Project Description
Project ID
08TU001
Project Type
Funded Project - Normal Project
Project Title
Epidemiology of Endemic P arasites among Chepang Tribal Population of Gorkha District, Nepal
Project Summary
General Objective
To study the epidemiology of endemic parasites among Chepangs at Taklung VDC of Gorkha aiming at elevating health status of the Chepangs.
Specific Objectives
- To determine the prevalence of intestinal parasites among Chepang population.
- To find out the status of filariasis among the study population.
- To study the status of ectoparasites like head louse, body louse etc. among the Chepang people.
- Prevalence of Malaria survey.
- To bring awareness about different aspects of parasites among the Chepang people.
Location
Taklung VDC, Gorkha District, Nepal
Time Frame
6 months
Institution
Parasitological Research and Socio-Environmental
Development, Nepal (PARASED)
Tribhuvan University
Contact
Dr. Ranjana Gupta
Associate Professor
HOD – Parasitology
Central Department of Zoology
Tribhuvan University,
Kirtipur, Kathmandu
Email: drgupta.ohm
gmail.com
Telephone: 9841-362343
ANMF/Nepal Project Manager
Prativa Pandey, MD
PrativaPandeyanmf.net
ANMF/America Project Manager
Bob Gerzoff
BobGerzoffanmf.net
Project Description
RATIONALE
Tribal population constitutes an important fraction of Nepal’s population. Their overall status directly or indirectly contributes to country’s state of economy, health, manpower resources and productivity.
The tribal population of Nepal is far away from the mainstream population. They are still found to be practicing primitive life style and are unaware of basic modern amenities of life. Various factors like poverty, illiteracy, lack of awareness, malnutrition etc further increases their state of miseries and hardships. This deprived and depressed part of population contribute an important role of carrier and reservoir of some endemic diseases as their socio-economic and socio behavioral practices favour a good member of pathogenic parasites to survive.
The present study has been selected among Chepang (Praja), a tribal community to obtain their health status in relation to their socio-economic, socio-cultural and behavioral practices. The aim of the present study is to highlight the endemic parasites in Chepang community. These parasites unknowingly influence on the health and have a direct bearing on the incidence, cause and outcome of a variety of parasitic diseases as well as many other health problems besetting the world today. Parasitic diseases probably retard or reduce the socio-economic development to a greater extent and declare them to be the public enemy number one.
Parasites have an important effect on the provision health care to all strata of society. Poverty, malnutrition, poor sanitation, age factors, lack of education, cultural and behavioural factors all predispose to ill health. Parasite infection contributes directly to malnutrition and malnutrition in turn reduces the resistivity or immunity of an individual to parasitic diseases. Zoonoses with reservoir of infection in domesticated animals impose particularly a serious burden of ill health on vast number of people who live in rural areas.
There exist very complex relationship between parasitic diseases and economic development. According to Oliver (1974) it is not easy to access the socio-economic impact of parasitic diseases but the adverse effect of parasitic disease in economic development is widely accepted.
Lymphatic filariasis (LF) also known as elephantiasis is a parasitic disease caused by filarial nematode, Wuchereria bancrofti, the infection of which causes the inflammation of lymphatic system resulting hydrocele of scortum, breast enlargement, lymphoedema of limbs, enlargement of penis, swollen clitoris and vulva. Other complications may include acute fever, chyluria and chronic pulmonary fibrosis.
Baseline survey of LF has been conducted in some of the districts of Nepal. Some districts have shown high prevalence of Mf of W. bancrofti and endemicity rate of LF.
Malaria in its various forms has been the cause of mortality in Nepal through out the ages. The endemic malarial parasites have shown periodic malaria outbreaks. The Chepangs live near the forests which are the favourable sites for the malaria vectors.
Intestinal parasitosis is highly prevalent in rural communities of Nepal (Sherchand et al., 1997) and constitutes an important cause of morbidity and mortality among Nepalese. In certain rural areas, prevalence has been found to be over 90% (Rai et al., 2000). Thus the public health importance of intestinal parasitosis continues because of its high prevalence, virtually global distribution and effects on both nutritional and immune status of individuals (WHO, 1987).
Likewise injury from venoms of the arthropods is a common hazard in temperate and tropical regions. From order Anoplura, three varieties of wingless insects commonly attack man, although others infest the lower animals and may become temporarily deposited upon human hosts. They are Pediculus humanus var. capitis (head louse), P.humanus var. corporis (body louse) and Pthirus pubis (pubic or crab louse). Mites cause scabies.
Each variety of lice has a predilection for certain parts of the body and rarely migrates to other regions. They attach themselves to the skin and live upon the blood that they suck. In piercing the skin the parasites exude an antigenic salivary secretion. This, together with the mechanical puncture, produces pruritic dermatitis. In addition, the louse may be a carrier of disease and through its bite or excretions may transmit as infectious disease – epidemic typhus, relapsing fever, or trench fever.
Pediculosis capitis: There is usually intense pruritus of the scalp, and the affected hairs become lusterless and dry. Because of the itching, secondary complications with impetigo and furunculosis are common. Owing to secondary infection, the cervical lymph glands may become enlarged.
Pediculosis corporis: This is also known as pediculosis vestimenti or vagabond’s disease. These live in the seams of clothing, especially wherever there is pressure, and therefore warmth, as beneath the belt or the collar, or in bedding. The parasite is rarely discovered on the skin, but obtains its nourishment from it by descending to the skin and piercing it with its teeth. The disease causes generalized itching, which may be accompanied by erythematous macules or urticarial wheals due to the punctures, or by excoriated papules, parallel linear scratch marks, and a pigmented thickening of the skin from continued rubbing. Secondary furunculosis is common.
Pediculosis pubis: This disease is contracted chiefly by adults as the result of sexual intercourse. The crab louse, usually limits its incursions to the genital region and hypogastrium or, rarely, the axillae or eyelashes. The symptoms vary from slight discomfort to intolerable itching.
Scabies due to itch mites Sarcoptes scabiei is characterized by pruritic popular lesions and also burrows, which house the female and the young ones. Scabies is usually contracted by close contact such as nursing an infested patient, overcrowding, close living quarters as occurs in institutionalized patients, or sleeping together, and only infrequently by the common use of contaminated towels, bed linen, and clothing. The diagnosis is made however, from the distribution of the itching and the lesions present. When the disease has been present for a long time eczematization, lichenification, impetigo, and furunculosis may be present.
OBJECTIVES
General Objective
To study the epidemiology of endemic parasites among Chepangs at Taklung VDC of Gorkha aiming at elevating health status of the Chepangs.
Specific Objectives
- To determine the prevalence of intestinal parasites among Chepang population.
- To find out the status of filariasis among the study population.
- To study the status of ectoparasites like head louse, body louse etc. among the Chepang people.
- Prevalence of Malaria survey.
- To bring awareness about different aspects of parasites among the Chepang people.
MATERIALS AND METHODS
Study Site
The study will be carried out in the Chepang community of Taklung VDC at Gorkha district. Gorkha district is located between 488 to 7162 meter altitude and 27015' to 28045' latitude North and 84071' to 840 98' longitude east. It's boarder are Chitwan district in the South, Lamjung and Tanahun in South West, Dhading in East, and Manang in the North. Gorkha district is surrounded by Budigandaki in East, West and South while by Marsyangdi river (CBS, 2001).
Gorkha district is divided into sixty eight VDCs and one municipality. Among sixty eight VDCs, Chepang communities are present in only four VDCs. This district is one of the Hilly and some what rectangular extending from North to South with an area of 3,610 square kilometers. The average temperature of the district is 250C (Red Cross Profile, 2061).
In Nepal the total population of Chepang is 52,237. In Gorkha district, the population of Chepang is only 2742 in which males are 1341 (48.91%) and females are 1401 (51.09%).
In Nepal, more than 75 ethnic groups are present, speaking over 35 languages (Bista, 1985). Taklung VDC has 14 ethnic groups. Chepangs are one of them. There are people of seven different religions in this VDC. The famous hill lake Danda is at about 2200 meter height. Danda is located at about 1800 meter height while Dhodeni is at about 488 meter height. This VDC is attached to the Kuringhat in the Southern side of Chitwan district and about 10 Km. from Mugling (CBS, 2001).
There are 68 Village Development Committees (VDC) in Gorkha district. The selected area for study is ward no. 1 and 3 of Taklung VDC. Taklung VDC is attached to famous Manakamana. The total population of Taklung VDC is 5413 in which males are 2545 (47.02%) and females are 2868 (52.98%), sheltering in 964 households. Among total population 360 are Chepang community sheltering in 63 households (CBS, 2001). But at present the expected number of Chepang is about 500.
Chepang Community
In past time, Chepang community used to migrate from jungle to jungle and had shelter in caves. They still utilize tubers, insect, roots, fruits, wild shoots as good source of food. Hence, Chepang are previously caucasoid people of lean frame. They were nomadic tribes but nowadays they have settled community near jungle.
Settlements
Chepang inhabits near the jungle and their houses are small and low in height. They visit from place to place and still utilize cave for hunting and storage purposes. Houses are at 5 to 10 m distance at a single place. They have bad sanitary condition. They live with clustered dwelling, poultry, muddle dwelling with cracks and pig shelter. Open air defecation practice serves as a means of transmission of zoonotic diseases. Every household keeps pigs, hen, goats for personal use and also to sacrifice for God and Goddess in Baishak Purnima and other cultural activities.
Food and Water
Chepang feed on grains such as Kodo, corn etc. as food. They are omnivorous in habit with meat of different animals such as buffalo, pig, chicken, fish, goat, ox, cow etc. in their food. They lack proper knowledge of transmission of diseases. They eat inadequate cooked meat with drinks and raksi (locally prepared alcohol). They eat tarul, sakharkhanda, vacure, gittha and also wild fruits, such as daicamblo, katuse, chiuri, wild mango, valayo etc. They also feed on various types of insects, and larvae of wasp, aringle, bee, bachhim etc. as well as aquatic animals such as crabs, prawn, fish, molluscs etc.
The major source of water is Kholsa for drinking, washing and bathing etc. Some Chepang community utilizes tap and well water. Kholsa is a kind of small but very deep land, usually in the hilly region, where people get many small sources of water. It is very wet and humid, usually made by a small stream flowing down.
Study Design
Sentinel surveillance study design will be carried out and the entire study will be divided into five parts:
- Questionnaire survey for socio-economic and health condition
- Stool sample collection, examination and identification for intestinal parasites.
- Blood sample collection, examination and identification for filarial parasite.
- Blood examination of fever cases of suspected malaria.
- Awareness programme about parasites and medicine distribution to the infected individuals.
Sample Size
The total expected Chepang population i.e. 500 of ward no. 1 and 3 of Taklung VDC will be the target group.
Diagnostic Tools
- Questionnaire:
A set of structured questionnaire will be prepared and administered in order to determine the impact of parasitic infections regarding their socio-economic condition.
- Sample Collection:
Stool samples will be collected and preserved in a suitable preservative for the diagnosis of intestinal parasites.
Night blood samples between 11 pm to 2 am will be collected and thick three smears on a slide will be prepared for the Lymphatic Filariasis.
Ectoparasites and diseases due to ectoparasites will be identified clinically.
Blood samples of the suspected malaria case having fever will be collected for blood smear (thick and thin) preparation on a slide or 5ul blood will be collected for RDT use.
- Lab Diagnosis
The collected samples will be examined and diagnosed in the laboratory by using suitable methodology.
- Drug Administration
After the lab diagnosis drug will be provided or will be advised to the infected respondents.
Result Interpretation
The questionnaire and result from sample diagnosis will be tabulated in the special format. The result obtained will be analyzed using the appropriate statistic tools and tested for its reliability.
RESPONSIBILITY OF THE PROJECT MEMBERS
Principal Investigator (PI): PI will be responsible for management of project, co-ordination with funding organization, monitoring both in field and laboratory, report preparation and submission.
Co-Investigator (CO-I): CO-I will be responsible to assist the PI. Particularly in the field as well as laboratory, data interpretation and analysis.
Research Assistant: There will be a few research assistants from PARASED and a few will be hired from the site (acc. to the budget demand sheet). All of them will be responsible for questionnaire survey and sample collection.
Medical Officer: for clinical diagnosis and advice after Lab. diagnosis.
TIME SCHEDULE
The expected time for the study will be of 6 months.
Activities Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Literature review * * * * * Training & orientation * Questionnaire survey * * Sample collection * Clinical Examination * Lab diagnosis * Medicine distribution * * Data analysis * * Report writing and submission of report *
REFERENCES
CBS (2002). Population Census 2001. HMG/N National Planning Commission Secretarial Central Bureau of Statistics, Ram Shaphpath, Thapathali, Kathmandu, Nepal.
Olivier, C., Vandepas, S., Lepp, P.W., Yoder, K. and Relman, D.A. (2001). Sequence Variablility in The First Internal Transcribed Spacer Region Within And Among Cyclospora Species Is Consistent With Polyparasitism. Int J Parasitol, 31:1475-87.
Rai, S.K., Uga, S., Ono, K. and Rai, G. (2000). Contamination of Soil with Helminth Parasite eggs in Nepal. Southeast Asian J Trop Med Public Health, 31:388-393.
Sherchand, J.B., Ohara, H., Sherchand, S., Cross, J.H. and Shrestha, M.P. (1997). Intestinal Parasitic Infections in Rural Areas of Southern Nepal. J Inst Med, 19: 115-21.
W.H.O. (1987). Intestinal Protozoan and Helminthic Infections: Report of WHO Expert Committee, Tech Rep. Ser: 749.
Material Requested
See budget
Training Requested
None
Advisors/Instructors Requested
None
Travel/Expenses Requested
See budget
Grants/Stipends Requested
None
Other Items Requested
See budget
Total Funds Requested
NRs 2,37,006 / US $3,703.22
Budget
Budget Breakdown
List of facilities that will be extended to the investigator (s) by the implementing Organisation:
S.N. Items 1 Laboratory with microscopes 2 Administrative and secretarial 3 Libraries facilities 4 Computer with data retrieval and storing 5 Micro photographic facilities 6 Support for statistical data analysis 7 Remaining goods
Questionnaire development and printing
Quantity for LF Quantity for feacal exam Quantity for ectoparasites Total Quantity Unit cost Total NRs US $ Questionnaire development and printing 550 550 550 1650 2 3300 Total NRs 3300 $51.56
Travel
S.N. Title No. of person 2 ways (Going & returning) unit Rate Total NRs US $ 1 P. investigator 1 4 1000 4000 2 Co- investigator 1 2 1000 2000 3 Parasitologist 4 2 1000 8000 4 Medical doctor 1 4 1000 4000 Total NRs 18000 $281.15
Interaction, awareness & training at the site
S.N. Title No. of persons Day Perdiem Total NRs US $ 1 Trainers 8 1 2 Participants 6 1 100 600 3 Stationeries 8 1 100 800 4 Refreshment Interaction, awareness & training 30 1 200 6000 5 Training hall 1 500 500 Total NRs 7900 $123.44
Field Diem
S.N. Title No. of person months Monthly allowance Total NRs US $ 1 P Investigator 1 1 15000 15000 2 Co- Investigator 1 1 12000 12000 3 Med.doctor 1 1 18000 18000 4 Parasitologist 4 1 7000 7000 5 Research assistants 3 1 5000 5000 6 Field assistants 3 1 3000 3000 Total NRs 97000 $1,515.63
Personnel for Lab.
S.N. Title No. of persons Days Daily allowance Total NRs US $ 1 1 10 420 4200 2 2 10 420 8400 3 4 10 420 16800 4 2 10 300 6000 Total 35400 $553.13
Report preparation:
S.N. Title Total NRs US $ 1 Final report writing, printing and binding 10000 Total 10000 $156.25
List of supplies for Microfilaremia prevalence survey
S.N. Items Quantity Unit Unit cost Total NRs US $ 1 Disposable lancets 600 pcs. 5 3000 2 Slide box (100 cabins) 8 pcs. 350 2800 3 Giemsa stock solution 4 pcs. 300 1200 4 Methanol 1 500ml 90 90 5 Spirit 2 100ml 90 180 6 Gloves 30 Pairs 25 750 7 Staining rack 5 pcs. 200 1000 8 Emergency light 2 pcs. 1000 2000 9 Aprons 4 pcs. 600 2400 10 Micro slides 1100 pcs. 2 2200 11 Torch light with cells 6 pcs. 150 900 12 Packing bags 4 pcs. 350 1400 13 Mosquito repellents 6 pcs. 75 450 14 umbrella 8 pcs. 150 1200 15 Luggage bag 4 pcs. 500 2000 16 Sticker 1100 pcs. 1 1100 17 First aid pack 2 pcs. 500 1000 18 Iodine solution 1 200 200 19 cover slip 550 1 550 20 toothpicks 5 100 500 21 RDTs for malaria 25 60 1500 22 Container for stool samples 500 1 500 Total 19120 $298.75
Other
S.N. Total NRs US $ 1 Medicines for the effected persons 30000 $468.75 2 Stationeries 5000 $78.13 Total 35000 $546.88
Totals
Total NRs US $ Total NRs 225720 $3,526.88 Overhead 5% NRs 11286 $176.34 Grand Total NRs 237006 $3,703.22
Additional Information
None
Project Status
4/4/08 Request received by ANMF/Nepal as Word document 9/14/08 Project approved by ANMF Board for full funding of NRs 2,37,006 (approximately $3,703). Bob Gerzoff appointed project manager. 10/31/08 MOU signed
11/9/08 Funds ($2,963 at current exchange rate of $1 = NRs 80) transferred to ANMF/Nepal 12/2/08 Funds transferred to PARASED. Update received from PARASED
1/11/09 Update received from PARASED 2/6/09 Update received from PARASED 2/8/09 Update received from PARASED 3/5/09 Update received from PARASED
