EPIDEMIOLOGICAL STUDY: LABORATORY DATA MINING IN SOUTH OF JORDAN

Introduction: To determine the prevalence of parasi tic infection among the population of Ma’an governo rate. Methodology: A retrospective data mining of retriev ed and analysis laboratory stool specimens records f patients seen in Ma’an Hospital (in different speci alties) during the period 1st January 2009 to 31 De cember 2009 were carried out for the detection of intestin al parasites. Results:-1999 Stool samples were exam ined; 338 were positive samples (16.9%). The highest inci dence of intestinal parasites was during summer mon ths (June -October) and the lowest was during winter mo nths (December-January). Six different parasitic sp ecies were detected. The highest frequency was among adul t males and females higher than children. Amoebiasi s and Giardiasis (80.7% and 15.7%.respectively) were the commonest species detected while Entrobius. vermicularis (0.9%), Strongyloides. Stercoralis (0.6%) and hookworms (0.9%) were the least common. Conclusion:Intestinal parasite is not a major pub lic health problem in Ma’an governorate. Neverthele ss a comprehensive health education program, improvement s to environmental sanitation should be developed t o keep this health problem under control and activate the role of community nursing to raise community h ealth awareness. Furthermore, a wider survey should be co ndu ted in different health centers in the governor ate to obtain a better epidemiological picture of parasiti c infection in this region.


INTRODUCTION
Parasitic infestations are one of many factors that cause gastrointestinal syndromes such as, diarrhea, weight loss, abdominal discomforts and pain in many tropical and subtropical countries of the world (WHO, 2010;Bdir and Adwan, 2010). Many environmental and socioeconomic factors such as poverty, malnutrition, potable water, low health status, poor sanitary facilities and other factors are the major causes of the increasing incidence of parasitic infections in these areas (Bdir and Adwan, 2010).
Epidemiological surveys carried out in many countries have demonstrated the importance of parasitic infections and some of these studies showed that there is correlation between the incidence of parasitic infections and seasons of the year (Bdir and Adwan, 2010;Niyyati, et al., 2009;Razi and Sami, 2009;Yassin et al., 1999). It appears that summer monthsare a favorable period for the development and survival of many parasitic species and accordingly the rate of incidence increases during this season (Ali-Shtayeh et al., 1989;Fadel, 2002).
All published reports on prevalence and importance of parasitic infections in Jordan indicated that E. histolytica and G. lamblia are among the most common parasites (MOH, 2002;Al-Momani et al., 2000;Ammoura, 2010). However very little information is available concerning the incidence of parasitic infestations in Ma'an governorate and therefore, the aim of the present study was to determine the incidence among people referred to Ma'an hospital in order to help the health authorities in Ma'an governorate in planning for the, prevention and control of such diseases.

MATERIALS AND METHODS
A laboratory data mining study through a retrospective approach retrieve and examine a stool samplesof 1999 patients suffering from different abdominal disorders, who had been referred to Ma'an Hospital in south of Jordan during the period between 1st January to 31st December 2009. These samples were retrospectively reviewed and the incidence and percentages of parasitic infections were determined. Prior to that a permission was obtained from the director of Ma'an Hospital, samples were coded anonymous.
All the specimens were examined by direct fecal smear with saline or lugol iodine. Data including, gender and other relevant information were recorded on a special form. Chi square test of statistical significance was applied to study the association between prevalence of intestinal parasites and demographical factors. P value <0.05 was considered as significant.

RESULTS AND DISCUSSION
The total number of stool examined in the study period at Ma'an Hospital was 1999, including 1117 (55.9%) male and 739 (44.1%) female. Of these 857 (42.9%) were children less than 12 years old and 1142 (57.1%) adults.
The tests showed that 338 (16.9%) of the 1999 subjects had parasitic infections and six different parasitic species were identified. Amoebiasis and Giardiasis (80.7 and 15.7%) respectively, were the commonest intestinal parasites isolated and E. vermicularis, hookworms and Strongyloidsstercoralis were the least prevalent (Table 1). Table 2 and 3, show that the highest incidence was amongst male adults and children than female adults and children (p<0.01) and was true for all the species encountered in this study. Furthermore, the prevalence is higher in adult male and female than children, male and female (p<0.05), ( Table 4).
The result also showed that the total number of subjects admitted to the hospital increased during summer months. This was accompanied by a much higher prevalence with both E. histolytica and Giardialamblia during the same period which extended from June to October (Table 5,  The overall prevalence and percentage of intestinal parasitic infections in this study 338 (16.9%) is higher than the overall prevalence rate (9.9%) reported by the Ministry of Health in Jordan, Directorate for Disease Prevention andControl in 1996 (MOH, 2002) and that of (Al-Momani et al., 2000) in their retrospective study in Jordan .        However the overall prevalence is lower than that reported from southern Jordan (28.5%) (Ammoura, 2010). Several reports from neighboring countries showed that the prevalence rates varies between these countries and our findings (Bdir and Adwan, 2010;Yassin et al., 1999;Ali-Shtayeh et al., 1989). It seems that these differences can be attributed to a number of factors such as geographic, socioeconomic, climate, poverty, malnutrition, personal hygiene, population density, potable water and sanitary facilities. These factors play a key role in determining the prevalence of any parasite population in any geographical region of the world (Bdir and Adwan, 2010).
Six types of different intestinal parasites were detected during this retrospective study Entamoeba. histolytica is by far the most common species in both male and female patients as well as in adults and children. In general protozoal infections with E. histolytica and Giardialamblia were found to be much higher than helminth infestations.  This is an agreement with reports from Iran (Niyyati et al., 2009), Jordan (Al-Momani et al., 2000) and Palestine (Bdir and Adwan, 2010). However G. lamblia seems to be the commonest species in south Jordan with a prevalence rate of (42.6%) (Ammoura, 2010). The low prevalence of helminth parasites such as A. lumbercoides, hookworms and S. stercoralis is probably due to adverse conditions in this area of Jordan where the climate is characterized by a desert environment. Such weather is not suitable for the survival of eggs and larvae of helminth parasites in the environment. However, the unexpected result of a low incidence of E. vermicularis in children is probably due to the method employed in the stool examination. A higher percentage (5.9%) from southern Jordan was reported with E. vermicularis (Ammoura, 2010). This difference is probably due to both sample groups which were selected from a community population (school children) and the technique employed (scotch tape exam).

AJID
With regard to the seasonal effect on the prevalence of parasites, a remarkable seasonal fluctuation was observed. The highest numbers and percentage occurred in summer months with a peak incidence in September (26.2%), while the lowest occurrence of parasitic infestations was evident in winter season (November-February). The prevalence showed the lowest percentage during November (8.1%). A similar finding was reported from Palestine a peak of incidence occurred during summer months (Ali-Shtayeh et al., 1989). The higher prevalence may be linked to unsanitary conditions and the abundance of house flies during the summer months. The incidence of intestinal parasitism in Ma'an Governorate is therefore considered to be comparatively low as compared to other parts of Jordan and other Arab countries and countries in middle east (Bdir and Adwan, 2010;Niyyati et al., 2009;Razi and Sami, 2009;Yassin et al., 1999).
Though the prevalence of intestinal parasites in Ma'an governorate southern Jordan is low, it is Science Publications AJID necessary to develop a comprehensive health education program and sanitation improvements to keep this problem under control and at a low level. Nurses at Maan governorate and Al-Hussein Bin Talal University particularly community health nurses students at Princess Aisha Bint Al-Hussien College of Nursing, should play active role in promoting healthy life style and raising community and school health awareness to reduce the incidence of parasitic infection among the population of Ma'an governorate. To confirm these results a further survey is needed in order to obtain reliable data on the prevalence of intestinal parasites in different health care centers in the governorate.

CONCLUSION
The result of some preliminary study on the prevalence of intestinal parasites is described. The overall prevalence with these parasites is low as compared to other parts of Jordan. However among the species detected Amoebiasis and Giardiasis seem to be the commonest species, while other parasites species showed a low prevalence and has no significant role in public health in Ma'an governorate. With regards to seasonal effect, the present results reveal that the highest prevalence occurs during summer months and the highest frequency was among adult male and female.
Health education program, improvements to environmental sanitation should be developed to keep this health problem under control. Furthermore, a wider survey should be conducted in different health centers in the governorate to obtain a better epidemiological picture of parasitic infection in this region.