 5% level of significance thus, there was no significant association, this means that parasites isolated from the respondents were not been affected by educational attainment. However, there was again a violation of the assumption of chi-square test of independence so categories from the column of parasites were combined to make the chisquare result with regards to marital status more reliable.

Table 4.4 Educational Attainment and Parasite Cross tabulation. Educational Attainment At most elementary graduate /level At least high school graduate/level Total Chi-square Test Result NOPS Parasite 20 10 11 6 31 16 Value df 9 0.019 1 Total 30 17 47 Fisher Exact Value 0.569

This table shows the frequency count of all the soil transmitted intestinal parasites with regards to educational attainment of the respondents. Based from the result of the chi-square test of independence with a fisher exact value of 0.569 at 5% level of significance, there was again no association. This clearly implies that parasites isolated from the respondents had not been affected by educational attainment.

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Table 4.5 Marital Status and Individual Parasite Count Cross Tabulation. Result Marital Status Single Married Total Chi-square NOPS 7 24 31 Value 2.056 Ascaris lumbricoides 1 13 14 Df 2 Total Hookwor m 0 8 2 39 2 47 P value 0.358

This table shows the frequency count of the specific soil-transmitted intestinal parasites with regards to marital status of the respondents. Based from the result of the chi-square test of independence with a P value of 0.358 at 5% level of significance, there was no association. This result simply means that parasites isolated from the respondents had not been affected by marital status of the respondents. However, there was also a violation of assumption of chi-square test of independence as two preceding parameters do. In conjunction, categories from the column of parasites were combined to make the chi-square result more reliable.

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Table 4.6 Marital Status and Parasite Count Cross tabulation. Marital Status Single Married Total Chi-square Test Result NOPS 7 24 31 Value 1.9939 Parasites 1 15 16 df 1 Total 8 39 47 Fisher Exact Test 0.234

This table shows the frequency count of all soil-transmitted intestinal parasites with regards to marital status of the respondents. Based on the result of the chi-square test of independence with a fishers exact value of 0.234 at 5% level of significance has no association. This result implies that marital status has really o effect on the parasites species isolated from the respondents.

Table 4.7 Livelihood and Individual Parasite Count Cross tabulation. Result Livelihood Not applicable Scavengers Garbage Collector Garbage Truck Drivers Total Chi-square NOPS 7 8 14 2 31 Value 14.38 9 Ascaris Lumbricoides 0 3 6 5 14 Df 6 Total Hookworm s 0 7 2 13 0 20 0 7 2 47 P Value 0.026

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Phi Cramers V

Value 0.553 0.391

P Value 0.026 0.026

This table shows the frequency count of specific soil-transmitted intestinal parasites with regards to livelihood of the respondents. Based from the result of the chi-square test of independence with a P value of 0.026, association was found to exist. In addition, with a P value of again 0.026 in terms of Phi and Cramers V when symmetrically measured, it was showcased that there is a strong degree of association. Meaning livelihood is strongly associated with the parasites isolated from the respondents. However, there was a violation of the assumption of chi-square test independence so categories from the column of parasite were combined to make the chi-square result more reliable.

Table 4.8 Livelihood and Parasite Count Cross tabulation. Livelihood Not applicable Scavengers Garbage Collector Garbage Truck Drivers Total Chi-square Phi Cramers V Result Total Parasite NOPS 7 0 7 8 5 13 14 6 20 2 5 7 31 16 47 Value df P Value 8.229 3 0.042 Value P Value 0.418 0.042 0.418 0.042

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This table shows the frequency of all the soil-transmitted intestinal parasites with regards to livelihood of the respondents. Based from the chi-square test of independence with a P value of 0.042 at 5% level of significance, there was no association. It was further symmetrically measured wherein Phi and Cramers V P values is 0.042 again. This simply means that, there is a strong degree of association as the result of the first measurement implied. However, like the first one, there was still a violation of the assumption of chisquare test of independence so categories from the column of parasites were again recombined to make the chi-square result exactly reliable.

Table 4.9 Categorized Livelihood and Parasite Cross tabulation. Result Livelihood Not applicable On garbage exposure Total Chi-square Phi Cramers V NOPS 7 24 31 Value 4.245 Value 0.301 0.301 Parasite 0 16 16 df 1 Total 7 40 47 Fisher Exact Test Value 0.042 P Value 0.039 0.039

This table shows the frequency count of all the soil-transmitted intestinal parasites with regards to livelihood of the respondents. Livelihood was further categorized only into two broader group either not applicable or on garbage exposure. Based on the result of the chi-square test of independence with a fishers exact test value of again 0.042, like the first two testing, it means, there was an association and

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it was further found out with, symmetrical measurement that the association is strong with a Phi and Cramers V P value of 0.039.

Table 4.10 Parasite Isolated from the Respondents and Soil Sample from Dumpsite Vicinity Cross tabulation. Result NOPS Ascaris lumbricoides Hookworm Total Chi-square Df P Value Observed N 31 14 2 47 Expected N 33.3 12.7 1.0 Result 1.3499 2 0.509 Residual -2.3 1.3 1.0

This table shows the count of parasite isolated from the respondents and parasites isolated from the soil taken from the vicinity of the dumpsite. Based from the chi-square goodness of fit with a P value of 0.509 at 5% level of significance it was found out that the number of occurrence of parasite from the respondents followed the distribution of the parasite seen in the soil sample from the dumpsite vicinity.

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Table 4.11 Parasite Isolated from the Respondents and Soil Sample from the Vicinity of the Residents near the Dumpsite. Result NOPS Ascaris lumbricoides Hookworm Total Chi-square Df P Value Observed N 31 14 2 47 Expected N 33.3 12.7 1.0 Result 1.3499 2 0.509 Residual -2.3 1.3 1.0

This table shows the count of parasite isolated from the respondents and parasites isolated from the soil taken from the vicinity of the residents nearby dumpsite. Based from the chi-square goodness of fit with a P value of 0.509 at 5% level of significance it was found out that the proportion of parasite found to be present in the respondents followed the distribution of the parasite isolated from the soil sample taken from the vicinity of the residents.

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Chapter V Summary of Findings, Conclusion and Recommendation

This chapter presents the summary of the study, the conclusions drawn from the analysis of the data and some recommendations based on the research findings relative to the prevalence of intestinal parasites at Tuguegarao City dumpsite.

Summary The study generally determined the prevalence of intestinal parasitism at Tuguegarao City dumpsite. Specifically, it determined the intestinal parasites harbored by the respondents such as the residents of Tuguegarao City dumpsite as well the garbage collectors and garbage truck drivers. It further identify intestinal parasite in soil samples taken at Tuguegarao City dumpsite within the vicinity itself ad soil from the vicinity of the residents. The study also assessed if the intestinal parasites harbored by the respondents is the same with those isolated from the soil. Moreover, it determined if there is significant association of parasites isolated from the respondents when grouped according to: gender, educational attainment, marital status and livelihood. It likewise assessed the degree of association if ever it exists. Data were gathered through fecalysis and soil analysis using formalin, ether concentration technique microscopic examination. Analysis of data included test of correlations and proportion wherein chi-square test of independence chi-square goodness of fit test were utilized appropriately.

41

Results indicated that intestinal parasitism exist at Tuguegarao City dumpsite. Ascaris lumbricoides and hookworm were the species isolated from the soil samples both from the dumpsite vicinity and from the vicinity of the residents. The same species of soil-transmitted intestinal parasites were found out to be harbored by the respondents. Regarding the parameters measured with regards to the isolated species of parasites only livelihood resulted with association and the other three (gender, educational attainment and marital status) were not associated with the isolated parasites. Thus, it implied that livelihood greatly intestinal prasitoses among the respondents. Finally, the study resulted that the species of parasites harbored by the respondents were similar to the species isolated from the soil samples. This is so since the statistical analysis showed the existence of proportion and distribution similarity of parasites between the stool specimen and soil samples.

Conclusion As revealed in the results of the study which were carefully observed and evaluated, the following conclusions where made: 1. Generally, it was found out that there is an existence of parasite at Tuguegarao City dumpsite. 2. It was further found out that Ascaris lumbrocoides and hookworm was the parasites that were harbored by the neighbor near the dumpsite of Tuguegarao City garbage collector and garbage truck driver. 3. There is an association of parasites isolated from the respondents with regards to gender, educational attainment, marital status and livelihood. On the other

42

hand livelihood is strongly associated with the parasite taken from the residents. 4. The intestinal parasite present in the soil either taken from the dumpsite or from the vicinity of the residents was Ascaris lumbricoides and hookworm species. 5. The intestinal parasites harbored by the respondents were the same with those isolated from the soil samples since it was showcased that species and probability distribution of parasites from the respondents coincide with those seen and observed from the soil sample.

Recommendation In reference with the findings and conclusion of the study, the researchers suggest the following recommendations: 1. It was found out that there is really a prevalence of intestinal parasitism in Tuguegarao City dumpsite thus, the researchers recommend the council of Tuguegarao and other local government units to give more priority and exert more effort to solve the problem of parasitism specially the people who are exposed at the dumpsite and have direct to the garbage and including the soil which may contain parasites. 2. Since there was children who were infected with intestinal parasites, the Department of Health (DOH) specifically the DOH Region 02 should strength their on going program regarding parasitism such as the Garantisadong Pambata

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Program . Moreover, they must take into consideration also the health of the other people involved who are considered to be the vulnerable group. 3. The respondents should be disseminated properly on the prevention, control and treatment of the intestinal parasitism. As such, they should also conform to what they had learned such as using gloves, boots, masks and other necessary materials to avoid direct contact to the garbage and soil at the dumpsite which are contaminated with parasite. 4. A replicable study is suggested to further validate the data on the parameters assessed. The future researchers must also formulate other parameters which are essential in the study. 5. On the procedure, Formalin Ether Concentration Technique, other methods must be tested and compared to the said procedure to look for the best and most appropriate suitable for the study.

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Literature Cited Internet/s Bethony, J. et.al,. Soil-Transmitted Helmith Infections: ascaris, trichuriasis and hookworm. http://emedicine.medscape.com/article/1000631-treatment Hickman, J. et.al., The Sanitary Landfill. A Brief History of Solid Waste Mangement in US during the last 50 years.

http://en.wikipedia.org/wiki/landpill http://Findarticles.com/p/articles/mi_mOWPD/iv_2001_Jan_8lai_70384771 http://www.cncbi.nlm.nih.gov/pubmed/18645945 http://www2.doh.gov.ph/NOHWel32/NOHpersubj/Chap4/SoilTHOP.pdf Book Training Course in Diagnostic Medical Parasitology, College of Public Health Universityof the Philippines, Manila. Pg. 64-75

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APPENDICES

46

APPENDIX A Results of the Statistical Analysis Using Chi- Square Test of Independence and ChiSquare Goodness of Fit

A) Chi-square test of independence showing the possibility of association of isolated intestinal parasites from the respondents with regards to gender, educational attainment, marital status and livelihood.

Ho: x & y are not associated Ha: x & y are associated Decision rule: Reject Ho if P value <.05, else fail to reject Ho. 1) Gender gender * result Cross tabulation Count Result Ascaris NOPS lumbricoides hookworm 27 11 1 4 3 1 31 14 2 Total 39 8 47

Gender male female Total

47

Chi-Square Tests Value df a Pearson Chi-Square 2.105 Likelihood Ratio 1.723 Linear-by-Linear 1.720

2 2 1

P value .349 .423 .190

Association N of Valid Cases 47 a. 3 cells (50.0%) have expected count less than 5. The minimum expected count is .34. gender * result 2 Cross tabulation Count Result 2 NOPS parasite 27 12 4 4 31 16 Total 39 8 47

Gender male female Total

Pearson Chi-Square Continuity Correction Likelihood Ratio Fisher's Exact Test Linear-by-Linear

Chi-Square Tests Value df P value 1.093a 1 .296 .405 1 .525 1.049 1 .306 .416 1.070 1 .301

Association N of Valid Cases 47 a.1 cells (25.0%) have expected count less than 5. The minimum expected count is 2.72. b. Computed only for a 2x2 table

48

1) Educational attainment Educational attainment* result Cross tabulation Count Result Ascaris. lumbricoi hookwor NOPS 6 des 0 m 1 Total 7

Educatio nal

not yet

studying Elementary attainmen High school College t (level/ graduate) Total

14 9 2

8 4 2

1 0 0

23 13 4

31

14

47

49

Chi-Square Tests Value df a Pearson Chi-Square 5.890 Likelihood Ratio 7.937 Linear-by-Linear .039

6 6 1

P value .436 .243 .843

Association N of Valid Cases 47 a. 9 cells (75.0%) have expected count less than 5. The minimum expected count is .17. Educational attainment * result 2 Cross tabulation Count Result 2 parasit NOPS 20 e 10 Total 30

Educational attainme ntl Total graduate/level graduate/level

At most elementa

At least high school

11

17

31

16

47

50

Chi-Square Tests Value df a Pearson Chi-Square 2.056 Likelihood Ratio 2.562 Linear-by-Linear 1.954

2 2 1

P value .358 .278 .162

Association N of Valid Cases 47 a. 3 cells (50.0%) have expected count less than 5. The minimum expected count is .34. Marital Status*Result 2 Cross Tabulation Count Result 2 NOPS Marital Status Single Marrie d Total 7 24 31 1 15 16 Parasite Total 8 39 47

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Pearson Chi-Square Continuity Correctionb Likelihood Ratio Fisher's Exact Test Linear-by-Linear

Chi-Square Tests Value df a 1.993 1 1.004 2.286 1.950

1 1 1

P value .158 .316 .131 .234 .163

Association N of Valid Cases 47 a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is 2.72. b. Computed only for a 2x2 table 1) Livelihood Criteria for the degree of association <.3 = weak =.3 = moderate >.3 = strong

Livelihood*Result Cross Tabulation Count

52

Result Total Livelihood not applicable Scaveng er Garbage collector Garbage truck drivers Total NOPS Ascaris lumbricoides 7 O 8 3 14 6 2 5 31 14 Hookwor m 0 2 0 0 2 7 13 20 7 47

Pearson Chi-

Chi-Square Tests Value df a 14.389 6

P value .026

Square Likelihood Ratio Linear-by-Linear

15.477 2.470

6 1

.017 .116

Association N of Valid Cases 47 a. 9 cells (75.0%) have expected count less than 5. The minimum expected count is . 30.

Symmetric Measures Approx. Value Nominal by Nominal N of Valid Cases Phi Cramer's V .553 .391 47 53 Sig. .026 .026

Livelihood * result 2 Cross tabulation Count number 2 Result NOPS parasite Total Livelihood not applicable 7 0 7 Scavenger 8 5 13 Garbage collectors 14 6 20 Garbage truck 2 5 7 drivers Total 31 16 47

54

Chi-Square Tests Value df a Pearson Chi-Square 8.229 Likelihood Ratio 10.150 Linear-by-Linear 5.117

3 3 1

P value .042 .017 .024

Association N of Valid Cases 47 a. 5 cells (62.5%) have expected count less than 5. The minimum expected count is 2.38.

Nominal by Nominal N of Valid Cases

Symmetric Measures Value Approx. Sig. Phi .418 .042 Cramer's V .418 .042 47

Livelihood2 * result 3 Cross tabulation Count number 3 Result 3 NOPS parasite Livelihood Not app 7 0 On Garbage 24 16 exposure Total 31 16

Total 7 40

47

55

Chi-Square Tests

Pearson Chi-Square Continuity Correctionb Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases

Value 4.245a 2.651 6.443 4.155 47

df 1 1 1

P value .039 .104 .011 .042 1 .042

Nominal by Nominal N of Valid Cases

Symmetric Measures Value Approx. Sig. Phi .301 .039 Cramer's V .301 .039 47

B) Chi-square goodness of fit on the determination of the relationship between the parasites isolated from the respondents and the one that were isolated from the soil

Ho: The data follow a specified distribution Ha: The data do not follow a specified distribution Decision Rule: Reject Ho if P value < .05, else accept Ho.

Respondents vs Soil Sample from the Dumpsite Vicinity

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Result Observed N NOPS A.lumbricoi des Hookworm Total Expected N Residual 31 33.3 -2.3 14 12.7 1.3

2 47

1.0

1.0

Test Statistics result Chi-Square 1.349a Df 2 P value .509 a. 1 cells (33.3%) have expected frequencies less than 5. The minimum expected cell frequency is 1.0.

57

Respondents vs Soil Sample from the Vicinity of the Residents Result Observed N Expected N Residual NOPS 31 33.3 -2.3 A.lumbri 14 12.7 1.3 Hookworm 2 1.0 1.0 Total 47

Test Statistics result Chi-Square 1.349a Df 2 P value .509 a. 1 cells (33.3%) have expected frequencies less than 5. The minimum expected cell frequency is 1.0.

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APPENDIX B Table of Results in Fecalysis and Soil Anlysis Table of results in Fecalysis Respondents Sex no. 1 M 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 M M M F M M F F M M F M F M F M F F M Marital status Married Married Single Single Married Single Married Married Married Single Married Married Married Married Married Married Married Married Single Single Educational attainment Elementary graduate High school graduate Not yet studying Not yet studying Elementary graduate Not yet studying Grade VI 3RD year high school Elementary graduate Grade II College graduate 2ND year college 3RD year high school Grade V Grade V 3RD year high school Not yet studying Not yet studying Not yet studying Not yet Livelihood Scavenger Scavenger Not applicable Not applicable Scavenger Not applicable Scavenger Scavenger Scavenger Not applicable Scavenger Scavenger Scavenger Scavenger Scavenger Scavenger Not applicable Scavenger Not applicable Not applicable Result -( NOPS) -( NOPS) -( NOPS) -( NOPS) +( Ascaris lumbricoides) -( NOPS) +(Hookworm) +( Ascaris lumbricoides) -( NOPS) -( NOPS) -( NOPS) -( NOPS) -( NOPS) +( Ascaris lumbricoides) -( NOPS) -( NOPS) -( NOPS) +(Hookworm) -( NOPS) -( NOPS)

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

M M M M M M M M M M M M M M M M M M M M M M M M M M M

Married Married Married Married Married Single Married Single Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married

studying Grade VI Grade VI Grade VI 3RD year college High school graduate Grade II High school graduate 2ND year high school Grade IV Grade VI Grade VI 3RD year high school 2ND year college 3RD year college 2ND year high school Grade VI High school graduate Grade IV Grade VI Grade VI 3RD year high school Grade IV Grade VI Elementary graduate Grade VI 3RD year high school Elementary

Garbage truck driver Garbage collector Garbage collector Garbage collector Garbage collector Garbage truck driver Garbage collector Garbage collector Garbage truck driver Garbage collector Garbage collector Garbage collector Garbage truck driver Garbage truck driver Garbage collector Garbage collector Garbage collector Garbage truck driver Garbage collector Garbage collector Garbage collector Garbage collector Garbage collector Garbage truck driver Garbage collector Garbage collector Garbage

-( NOPS) +( Ascaris lumbricoides) +( Ascaris lumbricoides) -( NOPS) -( NOPS) +( Ascaris lumbricoides) -( NOPS) -( NOPS) +( Ascaris lumbricoides) -( NOPS) -( NOPS) +( Ascaris lumbricoides) +( Ascaris lumbricoides) +( Ascaris lumbricoides) +( Ascaris lumbricoides) -( NOPS) -( NOPS) +( Ascaris lumbricoides) -( NOPS) +( Ascaris lumbricoides) +( Ascaris lumbricoides) -( NOPS) -( NOPS) -( NOPS) -( NOPS) -( NOPS) -( NOPS)

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graduate LEGEND: NOPS- No ova of parasite seen M- Male F- Female

collector

Table of Results in Soil Analysis A Sample no. Results 1 -( NOPS) 2 -( NOPS) 3 -( NOPS) 4 -( NOPS) 5 +( Ascaris lumbricoides) 6 -( NOPS) 7 -( NOPS) 8 -( NOPS) 9 +( Ascaris lumbricoides) 10 +( Ascaris lumbricoides) 11 +( Ascaris lumbricoides) 12 -( NOPS) 13 -( NOPS) 14 -( NOPS) 15 -( NOPS) LEGEND: NOPS- No ova of parasite seen A- Soil sample from the dumpsite

B Sample no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Results -( NOPS) +( Ascaris lumbricoides) -( NOPS) -( NOPS) -( NOPS) -( NOPS) -( NOPS) +( Ascaris lumbricoides) +( Ascaris lumbricoides) +( Ascaris lumbricoides) -( NOPS) -( NOPS) -( NOPS) -( NOPS) -( NOPS)

B- soil sample from the vicinity of the squatter area

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APPENDIX C Documentation

62

APPENDIX D Letters

63

CURRICULUM VITAE
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PERSONAL DATA Name Age Birthday Contact No. E-mail Address Sex Civil Status Address Parents Father Mother Citizenship Elementary : : : : Jaime F.Saludares Sally C. Saludares Filipino Bagu Elementary School (1997-2003) High School : College : Abulug School of Fisheries (2003-2007) Cagayan State University (Andrews Campus) (2007 Present) : : : : : : : : HAZEL JOY C. SALUDARES 20 August 20, 1990 09059612290 pilintikngdaliri@yahoo.com. Female Single 96 Rizal Street Bagu, Abulug, Cagayan

EDUCATIONAL BACKGROUND

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PERSONAL DATA Name Age Birthday Contact No. E-mail Address Sex Civil Status Address Parents Father Mother Citizenship : : : Armando C. Biag Teresita A. Biag Filipino : : : : : : : : HERNANI A. BIAG 21 September 15, 1989 09262892608 hernanibiag@yahoo.com Male Single Tallang, Baggao, Cagayan

EDUCATIONAL BACKGROUND Elementary : Tallang Elementary School (1997-2003) High School : College : Baggao National Agricultural School (2003-2007) Cagayan State University ( Andrews Campus) (2007 Present)

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PERSONAL DATA Name Age Birthday Contact No. E-mail Address Sex Civil Status Address Parents Father Mother Citizenship : : : Loreto T. Tumanguil Leonida R. Tumanguil Filipino : : : : : : : : LEILORAINE R. TUMANGUIL 20 December 29, 1990 09059259594 lorainetumanguil@yahoo.com. Female Single 19 B Tumanguil Street Annafunan East, Tuguegarao City

EDUCATIONAL BACKGROUND Elementary : Annafunan East Elementary School (1997-2003) High School : College : Cagayan National High School (2003-2007) Cagayan State University (Andrews Campus) (2007 Present)

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PERSONAL DATA Name Age Birthday Contact No. E-mail Address Sex Civil Status Address Parents Father Mother Citizenship : : : Melecio C. Tabua Elizabeth L. Tabua Filipino : : : : : : : : MARYBETH L. TABUA 20 August 5, 1990 09351284065 marybethtabua@yahoo.com Female Single 031 Lingu Highway, Solana, Cagayan

EDUCATIONAL BACKGROUND Elementary : Lingu Elementary School (1997-2003) High School : College : Cagayan National High School (2003-2007) Cagayan State University (Andrews Campus) (2007 Present)

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69