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\title{Prevalence and Associated Risk Factor of Intestinal Parasitic Infection between Marginalized and Non-marginalized People in AL-Turbah City. Taiz Governorate, Yemen}
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             \author[1]{Cao  Deping}

             \author[2]{Emad  Shamsan}

             \author[3]{Khadeeja Abees Hmood  Al-Khalidy}

             \author[4]{Mustafa abdo Saif  Dehwah}

             \author[5]{Khadeeja  Al-Khalidy}

             \author[6]{Fan  Hai-Ning}

             \affil[1]{  Qinghai university}

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\date{\small \em Received: 14 December 2019 Accepted: 31 December 2019 Published: 15 January 2020}

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\begin{abstract}
        


The infection of individuals due to their behavior and extent of health education. In marginalized people often live in crowded conditions, limited sanitation, and personal hygiene is lack. they suffer a lack of health education and low income.Aim: This study was carried out to determine the prevalence of intestinal parasites at marginalized people (Al-akhdam-The neglected group) and other people in different areas in Al -Turbah city, and the relationship between parasites infection and race, age, sex, Family size, educational level, water source and type of job. Methods:The study was carried out from areas in Al-Turbah city, during March to December 2016.

\end{abstract}


\keywords{marginalized people, parasites, al -turbah city, yemen.}

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\section[{I. Introduction}]{I. Introduction}\par
n intestinal parasitic infection (IPI) caused by intestinal helminthes and protozoan parasites are one of the most prevalent infections in humans residing in developing countries \hyperref[b0]{[1]}. It is estimated that 3.5 billion people are affected, the majority being children \hyperref[b1]{[2]}. The happening and prevalence of intestinal parasitic infections varies in countries due to environmental, social and geographical factors \hyperref[b2]{[3]}. high prevalence of intestinal parasitic infections in human are positively correlated with poverty and poor personal hygiene, lack of safe water supply and contamination of the environment by human excreta and animal wastes \hyperref[b3]{[4]}. Morbidity and mortality due to intestinal parasitic infections are usually more pronounced in children compared to adults due to their higher nutritional requirements and less mature immune systems \hyperref[b4]{[5]}. Intestinal protozoan infections are endemic worldwide. In developed countries the prevalence of human intestinal parasitic protozoan infection is estimated to be between 1-7\%, but it may be as high as 50\% in developing countries. All age groups are equally affected during epidemics, but both subclinical infection and clinical disease are more common in children in endemic areas. Outbreaks occur regularly in childcare facilities. Immuno-compromised individuals are also more commonly affected than members of the general population \hyperref[b5]{[6]}. 
\section[{A}]{A}\par
Abstract-The infection of individuals due to their behavior and extent of health education. In marginalized people often live in crowded conditions, limited sanitation, and personal hygiene is lack. they suffer a lack of health education and low income.\par
Aim: This study was carried out to determine the prevalence of intestinal parasites at marginalized people (Al-akhdam-The neglected group) and other people in different areas in Al -Turbah city, and the relationship between parasites infection and race, age, sex, Family size, educational level, water source and type of job.\par
Methods: The study was carried out from areas in Al-Turbah city, during March to December 2016.\par
Methodology: cross-sectional descriptive and comparative study a total of 322 cases were randomly collected, aged between 5 and 45 years were examined using examined by direct wet mount technique and formalin-ether concentration technique, the questionnaire data was used for determining the correlation between parasites infection and other factors such as race, age, sex, Family size, educational level, water source and type of job. 
\section[{Statistical analysis:}]{Statistical analysis:}\par
The data analyzed by SPSS program. Results: The study found that 124 cases of parasites infection are positive for marginal people from a total of 153 and 89 cases are positive for non-marginal (other people)from a total of 169 specimens were collected from areas in Al-Turbah city. Also found from 124 +ve in marginal people 60 cases (78.9\%) are mal and 64 cases (64\%) female are positive while found from 89 cases in other people 44 cases (51.2\%) are male and 45 cases (54.2\%) are female. The results of the study indicate that there was highly significant associated between positive of parasites infection and marginal people (p=0, 01) and there significant differences between age (p=0.04), illiterate aged between 5 and 45 years were tasted. As a standard protocol, after reached the samples in the laboratory, the fecal specimens also processed by the formalin-ether concentration technique.\par
Were examined for detection the present of ova, larva, cyst, and trophozoites, using Wet mount method with both saline and iodine were prepared within 2 h of sample collection \hyperref[b6]{[7]}. Stool samples were also processed by the formalin-ether concentration technique, Each wet-mount method and formalin-ether concentration technique were examined by team researchers independently and findings were crosschecked. 
\section[{III. Statistical Analysis}]{III. Statistical Analysis}\par
Data was presented in form of tables by using SPSS, after those demographic data and other factors were collected in a standard questionnaire. Next, findings of positive intestinal parasites were analyzed data was presented in form of tables by using SPSS. 
\section[{IV. Results}]{IV. Results}\par
The study results illustrated in Table1 to Table9. The prevalence of intestinal parasites in marginalized were 81\% while, in the other people were (52.7\%). There was significant association between marginalized people and non-marginalized (OR= 3.84 times, P=0.01), and shows statistically significant among the illiterate (p=0.05, OR=OR=1.69), secondary school (p=0.05, OR=OR=0.55, while there was no significant association between positive of marginalized and non-marginalized people and others factors studied. 
\section[{V. Discussion}]{V. Discussion}\par
Intestinal parasitic infections of humans are important threats to healthy living in developing countries \hyperref[b7]{[8]}. These infections are usually associated with poor sanitary habits, lack of access to safe water and improper hygiene. The degree of each factor and prevalence of infections varies from one region to the non-marginalized \hyperref[b8]{[9]}.\par
In our result, table \hyperref[b0]{(1)} shows that the marginalized was much higher infected by IPIs [124/153(81\%] compared to non-marginalized people [89/169(52.7\%)] and was statistically significant (p .value=0.01). These variations in prevalence of IPIs among two race might be due to the majority of marginalized do not care for education, poor sanitary disposal of sewage system, poverty of personal hygiene, also the randomly, crowdedness, and type of job play role in the transmission of parasites where the majorities of marginalized worker in the refuse collector and clean worker ?ect. Also, the results showed were three species of protozoa were found in the population studied, (E. histolytica was the most frequent intestinal protozoan infection in marginalized and non-marginal--ized was (41.2\% and 29.6\%) respectively. followed by E. Coli 67(20.8\%), were in marginalized and non-marginalize (29.4\%), (13\%) respectively, G. Lamblia 39(12.1\%) were marginalized and non-marginalized people (11.1\%), (0.6\%) respectively. There high significant between E. histolytica and marginalized people. As in table \hyperref[b1]{(2)}. In contrast, other studies conducted in Yemen found that the most predominant parasite was G. lamblia \hyperref[b9]{[10]}.\par
The results in table (3) which showed the type of parasites infection, find the rate prevalence of H. nana10.5\%, 0.6\%, A. lambricoides3.6\%, 3.6\%, S. mansoni 4.6\%, 0.65, Teania. Spp2.6\%, 0.0\%, E. vermecularis 0.7\%, 0.6\% in Marginalized, Non-marg. respectively. There are only significant among H. nana and T.spp. Parasites and marginal people. Our results agree with the results in Soudia Arabia, Who confirmed H. nana was dominant followed by A. lambricoides, S. mansoni and E. vermicularis \hyperref[b10]{[11]}. In table \hyperref[b3]{(4)} The majorities of the positive cases of IPI among 213/322 were single infections among race[50.6] with p=0.02 and OR=1.99 and was [ 91/124(59.5\%) , 72/89(42.6\% )] , in marginalized and non-marginalized at respectively, followed by double infection was [14.6] with p =0.01 ,followed by triple infection that was =0.9 with 0R=2.23.and p=0.5052and was [(1.3),1(0.6)] in the marginalized and non -marginalized at respectively. It is clear that double infection and triple infection because of the highly exposure to the infection sources such as contaminated food or water \hyperref[b11]{[12]}.\par
From the table (5) in our result shows there no significant between parasites infection and gender (p=0.46) the rate of infection was slightly higher in females than males the modes of transmission of the parasites, study population and the methods used probable attribute to this observed difference in detections of various parasites, a recent study in Cameroon found that the higher prevalence of human intestinal protozoan in females was attributed to the fact that women usually eat unwashed fruits and vegetables or un boiled salads which may be contaminated with protozoan cysts [13], also other study showed Female participants the highest infection rate (41.0\%), followed closely by male participants (38.6\%) [14] While, the study detect significant association between the occurrence intestinal parasitic infection and age group 5-15 [94/129(72.9\%)] when compared to age group 16-45 [119/193(61.7\%)] (p=04) and OR=1.67 ,which indicated that younger children are more exposed since the usually play in the open fields and eat food without washing hands .thus, as age increases (16-45yr) the prevalence of parasitic infection decreases possibly due to improved personal hygiene and reduced contact with soil (These findings are in agreement with that reported by  {\ref [15]}.\par
Table \hyperref[b5]{(6)} in our result shows no significant between IPI and family size, but the IPIs was related to family size ?6 person [115/152 (75.7) (p>0, 43, OR=1.22 times) when compared to family size ?5 person (p=0.43 and OR=0.82time). Studies of  {\ref [16]}. supported our study, large families are more susceptible to parasitic infections than small families, because of the crowding in houses leading to participation in food tools, clothes and bed finally these lead to poor personal hygiene thus, increasing the infection.\par
Table \hyperref[b6]{(7)} shows statistically significant among the illiterate (p=0.05, OR=OR=1.69), secondary school (p=0.05, OR=OR=0.55) and IPI. 60/87(69\%), IPI was related to primary school (p=more than 0.05) when compared to high school (p=more than 0.05) and diploma (P. value more than 0.05), our results similar of study of  {\ref [17]}.their illiterate showed high significant than other levels of education.\par
Table \hyperref[b7]{(8)} shows relationship between parasites infection and source of water in marginal and nonmarginal people, the rate of prevalence of intestinal parasites was 83.9\%, 51.6\% in the protect water in marginal, and 76.6\%,66.7\% in Non-protect water in marginal, non-marginal respectively. according to study of  {\ref [17]}it was significant between parasites infection and source of water, this study disagree with our results.\par
Table \hyperref[b8]{(9)} shows association between IPI and kind of occupation there high significant among parasites infection and workers, while there was no significant associated between positive of parasites infection and others occupations studied. schools' students about the intestinal parasite infections, sources and routes of parasites transmission, some students frequently eating street cooked foods that may be contaminated or not properly cooked could attributed to the infections by intestinal parasites some Childs like working without shoes which could assists the infections by intestinal parasites especially soil transmitted parasites, food that may increase the infections by intestinal parasites in housewives who considered the most connecting with water compared to other of the family members ,agriculture working and the connection with animal and their wastes may although responsible for prevalence of IPIs among housewives, the dealing with wastes and low personal hygiene with culpa hand washing before eating practices mentioned among refuse collectors, that make them more prone to the infection by intestinal parasites, the present findings showed that those who do not practice proper hand washing before eating was at two fold higher risk of acquiring E. histolytica /dispar infection  {\ref [18]}. 
\section[{VI. Conclusion}]{VI. Conclusion}\par
The study highlights the high prevalence of parasites infection between marginal people and nonmarginal people in Yemen. The clinicians in Yemen need to be aware that parasites are a potential cause of endemic specially in children. 
\section[{Level especially in primary and secondary}]{Level especially in primary and secondary} 
\section[{Conflict of interest}]{Conflict of interest}\par
Al-Mahaweel district, Babylon province. 2000, MSc. Thesis, Sci. Coll., Babylon Univ.: 122pp.(In Arabic). 13. Mbuh, J.V., H.N. Ntonifor, and J.T.  {\ref Ojong} Tables Legends \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.28936170212765955\textwidth}P{0.09946808510638298\textwidth}P{0.18085106382978722\textwidth}P{0.09042553191489361\textwidth}P{0.10851063829787233\textwidth}P{0.08138297872340425\textwidth}}
Race\tabcellsep Number\tabcellsep Percentage\%\tabcellsep OR\tabcellsep ?2\tabcellsep P\\
Marginalized\tabcellsep 124\tabcellsep 81.0\tabcellsep 3.84\tabcellsep 28.89\tabcellsep 0.01\\
Non-Marginalized\tabcellsep 89\tabcellsep 52.7\tabcellsep 0.26\tabcellsep 28.89\tabcellsep 0.01\end{longtable} \par
 
\caption{\label{tab_1}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.22156398104265404\textwidth}P{0.0966824644549763\textwidth}P{0.12488151658767771\textwidth}P{0.05639810426540284\textwidth}P{0.09265402843601896\textwidth}P{0.1490521327014218\textwidth}P{0.05639810426540284\textwidth}P{0.0523696682464455\textwidth}}
\tabcellsep \multicolumn{2}{l}{Marginalized}\tabcellsep \multicolumn{2}{l}{Non-marg.}\tabcellsep \tabcellsep \tabcellsep \\
Type of parasites Infection\tabcellsep Number\tabcellsep \multicolumn{2}{l}{Percentage\% Number}\tabcellsep Percentage\%\tabcellsep Total\tabcellsep OR\tabcellsep P\\
E.histolytica\tabcellsep 63\tabcellsep 41.2\tabcellsep 50\tabcellsep 29.6\tabcellsep 113(35.1\%)\tabcellsep 1.66\tabcellsep 0.03\\
E.coli\tabcellsep 45\tabcellsep 29.4\tabcellsep 22\tabcellsep 13.0\tabcellsep 113(35.1\%)\tabcellsep 2.78\tabcellsep 0.01\\
G.lamblia\tabcellsep 17\tabcellsep 11.1\tabcellsep 1\tabcellsep 0.6\tabcellsep 39(12.1\%)\tabcellsep 0.84\tabcellsep 0.60\end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.2716165413533835\textwidth}P{0.07669172932330827\textwidth}P{0.0894736842105263\textwidth}P{0.06710526315789474\textwidth}P{0.0862781954887218\textwidth}P{0.143796992481203\textwidth}P{0.0575187969924812\textwidth}P{0.0575187969924812\textwidth}}
Type of parasites\tabcellsep \multicolumn{2}{l}{Marginalized}\tabcellsep \multicolumn{2}{l}{Non-marg.}\tabcellsep \tabcellsep \tabcellsep \\
Infection\tabcellsep Number\tabcellsep Percentage\%\tabcellsep Numb er\tabcellsep Percentage\%\tabcellsep Total\tabcellsep OR\tabcellsep P\\
H. nana\tabcellsep 16\tabcellsep 10.5\tabcellsep 1\tabcellsep 0.6\tabcellsep 17(5.3\%)\tabcellsep 1.9\tabcellsep 0.01\\
A . lambricoides\tabcellsep 6\tabcellsep 3.6\tabcellsep 6\tabcellsep 3.6\tabcellsep 12(3.7\%)\tabcellsep 1.1\tabcellsep 0.8\\
S. mansoni\tabcellsep 7\tabcellsep 4.6\tabcellsep 1\tabcellsep 0.6\tabcellsep 8(2.5\%)\tabcellsep 0.85\tabcellsep 0.2\\
Teania. Spp\tabcellsep 4\tabcellsep 2.6\tabcellsep 0\tabcellsep 0.0\tabcellsep 4(1.2\%)\tabcellsep 2.1\tabcellsep 0.03\\
E. vermecularis\tabcellsep 1\tabcellsep 0.7\tabcellsep 1\tabcellsep 0.6\tabcellsep 2(0.6)\tabcellsep 1.1\tabcellsep 0.9\end{longtable} \par
 
\caption{\label{tab_3}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.4293515358361774\textwidth}P{0.0667235494880546\textwidth}P{0.0667235494880546\textwidth}P{0.05802047781569966\textwidth}P{0.06382252559726963\textwidth}P{0.09573378839590443\textwidth}P{0.03481228668941979\textwidth}P{0.03481228668941979\textwidth}}
Year 2020\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
22\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Volume XX Issue I Version I\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
D D D D ) C\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
(\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Medical Research\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Global Journal of\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \multicolumn{2}{l}{Marginalized}\tabcellsep \multicolumn{2}{l}{Non-marg.}\tabcellsep \tabcellsep \tabcellsep \\
Type of Infection\tabcellsep Number\tabcellsep Percentage\%\tabcellsep Number\tabcellsep Percentage\%\tabcellsep Total\tabcellsep OR\tabcellsep P\\
Single infection\tabcellsep 91\tabcellsep 59.5\tabcellsep 72\tabcellsep 42.6\tabcellsep (163)50.6\%\tabcellsep 1.98\tabcellsep 0.02\\
Double infection\tabcellsep 31\tabcellsep 20.3\tabcellsep 16\tabcellsep 9.5\tabcellsep (47)14.6\%\tabcellsep 2.4\tabcellsep 0.03\\
Triple infection\tabcellsep 2\tabcellsep 1.3\tabcellsep 1\tabcellsep 0.6\tabcellsep (3) 0.9\tabcellsep 2.2\tabcellsep 0.5\end{longtable} \par
 
\caption{\label{tab_4}Table 4 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{5} \par 
\begin{longtable}{P{0.16392857142857142\textwidth}P{0.10625\textwidth}P{0.05464285714285714\textwidth}P{0.12142857142857141\textwidth}P{0.05464285714285714\textwidth}P{0.19428571428571428\textwidth}P{0.04857142857142857\textwidth}P{0.05464285714285714\textwidth}P{0.05160714285714286\textwidth}}
Characters\tabcellsep \multicolumn{2}{l}{Positive Marg.}\tabcellsep \multicolumn{2}{l}{Positive Non-Marg.}\tabcellsep Total\tabcellsep OR\tabcellsep ?2\tabcellsep P\\
Sex\tabcellsep N\tabcellsep \%\tabcellsep No\tabcellsep \%\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Male\tabcellsep 60/76\tabcellsep 78.9\tabcellsep 44/86\tabcellsep 51.2\tabcellsep 104/162(64.2\%)\tabcellsep 0.84\tabcellsep 0.56\tabcellsep 0.46\\
Female\tabcellsep 64/77\tabcellsep 83.1\tabcellsep 45/83\tabcellsep 54.2\tabcellsep 109/160(68.1\%)\tabcellsep 1.2\tabcellsep 0.56\tabcellsep 0.46\\
Age groups\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
5-15 years\tabcellsep 47/59\tabcellsep 79.7\tabcellsep 47/70\tabcellsep 67.1\tabcellsep 94/129(72.9\%)\tabcellsep 1.67\tabcellsep 4.34\tabcellsep 0.04\\
16-45 years\tabcellsep 77/94\tabcellsep 81.9\tabcellsep 42/99\tabcellsep 42.4\tabcellsep 119/193(61.7\%)\tabcellsep 0.6\tabcellsep 4.34\tabcellsep 0.04\end{longtable} \par
 
\caption{\label{tab_5}Table 5 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{6} \par 
\begin{longtable}{P{0.1433139534883721\textwidth}P{0.14825581395348839\textwidth}P{0.029651162790697672\textwidth}P{0.17296511627906977\textwidth}P{0.03953488372093023\textwidth}P{0.17296511627906977\textwidth}P{0.04941860465116279\textwidth}P{0.04941860465116279\textwidth}P{0.04447674418604651\textwidth}}
Family size\tabcellsep \multicolumn{2}{l}{Positive Marg. N \%}\tabcellsep \multicolumn{2}{l}{Positive Non-Marg. No \%}\tabcellsep Total\tabcellsep OR\tabcellsep ?2\tabcellsep P\\
?5 person\tabcellsep 37/52\tabcellsep 71\tabcellsep 61/118\tabcellsep 51.7\tabcellsep 98/170(57.6\%)\tabcellsep 0.82\tabcellsep 0.63\tabcellsep 0.43\\
?6 person\tabcellsep 87/101\tabcellsep 86.1\tabcellsep 28/51\tabcellsep 54.9\tabcellsep 115/152 (75.7\%)\tabcellsep 1.22\tabcellsep 0.63\tabcellsep 0.43\end{longtable} \par
 
\caption{\label{tab_6}Table 6 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{7} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_7}Table 7 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{8} \par 
\begin{longtable}{P{0.21099290780141844\textwidth}P{0.06631205673758865\textwidth}P{0.1024822695035461\textwidth}P{0.04822695035460993\textwidth}P{0.19893617021276597\textwidth}P{0.04822695035460993\textwidth}P{0.060283687943262415\textwidth}P{0.060283687943262415\textwidth}P{0.054255319148936165\textwidth}}
Type of water\tabcellsep N\tabcellsep \multicolumn{2}{l}{Positive Marg. \%}\tabcellsep \multicolumn{2}{l}{Positive Non-Marg. No \%}\tabcellsep OR\tabcellsep ?2\tabcellsep P\\
protected\tabcellsep \multicolumn{2}{l}{78/93}\tabcellsep 83.9\tabcellsep 81/157\tabcellsep 51.6\tabcellsep 0.58\tabcellsep 3.24\tabcellsep 0.07\\
Non protected\tabcellsep \multicolumn{2}{l}{36/47}\tabcellsep 76.6\tabcellsep 4/6\tabcellsep 66.7\tabcellsep 1.71\tabcellsep 2.46\tabcellsep 0.12\end{longtable} \par
 
\caption{\label{tab_8}Table 8 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{9} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_9}Table 9 :}\end{figure}
 			\footnote{© 2020 Global JournalsPrevalence and Associated Risk Factor of Intestinal Parasitic Infection between Marginalized and Nonmarginalized People in AL-Turbah City. Taiz Governorate, Yemen} 		 		\backmatter   			 
\subsection[{Acknowledgments}]{Acknowledgments}\par
The authors would like to acknowledge Faculty of medical science, Taiz university, Yemen for support and provided working space and materials.\par
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