Consistency of stools as an indicator of type of intestinal parasites harboured by patients with abdominal pain at Kenyatta National hospital, Nairobi, Kenya
Githigaro, Peter Mathenge
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Abdominal pain is a common problem reported to clinicians for various ailments. Hospital records in Kenya show that high percentage of patients suffers from abdominal pain. Among the causes of abdominal pain are intestinal parasites. Intestinal parasites include protozoa and helminthes living in the intestine of animals and human. They are among the most common infections in developing countries. About 3.5 billion people worldwide are infected with intestinal parasites without considering those with abdominal pain. There are many people living with intestinal parasites without knowing. The impact of these parasites on public health has been under estimated, although they cause considerable morbidity and mortality. The main objective of this study was to determine whether consistency of stool could be used as an indicator of type of intestinal parasites causing abdominal pain in a patient. Patients being investigated for intestinal parasitic infections in the clinical laboratory were interviewed and a sample size of 400 patients suffering from abdominal pain selected. Stools of patients were macroscopically examined to determine their consistency; both direct saline and formal-ether concentration methods were used to identify parasitic agents. Stool specimens with eggs of Taenia species were stained and eggs differentiated to species using modified Ziehl-Neelsen stain technique. Harada-Mori culture technique was done on positive stools with hookworm looking like eggs in order to differentiate the worm species. Data was analyzed, and association among stool consistency, age groups, sex and intestinal parasites were tested using chi-square. Of the 400 patients 164(42.0%) had acute abdominal pain, 181(45.3°/x) had chronic abdominal pain and 55(13.8%) had recurrent abdominal pain. The consistency of stools from those patients were 218(54.5%) formed, 95(23.8%) soft, 78(19.5%) loose and 9(2.3%) watery. Stools from 79(19.75%) patients had inclusions; those with pus cells were 44(11.0%), mucus 33(8.25%), blood 23(:5.75%) and yeast cells 15(3.75%). The results show 27.5% of patients complaining of abdominal pain had intestinal parasitic infections. The most prevalent helminth was hookworm (2.5%) while the most prevalent protozoan was Blastocystis hominis (10.75°/). The study show stools from patients complaining of acute abdominal pain had higher amount of water than stools from patients with ether chronic or recurrent abdominal pain (x2=47.3, df=6, P=0.000). Patient's complains of different duration of abdominal pain was not related to presence of intestinal parasitic agents in stools (x2=72.55, df 64, P=0.207). There was no association between intestinal parasitic infections and consistency of stools (x2=0.000, df 3, P=1.000). Patients of 36-40 years age group had the highest number 50% of parasitic infection eases than any other age group (x2=38.52, df=10, P<0.001). The findings from this study provide a general awareness among KNH practicing physicians the need of laboratory diagnosis of stools, in confirming clinical findings when treating patients with abdominal pain.