"Impact of a Model of Educational Intervention on Intestinal Parasitism in Children of Havana. 2021 Second Post-Evaluation and Intervention Study"

In order to determine the influence of educational work on hygienic practices and the prevalence of parasitism, an educational intervention on intestinal parasitism was carried out in schoolchildren belonging to six primary schools in the Municipality of Marianao, Havana during the first quarter of 2021. The study included 210 (5 children were chosen from each grade of the six schools), children enrolled from preschool to sixth grade, who were collected stool samples and in the anal region by the Graham method. A survey was applied to the parents to know the hygienic practices and the hygienicepidemiological conditions. The variables studied were the presence of parasitism, the type of parasite, associated symptoms and hygienic practices present. Absolute numbers and percentages were used to summarize the information and tables for its presentation. It was obtained that the prevalence of parasitism was 65.2 % and Enterobius vermicularis was the most frequent. Anal itching and irritability were the predominant symptoms for which treatment was applied. The learning needs and modifications of attitudes were identified, for which a study program was designed, after six months of the educational intervention, the second sample collection and application for the second time of the parent survey was indicated. A significant decrease in parasitism was found, as well as positive modifications in the hygienic practices of the studied population. Received: July 16, 2021


Introduction
Among infectious diseases, those produced by parasites constitute important health problems for man and at the present time they are a medico-social problem that affects not only the so-called Third World countries, but also those with the highest development. In studies carried out in children from suburban regions of the American continent, at least seven parasites for the mentally handicapped, or for patients with primary or secondary immunosuppression, in whom the infection can be severe. In addition to immunosuppression, various sociological phenomena make the topic of intestinal parasitism of current interest to the pediatrician. The most important are emigration and the adoption of children from third world countries, but also the phenomenon of globalization, with constant mobility of large masses of the population and frequent trips to underdeveloped countries for tourism or work reasons that expose the indigenous population. to the contagion of endemic parasites in certain areas.
The orientation of the problem in these cases must be done taking into account not only the symptoms but also the origin of the population or the place of displacement since certain pathogens will predominate over another [4].
Intestinal parasitic infections by helminths and protozoa are among the most common in man in Latin America [5]. These have been consistently and considerably estimated in their impact on public health; However, in the last decade, its recognition as an important public health problem has increased even more [6]. In Venezuela, various studies indicate variable prevalences, but most of them have been carried out in urban populations. There is great morbidity, among protozoa, especially blastocystis hominis and entamoeba coli, and among helminths, ascaris lumbricoides [3][4]. Intestinal parasitism represents an alarming health problem in Venezuela due to the large number of people affected and the intense organic disturbances that they can cause. Many times it corresponds to the only morbid process of the patient and sometimes they aggravate other concomitant diseases Due to the aforementioned and taking into account that the mission of the doctor is the promotion and prevention of health, it was decided to carry out an educational intervention study in children of primary education of the Municipality of Marianao Province of Havana , in order to determine the influence of this work on hygienic practices and the prevalence of intestinal parasitism in students, identify the associated symptoms, as well as compare the hygienic practices of the population before and after the educational work.

Material and Methods
An intervention study was carried out in order to determine the influence of educational work on hygienic practices and the prevalence of intestinal parasitism in students from preschool to sixth grade. 210 children were studied, five for each grade of the six primary schools enrolled in said institution. These schools have already been previously evaluated and intervened, for which the results meter will help us to see the impact of the intervention carried out. The homes were visited to explain the objective of the study to the parents or guardians of the children, their informed consent was collected and a survey was applied to them. The symptoms and clinical signs presented in the children were analyzed, to describe the health education of the family, the quality of the drinking water, the washing of hands before eating food and after defecation, the presence of vectors, the presence of vectors, was taken into account. washing fruits and vegetables, if they are used to walking barefoot, playing with dirt or biting their nails.
Then a stool sample was taken by spontaneous defecation, guiding the parents about the need for non-contamination of it.

Results
The prevalence of intestinal parasitism (Graph 1) was observed that out of a total of 210 schoolchildren, 137 children were parasitized for 65.2 % and only 73 were not parasitized for 34.8 %, so it can be considered that in schoolchildren studied there is a high prevalence of parasites. Parasitic agents in school (Table 1) were more frequently Enterobius vermicularis in 65 children for  (Table 3), an inadequate hygiene of the population was observed before the intervention, after which all the hygienic habits of the population were positively modified ( Table 4). The epidemiological factors present in the home of the schoolchildren were the most prevalent Do not wash foods consumed raw with 28.1% and the consumption of non-potable water with 51%, after the intervention all modifiable epidemiological risks decreased In the variable quality of drinking water (Graph 2) it was shown that 51% of the patients did not boil their drinking water, 63% of them treated the water, with the bottled water trade and the myths that it contains 55% of those who consumed this water were shown to be parasitized After the educational work, those who consumed the water without boiling decreased to 8%, while those who boiled or chlorinated it represented 5% and 11% respectively.   Note: N:137 Source: sociodemographicregistry.  Note: Source: sociodemographicsurvey.

Discussion
The Enterobius vermicularis causes the disease called  [4][5][6][7]. The authors refer that oxyuriosis becomes frequent because the eggs are highly infective from the moment the adult female parasite lays them on the margins of the anus, and there may be self-reinfection by the hands or indirectly by contaminated items such as furniture, desks, bathrooms, or by inhalation of dust in homes and institutions [8][9]. In this study, the most frequent symptoms were (after anal itching and irritability) abdominal pain and loss of appetite, related to enterobiasis or ascariasis, a parasite that was identified in the first and second order in the study. In a study carried out by Kucik and collaborators, they state that among the most frequent symptoms caused by enterobiousvermicularis were irritability and anal itching; while ascarislumbricoides is more associated with diarrhea, abdominal pain, decreased appetite, and weight loss, and trichuristrichiura is associated with anemia, decreased appetite, and weight loss [10][11][12].
After the educational intervention was carried out, intestinal parasitism was significantly reduced and hygienic practices increased, indicating that inadequate hygienic practices influenced the presence of parasitism, similar conclusions reported by Medina and González in their study Intestinal Parasitism in Spain [12][13][14][15] As it is a comparison of the same subject before and after, it can be affirmed that the educational work together with the treatment helped the success of the group work. Hernández, Rauda and collaborators in a study carried out in San Salvador, on the socioepidemiological factors related to the specific prevalence of intestinal parasitic infections caused by protozoa and helminths in children under 14 years of age from the Atonatl community, metropolitan area of San Salvador, pointed out that the lack of habit of applying chemical or thermal treatment to water, prior to consumption, was significantly related to the parasitism found in children, which coincides with the results of the present work .

Conclusion
The prevalence of intestinal parasites in school children studied was elevated preoperatively, predomin or the Enterobius vermicularis. An obvious decrease in the prevalence of parasitism was evidenced after the educational intervention carried out. The most frequent symptoms in parasitized children were anal itching, irritability, abdominal pain and loss of appetite, which decreased after the intervention. The educational intervention applied was effective, since hygiene practices such as washing hands before eating food or after defecating, walking barefoot, playing with dirt, biting nails and not boiling drinking water, were significantly modified.