‫ﻓﻬﺭﺱ ﺍﻟﻣﻭﺿﻭﻋﺎﺕ‬ ‫‪R‬‬

‫ﺭﻗﻡ ﺍﻟﺻﻔﺣﺔ‬ ‫ﺍﻟﻣﺣﺗﻭﻳﺎﺕ‬ ‫ﺭ‪.‬ﻡ‬

‫‪3‬‬ ‫ﺍﻟﻣﻘﺩﻣﺔ‬ ‫‪1‬‬
‫‪5‬‬ ‫ﺍﻟﺗﺻﻧﻳﻑ‬ ‫‪2-1‬‬
‫‪6‬‬ ‫ﺷﻛﻝ ﻭﻣﻅﻬﺭ ﺍﻟﻁﻔﻳﻠﻲ‬ ‫‪3-1‬‬
‫‪9‬‬ ‫ﺩﻭﺭﺓ ﺍﻟﺣﻳﺎﺓ‬ ‫‪4-1‬‬
‫‪11‬‬ ‫ﺍﻟﻭﺑﺎﺋﻳﺔ‬ ‫‪5-1‬‬
‫‪13‬‬ ‫ﺍﻻﻣﺭﺍﺿﻳﺔ‬ ‫‪6-1‬‬
‫‪14‬‬ ‫ﺍﻟﺗﺷﺧﻳﺹ‬ ‫‪7-1‬‬
‫‪15‬‬ ‫ﺍﻟﻌﻼﺝ‬ ‫‪8-1‬‬
‫‪16‬‬ ‫ﻁﺭﻕ ﺍﻟﺳﻳﻁﺭﺓ ﻭﺍﻟﻭﻗﺎﻳﺔ‬ ‫‪9-1‬‬
‫‪17‬‬ ‫ﺍﻟﻬﺩﻑ ﻣﻥ ﺍﻟﺑﺣﺙ‬ ‫‪10-1‬‬
‫‪18‬‬ ‫ﺍﻟﻣﻭﺍﺩ ﻭﻁﺭﻕ ﺍﻟﻌﻣﻝ‬ ‫‪2‬‬
‫‪20‬‬ ‫ﺍﻟﻧﺗﺎﺋﺞ‬ ‫‪3‬‬
‫‪27‬‬ ‫ﺍﻟﻣﻧﺎﻗﺷﺔ‬ ‫‪4‬‬
‫‪29‬‬ ‫ﺍﻻﺳﺗﻧﺗﺎﺟﺎﺕ ﻭﺍﻟﺗﻭﺻﻳﺎﺕ‬ ‫‪5‬‬
‫‪31‬‬ ‫ﺍﻟﻣﺭﺍﺟﻊ‬ ‫‪6‬‬

‫‪1‬‬
 ‫ﻓﻬﺭﺱ ﺍﻟﺟﺩﺍﻭﻝ‬
‫ﺭﻗﻡ ﺍﻟﺻﻔﺣﺔ‬ ‫ﺍﻟﻣﺣﺗﻭﻳﺎﺕ‬ ‫ﺭ‪.‬ﻡ‬

‫‪20‬‬ ‫ﺍﻟﻌﻼﻗﺔ ﺑﻳﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ ﻭﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ‬ ‫ﺟﺩﻭﻝ‪1‬‬

‫‪21‬‬ ‫ﺍﻟﻌﻼﻗﺔ ﺑﻳﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻭﺍﻟﺟﻧﺱ‬ ‫ﺟﺩﻭﻝ‪2‬‬

‫‪22‬‬ ‫ﺍﻟﻌﻼﻗﺔ ﺑﻳﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻭﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ‬ ‫ﺟﺩﻭﻝ‪3‬‬

‫ﺍﻟﻌﻼﻗﺔ ﺑﻳﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻭﻣﻛﺎﻥ ﺍﻟﺳﻛﻥ‬
‫‪23‬‬ ‫ﺟﺩﻭﻝ‪4‬‬

‫ﺍﻟﻌﻼﻗﺔ ﺑﻳﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻭ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺳﺭﻳﺭﻳﺔ ﺑﻳﻥ ﺍﻻﻁﻔﺎﻝ ﺍﻟﻣﺻﺎﺑﻳﻥ‬

‫‪24‬‬ ‫ﺟﺩﻭﻝ‪5‬‬
‫ﺑﺎﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ‬

‫‪26‬‬ ‫ﺍﻧﺘﺸﺎﺭ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﺍﻟﻠﻤﺒﻠﻴﺎ ﻓﻲ ﻟﻴﺒﻴﺎ‬ ‫ﺟﺩﻭﻝ‪6‬‬

‫ﻓﻬﺭﺱ ﺍﻷﺷﻛﺎﻝ‬

‫ﺭﻗﻡ ﺍﻟﺻﻔﺣﺔ‬ ‫ﺍﻟﻣﺣﺗﻭﻳﺎﺕ‬ ‫ﺭ‪.‬ﻡ‬

‫‪20‬‬ ‫ﺷﻛﻝ )‪(1-3‬ﻳﻭﺿﺢ ﺍﻟﻧﺳﺑﺔ ﺑﻳﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ ﻭﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ‬ ‫‪1‬‬

‫‪21‬‬ ‫ﺷﻛﻝ)‪(2-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﺑﻳﻥ ﺍﻟﺟﻧﺳﻳﻥ‬ ‫‪2‬‬

‫‪22‬‬ ‫ﺷﻛﻝ )‪(3-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﺣﺳﺏ ﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ﻟﻠﺫﻛﻭﺭ ﻭﺍﻹﻧﺎﺙ‬ ‫‪3‬‬

‫‪24‬‬ ‫ﺷﻛﻝ )‪(4-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻟﻣﻛﺎﻥ ﺍﻟﺳﻛﻥ‬ ‫‪4‬‬

‫‪25‬‬ ‫ﺷﻛﻝ )‪(5-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻟﻸﻋﺭﺍﺽ ﺍﻟﺳﺭﻳﺭﻳﺔ‬ ‫‪5‬‬

‫‪2‬‬
 ‫ﺍﻟﻤﻘﺪﻣﺔ‬
‫‪Introduction‬‬

‫ﻁﻔﻳﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ‪ Giardia lamblia‬ﻫﻭ ﺃﺣﺩ ﺃﻧﻭﺍﻉ ﺟﻧﺱ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ‬

‫‪ Giardia‬ﻭﻫﻭ ﻳﻌﻳﺵ ﻣﺗﻁﻔﻝ ﻋﻠﻰ ﺍﻹﻧﺳﺎﻥ ﻭ ﻳﻭﺟﺩ ﻓﻲ ﺍﻟﺟﺯء ﺍﻟﻌﻠﻭﻱ ﻣﻥ ﺍﻷﻣﻌﺎء‬
‫ﺍﻟﺩﻗﻳﻘﺔ ﻭﺧﺎﺻﺔ ﺍﻹﺛﻧﻰ ﻋﺷﺭ ‪،‬ﻭﻗﺩ ﻳﻐﺯﻭ ﺍﻟﻁﻔﻳﻠﻲ ﺍﻟﻘﻧﻭﺍﺕ ﺍﻟﺻﻔﺭﺍﻭﻳﺔ‪.‬‬
‫)‪( Bogitsh and Cheng.,1998‬‬
‫ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﺍﻟﻠﻣﺑﻠﻳﺎ ﺗﺩﻋﻰ ﺃﻳﺿﺎ ﺑﺎﻟﻠﻣﺑﻠﻳﺎ ﺍﻟﻣﻌﻭﻳﺔ ‪ Lamblia intestinalis‬ﺍﻟﺗﻲ‬
‫ﺍﻛﺗﺷﻔﺕ ﻓﻲ ﻋﺎﻡ ‪ 1689‬ﻣﻦ ﻗﺒﻞ ﺍﻟﻌﺎﻟﻢ ﻟﻴﻔﻨﻬﻮﻙ ﻭ ﺫﻟﻚ ﻋﻨﺪﻣﺎ ﻗﺎﻡ ﺑﻔﺤﺺ ﺑﺮﺍﺯﻩ‬
‫ﺍﻟﺨﺎﺹ‪ ،‬ﻳﻠﻲ ﻫﺬﺍ ﺍﻟﻌﺎﻟﻢ ﻋﻠﻤﺎء ﺍﺟﺘﻬﺪﻭﺍ ﻟﻤﻌﺮﻓﺔ ﻫﺬﺍ ﺍﻟﻄﻔﻴﻠﻲ ﻭﺗﻔﺎﺻﻴﻠﻪ‪،‬ﻭﺗﺮﻛﻴﺒﻪ‪ ،‬ﻓﻘﺪ ﺗﻢ‬
‫ﻭﺻﻒ ﻫﺬﺍ ﺍﻟﻄﻔﻴﻠﻲ ﻓﻲ ﻋﺎﻡ ‪ 1859‬ﻣﻦ ﻗﺒﻞ ﺍﻟﻌﺎﻟﻢ ‪ Lamblia‬ﻭﺟﺎء ﺑﻌﺪﻩ ﺍﻟﻌﺎﻟﻢ‬
‫ﺟﻴﺎﺭﺩﻳﺎ ﻭﺃﻁﻠﻖ ﻋﻠﻴﻪ ﺍﺳﻢ ﺟﻴﺎﺭﺩﻳﺎ ﻭﻗﺪ ﺳﻤﻰ ﻫﺬﺍ ﺍﻟﻄﻔﻴﻠﻲ ﺑﻌﺪﺓ ﺗﺴﻤﻴﺎﺕ ﻣﻨﻬﺎ‬
‫‪ G. lamblia‬ﻭ ‪ G.doudenalis‬ﻭ ‪.( Faust et al.,1979) . intestinalis‬‬

‫ﻁﻔﻴﻞ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﻻﻣﺒﻠﻴﺎ ﻛﺎﺋﻦ ﺣﻲ ﺃﻭﻟﻲ ﻭﺣﻴﺪ ﺍﻟﺨﻠﻴﺔ ﻳﺘﻜﺎﺛﺮ ﺑﺎﻻﻧﻘﺴﺎﻡ ﺍﻟﻄﻮﻟﻲ ﻳﺘﺤﺮﻙ‬
‫ﺑﻮﺍﺳﻄﺔ ﺍﻷﺳﻮﺍﻁ ﻭﻳﺴﺒﺐ ﺩﺍء ﺍﻟﺠﻴﺎﺭﺩﻳﺎ )‪Duerden et .,1993 Smyth.,1994‬‬
‫‪ (al‬ﻳﺼﻴﺐ ﺍﻹﻧﺴﺎﻥ ﻭﺍﻟﻘﺮﻭﺩ ﻭﺍﻟﺨﻨﺎﺯﻳﺮ )‪.( Baker,1969‬‬
‫ﻭﻳﻮﺟﺪ ﻟﻠﻄﻔﻴﻠﻲ ﺷﻜﻼﻥ ‪ :‬ﺍﻟﺸﻜﻞ ﺍﻟﻨﺸﻂ ﺍﻟﺬﻱ ﻳﺘﻐﺬﻯ ﻭ ﻳﺘﻜﺎﺛﺮ ﻓﻲ ﺍﻟﺠﺰء ﺍﻟﻌﻠﻮﻱ ﻣﻦ‬
‫ﺍﻷﻣﻌﺎء ﺍﻟﺪﻗﻴﻘﺔ ﻭﺧﺎﺻﺔ ﻓﻲ ﺍﻹﺛﻨﻰ ﻋﺸﺮ ﻭﺍﻟﺸﻜﻞ ﺍﻟﻜﻴﺴﻲ ﺍﻟﺬﻱ ﻳﺘﺤﻤﻞ ﺍﻟﻈﺮﻭﻑ‬
‫ﺍﻟﺨﺎﺭﺟﻴﺔ ﻭﻳﻨﻘﻞ ﺍﻟﻌﺪﻭﻯ )‪.( Bogitsh and Cheng,1998‬‬
‫ﻳﻨﺘﺸﺮ ﻁﻔﻴﻠﻲ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﻓﻲ ﺟﻤﻴﻊ ﺃﻧﺤﺎء ﺍﻟﻌﺎﻟﻢ ﻭﺧﺎﺻﺔ ﺍﻟﻤﻨﺎﻁﻖ ﺫﺍﺕ ﺍﻟﻤﻨﺎﺥ ﺍﻟﺤﺎﺭ‬
‫ﻭﺍﻟﻤﻌﺘﺪﻝ ﻭﻳﺼﻴﺐ ﻫﺬﺍ ﺍﻟﻄﻔﻴﻠﻲ ﺟﻤﻴﻊ ﺍﻷﻋﻤﺎﺭ ﻭ ﺧﺎﺻﺔ ﺍﻟﻤﺠﺘﻤﻌﺎﺕ ﺍﻟﻔﻘﻴﺮﺓ ﺍﻟﺘﻲ ﻳﻘﻞ‬
‫ﻓﻴﻬﺎ ﺍﻟﻮﻋﻲ ﺍﻟﺼﺤﻲ ﻭﺍﻷﻁﻔﺎﻝ ﺍﻟﺪﻳﻦ ﺗﻜﻮﻥ ﻣﻨﺎﻋﺘﻬﻢ ﺍﻟﺠﺴﺪﻳﺔ ﺿﻌﻴﻔﺔ ﻛﻤﺎ ﻓﻲ ﺩﻭﺭ ﺍﻷﻳﺘﺎﻡ‬
‫‪.‬‬

‫‪3‬‬
4
 ‫ﺍﻟﺘﺼﻨﻴﻒ‬
Classification

‫ﺍﻋﺗﻣﺩ ﺍﻟﺗﺻﻧﻳﻑ ﺍﻟﺗﺎﻟﻲ ﻟﻁﻔﻳﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ﻭﺍﻟﻭﺍﺭﺩ ﻣﻥ ﻗﺑﻝ ﺍﻟﻌﺎﻟﻡ‬

(Despommier and Karapelou 1987)

Kingdom: Protista .
Phylum: Sarcomastigophora
Subphylum: Mastigophora
Class: Zoomastigophora
Order: Diplomonadina
Family: Hexamitidae
Genus: Giardia
Species: Lamblia

5
 ‫ﺍﻟﺸﻜﻞ ﺍﻟﻈﺎﻫﺮﻱ ﻭﺍﻟﺒﻨﻴﺔ ﺍﻟﺪﺍﺧﻠﻴﺔ‬
‫‪Morphology and‬‬
‫ﺍﻟﺷﻛﻝ ﺍﻟﺗﺭﻛﻳﺑﻲ ﻟﻠﻁﻔﻳﻝ ﻳﻣﻛﻥ ﺃﻥ ﻳﺩﺭﺱ ﻣﻥ ﺧﻼﻝ ﺍﻟﺗﺣﺿﻳﺭﺍﺕ ﺍﻟﻣﺻﺑﻭﻏﺔ ﻭﺍﻟﻐﻳﺭ‬
‫ﺍﻟﻣﺻﺑﻭﻏﺔ ) ‪ ( Iodine-Iron hematoxylen‬ﻭﻏﺎﻟﺑﺎ ﻳﺗﻡ ﺍﻟﺗﻌﺭﻑ ﺑﺩﻭﻥ ﺻﺑﻎ‪،‬‬
‫ﻫﻧﺎﻙ ﻁﻭﺭﻳﻥ ﻣﻣﻳﺯﻳﻥ ﻟﻬﺫﺍ ﺍﻟﻁﻔﻳﻠﻲ ﻭﻫﻣﺎ‪-:‬‬
‫ﺍﻟﻄﻮﺭ ﺍﻟﻨﺸﻂ ‪Trophozoite‬‬
‫ﻳﺄﺧﺫ ﻫﺫﺍ ﺍﻟﻁﻔﻳﻝ ﺍﻟﺷﻛﻝ ﺍﻟﻛﻣﺛﺭﻱ )ﺷﻛﻝ( ﻭ ﻫﺫﺍ ﻣﺎ ﻳﻣﻳﺯﻫﺎ ﻋﻥ ﺑﺎﻗﻲ ﺍﻷﻭﻟﻳﺎﺕ‪،‬‬
‫‪ ،Schmidt and Roberts,1981‬ﻭﻧﻬﺎﻳﺗﻪ ﺍﻷﻣﺎﻣﻳﺔ ﺗﻛﻭﻥ ﻣﺳﺗﺩﻳﺭﺓ ﺃﻭ ﻋﺭﻳﺿﺔ‬
‫ﻭ ﺍﻟﻧﻬﺎﻳﺔ ﺍﻟﺧﻠﻔﻳﺔ ﺗﻛﻭﻥ ﻣﺩﺑﺑﺔ ﻧﺣﻭ ﺳﻁﺢ ﺍﻟﺟﺳﻡ ﺍﻟﻅﻬﺭﻱ‪ ،‬ﻁﻭﻟﻪ ) ‪ 20 -10‬ﻣﻳﻛﺭﻭﻥ(‬
‫ﻭﻋﺭﺿﻪ ) ‪ 15 - 5‬ﻣﻳﻛﺭﻭﻥ ( ﻭﻳﺣﻣﻝ ﺃﺭﺑﻌﺔ ﺃﺯﻭﺍﺝ ﻣﻥ ﺍﻷﺳﻭﺍﻁ ‪ 8‬ﺃﺳﻭﺍﻁ )ﺯﻭﺝ‬
‫ﻭﻳﻭﺟﺩ ﻧﻭﺍﺗﺎﻥ ﻟﻛﻝ ﻣﻧﻬﻣﺎ ﺟﺳﻡ‬ ‫ﺃﻣﺎﻣﻲ ﻭﺯﻭﺝ ﺟﺎﻧﺑﻲ ﻭ ﺯﻭﺝ ﺑﻁﻧﻲ ﻭ ﺯﻭﺝ ﺧﻠﻔﻲ(‬
‫ﻧﻭﻭﻱ ﻛﺑﻳﺭ ﻭﺗﻭﺟﺩ ﺑﻳﻥ ﺍﻟﻧﻭﺍﺗﻳﻥ ﻗﺿﻳﺑﻳﻥ ﺍﺳﻁﻭﺍﻧﻳﻳﻥ ﻳﺭﺑﻁﺎﻥ ﺍﻟﻧﻭﺍﺗﺎﻥ ﺑﺎﻟﺧﻳﻁ ﺍﻟﺯﺟﺎﺟﻲ‬
‫)ﺍﻹﺑﺭﺓ ﺍﻟﻣﺣﻭﺭﻳﺔ ‪ ( Axostyle‬ﻭ ﻳﻭﺟﺩ ﻋﻠﻰ ﺳﻁﺢ ﺍﻟﺟﺳﻡ ﻣﻥ ﺍﻟﻧﺎﺣﻳﺔ ﺍﻟﺑﻁﻧﻳﺔ ﺟﺯء‬
‫ﻣﺎﺹ‪ ،‬ﻳﺳﺗﻁﻳﻊ ﺍﻟﻁﻔﻳﻝ ﺗﺛﺑﻳﺕ ﺟﺳﻣﻪ ﻓﻲ ﺍﻟﻐﻼﻑ ﺍﻟﻣﺧﺎﻁﻲ ﻟﻠﻌﺎﺋﻝ ﻭ ﻫﺫﺍ ﻣﺎ ﻳﺳﻣﻰ‬
‫ﺑﺎﻟﻘﺭﺹ ﺍﻟﻣﺎﺹ ﻭ ﻳﻭﺟﺩ ﻣﻥ ﺍﻟﺧﻠﻑ ﻣﻥ ﺍﻟﻘﺭﺹ ﺍﻟﻣﺎﺹ ﺟﺳﻳﻣﺎﻥ ﻣﺗﻭﺳﻁﺎﻥ‪ ،‬ﻛﻣﺎ‬
‫ﻳﺷﻣﻝ ﺍﻟﻁﻔﻳﻝ ﻋﻠﻰ ﺟﺳﻳﻣﻳﻥ ﻳﺗﻭﺍﺿﻌﺎﻥ ﻋﺭﺿﻳﺎ ﻓﻭﻕ ﺍﻟﻘﻠﻡ ﺍﻟﻣﺣﻭﺭﻱ ‪ ،‬ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ‬
‫ﻭﺟﻭﺩ ﺣﺑﻳﺑﺎﺕ ﻗﺎﻋﺩﻳﺔ ) ‪ ،(John and Petri, 2006‬ﻳﻌﻳﺵ ﻫﺫﺍ ﺍﻟﻁﻔﻳﻝ ﻓﻲ ﺩﺭﺟﺔ‬
‫ﺍﻟﺣﺭﺍﺭﺓ ﺍﻟﺩﺍﻓﺋﺔ ﻟﻠﺟﺳﻡ‪ ،‬ﻭﻳﻧﺩﺭ ﺭﺅﻳﺔ ﺍﻷﻁﻭﺍﺭ ﺍﻟﻧﺷﻁﺔ ﻓﻲ ﺍﻟﺑﺭﺍﺯ ﺇﻻ ﻓﻲ ﺣﺎﻟﺔ ﻭﺟﻭﺩ‬
‫ﺇﺳﻬﺎﻝ )‪ Faust et al,1970‬ﻭ ﺑﺻﻣﺟﻲ‪.(1990،‬‬

‫ﺍﻟﻄﻮﺭ ﺍﻟﻤﺘﻜﻴﺲ ‪Cyst stage‬‬

‫‪ 14 - 8‬ﻣﻳﻛﺭﻭﻣﺗﺭ ﻭﻋﺭﺿﻪ ‪10-6‬‬ ‫ﺗﺄﺧﺫ ﺍﻷﻛﻳﺎﺱ ﺷﻛﻼ ﺑﻳﺿﺎﻭﻳﺎ‪ ،‬ﻭﻳﺑﻠﻎ ﻁﻭﻟﻪ‬
‫ﻣﻳﻛﺭﻭﻣﺗﺭ‪ ،‬ﻭ ﻳﺣﺗﻭﻱ ﺍﻟﻛﻳﺱ ﺍﻟﻧﺎﺿﺞ ﻋﻠﻰ ﺃﺭﺑﻌﺔ ﺃﻧﻭﻳﺔ ‪ ،‬ﻭﺗﺧﺗﻠﻑ ﺍﻷﻛﻳﺎﺱ ﻋﻥ ﺍﻟﻁﻭﺭ‬
‫‪Beek and‬‬ ‫ﺍﻟﻧﺷﻁ ﻣﻥ ﺣﻳﺙ ﻋﺩﻡ ﺍﺣﺗﻭﺍﺋﻬﺎ ﻋﻠﻰ ﺍﻷﺳﻭﺍﻁ ﺃﻭ ﺍﻟﻘﺭﺹ ﺍﻟﻣﺎﺹ )‬
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 ‫‪ ( Davies, 2003‬ﻭﺗﺳﺗﻁﻳﻊ ﻫﺫﻩ ﺍﻷﻛﻳﺎﺱ ﺃﻥ ﺗﺑﻘﻰ ﺣﻳﺔ ﻓﻲ ﺍﻟﻭﺳﻁ ﺍﻟﺧﺎﺭﺟﻲ ﻟﻣﺩﺓ‬
‫‪ 66‬ﻳﻭﻡ ‪ ،‬ﻭ ﺑﺫﻟﻙ ﺗﺣﺻﻝ ﺍﻟﻌﺩﻭﻯ ﺑﻳﻥ ﺍﻷﺷﺧﺎﺹ ) ‪Peters and Gilles,1995‬‬
‫ﻭﻁﻌﻳﻣﺔ‪.( 2005،‬‬
‫ﻭﻋﻧﺩ ﺍﺳﺗﺧﺩﺍﻡ ﺍﻟﻣﺳﺣﺎﺕ ﺍﻟﻣﺳﺗﺧﺩﻡ ﻓﻳﻬﺎ ﺍﻟﻣﺣﻠﻭﻝ ﺍﻟﻣﻠﺣﻲ ﻳﻣﻛﻥ ﺭﺅﻳﺔ ﺣﺑﻳﺑﺎﺕ ﻋﺎﻛﺳﺔ‬
‫ﺩﺍﺧﻝ ﺍﻟﻁﻭﺭ ﺍﻟﻣﺗﺣﻭﺻﻝ ﻭ ﻳﻅﻬﺭ ﺍﻟﺳﻳﺗﻭﺑﻼﺯﻡ ﻣﻧﻔﺻﻝ ﻋﻧﺩ ﺍﻟﺟﺩﺍﺭ ﺍﻟﺣﻭﻳﺻﻠﻲ‪ ،‬ﻭﻋﻧﺩ‬
‫ﺍﻟﺻﺑﺎﻏﺔ ﺑﺎﺳﺗﺧﺩﺍﻡ ﺍﻟﻳﻭﺩ ﺃﻭ ﺍﻟﻬﻳﻣﺎﺗﻭﻛﺳﻠﻳﻥ ﺗﻅﻬﺭ ﻫﺫﻩ ﺍﻷﻛﻳﺎﺱ ﻣﺣﺗﻭﻳﺔ ﻋﻠﻰ ﻧﻭﺍﺗﻳﻥ‬
‫ﺇﻟﻰ ﺃﺭﺑﻊ ﺃﻧﻭﻳﺔ ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺃﻟﻳﺎﻑ ﺷﻌﻳﺭﺍﺕ ﻋﺩﻳﺩﺓ ﻭﻛﺫﻟﻙ ﺃﺟﺳﺎﻡ ﻭﺳﻁﻳﺔ‪ ،‬ﻭﺇﺫﺍ ﻛﺎﻧﺕ‬
‫ﺍﻷﻛﻳﺎﺱ ﺗﺣﺗﻭﻱ ﻋﻠﻰ ﺍﻟﻧﺷﺎ ﻋﻧﺩ ﺻﺑﺎﻏﺗﻬﺎ ﻓﺈﻧﻬﺎ ﺗﻅﻬﺭ ﺯﺭﻗﺎء ﻭﻳﺷﺎﺭ ﺇﻟﻳﻬﺎ )ﺍﻟﺟﻳﺎﺭﺩﻳﺎ‬
‫ﺍﻟﺯﺭﻗﺎء‪ (Blue Giardia‬ﻭﻗﺩ ﺗﺧﻔﻲ ﺣﺑﻳﺑﺎﺕ ﺍﻟﺟﻠﻳﻛﻭﺟﻳﻥ ﺍﻟﻌﺿﻳﺎﺕ ﺍﻷﺧﺭﻯ ﺇﺫﺍ ﻛﺎﻧﺕ‬
‫ﺑﺄﻋﺩﺍﺩ ﻛﺑﻳﺭﺓ)ﺍﻟﻣﻧﺳﻲ ﻭﺁﺧﺭﻭﻥ‪.(Bogitsh and Cheng,1998:1994 ،‬‬

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8
9
 ‫‪ - 4‬ﺩﻭﺭﺓ ﺍﻟﺤﻴﺎﺓ‬
‫‪Life cycle‬‬

‫ﻳﻌﻳﺵ ﻁﻔﻳﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ‪ Giardia lamblia‬ﻓﻲ ﺍﻹﺛﻧﻰ ﻋﺷﺭ ﻭﺍﻟﺻﺎﺋﻡ ﻭﺍﻟﻠﻔﺎﺋﻔﻲ ﻓﻲ‬
‫ﺍﻹﻧﺳﺎﻥ ﻣﺛﺑﺗﺎ ﺍﻟﻘﺭﺹ ﺍﻟﻼﺻﻕ ﻋﻠﻰ ﺳﻁﺢ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻁﻼﺋﻳﺔ‪ ،‬ﻭ ﻓﻲ ﺍﻟﻌﺩﻭﻯ ﺍﻟﺣﺎﺩﺓ ﻳﻛﻭﻥ‬
‫ﺍﻟﺳﻁﺢ ﺍﻟﻌﻠﻭﻱ ﻟﻛﻝ ﺧﻠﻳﺔ ﻁﻼﺋﻳﺔ ﻣﻐﻁﻰ ﺑﻁﻔﻳﻝ ﻭ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﻟﻠﺟﻳﺎﺭﺩﻳﺎ ﻳﺗﻛﺎﺛﺭ ﻻ‬
‫ﺟﻧﺳﻳﺎ ﺑﺎﻻﻧﻘﺳﺎﻡ ﺍﻟﻁﻭﻟﻲ ‪ ،longitudinal binary fission‬ﻓﺎﻟﺗﺭﻛﻳﺑﺎﺕ ﺍﻟﺩﺍﺧﻠﻳﺔ‬
‫ﻟﻠﺧﻠﻳﺔ ﺗﺧﺿﻊ ﻟﻼﻧﻘﺳﺎﻡ ﻋﻠﻰ ﺍﻟﺗﺭﺗﻳﺏ ﺍﻟﺗﺎﻟﻲ ‪:‬ﺍﻷﻧﻭﻳﺔ ﺛﻡ ﺍﻟﻘﺭﺹ ﺍﻟﻼﺻﻕ ﺛﻡ‬
‫ﺍﻟﺳﻳﺗﻭﺑﻼﺯﻡ‪ ،‬ﻭﺗﻧﺗﺞ ﺃﻋﺩﺍﺩ ﻫﺎﺋﻠﺔ ﻣﻥ ﺍﻟﻁﻔﻳﻝ ﺑﻬﺫﻩ ﺍﻟﻁﺭﻳﻘﺔ ﺣﻳﺙ ﺃﻣﻛﻥ ﻋﺩ ‪ 14‬ﺑﻠﻳﻭﻥ‬
‫ﻁﻔﻳﻝ ﻓﻲ ﻣﺭﺓ ﻭﺍﺣﺩﺓ ﻣﻥ ﺑﺭﺍﺯ ﺇﺳﻬﺎﻟﻲ‪ ،‬ﻭﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﺗﻭﺳﻁﺔ ﻗﺩ ﻳﺣﺗﻭﻱ ﺍﻟﺗﺑﺭﺯ‬
‫ﻓﻲ ﺍﻟﻣﺭﺓ ﺍﻟﻭﺍﺣﺩﺓ ‪ 300‬ﻣﻠﻳﻭﻥ ﻛﻳﺱ ‪.‬ﺗﺣﺩﺙ ﺍﻹﺻﺎﺑﺔ ﻣﻥ ﺍﺑﺗﻼﻉ ﺍﻟﻐﺫﺍء ﺃﻭ ﺍﻟﻣﺎء ﺍﻟﻣﻠﻭﺙ‬
‫ﺑﺎﻟﺣﻭﻳﺻﻼﺕ ﺃﻭ ﺍﻻﺗﺻﺎﻝ ﺍﻟﻣﺑﺎﺷﺭ ﺑﻳﻥ ﺍﻟﻳﺩ ﻭﺍﻟﻔﻡ ‪ ،‬ﻭﺑﻌﺩ ﺍﺑﺗﻼﻉ ﺍﻟﺣﻭﻳﺻﻼﺕ ﻓﺈﻧﻬﺎ ﺗﻌﺑﺭ‬
‫ﻣﻥ ﺍﻟﻣﻌﺩﺓ ﺇﻟﻰ ﺍﻷﻣﻌﺎء ﺍﻟﺻﻐﻳﺭﺓ ﻭﻫﻧﺎﻙ ﺗﻧﻔﻙ ﺍﻟﺣﻭﻳﺻﻼﺕ ﻭ ﺗﻛﻭﻥ ﺍﻟﻔﺿﻼﺕ ﺳﺎﺋﻠﺔ‬
‫ﻧﺗﻳﺟﺔ ﻟﺗﺣﻭﻝ ﺍﻟﺣﻭﻳﺻﻼﺕ ﺇﻟﻰ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﺍﻟﻣﻣﺭﺽ‪ ،‬ﻭﻟﻛﻥ ﻋﻧﺩﻣﺎ ﻳﺩﺧﻝ ﺍﻟﺑﺭﺍﺯ‬
‫ﺍﻟﻘﻭﻟﻭﻥ ﻭﻳﻣﺗﺹ ﻣﻧﻪ ﺍﻟﻣﺎء ﻓﺈﻥ ﺍﻟﺟﻔﺎﻑ ﻳﻧﺑﻪ ﺍﻟﻁﻔﻳﻝ ﻟﻠﺗﻛﻳﺱ ﻭﻳﻛﻭﻥ ﻫﻭ ﺍﻟﻁﻭﺭ ﺍﻟﻣﻌﺩﻱ‬
‫ﺣﻳﺙ ﺗﻘﺻﺭ ﺍﻷﺳﻭﺍﻁ ﻭ ﻻ ﺗﺑﺭﺯ ﻣﻥ ﺍﻟﺧﻠﻳﺔ ﻭ ﻳﺗﻛﺎﺛﻑ ﺍﻟﺳﻳﺗﻭﺑﻼﺯﻡ ﻭﻳﻔﺭﺯ ﺟﺩﺍﺭ ﻛﻳﺳﻲ‬
‫‪ 36 -10‬ﻳﻭﻡ‬ ‫ﻫﻼﻣﻲ ﺳﻣﻳﻙ ﻭﺗﺑﺩﺃ ﺩﻭﺭﺓ ﺍﻟﺣﻳﺎﺓ ﺍﻟﺟﺩﻳﺩﺓ ﻭﺗﺗﺭﺍﻭﺡ ﻓﺗﺭﺓ ﺍﻟﺣﺿﺎﻧﺔ ﻣﻥ‬
‫)‪. ( Bogitsh and Cheng ,1998‬‬

‫‪10‬‬
 ‫ﺷﻜﻞ )‪ (3‬ﺩﻭﺭﺓ ﺣﻴﺎﺓ ‪( CDC , 2007) Giardia lamblia‬‬
‫‪-1‬ﺍﻟﺣﻭﻳﺻﻼﺕ ﻫﻲ ﺃﺷﻛﺎﻝ ﻣﻘﺎﻭﻣﺔ ﻭ ﻣﺳﺋﻭﻟﺔ ﻋﻥ ﺍﻧﺗﻘﺎﻝ ﺍﻟﻣﺭﺽ‪ ،‬ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﻭ‬
‫ﺍﻟﺣﻭﻳﺻﻠﻲ ﻛﻼﻫﻣﺎ ﻳﻣﻛﻥ ﺇﻳﺟﺎﺩﻫﻣﺎ ﻓﻲ ﺍﻟﺑﺭﺍﺯ )ﻣﺭﺣﻠﺔ ﺗﺷﺧﻳﺹ( ‪.‬‬
‫‪-2‬ﺍﻟﺣﻭﻳﺻﻼﺕ ﺗﻛﻭﻥ ﻣﻘﺎﻭﻣﺔ ﻭ ﺗﺳﺗﻁﻳﻊ ﺃﻥ ﺗﺑﻘﻰ ﺣﻳﺔ ﻟﻌﺩﺓ ﺷﻬﻭﺭ ﻓﻲ ﺍﻟﻣﺎء ﺍﻟﺑﺎﺭﺩ‪،‬‬
‫ﺗﺣﺩﺙ ﺍﻟﻌﺩﻭﻯ ﺑﺎﺑﺗﻼﻉ ﺍﻟﺣﻭﻳﺻﻼﺕ ﻓﻲ ﺍﻟﻣﺎء ﺃﻭ ﺍﻟﻐﺫﺍء ﺍﻟﻣﻠﻭﺙ ﺃﻭ ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﺑﺭﺍﺯ‬
‫ﺍﻟﻔﻣﻲ‪.‬‬
‫‪ -3‬ﻓﻲ ﺍﻷﻣﻌﺎء ﺍﻟﺩﻗﻳﻘﺔ ﺍﻻﻧﻔﻛﺎﻙ ﺍﻟﺣﻭﻳﺻﻠﻲ ﻳﺣﺭﺭ ﺍﻷﻁﻭﺍﺭ ﺍﻟﻧﺷﻁﺔ‬
‫‪)Trophozoites‬ﺣﻳﺙ ﻳﻧﺗﺞ ﻛﻝ ﻛﻳﺱ ﺍﺛﻧﺎﻥ ﻣﻥ ‪.(Trophozoites‬‬

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‫‪ -4‬ﻳﺗﺿﺎﻋﻑ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ‪ Trophozoite‬ﺑﺎﻻﻧﻘﺳﺎﻡ ﺍﻟﺷﻁﺭﻱ ﺍﻟﻁﻭﻟﻲ ﻓﻲ ﺗﺟﻭﻳﻑ‬
‫ﺍﻷﻣﻌﺎء ﺍﻷﺩﻧﻰ ﺣﻳﺙ ﻳﻣﻛﻧﻬﺎ ﺃﻥ ﺗﻛﻭﻥ ﻣﺭﺗﺑﻁﺔ ﺑﺎﻟﻐﺷﺎء ﺍﻟﻣﺧﺎﻁﻲ ﺑﻭﺍﺳﻁﺔ ﺍﻟﻘﺭﺹ‬
‫ﺍﻟﻣﺎﺹ‪.‬‬
‫‪ -5‬ﻳﺣﺩﺙ ﺍﻟﺷﻛﻝ ﺍﻟﺣﻭﻳﺻﻠﻲ ﻛﻠﻣﺎ ﺍﺗﺟﻪ ﺍﻟﻁﻔﻳﻝ ﻧﺣﻭ ﺍﻟﻘﻭﻟﻭﻥ‪ ،‬ﻣﺭﺣﻠﺔ ﺍﻟﻁﻭﺭ‬
‫ﺍﻟﻣﺗﺣﻭﺻﻝ ﺗﻭﺟﺩ ﻏﺎﻟﺑﺎ ً ﻭﺑﺷﻛﻝ ﺷﺎﺋﻊ ﻓﻲ ﺍﻟﻐﺎﺋﻁ ﺍﻟﻐﻳﺭ ﺇﺳﻬﺎﻟﻲ ‪.‬‬

‫‪ - 5‬ﺍﻟﻮﺑﺎﺋﻴﺔ‬
‫‪Epidemiology‬‬
‫ﻳﻌﺗﺑﺭ ﺩﺍء ﺍﻟﺟﻳﺎﺭﺩﻳﺎﺕ ﺍﻷﻛﺛﺭ ﺍﻧﺗﺷﺎﺭﺍً ﻓﻲ ﺍﻷﻁﻔﺎﻝ ﺍﻟﺑﺎﻟﻐﻳﻥ ﻭ ﺧﺎﺻﺔ ﺃﻁﻔﺎﻝ‬
‫ﺍﻟﻣﺩﺍﺭﺱ‪ ،‬ﻭ ﺃﻳﺿﺎ ً ﻳﺻﻳﺏ ﺍﻷﺷﺧﺎﺹ ﺫﻭﻱ ﺍﻟﻣﻧﺎﻋﺔ ﺍﻟﺿﻌﻳﻔﺔ‪ ،‬ﻛﻣﺎ ﺗﻌﺗﺑﺭ ﺍﻷﻏﺫﻳﺔ ﻭﺍﻟﻣﻳﺎﻩ‬
‫‪(Craig and Faust,1970‬‬ ‫ﺍﻟﻣﻠﻭﺛﺔ ﺑﺄﻛﻳﺎﺱ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻫﻲ ﻣﺻﺩﺭ ﺍﻟﻌﺩﻭﻯ )‬
‫ﻭﻳﻛﻭﻥ ﺍﻟﻁﻔﻳﻠﻲ ﺷﺎﺋﻊ ﻋﻧﺩ ﺍﻷﻁﻔﺎﻝ ﺍﻟﺫﻳﻥ ﺗﻛﻭﻥ ﺃﻋﻣﺎﺭﻫﻡ ﺑﻳﻥ ‪ 10-6‬ﺳﻧﻭﺍﺕ ﻭﻟﻛﻧﻬﺎ‬
‫ﺗﻭﺟﺩ ﺃﻳﺿﺎ ً ﻓﻲ ﺍﻷﻁﻔﺎﻝ ﺍﻷﻛﺑﺭ ﺳﻧﺎ ﻭﺍﻟﺑﺎﻟﻐﻳﻥ )‪،(Bogitch and Cheng,1998‬‬
‫ﺗﻛﺛﺭ ﺍﻹﺻﺎﺑﺔ ﺑﻪ ﻓﻲ ﺍﻟﻣﻧﺎﻁﻕ ﺫﺍﺕ ﺍﻟﻣﻧﺎﺥ ﺍﻟﺣﺎﺭ ﺃﻭ ﺍﻟﻣﻌﺗﺩﻝ ﺃﻭ ﻓﻲ ﺍﻟﻣﻧﺎﻁﻕ ﺍﻻﺳﺗﻭﺍﺋﻳﺔ‬
‫ﺃﻭ ﺷﺑﻪ ﺍﻻﺳﺗﻭﺍﺋﻳﺔ )‪ ،(Neva and Browb,1994‬ﺇﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻙ ﻓﺈﻥ ﺍﻷﻛﻳﺎﺱ‬
‫ﺍﻟﻁﻔﻳﻠﻳﺔ ﺗﺗﺻﻑ ﺑﻣﻘﺎﻭﻣﺔ ﺷﺩﻳﺩﺓ ﻟﻠﻌﻭﺍﻣﻝ ﺍﻟﻣﺧﺗﻠﻔﺔ‪ ،‬ﻓﻣﺛﻼ ﺗﺣﺎﻓﻅ ﻋﻠﻰ ﺣﻳﻭﻳﺗﻬﺎ ﻟﻣﺩﺓ‬
‫ﺛﻼﺙ ﺃﺳﺎﺑﻳﻊ ﺃﺛﻧﺎء ﻭﺟﻭﺩﻫﺎ ﻓﻲ ﺍﻟﺑﺭﺍﺯ ﺍﻟﻠﻳﻥ ﻏﻳﺭ ﺍﻟﺟﺎﻑ ﻭ ﺑﺫﺍﻟﻙ ﻳﺳﻬﻝ ﺍﻧﺗﺷﺎﺭﻫﺎ‬
‫)ﺑﺻﻣﺟﻲ ‪ .(1990,‬ﻭﻳﻌﺗﺑﺭ ﻫﺫﺍ ﺍﻟﻁﻔﻳﻠﻲ ﻋﺎﻟﻣﻲ ﺍﻻﻧﺗﺷﺎﺭ ﻭﺗﺧﺗﻠﻑ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻋﻠﻰ‬
‫‪) %20-1‬ﻣﻧﻅﻣﺔ ﺍﻟﺻﺣﺔ‬ ‫ﺍﻟﻣﺳﺗﻭﻯ ﺍﻟﻌﺎﻟﻣﻲ ﻓﺎﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺗﺗﺭﺍﻭﺡ ﻣﻥ‬
‫ﺍﻟﻌﻠﻣﻳﺔ‪ .(Markell et al.,1992 :1981،‬ﺣﻳﺙ ﻓﻲ ﺃﻣﺭﻳﻛﺎ ﻭﺑﺎﺋﻳﺔ ﻟﻠﻣﺭﺽ ﻋﻧﺩﻣﺎ‬
‫ﺗﻠﻭﺛﺕ ﻣﻳﺎﻩ ﺍﻟﺷﺭﺏ ﻣﻊ ﺧﻁ ﻣﺟﺎﺭﻱ ﺣﻳﺙ ﺃﻥ ﺣﻭﺍﻟﻲ ‪ %10‬ﻣﻥ ﺍﻷﺷﺧﺎﺹ ﺍﻟﺣﺎﺿﺭﻳﻥ‬
‫ﺫﻟﻙ ﺍﻟﻣﻭﺳﻡ ﺃﺻﺑﺣﻭﺍ ﻣﺻﺎﺑﻳﻥ‪ ،‬ﻭ ﺣﻭﺍﻟﻲ ‪ 56‬ﻣﻥ ‪ 59‬ﺷﺧﺹ ﻋﺎﻧﻭﺍ ﻣﻥ ﺃﻋﺭﺍﺽ‬
‫‪1970‬ﺣﻭﺍﻟﻲ ‪,1998 ) %23‬‬ ‫ﺳﺭﻳﺭﻳﺔ ﻟﻠﻣﺭﺽ ﻭﻗﺩﺭﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻓﻲ ﺳﻧﺔ‬
‫‪(Bogitsh and Cheng‬ﻭ ﺳﺟﻠﺕ ﺑﻌﺽ ﺍﻟﺩﺭﺍﺳﺎﺕ ﺣﻭﻝ ﺍﻟﻌﺎﻟﻡ ﻣﻧﻬﺎ ﺍﻟﺩﺭﺍﺳﺔ ﺍﻟﺗﻲ‬
‫ﺃﺟﺭﻳﺕ ﻓﻲ ﻣﻧﻁﻘﺔ ‪ Havana‬ﻋﻠﻰ ﺍﻷﻁﻔﺎﻝ ﻓﻲ ﺩﻭﺭ ﺍﻟﺭﻋﺎﻳﺔ‪ ,‬ﻭﻛﺎﻧﺕ ﺍﻟﻧﺳﺑﺔ ‪%20‬‬
‫)‪ .(Nune et al., 1999‬ﻛﻣﺎ ﺃﺟﺭﻳﺕ ﺩﺭﺍﺳﺔ ﻓﻲ ﺍﻟﻧﻳﺟﺭ ﻓﻛﺎﻥ ﻣﻌﺩﻝ ﺍﻧﺗﺷﺎﺭ‬
‫ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﺣﻭﺍﻟﻲ ‪ .(Develoux,1990) %28.5‬ﻭﺳﺟﻠﺕ ﺩﺭﺍﺳﺔ ﺃﺧﺭﻯ ﻓﻲ‬
‫‪ Lagos‬ﻓﻲ ﺍﻟﺑﺭﺗﻐﺎﻝ ﻓﻛﺎﻧﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ‪.(Ogwrinde et al .,1997)%7.9‬‬
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 ‫ﻭﻓﻲ ﻣﻧﻁﻘﺔ ﻛﻭﺑﺎ ﻋﺎﻡ ‪ 1978‬ﺃﺟﺭﻳﺕ ﺩﺭﺍﺳﺔ ﻋﻠﻰ ‪ 100‬ﻣﺭﻳﺽ ﻓﻛﺎﻧﺕ ﻣﻅﺎﻫﺭﻫﻡ‬
‫ﺍﻟﺳﺭﻳﺭﻳﺔ ﺗﺗﻣﺎﺷﻰ ﻣﻊ ﺃﻋﺭﺍﺽ ﻣﺗﻼﺯﻣﺔ ﻗﺭﺣﻳﺔ‪ ،‬ﻭﺟﺩ ﻟﺩﻯ ‪ %65‬ﻣﻧﻬﻡ ﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ‬
‫)‪ .(Beek and Davies, 2003‬ﻓﻲ ﺩﺭﺍﺳﺔ ﺃﺟﺭﻳﺕ ﻋﻠﻰ ‪ 134.966‬ﺷﺧﺹ‬
‫ﺣﻭﻝ ﺍﻟﻌﺎﻟﻡ ﺃﺷﺎﺭ ﺃﻥ ﻣﻌﺩﻝ ﺍﻹﺻﺎﺑﺔ ﻳﻣﺛﻝ ‪(Schmidt and % 67.5-%4.2‬‬
‫)‪ . Robert,1981‬ﻭﻓﻲ ﺍﻟﻭﻻﻳﺎﺕ ﺍﻟﻣﺗﺣﺩﺓ ﺗﻡ ﻓﺣﺹ ‪ 35.299‬ﺷﺧﺹ ﺣﻳﺙ ﻣﺛﻠﺕ‬
‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻟﺩﻳﻬﻡ ﺣﻭﺍﻟﻲ ‪ ، %7.4‬ﻣﺛﻝ ﻫﺫﻩ ﺍﻟﺗﻔﺷﻳﺎﺕ ﻗﺎﺩﺕ‬
‫ﺍﻻﺷﺧﺎﺹ ﺍﻟﻌﺎﻣﻠﻳﻥ ﻓﻲ ﻋﻠﻡ ﺍﻷﻭﺑﺋﺔ ﺃﻥ ﻳﺗﻭﻗﻌﻭﺍ ﺃﻥ ﺣﻳﻭﺍﻧﺎﺕ ﻏﻳﺭ ﻣﺳﺗﺄﻧﺳﺔ ﺗﺣﻣﻝ ﺃﻧﻭﺍﻉ‬
‫ﻣﻥ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻗﺎﺩﺭﺓ ﻋﻠﻰ ﺇﺻﺎﺑﺔ ﺍﻹﻧﺳﺎﻥ ﻣﺛﻝ ‪ :‬ﺍﻷﺭﻧﺏ ﻭ ﺍﻟﻛﻼﺏ ﻭ ﺍﻷﻏﻧﺎﻡ ﻛﻣﺻﺎﺩﺭ‬
‫ﺃﺳﺎﺳﻳﺔ ﻹﺻﺎﺑﺔ ﺍﻹﻧﺳﺎ ﻥ ) ‪ .(Noble and Noble,1971‬ﻭ ﺑﺎﻟﻧﺳﺑﺔ ﺇﻟﻰ ﺍﻹﺻﺎﺑﺔ‬
‫ﺑﺎﻟﺟﻳﺎﺭﺩﻳﺎ ﻓﻲ ﻟﻳﺑﻳﺎ ﻧﺟﺩ ﺃﻥ ﺍﻹﺻﺎﺑﺔ ﻣﻧﺧﻔﺿﺔ ﻓﻲ ﺑﻌﺽ ﺍﻟﻣﻧﺎﻁﻕ ﻭ ﻣﺭﺗﻔﻌﺔ ﻓﻲ ﻣﻧﺎﻁﻕ‬
‫‪ 1039‬ﻁﻔﻝ‬ ‫ﺃﺧﺭﻯ‪ ،‬ﻓﻔﻲ ﺩﺭﺍﺳﺔ ﺃﺟﺭﻳﺕ ﻓﻲ ﻣﺩﺭﺳﺔ ﺍﺑﺗﺩﺍﺋﻳﺔ ﻓﻲ ﻣﺩﻳﻧﺔ ﺩﺭﻧﺔ ﻋﻠﻰ‬
‫ﺣﻳﺙ ﻛﺎﻧﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺑﻁﻔﻳﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ‪.(Kassem et al.,2007) 12.7‬‬
‫‪ 350‬ﻁﻔﻝ‬ ‫ﻓﻲ ﺩﺭﺍﺳﺔ ﺃﺧﺭﻯ ﺃﺟﺭﻳﺕ ﻓﻲ ﻣﺳﺗﺷﻔﻰ ﺍﺑﻥ ﺳﻳﻧﺎ ﻓﻲ ﻣﺩﻳﻧﺔ ﺳﺭﺕ ﻋﻠﻰ‬
‫ﻭﻣﻭﺍﻟﻳﺩ ﺃﻋﻣﺎﺭﻫﻡ ﺍﻗﻝ ﻣﻥ ﺷﻬﺭ ﺣﻳﺙ ﺷﻛﻠﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ‪Kassem et )%10.2‬‬
‫‪ . ( al.,2007‬ﻛﻣﺎ ﺳﺟﻠﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﻁﻔﻳﻠﻲ ﻓﻲ ﺑﻧﻐﺎﺯﻱ ‪) %6.24‬ﺇﺣﺻﺎﺋﻳﺎﺕ‬
‫ﻣﺳﺗﺷﻔﻳﺎﺕ ﺑﻧﻐﺎﺯﻱ ‪. (1996 ،‬ﺃﻣﺎ ﻓﻲ ﺍﻟﺑﻳﺿﺎء ﻧﺟﺩ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻣﺭﺗﻔﻌﺔ ﺣﻳﺙ ﻛﺎﻧﺕ‬
‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ‪ ،% 38 ،% 43 ،% 35 ،% 30‬ﻓﻲ ﺍﻟﺳﻧﻭﺍﺕ ﻣﻥ ‪1993 -1990‬‬
‫) ﺍﻟﺧﺎﻟﺩﻱ‪ ،( 1996 ،‬ﻭ ﺃﻳﺿﺎ ﺩﺭﺍﺳﺔ ﺃﺧﺭﻯ ﺃﺟﺭﻳﺕ ﺑﻳﻥ ﺍﻷﻁﻔﺎﻝ ﻓﻲ ﻣﻧﻁﻘﺔ ﺯﻟﻳﺗﻥ‬
‫ﻛﺎﻧﺕ ﻧﺳﺑﺗﻬﺎ ‪ . (Ali et al .,2005)% 1.2‬ﺣﻳﺙ ﺃﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﺟﻳﺎﺭﺩﻳﺎ ﺗﺯﻳﺩ‬
‫ﻣﻊ ﻓﺻﻭﻝ ﺍﻟﺳﻧﺔ ﻭ ﺧﺎﺻﺔ ﻓﻲ ﻓﺻﻠﻲ ﺍﻟﺭﺑﻳﻊ ﻭﺍﻟﺧﺭﻳﻑ )‪.(Wallis et al.,1996‬‬

‫‪ -6‬ﺍﻹﻣﺮﺍﺿﻴﺔ‬
‫‪Pathogencity‬‬
‫ﻳﺳﺑﺏ ﻁﻔﻳﻠﻲ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ﺩﺍء ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ) ‪ (Giardiasis‬ﻭﻻ ﺗﻅﻬﺭ ﺃﻋﺭﺍﺽ‬
‫ﺍﻟﻣﺭﺽ ﻋﻠﻰ ﻛﺛﻳﺭﺍ ﻣﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ‪ ،‬ﻭﺗﺗﺭﺍﻭﺡ ﻓﺗﺭﺓ ﺍﻟﺣﺿﺎﻧﺔ ﻣﻥ ﺃﺳﺑﻭﻉ ﺇﻟﻰ ﺛﻼﺙ‬
‫ﺃﺳﺎﺑﻳﻊ )ﺍﻟﺳﻭﻳﺣﻠﻲ ﻭ ﻣﺭﺍﺩ ‪.( 1995 ،‬‬
‫ﻭﻣﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺗﻲ ﻗﺩ ﻳﺳﺑﺑﻬﺎ ﺍﺿﻁﺭﺍﺑﺎﺕ ﻣﻌﻭﻳﺔ ﺣﺎﺩﺓ ﺃﻏﻠﺑﻬﺎ ﺍﻹﺳﻬﺎﻝ ﻗﺩ ﻳﻛﻭﻥ‬
‫ﺣﺎﺩﺍ ﺃﻭ ﻣﺯﻣﻧﺎ ﻭﺃﻋﺭﺍﺽ ﻣﺻﺎﺣﺑﺔ ﻧﺗﻳﺟﺔ ﺳﻭء ﺍﻻﻣﺗﺻﺎﺹ ) ‪(Gardner 2001‬‬
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‫‪ .and Hill,‬ﺗﻛﻭﻥ ﺁﻟﻳﺔ ﺃﻣﺭﺍﺿﻳﺔ ﺍﻟﻁﻔﻳﻠﻲ ﻋﻥ ﻁﺭﻳﻕ ﺍﻟﺗﺻﺎﻕ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﺑﻣﺧﺎﻁﻳﺔ‬
‫ﺍﻷﻣﻌﺎء ﺑﻭﺍﺳﻁﺔ ﺍﻟﻘﺭﺹ ﺍﻟﻣﺎﺹ ﺍﻟﺗﻲ ﺗﺅﺩﻱ ﺇﻟﻰ ﺗﺧﺩﺵ ﻭ ﺗﻘﺭﺡ ﻓﻲ ﺟﺩﺍﺭ ﺍﻷﻣﻌﺎء ﻭ‬
‫ﺍﻧﺳﻼﺥ ﺍﻟﻐﺷﺎء ﺍﻟﻅﺎﻫﺭﻱ ﻧﺗﻳﺟﺔ ﻟﺗﻐﺫﻱ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﻋﻠﻰ ﺧﻼﻳﺎ ﺍﻟﻐﺷﺎء‪ ،‬ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ‬
‫ﺿﻣﻭﺭ ﺍﻟﺯﻏﺑﺎﺕ ﺍﻟﻣﻌﻭﻳﺔ ﻭﺗﺿﺧﻡ ﺍﻟﻐﺩﺩ ﺍﻟﻠﻳﻣﻔﺎﻭﻳﺔ ﺍﻟﻣﻌﻭﻳﺔ ﻭ ﻋﺳﺭ ﻓﻲ ﺍﻣﺗﺻﺎﺹ‬
‫ﺍﻟﺩﻫﻭﻥ ﻭ ﺍﻟﺳﻛﺭﻳﺎﺕ ﻭﺑﻌﺽ ﺍﻟﻔﻳﺗﺎﻣﻳﻧﺎﺕ ﻣﺛﻝ ﻓﻳﺗﺎﻣﻳﻥ ) ‪(A‬ﻭﻓﻳﺗﺎﻣﻳﻥ ) ‪1994).(B12‬‬
‫‪ ،(Brook et al .,2001;Neva and Brown,‬ﻭﻋﻧﺩﻣﺎ ﻳﻐﺯﻭ ﺍﻟﻁﻔﻳﻠﻲ ﺍﻟﻘﻧﺎﺓ‬
‫ﺍﻟﺻﻔﺭﺍﻭﻳﺔ ﻓﺎﻧﻪ ﻳﺳﺑﺏ ﺍﻧﺳﺩﺍﺩﻫﺎ ﻭ ﺗﻧﺧﺭ ﻓﻲ ﺟﺩﺍﺭ ﺍﻷﻣﻌﺎء ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﺍﻹﺻﺎﺑﺔ‬
‫ﺑﺎﻟﻳﺭﻗﺎﻥ‪ ،‬ﺃﻣﺎ ﻣﻥ ﺣﻳﺙ ﺍﻷﻋﺭﺍﺽ ﻓﻣﻌﻅﻡ ﺍﻟﻣﺻﺎﺑﻳﻥ ﻳﺷﻛﻭﻥ ﻣﻥ ﺍﻷﻭﺭﺍﻡ ﻭﺍﻧﺗﻔﺎﺥ ﺍﻟﺑﻁﻥ‬
‫ﻭ ﺇﺳﻬﺎﻝ ﻣﻣﺎ ﻳﺅﺩﻱ ﺇﻟﻰ ﻓﻘﺩﺍﻥ ﺍﻟﺑﺭﻭﺗﻳﻥ‪ ،‬ﻭﻳﻛﻭﻥ ﺍﻟﺑﺭﺍﺯ ﺳﺎﺋﻝ ﻛﺭﻳﻪ ﺍﻟﺭﺍﺋﺣﺔ‪ ،‬ﻟﻛﻧﻪ ﺧﺎﻟﻲ‬
‫ﻣﻥ ﺍﻟﺩﻡ ﺃﻭ ﺻﺩﻳﺩ ﻭ ﻫﺫﺍ ﻣﺎ ﻳﺳﻣﻰ ﺑﺎﻟﺗﻐﻭﻁ ﺍﻟﺩﻫﻧﻲ ﻛﻣﺎ ﻳﺻﺎﺏ ﺑﻌﺽ ﺍﻟﻣﺭﺿﻰ ﺑﻔﻘﺩﺍﻥ‬
‫ﺍﻟﺷﻬﻳﺔ ﻭ ﺗﻭﻋﻙ ﻭ ﺍﻟﻐﺛﻳﺎﻥ ﺍﻟﻘﺊ ) ‪ (Brooks et al., 2001‬ﻭﺗﻛﻭﻥ ﺃﻋﺭﺍﺽ‬
‫ﺍﻟﻣﺭﺽ ﺍﺷﺩ ﻋﻠﻰ ﺍﻷﻁﻔﺎﻝ ﺑﺷﻛﻝ ﺧﺎﺹ ﻓﻬﻲ ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﻣﺎ ﺳﺑﻕ ﻗﺩ ﺗﺣﻭﻝ ﺩﻭﻥ‬
‫ﻧﻣﻭﻫﻡ ﺑﺷﻛﻝ ﻁﺑﻳﻌﻲ ﻭﺍﻧﺧﻔﺎﺽ ﺃﻭﺯﺍﻧﻬﻡ ﻭ ﺍﻧﺧﻔﺎﺽ ﻧﺳﺑﺔ ﺍﻟﺫﻛﺎء ﻓﻳﻬﻡ‪ ،‬ﻭﺍﻟﻧﻣﻭ‬
‫ﺍﻟﻌﻘﻠﻲ)ﺍﻟﺳﻭﻳﺣﻠﻲ ﻭﻣﺭﺍﺩ ‪.(Berkman et al., 2002 ;1995‬‬

‫‪ - 7‬ﺍﻟﺘﺸﺨﻴﺺ‬
‫‪Diagnosis‬‬
‫ﻳﻌﺗﻣﺩ ﺗﺷﺧﻳﺹ ﺩﺍء ﺍﻟﺟﻳﺎﺭﺩﻳﺎﺕ ﻋﻠﻰ ﺍﻟﺗﻌﺭﻑ ﻋﻠﻰ ﺍﻟﻁﻭﺭ ﺍﻟﻣﺗﻛﻳﺱ ﻓﻲ ﺍﻟﺑﺭﺍﺯ‬
‫ﺍﻟﻣﺗﻣﺎﺳﻙ ﺃﻭ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﻓﻲ ﺍﻟﺑﺭﺍﺯ ﺍﻟﺳﺎﺋﻝ ﺑﺎﻟﻔﺣﺹ ﺍﻟﻣﺑﺎﺷﺭ‪ ،‬ﻭﺗﻛﻭﻥ ﺍﻟﻌﻼﻣﺎﺕ‬
‫ﺍﻟﺗﺷﺧﻳﺻﻳﺔ ﻟﻠﻁﻭﺭ ﺍﻟﻣﺗﻛﻳﺱ ‪ :‬ﺍﻟﻁﻭﻝ ﺣﻭﺍﻟﻲ ‪10u‬ﻭﻅﻬﻭﺭ ﻋﻣﻭﺩ ﻣﺣﻭﺭﻱ‪ ،‬ﻭﻭﺟﻭﺩ ‪4‬‬
‫ﺃﻧﻭﻳﺔ ﻋﻧﺩ ﺍﻟﻧﺿﻭﺝ ﻭﺃﺣﻳﺎﻧﺎ ﻳﻛﻭﻥ ﺟﺳﻣﻬﺎ ﻗﺎﻋﺩﻱ ‪.‬‬

‫ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ‪ :‬ﻣﻥ ‪ 20 – 10‬ﻣﻳﻛﺭﻭﻥ‪ ،‬ﻭﺍﻟﻌﺭﺽ ﻣﻥ ‪ 10 – 5‬ﻣﻳﻛﺭﻭﻥ‪ ،‬ﻭﺟﻭﺩ‬

‫‪ 4‬ﺃﺳﻭﺍﻁ ﺯﻭﺟﻳﺔ ﻭﻗﺭﺹ‬ ‫ﻋﻣﻭﺩ ﻣﺣﻭﺭﻱ ﻭ ﻧﻭﺍﺗﻳﻥ ﻭ ﺟﺳﻡ ﻗﺎﻋﺩﻱ‪ ،‬ﻭ ﺃﻳﺿﺎ ً ﻳﻭﺟﺩ‬

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 ‫ﻻﺻﻕ‪ .‬ﺃﻭ ﺑﺎﺳﺗﺧﺩﺍﻡ ﻁﺭﻕ ﺍﻟﺗﺭﻛﻳﺯ ﻣﺛﻝ ﺍﻟﻁﻔﻭ ﺑﺎﺳﺗﺧﺩﺍﻡ ﻛﺑﺭﻳﺗﺎﺕ ﺍﻟﺯﻧﻙ ﺃﻭ ﺍﻟﺗﺭﺳﻳﺏ‬
‫ﺑﺎﺳﺗﺧﺩﺍﻡ ﺍﻟﻔﻭﺭﻣﺎﻟﻳﻥ ﻭﺍﻹﻳﺛﺭ‪. ( (Neva and Brown, 1994‬‬
‫ﺍﻟﻔﺣﺹ ﻟﻠﺗﻌﺭﻑ ﻋﻠﻰ ﺍﻷﻁﻭﺍﺭ ﺍﻟﻧﺷﻁﺔ ﻧﺎﺩﺭ ﺟﺩﺍً ﻷﻥ ﺍﻛﺗﺷﺎﻓﻬﺎ ﻳﻌﺗﻣﺩ ﻋﻠﻰ ﺍﻟﻔﺣﺹ‬
‫ﻓﻲ ﺍﻟﺣﺎﻝ ﺃﻭ ﺣﻔﻅ ﻋﻳﻧﺎﺕ ﺍﻟﺑﺭﺍﺯ ﺍﻟﺗﻲ ﺗﻛﻭﻥ ﻓﻲ ﺣﺎﻟﺔ ﺇﺳﻬﺎﻝ ﻣﺑﺎﺷﺭ ‪(Bogitsh et al‬‬
‫)‪..,2001‬‬
‫ﻛﺫﻟﻙ ﻳﻣﻛﻥ ﺍﻟﻛﺷﻑ ﻋﻥ ﺣﻭﻳﺻﻼﺕ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻓﻲ ﺍﻟﺑﺭﺍﺯ ﺍﻟﻣﺗﻣﺎﺳﻙ ﻛﻣﺎ ﻳﺟﺏ ﺍﻟﺗﻔﺭﻳﻕ‬
‫ﺑﻳﻥ ﻫﺫﻩ ﺍﻟﺣﻭﻳﺻﻼﺕ ﻋﻥ ﺣﻭﻳﺻﻼﺕ ﺍﻟﺣﻳﻭﺍﻧﺎﺕ ﻭﻋﻥ ﺍﻟﻔﻁﺭﻳﺎﺕ‪ ،‬ﻟﺫﻟﻙ ﻣﻥ ﺍﻟﻣﻬﻡ ﺍﻟﻘﻳﺎﻡ‬
‫ﺑﺎﻟﻔﺣﺹ ﻋﺩﺓ ﻣﺭﺍﺕ ﻣﻥ ﺃﺟﻝ ﺍﻟﺗﺄﻛﺩ ﻣﻥ ﻭﺟﻭﺩ ﺇﺻﺎﺑﺔ ﺃﻭ ﻋﺩﻡ ﺇﺻﺎﺑﺔ‪ ،‬ﻷﻧﻪ ﺃﺣﻳﺎﻧﺎ ً ﻳﻭﺟﺩ‬
‫ﻓﻲ ﺗﻘﺭﺣﺎﺕ ﺍﻟﻣﻌﻲ ﺍﻟﻐﻠﻳﻅ ﻛﻣﺎ ﺫﻛﺭ ﻓﻲ ﺑﺣﺙ ﺳﺎﺑﻕ )ﻋﺯ ﺍﻟﺩﻳﻥ ‪ . (1996 ،‬ﻛﻣﺎ ﺇﻥ‬
‫ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ ﻗﺩ ﻳﻠﺗﺻﻕ ﺑﻣﺧﺎﻁﻳﺔ ﺍﻷﻣﻌﺎء ﻭ ﻳﺗﺣﺭﺭ ﻓﻲ ﻓﺗﺭﺍﺕ ﻣﺗﻔﺎﻭﺗﺔ ﻟﺫﻟﻙ ﻗﺩ ﻳﺗﻁﻠﺏ‬
‫ﺍﻷﻣﺭ ﻓﺣﺹ ﺃﻛﺛﺭ ﻣﻥ ﺛﻼﺙ ﻋﻳﻧﺎﺕ ﻋﻠﻰ ﺃﻳﺎﻡ ﻣﺗﻌﺎﻗﺑﺔ ‪،( (Brooks et al.,2001‬‬
‫ﻟﻭ ﻛﺎﻥ ﻫﻧﺎﻙ ﺷﻙ ﻓﻲ ﺃﻥ ﺍﻟﻣﺻﺎﺏ ﻳﻌﺎﻧﻲ ﻣﻥ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻭﺗﺣﻠﻳﻝ ﺍﻟﺑﺭﺍﺯ ﻛﺎﻥ ﺳﻠﺑﻲ‬
‫ﻋﺩﺓ ﻣﺭﺍﺕ ﻳﻣﻛﻧﻧﺎ ﺃﻥ ﻧﻠﺟﺄ ﺇﻟﻰ ﺍﺧﺗﺑﺎﺭ ﻋﺻﺎﺭﺓ ﺍﻹﺛﻧﻰ ﻋﺷﺭ ﻭﺍﻟﻣﻌﻲ ﺍﻟﺻﺎﺋﻡ ﻋﻥ ﻁﺭﻳﻕ‬
‫ﺗﺟﺭﺑﺔ ﺍﻟﺧﻳﻁ ‪ ((String test‬ﻭﻫﻲ ﺑﺳﻳﻁﺔ ﺟﺩﺍ ﺑﺎﻥ ﻳﺑﻠﻊ ﺍﻟﻣﺭﻳﺽ ﻛﺑﺳﻭﻟﺔ ﻣﻣﺳﻭﻛﺔ‬
‫ﺑﺧﻳﻁ ﻣﻥ ﺍﺣﺩ ﺃﻁﺭﺍﻓﻬﺎ ﺣﺗﻰ ﺗﺻﻝ ﺍﻷﻣﻌﺎء ﻓﻳﺫﻭﺏ ﺍﻟﺟﻳﻼﺗﻳﻥ ﻭﻳﻣﺗﺹ ﺍﻟﺧﻳﻁ ﺍﻟﻣﻭﺟﻭﺩ‬
‫ﺑﺩﺍﺧﻠﻬﺎ ﺍﻟﻌﺻﺎﺭﺓ ﺃﻭ ﺍﻟﺳﺎﺋﻝ ﺍﻟﻣﻌﻭﻱ ﻭﻳﺳﺣﺏ ﺍﻟﺧﻳﻁ ﻭﻳﻌﺻﺭ ﺍﻟﺟﺯء ﺍﻷﺧﻳﺭ ﺍﻟﺫﻱ ﻛﺎﻥ‬
‫ﻓﻲ ﺍﻷﻣﻌﺎء ﻭﻓﺣﺻﻪ ﺗﺣﺕ ﺍﻟﻣﺟﻬﺭ ﻟﻠﻛﺷﻑ ﻋﻥ ﻭﺟﻭﺩ ﺍﻟﻁﻭﺭﺍﻟﻧﺷﻁ‪.‬‬

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16
 ‫‪ -8‬ﺍﻟﻌﻼﺝ‬
‫‪Treatme‬‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻣﻧﺎﺳﺏ ﻟﺣﺎﻻﺕ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻣﻥ ﺍﺟﻝ ﺇﺯﺍﻟﺔ ﺃﻋﺭﺍﺿﻬﺎ ﻫﻭ ﺍﻟﻣﺗﺭﻭﻧﻳﺩﺍﺯﻭﻝ‬
‫‪ Metronidazole‬ﺣﻳﺙ ﺃﻥ ﺍﻟﺷﻔﺎء ﺍﻟﻣﻌﺗﺎﺩ ﻳﻛﻭﻥ ﺧﻼﻝ ﺃﺳﺑﻭﻉ ﺑﻌﺩ ﺍﻟﺑﺩء ﻓﻲ ﺍﻟﻌﻼﺝ‬
‫ﺣﺩﻭﺙ ﺍﻹﺻﺎﺑﺔ ﺍﻟﺭﺟﻌﻳﺔ ﻭ ﺇﺫﺍ ﻛﺎﻥ ﻫﻧﺎﻙ ﺇﺻﺎﺑﺔ ﻓﻲ ﺍﻟﻘﻧﺎﺓ ﺍﻟﺻﻔﺭﺍﻭﻳﺔ ﻭ ﺫﻟﻙ ﺑﺳﺑﺏ‬
‫ﺳﻬﻭﻟﺔ ﺍﻧﺗﻘﺎﻝ ﺍﻟﺣﻭﻳﺻﻠﺔ‪ ،‬ﻭﻋﻠﻳﻪ ﻛﻝ ﺍﻟﺳﻛﺎﻥ ﻓﻲ ﺑﻳﺕ ﻭﺍﺣﺩ ﻳﺟﺏ ﻋﻼﺟﻬﻡ ﻓﻲ ﻭﻗﺕ‬
‫ﻭﺍﺣﺩ )‪ .(Bogitsh and Cheng.,1998‬ﻳﻌﻁﻰ ﻋﻼﺝ ﺍﻟﻣﺗﺭﻭﻧﻳﺩﺍﺯﻭﻝ ﺃﻣﺎ ﺑﺟﺭﻋﺔ‬
‫ﻣﻧﺧﻔﺿﺔ ‪ 200‬ﻣﻠﻳﺟﺭﺍﻡ ﺛﻼﺙ ﻣﺭﺍﺕ ﻳﻭﻣﻳﺎ ﻟﻣﺩﺓ ‪ 14 -10‬ﻳﻭﻡ‪ ،‬ﺃﻭ ﺑﺟﺭﻋﺔ ﻋﺎﻟﻳﺔ ‪2‬‬
‫ﺟﺭﺍﻡ ﻳﻭﻣﻳﺎ ﻟﻣﺩﺓ ﺛﻼﺙ ﺃﻳﺎﻡ‪ .‬ﻳﻣﻛﻥ ﺇﻋﻁﺎء ﺍﻟﺗﻳﻧﺩﺍﺯﻭﻝ ﺑﺟﺭﻋﺔ ﻭﺍﺣﺩﺓ ‪ 2‬ﺟﺭﺍﻡ )‪ 50‬ﻣﻠﺞ‬
‫‪ /‬ﻛﻠﺞ ﻋﻧﺩ ﺍﻷﻁﻔﺎﻝ( ﻭ ﻟﻛﻥ ﻛﻼ ﺍﻟﺩﻭﺍﺋﻳﻥ ﻳﺅﺩﻳﺎﻥ ﺇﻟﻰ ﺍﻟﻐﺛﻳﺎﻥ ﻓﻲ ﺍﻟﺟﺭﻋﺎﺕ ﺍﻟﻌﺎﻟﻳﺔ‬
‫)‪ .(Souhami and Moxham, 1995‬ﻭﻫﻧﺎﻙ ﻋﻼﺟﺎﺕ ﺃﺧﺭﻯ ﻣﺛﻝ‬
‫‪Nitrimidazine‬‬
‫ﻭﺍﻟﺗﻳﻧﺩﺍﺯﻭﻝ )ﻭ ﻫﻣﺎ ﻣﻥ ﻣﺷﺗﻘﺎﺕ ‪- 5‬ﻧﻳﺗﺭﻭﺍﻳﻣﻳﺩﺍﺯﻭﻝ( ﻭ ‪ Furoxone‬ﻓﻌﺎﻻ ﻓﻲ‬
‫ﻣﻌﺎﻟﺟﺔ ﺩﺍء ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻟﻛﻧﻬﺎ ﻻﺗﻔﻭﻕ ﺍﻟﻣﻳﺗﺭﻭﻧﻳﺩﺍﺯﻭﻝ )‪(Beck and Davies,2003‬‬
‫ﻫﻧﺎﻙ ﺃﺩﻭﻳﺔ ﺃﺧﺭﻯ ﺗﺳﺗﻌﻣﻝ ﻟﻌﻼﺝ ﺣﺎﻻﺕ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻭﻫﻲ ﻛﻠﻭﺭﻭﻛﻭﻳﻥ‬
‫‪ ،Chloroquine‬ﺃﻣﻭﺩﻳﺎﻛﻭﻳﻡ ‪ Amodiaquim‬ﻭﻻﻛﻥ ﺗﺄﺛﻳﺭﻫﺎ ﻳﻛﻭﻥ ﺍﻗﻝ ﻣﻥ‬
‫ﺍﻟﻣﺗﺭﻭﻧﻳﺩﺍﺯﻭﻝ )‪.(Criage and Faust,1970‬‬

‫‪ -9‬ﻁﺮﻕ ﺍﻟﺴﻴﻄﺮﺓ ﻭ ﺍﻟﻮﻗﺎﻳﺔ‬

‫ﺍﻟﺻﺣﺔ ﺍﻟﻌﺎﻣﺔ ﻭﺍﻟﺻﺣﺔ ﺍﻟﺷﺧﺻﻳﺔ ﻫﻣﺎ ﺃﺳﺎﺱ ﺍﻟﺳﻳﻁﺭﺓ ﻭ ﺍﻟﻭﻗﺎﻳﺔ ﻣﻥ ﺍﻟﻌﺩﻭﻯ‬

‫)ﺭﺑﻳﻊ‪ ،(1997،‬ﻭ ﺗﺷﺗﻣﻝ ﻁﺭﻕ ﺍﻟﺳﻳﻁﺭﺓ ﻭ ﺍﻟﻭﻗﺎﻳﺔ ﺍﻟﻧﻘﺎﻁ ﺍﻟﺗﺎﻟﻳﺔ ‪-:‬‬
‫‪ -1‬ﺍﻟﻌﻧﺎﻳﺔ ﺍﻟﻔﺎﺋﻘﺔ ﺑﻣﻳﺎﻩ ﺍﻟﺷﺭﺏ ﻭﺫﻟﻙ ﺑﺗﻌﻘﻳﻣﻬﺎ ﺑﺎﻟﻛﻠﻭﺭ ﻭ ﺍﻟﻳﻭﺩ ﺇﻻ ﺃﻥ ﺍﻟﻛﻠﻭﺭ ﺑﺎﻟﻧﺳﺏ‬
‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ ﻓﻲ ﺗﻧﻘﻳﺔ ﺍﻟﻣﻳﺎﻩ ﻻ ﺗﻘﺗﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ‪ ،‬ﻭﺗﻛﻣﻥ ﺃﻫﻣﻳﺔ ﺗﻌﻘﻳﻡ ﻣﻳﺎﻩ ﺍﻟﺷﺭﺏ ﺑﺎﻟﻳﻭﺩ ﻓﻲ‬
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 ‫ﺃﻧﻬﺎ ﻣﻣﻛﻥ ﺃﻥ ﺗﺧﺗﻠﻁ ﺑﻣﻳﺎﻩ ﺍﻟﻣﺟﺎﺭﻱ ﺍﻟﻣﺣﺗﻭﻳﺔ ﻋﻠﻰ ﻫﺫﻩ ﺍﻷﻛﻳﺎﺱ‪ ،‬ﻭﺭﺑﻣﺎ ﺗﺗﻠﻭﺙ ﺍﻟﻣﻳﺎﻩ‬
‫ﺑﺄﻛﻳﺎﺱ ﺍﻟﻁﻔﻳﻝ ﻣﻥ ﺍﻷﻏﻧﺎﻡ ﻭ ﺍﻟﻘﻭﺍﺭﺽ‪.‬‬
‫‪ -2‬ﻋﻼﺝ ﺍﻟﻣﺭﺿﻰ ﻭ ﺣﺎﻣﻠﻲ ﺍﻟﻌﺩﻭﻯ‪.‬‬
‫‪-3‬ﺍﻟﻐﺳﻳﻝ ﺍﻟﺟﻳﺩ ﻟﻠﺧﺿﺎﺭ ﻭ ﺍﻟﻔﺎﻛﻬﺔ ﻭﻏﺳﻝ ﺍﻷﻳﺩﻱ ﻗﺑﻝ ﺍﻷﻛﻝ‪.‬‬
‫‪ -4‬ﻣﺭﺍﻗﺑﺔ ﺍﻟﺣﻳﻭﺍﻧﺎﺕ ﺍﻷﻟﻳﻔﺔ ﺍﻟﺗﻲ ﺗﻌﻣﻝ ﻛﻌﻭﺍﺋﻝ ﺧﺎﺯﻧﺔ ﻟﻠﻁﻔﻳﻠﻲ ﻭ ﻋﻼﺟﻬﺎ‪.‬‬
‫‪ -5‬ﺍﻟﻔﺣﺹ ﺍﻟﺩﻭﺭﻱ ﻟﻌﻣﺎﻝ ﺍﻟﻣﻁﺎﻋﻡ ﻭﺍﻟﻔﻧﺎﺩﻕ ﻭﻋﻼﺝ ﺍﻟﻣﺻﺎﺑﻳﻥ ﻣﻧﻬﻡ )ﻁﻌﻳﻣﺔ‪.( 2005،‬‬
‫‪ -6‬ﻳﺟﺏ ﻋﻠﻰ ﺍﻟﻣﺳﺎﻓﺭﻳﻥ ﺇﻟﻰ ﺍﻟﻣﻧﺎﻁﻕ ﺍﻟﺗﻲ ﺗﻛﻭﻥ ﻓﻳﻬﺎ ﻣﻳﺎﻩ ﺍﻟﺻﻧﺑﻭﺭ ﻏﻳﺭ ﺻﺎﻟﺣﺔ‬
‫ﻟﻠﺷﺭﺏ ﺃﻥ ﻳﺗﺟﻧﺑﻭﺍ ﺍﻟﺳﻠﻁﺎﺕ ﻭ ﺍﻷﻁﻌﻣﺔ ﻏﻳﺭ ﺍﻟﻣﻁﺑﻭﺧﺔ‪ ،‬ﻭﺍﻟﻔﺎﻛﻬﺔ ﻏﻳﺭ ﺍﻟﻣﻘﺷﺭﺓ‬
‫ﻭﻣﻛﻌﺑﺎﺕ ﺍﻟﺛﻠﺞ ﺍﻟﺗﻲ ﺗﻭﺿﻊ ﻓﻲ ﺍﻟﻣﺷﺭﻭﺑﺎﺕ‪.‬‬
‫‪ -7‬ﺇﺟﺭﺍء ﻧﺩﻭﺍﺕ ﺗﺛﻘﻳﻔﻳﺔ ﻟﻠﺗﻌﺭﻳﻑ ﺑﺎﻟﻁﻔﻳﻠﻲ ﻭﻣﺩﻯ ﺧﻁﻭﺭﺗﻪ‪.‬‬

‫‪- 10‬ﺍﻟﻬﺪﻑ ﻣﻦ ﺍﻟﺒﺤﺚ‬

‫– ‪10‬‬ ‫‪ -1‬ﻣﻌﺭﻓﺔ ﻣﺩﻯ ﺍﻧﺗﺷﺎﺭ ﻁﻔﻳﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ﻓﻲ ﺍﻷﻁﻔﺎﻝ ﻣﻥ ﻋﻣﺭ ﺍﻟﺳﻧﺔ‬
‫ﺳﻧﻭﺍﺕ ﻓﻲ ﻣﻧﻁﻘﺔ ﺳﺑﻬﺎ‪.‬‬
‫‪ -2‬ﺇﻳﺟﺎﺩ ﺍﻟﻌﻼﻗﺔ ﺑﻳﻥ ﺍﻹﺻﺎﺑﺔ ﻭ ﺍﻟﺟﻧﺱ ﻭ ﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ‪.‬‬
‫‪ -3‬ﺗﻭﻓﻳﺭ ﻣﻌﻠﻭﻣﺎﺕ ﻟﻠﺭﻓﻊ ﻣﻥ ﻣﺳﺗﻭﻯ ﺍﻟﻭﻋﻲ ﺍﻟﺻﺣﻲ ﺑﻳﻥ ﺳﻛﺎﻥ ﻣﻧﻁﻘﺔ ﺳﺑﻬﺎ ﻣﻥ‬
‫ﺧﻁﻭﺭﺓ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﻁﻔﻳﻝ ﻭﻣﺎ ﻳﻧﺟﻡ ﻋﻧﻪ ﻣﻥ ﺃﺿﺭﺍﺭ ﺻﺣﻳﺔ ﻭﺍﻗﺗﺻﺎﺩﻳﺔ ﻭ ﺍﺟﺗﻣﺎﻋﻳﺔ‪.‬‬
‫‪ -4‬ﻭﺿﻊ ﻣﻌﻠﻭﻣﺎﺕ ﺗﺧﺩﻡ ﺍﻟﺟﻬﺎﺕ ﺍﻟﻣﺧﺗﺻﺔ ﻟﺗﻭﻓﻳﺭ ﺍﻟﺧﺩﻣﺎﺕ ﺍﻟﺻﺣﻳﺔ ﻟﻠﻭﻗﺎﻳﺔ ﻣﻥ ﻫﺫﺍ‬
‫ﺍﻟﻁﻔﻳﻠﻲ‪.‬‬

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 ‫* ﺍﻟﻔﺺ ﺍﻟﺜﺎﻧﻲ‬

‫ﺍﳌﻮﺍﺩ ﻭﻃﺮﻕ ﺍﻟﻌﻤﻞ‬

‫‪19‬‬
 ‫ﺍﻟﻤﻮﺍﺩ ﻭ ﻁﺮﻕ ﺍﻟﻌﻤﻞ‬
‫ﺗﻡ ﺇﺟﺭﺍء ﻫﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﻋﻠﻰ ﺍﻷﻁﻔﺎﻝ ﻣﻥ ﻋﻣﺭ ﺍﻟﺳﻧﺔ ﺇﻟﻰ ﻋﻣﺭ ﺍﻟﻌﺷﺭ ﺳﻧﻭﺍﺕ‬
‫ﺑﻣﻧﻁﻘﺔ ﺳﺑﻬﺎ ﻓﻲ ﺍﻟﻔﺗﺭﺓ ﻣﺎ ﺑﻳﻥ ‪ 2015-11-9‬ﺇﻟﻰ ‪ 2016-3-14‬ﺣﻳﺙ ﺗﻡ ﺟﻣﻊ ﻋﺩﺩ‬
‫‪ 200‬ﻋﻳﻧﺔ ﺑﺭﺍﺯ ﺑﻌﺩ ﺃﻥ ﺗﻡ ﺗﺳﺟﻳﻝ ﺍﻟﺑﻳﺎﻧﺎﺕ ﻋﻥ ﺍﻷﻓﺭﺍﺩ ﻣﻥ ﺧﻼﻝ ﺍﻻﺳﺗﺑﻳﺎﻥ ﺍﻟﺫﻱ‬
‫ﻳﺷﺗﻣﻝ )ﺍﺳﻡ ﺍﻟﻣﺭﻳﺽ‪ ،‬ﻭ ﻋﻣﺭﻩ‪ ،‬ﻭﺟﻧﺳﻪ‪ ،‬ﻭﺟﻧﺳﻳﺗﻪ‪ ،‬ﻭ ﻣﻛﺎﻥ ﺍﻟﺳﻛﻥ‪ ،‬ﻭﺍﻷﻋﺭﺍﺽ‪ :‬ﺍﻟﻡ‬
‫ﻓﻲ ﺍﻟﺑﻁﻥ – ﺇﺳﻬﺎﻝ – ﻓﻘﺩﺍﻥ ﺍﻟﺷﻬﻳﺔ – ﺷﺣﻭﺏ ﻓﻲ ﺍﻟﻭﺟﻪ – ﺿﻌﻑ ﻓﻲ ﺍﻟﺑﻧﻳﺔ – ﻏﺛﻳﺎﻥ‬
‫– ﻗﻲء – ﻏﺎﺯﺍﺕ ﺃﻭ ﺗﻁﺑﻝ ﺍﻟﺑﻁﻥ – ﺣﻣﻰ – ﺇﺳﻬﺎﻝ ﺩﻫﻧﻲ ﺍﻟﻘﻭﺍﻡ‪.‬‬
‫ﻫﺫﻩ ﺍﻟﻌﻳﻧﺎﺕ ﺟﻣﻌﺕ ﻓﻲ ﺣﺎﻭﻳﺎﺕ ﺑﻼﺳﺗﻳﻛﻳﺔ ﻧﻅﻳﻔﺔ ﺧﺎﺻﺔ ﻣﻌﺩﺓ ﻟﻬﺫﺍ ﺍﻟﻐﺭﺽ‪ ،‬ﻓﺣﺻﺕ‬
‫ﺍﻟﻌﻳﻧﺎﺕ ﻣﺑﺎﺷﺭﺓ‬
‫ﻓﻲ ﻣﻭﻋﺩ ﻭﺻﻭﻟﻬﺎ ﺇﻟﻰ ﺍﻟﻣﺧﺗﺑﺭ ﺑﺎﻟﻌﻳﻥ ﺍﻟﻣﺟﺭﺩﺓ )ﺍﻟﻔﺣﺹ ﺍﻟﻣﺑﺎﺷﺭ (‪ ،‬ﻭ ﺍﻟﻔﺣﺹ‬
‫ﺍﻟﻣﺟﻬﺭﻱ ‪.‬‬

‫‪ -1‬ﺍﻷﺩﻭﺍﺕ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ‪-:‬‬
‫ﺷﺭﺍﺋﺢ ﺯﺟﺎﺟﻳﺔ‪ ،‬ﺃﻏﻁﻳﺔ ﺷﺭﺍﺋﺢ‪ ،‬ﺃﻧﺎﺑﻳﺏ ﺟﻣﻊ ﺍﻟﻌﻳﻧﺎﺕ‪ Loops ،‬ﻭﻣﺟﻬﺭ‪.‬‬

‫‪ -2‬ﺍﻟﻤﺤﺎﻟﻴﻞ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ‪-:‬‬
‫ﻣﺣﻠﻭﻝ ﺍﻟﻳﻭﺩ‪.‬‬
‫ﺗﺭﻛﻳﺯ ﺍﻟﻳﻭﺩ ﺍﻟﻣﺳﺗﺧﺩﻡ ﻓﻲ ﺍﻟﻔﺣﺹ ﺍﻟﻣﺑﺎﺷﺭ ﻟﻌﻳﻧﺎﺕ ﺍﻟﺑﺭﺍﺯ‪ %35-30‬ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻳﻭﺩ‬
‫ﺍﻟﻣﺭﻛﺯ ﻳﺗﻡ ﺍﻟﺗﺧﻔﻳﻑ ﺑﺎﺳﺗﺧﺩﺍﻡ ﺍﻟﻣﺎء ﺍﻟﻣﻘﻁﺭ‪.‬‬

‫‪ -3‬ﻓﺤﺺ ﺍﻟﻌﻴﻨﺎﺕ‪-:‬‬
‫‪-1-3‬ﺍﻟﻔﺤﺺ ﺑﺎﻟﻌﻴﻦ ﺍﻟﻤﺠﺮﺩﺓ ‪-:Macroscopic examination‬‬
‫ﻓﺣﺻﺕ ﻋﻳﻧﺎﺕ ﺍﻟﺑﺭﺍﺯ ﺟﻣﻳﻌﻬﺎ ﺑﺎﻟﻌﻳﻥ ﺍﻟﻣﺟﺭﺩﺓ ﻗﺑﻝ ﺍﻟﻔﺣﺹ ﺍﻟﻣﺟﻬﺭﻱ ﻟﻣﻼﺣﻅﺔ ﻁﺑﻳﻌﺔ‬
‫ﺍﻟﺑﺭﺍﺯ )ﻁﺑﻳﻌﻲ ﺃﻭ ﻏﻳﺭ ﻁﺑﻳﻌﻲ( ﻣﻥ ﻣﻼﺣﻅﺔ ﺍﻵﺗﻲ ‪-:‬‬
‫‪20‬‬
 ‫ﺃ‪ -‬ﻗﻭﺍﻡ ﺍﻟﺑﺭﺍﺯ‪ :‬ﻗﺎﺳﻲ ﺃﻭ ﻟﻳﻥ ﺃﻭ ﻣﺎﺋﻲ‪.‬‬
‫ﺏ‪ -‬ﻟﻭﻥ ﺍﻟﺑﺭﺍﺯ ﻭ ﺍﺣﺗﻭﺍﺋﻪ ﻋﻠﻰ ﺑﻘﻊ ﺍﻟﺩﻡ ﻭ ﺍﻟﻣﺧﺎﻁ ﺃﻭ ﺍﻻﺛﻧﻳﻥ ‪.‬‬
‫ﻣﻬﺿﻭﻣﺔ‪.‬‬ ‫ﺝ‪ -‬ﻭﺟﻭﺩ ﺃﻟﻳﺎﻑ ﻭﻣﻭﺍﺩ ﻏﺫﺍﺋﻳﺔ ﻏﻳﺭ‬
‫‪-:Microscopic‬‬ ‫‪ 2-3‬ﺍﻟﻔﺤﺺ ﺍﻟﻤﺠﻬﺮﻱ )ﺍﻟﻔﺤﺺ ﺍﻟﻤﺒﺎﺷﺮ( ‪examination‬‬
‫ﺗﻡ ﺃﺧﺩ ﻣﻘﺩﺍﺭ ﻣﻧﺎﺳﺏ ﻣﻥ ﻋﻳﻧﺔ ﺑﺭﺍﺯ ﻣﻥ ﻣﻧﺎﻁﻕ ﻡﺧﺗﻠﻔﺔ ﻣﻥ ﺍﻟﻌﻳﻧﺔ ﻭﺣﺿﺭ ﻣﻧﻬﺎ‬
‫ﻣﺳﺣﺎﺕ ﺑﻣﺣﻠﻭﻝ ﺍﻟﻳﻭﺩ ﻛﺎﻵﺗﻲ‪-:‬‬

‫ﺗﺤﻀﻴﺮ ﻣﺴﺤﺎﺕ ﻣﻦ ﺍﻟﻐﺎﺋﻂ ﺑﺼﺒﻐﺔ ﺍﻟﻴﻮﺩ‪-:‬‬

‫ﺣﺿﺭﺕ ﺑﻣﺯﺝ ﻛﻣﻳﺔ ﻗﻠﻳﻠﺔ ﻣﻥ ﻋﻳﻧﺔ ﺍﻟﺑﺭﺍﺯ ) ‪1‬ﺟﻡ ﺗﻘﺭﻳﺑﺎ ( ﻣﻊ ﻗﻁﺭﺓ ﻣﻥ ﻣﺣﻠﻭﻝ ﺍﻟﻳﻭﺩ‬
‫ﺑﻭﺍﺳﻁﺔ ‪ .Loop‬ﺑﻌﺩ ﺗﻛﻭﻥ ﻣﺯﻳﺞ ﻣﺗﺟﺎﻧﺱ ﺛﻡ ﻭﺿﻊ ﻏﻁﺎء ﺍﻟﺷﺭﻳﺣﺔ ﻭﻓﺣﺻﺕ ﺑﺷﻛﻝ‬
‫ﻣﻧﺗﻅﻡ ﺑﺎﺳﺗﺧﺩﺍﻡ ﺍﻟﻌﺩﺳﺔ ﺍﻟﺷﻳﺋﻳﺔ )‪ (x10‬ﺛﻡ )‪.(x40‬ﻭ ﺑﺫﻟﻙ ﻳﻣﻛﻥ ﺍﻟﺗﻌﺭﻑ ﻋﻠﻰ ﺍﻟﻁﻔﻳﻠﻲ‬
‫ﻣﻥ ﺧﻼﻝ ﺧﺻﺎﺋﺻﻪ ﺍﻟﻌﺎﻣﺔ‪ ،‬ﻣﺛﻝ ﻋﺩﺩ ﺍﻷﻧﻭﻳﺔ ) ‪ 4 – 2‬ﻧﻭﻳﺎﺕ( ﻭﺍﻟﻘﻁﺭ ﻟﻛﻝ ﻣﻥ‬
‫ﺍﻟﺣﻭﻳﺻﻠﺔ ﻭ ﺍﻟﻁﻭﺭ ﺍﻟﻧﺷﻁ‪.‬‬

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‫ﺍﻟﻔﺼﻞ ﺍﻟﺜﺎﻟﺚ‬

‫ﺍﻟﻨﺘﺎﺋﺞ ﻭ ﺍﻟﻨﺎﻗﺸﺔ‬

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 ‫‪ -3‬ﺍﻟﻨﺘﺎﺋﺞ ﻭﺍﻟﻤﻨﺎﻗﺸﺔ‬
‫‪ 1-3‬ﺍﻟﻧﺗﺎﺋﺞ‪-:‬‬
‫ﺃﻅﻬﺭﺕ ﻧﺗﺎﺋﺞ ﻫﺩﻩ ﺍﻟﺩﺭﺍﺳﺔ ﺃﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺑﻁﻔﻳﻝ ﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ﻟﺩﻯ ﺗﻼﻣﻳﺫ‬
‫ﻣﺩﺍﺭﺱ ﺍﻟﺗﻌﻠﻳﻡ ﺍﻷﺳﺎﺳﻲ ﻭﺍﻷﻁﻔﺎﻝ ﺍﻟﻣﺗﺭﺩﺩﻳﻥ ﻋﻠﻰ ﺍﻟﻣﺧﺗﺑﺭ ﺍﻟﻣﺭﻛﺯﻱ ﻟﻣﺩﻳﻧﺔ ﺳﺑﻬﺎ ﻫﻲ‬
‫‪10)%5‬ﻋﻳﻧﺎﺕ ﻣﻭﺟﺑﺔ‪200/‬ﻋﻳﻧﺔ ﻣﻔﺣﻭﺻﺔ(ﻭﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ ‪. %95‬‬
‫ﺍﻟﻧﺳﺑﺔ ﺍﻟﻛﻠﻳﺔ ﺑﻳﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ ﻭﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ‬
‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ‬ ‫ﻋﺩﺩ ﺍﻟﻣﻔﺣﻭﺻﻳﻥ‬ ‫‪1T‬‬

‫‪%5‬‬ ‫‪10/200‬‬ ‫‪1T‬‬

‫ﺍﻟﻣﺻﺎﺑﻳﻥ‬
‫‪%95‬‬ ‫‪195 /200‬‬‫‪1T‬‬
‫ﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ‬

‫ﺟﺩﻭﻝ )‪(1-3‬ﻳﻭﺿﺢ ﺍﻟﻧﺳﺑﺔ ﺍﻟﻛﻠﻳﺔ ﻟﻠﻣﺻﺎﺑﻳﻥ ﻭﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ‬

‫‪5%‬‬

‫ﺍﻟﻣﺻﺎﺑﻳﻥ‬
‫ﻏﻳﺭ ﺍﻟﻣﺻﺎﺑﻳﻥ‬
‫‪95%‬‬

‫‪23‬‬
 ‫ﺭﺳﻡ ﺗﻭﺿﻳﺣﻲ)‪(1-3‬ﺷﻛﻝ ﻳﻭﺿﺢ ﺍﻟﻧﺳﺑﺔ ﺑﻳﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ ﻭﺍﻟﻐﻳﺭ ﻣﺻﺎﺑﻳﻥ‬
‫ﻭﺃﻅﻬﺭﺕ ﺍﻟﻧﺗﺎﺋﺞ ﺃﻥ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﻓﻲ ﺍﻟﺫﻛﻭﺭ ﺃﻋﻠﻰ ﻣﻥ ﺍﻹﻧﺎﺙ ﺣﻳﺙ ﻛﺎﻧﺕ‪%6.79‬‬
‫‪ %3.09‬ﻋﻠﻰ ﺍﻟﺗﻭﺍﻟﻲ ‪.‬‬

‫ﺟﺩﻭﻝ)‪(2-3‬ﻭﺍﻟﺷﻛﻝ )‪.(2-3‬ﺣﻳﺙ ﺃﻥ ﺍﻟﺣﺳﺎﺑﺎﺕ ﺍﻹﺣﺻﺎﺋﻳﺔ ﺃﻅﻬﺭﺕ ﺍﻧﻪ ﻻﻳﻭﺟﺩ ﻓﺭﻭﻕ‬

‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ)‪(%‬‬ ‫ﺍﻟﻣﺻﺎﺑﻳﻥ‬ ‫ﺍﻟﻣﻔﺣﻭﺻﻳﻥ‬ ‫ﺍﻟﺟﻧﺱ‬

‫‪%6.79‬‬ ‫‪7‬‬ ‫‪103‬‬ ‫ﺍﻟﺫﻛﻭﺭ‬
‫‪%3.09‬‬ ‫‪3‬‬ ‫‪97‬‬ ‫ﺍﻹﻧﺎﺙ‬
‫ﻣﻌﻧﻭﻳﺔ‬

‫)ﺍﻟﺟﺩﻭﻝ‪(2.3‬ﻳﺑﻳﻥ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﺑﻳﻥ ﺍﻟﺫﻛﻭﺭ ﻭﺍﻹﻧﺎﺙ‪.‬‬

‫ﺷﻛﻝ)‪(2-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﺑﻳﻥ ﺍﻟﺟﻧﺳﻳﻥ‬

‫‪24‬‬
‫ﺃﻅﻬﺭﺕ ﺍﻟﻧﺗﺎﺋﺞ ﺃﻥ ﺃﻛﺛﺭ ﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ ﺇﺻﺎﺑﺔ ﺑﻳﻥ ﺍﻟﺫﻛﻭﺭ ﻭﺍﻹﻧﺎﺙ ‪ 6 -5‬ﺳﻧﻭﺍﺕ‬
‫ﻭﻛﺎﻥ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ‪، %10‬ﻭﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ‪ 8 -7‬ﺳﻧﻭﺍﺕ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ‪،%7.89‬‬
‫ﻭﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ﻣﻥ ‪ 2-1‬ﺳﻧﺔ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ‪ ،%5.71‬ﻭﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ‪ 4 -3‬ﺳﻧﻭﺍﺕ‬
‫ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ‪ ،%4.76‬ﻭﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ﻣﻥ ‪ 10-9‬ﺳﻧﻭﺍﺕ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ‪. %1.31‬‬
‫ﺟﺩﻭﻝ)‪،(3-3‬ﺷﻛﻝ ) ‪.(3-3‬ﺃﻅﻬﺭﺕ ﺍﻟﺣﺳﺎﺑﺎﺕ ﺍﻧﻪ ﻳﻭﺟﺩ ﻓﺭﻭﻕ ﻣﻌﻧﻭﻳﺔ ﺑﻳﻥ ﺃﻋﻣﺎﺭ‬
‫ﺍﻟﻣﺻﺎﺑﻳﻥ ‪.‬‬

‫ﺟﺩﻭﻝ )‪(3-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﺑﻳﻥ ﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ ﺍﻟﺫﻛﻭﺭ ﻭﺍﻹﻧﺎﺙ‬

‫ﺍﻟﻔﺋﺎﺕ‬
‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ‬ ‫ﻋﺩﺩ ﺍﻟﻣﺻﺎﺑﻳﻥ‬ ‫ﻋﺩﺩ ﺍﻟﻣﻔﺣﻭﺻﻳﻥ‬
‫ﺍﻟﻌﻣﺭﻳﺔ)ﺳﻧﺔ(‬
‫‪%5.71‬‬ ‫‪2‬‬ ‫‪35‬‬ ‫‪2-1‬‬
‫‪%4.76‬‬ ‫‪1‬‬ ‫‪21‬‬ ‫‪4-3‬‬
‫‪%10‬‬ ‫‪3‬‬ ‫‪30‬‬ ‫‪6-5‬‬
‫‪%7.89‬‬ ‫‪3‬‬ ‫‪38‬‬ ‫‪8-7‬‬
‫‪%1.31‬‬ ‫‪1‬‬ ‫‪76‬‬ ‫‪10-9‬‬

‫‪25‬‬
 ‫ﺷﻛﻝ )‪(3-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﺣﺳﺏ ﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ﻟﻠﺫﻛﻭﺭ ﻭ ﺍﻹﻧﺎﺙ‬

‫ﻭﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﺃﻳﺿﺎ ﺗﻡ ﺍﻟﺗﻌﺭﻑ ﻋﻠﻰ ﻣﺩﻯ ﺍﻧﺗﺷﺎﺭ ﻁﻔﻳﻠﻲ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻭﻓﻘﺎ ﻟﻣﻛﺎﻥ‬
‫ﺍﻟﺳﻛﻥ ﺣﻳﺙ ﺗﺑﻳﻥ ﺃﻥ ﻫﻧﺎﻙ ﺗﻔﺎﻭﺕ ﻓﻲ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻓﻲ ﻣﻧﺎﻁﻕ ﻋﻥ ﺍﻟﻣﻧﺎﻁﻕ ﺍﻷﺧﺭﻯ‬
‫ﻭﺍﻥ ﺃﻛﺛﺭ ﻧﺳﺑﺔ ﺇﺻﺎﺑﺔ ﺳﺟﻠﺕ ﻓﻲ ﻣﻧﻁﻘﺔ ﺍﻟﻁﻳﻭﺭﻱ ) ‪1‬ﻣﺻﺎﺑﻳﻥ ‪3 /‬ﻣﻔﺣﻭﺻﻳﻥ ﻭﺑﻧﺳﺑﺔ‬
‫‪ (%33‬ﻭﻟﻡ ﺗﺳﺟﻝ ﺃﻱ ﻧﺳﺑﺔ ﺇﺻﺎﺑﺔ ﻓﻲ ﻛﻝ ﻣﻥ ﺍﻟﻣﻧﺎﻁﻕ )ﺍﻟﻧﺎﺻﺭﻳﺔ‪،‬ﺣﺟﺎﺭﺓ‪،‬ﺳﻛﺭﺓ‪،‬‬
‫ﺍﻟﻘﺭﺿﺔ‪ ،‬ﺷﺭﻛﺔﺍﻻﺷﻐﺎﻝ‪ ،‬ﺣﻲ ﺍﻟﻛﺭﺍﻣﺔ‪ ،‬ﺣﻲ ﻋﺑﺩ ﺍﻟﻛﺎﻑﻱ‪ ،‬ﺃﻗﻌﻳﺩ ‪ ،85 ،‬ﺣﻲ ﺍﻟﻬﺎﻧﻲ‪ ،‬ﺣﻲ‬
‫ﺍﻟﻔﺎﺗﺢ(‬

‫‪26‬‬
 ‫ﺟﺩﻭﻝ)‪(4-3‬ﻳﻭﺿﺢ ﻣﺩﻱ ﺍﻹﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻟﻣﻛﺎﻥ ﺍﻟﺳﻛﻥ‬

‫ﻋﺩﺩ ﺍﻟﻌﻳﻧﺎﺕ‬
‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ‬ ‫ﻋﺩﺩ ﺍﻟﻌﻳﻧﺎﺕ‬ ‫ﻣﻛﺎﻥ ﺍﻟﺳﻛﻥ‬
‫ﺍﻟﻣﻭﺟﺑﺔ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪55‬‬ ‫ﺍﻟﻧﺎﺻﺭﻳﺔ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪21‬‬ ‫ﺣﺟﺎﺭﺓ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪18‬‬ ‫ﺳﻛﺭﺓ‬
‫‪21%‬‬ ‫‪4‬‬ ‫‪19‬‬ ‫ﺍﻟﻣﻬﺩﻳﺔ‬
‫‪14%‬‬ ‫‪1‬‬ ‫‪7‬‬ ‫ﺍﻟﺛﺎﻧﻭﻳﺔ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪13‬‬ ‫ﺍﻟﻘﺭﺿﺔ‬
‫‪6%‬‬ ‫‪2‬‬ ‫‪32‬‬ ‫ﺍﻟﻣﻧﺷﻳﺔ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪1‬‬ ‫ﺷﺭﻛﺔ ﺍﻷﺷﻐﺎﻝ‬
‫‪11%‬‬ ‫‪2‬‬ ‫‪18‬‬ ‫ﺍﻟﺟﺩﻳﺩ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫ﺣﻲ ﻋﺑﺩ ﺍﻟﻛﺎﻓﻲ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪3‬‬ ‫ﺃﻗﻌﻳﺩ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫ﺣﻲ ﺍﻟﻛﺭﺍﻣﺔ‬
‫‪33%‬‬ ‫‪1‬‬ ‫‪3‬‬ ‫ﺃﻟﻁﻳﻭﺭﻱ‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪85‬‬
‫‪0%‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫ﺣﻲ ﺍﻟﻬﺎﻧﻲ‬
‫‪%0‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫ﺣﻲ ﺍﻟﻔﺎﺗﺢ‬

‫‪27‬‬
 ‫‪ .‬ﺷﻛﻝ )‪(4-3‬ﻳﻭﺿﺢ ﻣﺩﻯ ﺍﻹﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻟﻣﻛﺎﻥ ﺍﻟﺳﻛﻥ‬
‫ﺟﺩﻭﻝ )‪ ( 5-3‬ﻳﻭﺿﺢ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺳﺭﻳﺭﻳﺔ ﺑﻳﻥ ﺍﻷﻁﻔﺎﻝ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺎﻟﺟﻳﺎﺭﺩﻳﺎ‬

‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻮﻳﺔ ‪%‬‬ ‫ﻋﺪﺩ ﺍﻟﻌﻴﻨﺎﺕ‬ ‫ﺍﻷﻋﺮﺍﺽ ﺍﻟﺴﺮﻳﺮﻳﺔ‬

‫‪28.57‬‬ ‫‪2‬‬ ‫ﺍﻟﻢ ﻓﻲ ﺍﻟﺒﻄﻦ ﻣﻊ ﺇﺳﻬﺎﻝ‬

‫‪28.57‬‬ ‫‪2‬‬ ‫ﺍﻟﻢ ﻓﻲ ﺍﻟﺒﻄﻦ ﻣﻊ ﺇﺳﻬﺎﻝ ﺩﻫﻨﻲ‬
‫‪28.57‬‬ ‫‪2‬‬ ‫ﺍﻟﻢ ﻓﻲ ﺍﻟﺒﻄﻦ ﻣﻊ ﺇﺳﻬﺎﻝ ﻭ ﻗﻲء‬
‫‪14.28‬‬ ‫‪1‬‬ ‫ﺍﻟﻢ ﻓﻲ ﺍﻟﺒﻄﻦ ﻣﻊ ﻗﻲء ﻭ ﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ‬

‫ﻭﺃﻅﻬﺭﺕ ﻧﺗﺎﺋﺞ ﻫﺩﻩ ﺍﻟﺩﺭﺍﺳﺔ ﺃﻳﺿﺎ ﺃﻥ ﺃﻋﻠﻰ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻷﻋﺭﺍﺽ ﺍﻟﻣﺻﺎﺑﻳﻥ‬
‫ﻫﻲ ﺍﻟﻡ ﻓﻲ ﺍﻟﺑﻁﻥ ﻣﻊ ﺇﺳﻬﺎﻝ‪ ،‬ﻭ ﺍﻟﻡ ﻓﻲ ﺍﻟﺑﻁﻥ ﻣﻊ ﺇﺳﻬﺎﻝ ﺩﻫﻧﻲ ﻭﻛﺎﻧﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ‬
‫ﻫﻲ ‪ %28.57‬ﻟﻛﻠﻳﻬﻣﺎ ﻋﻠﻰ ﺍﻟﺗﻭﺍﻟﻲ‪.‬‬

‫‪28‬‬
 ‫ﻭﺍﻥ ﺃﺩﻧﻰ ﻧﺳﺑﺔ ﺇﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻷﻋﺭﺍﺽ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺍﻟﻡ ﻓﻲ ﺍﻟﺑﻁﻥ ﻣﻊ ﻗﻲء ﻭ ﻓﻘﺩﺍﻥ‬
‫ﺍﻟﺷﻬﻳﺔ ﻭﻛﺎﻧﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻫﻲ ‪%14.28‬‬

‫ﺷﻛﻝ)‪ (5-3‬ﻳﻭﺿﺢ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﻭﻓﻘﺎ ﻟﻸﻋﺭﺍﺽ ﺍﻟﺳﺭﻳﺭﻳﺔ ﺑﻳﻥ ﺍﻻﻁﻔﺎﻝ ﺍﻟﻣﺻﺎﺑﻳﻥ‬
‫ﻻﻣﺑﻠﻲ‬
‫ﺍ‬ ‫ﺑﺎﻟﺟﻳﺎﺭﺩﻳﺎ‬

‫ﺍﻟﺠﺪﻭﻝ )‪ (6-3‬ﺍﻧﺘﺸﺎﺭ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﺍﻟﻠﻤﺒﻠﻴﺎ ﻓﻲ ﻟﻴﺒﻴﺎ‬

‫ﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ‬
‫ﺍﻟﻣﺭﺍﺟﻊ‬ ‫)‪(%‬‬ ‫ﺍﻟﻔﺋﺔ‪/‬ﺍﻟﻣﻧﻁﻘﺔ‬

‫)‪Dar et al (1979‬‬ ‫‪11.4‬‬ ‫ﺍﻁﻔﺎﻝ ﺍﻟﻣﺩﺍﺭﺱ ﻓﻲ ﺑﻧﻐﺎﺯﻱ‬

‫)‪Bolbol et al (1981‬‬ ‫‪8.7‬‬ ‫ﺍﻟﻌﻳﺎﺩﺍﺕ ﺍﻟﺧﺎﺭﺟﻳﺔ ﻓﻲ ﻁﺭﺍﺑﻠﺱ‬
‫)‪El-Buni et al (1998‬‬ ‫‪7.8‬‬ ‫ﺍﻟﻣﻐﺗﺭﺑﻳﻥ ﻓﻲ ﺑﻧﻐﺎﺯﻱ‬
‫)‪El-Buni and Khan (1998‬‬ ‫‪6.2‬‬ ‫ﺍﻻﻁﻔﺎﻝ ﺍﻟﻣﺗﺭﺩﺩﻳﻥ ﻋﻠﻰ ﻣﺳﺗﺷﻔﻰ ﺑﻧﻐﺎﺯﻱ‬
‫ﺍﻷﻁﻔﺎﻝ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻤﻌﺪﺓ ﻭﺍﻷﻣﻌﺎء ﻓﻲ ﻣﺴﺘﺸﻔﻰ‬
‫‪Bugharara et al (1999).‬‬ ‫‪5.85‬‬
‫ﺍﻷﻁﻔﺎﻝ ﻓﻲ ﺑﻧﻐﺎﺯﻱ‬
‫)‪Al-Tawaty et al (2002‬‬ ‫‪3.77‬‬ ‫ﺍﻷﻁﻔﺎﻝ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻹﺳﻬﺎﻝ ﻓﻲ ﻣﺴﺘﺸﻔﻰ ﺍﻷﻁﻔﺎﻝ ﺑﻨﻐﺎﺯﻱ‬

‫)‪Al-Fellani et al (2005‬‬ ‫‪1.62‬‬ ‫ﺍﻟﻌﻳﺎﺩﺍﺕ ﺍﻟﺧﺎﺭﺟﻳﺔ ﻓﻲ ﺳﺑﻬﺎ‬

‫)‪Ali et al (2005‬‬ ‫‪1.2‬‬ ‫ﺍﻷﻁﻔﺎﻝ ﺍﻟﺫﻳﻥ ﻳﻌﺎﻧﻭﻥ ﻣﻥ ﺍﻹﺳﻬﺎﻝ ﻓﻲ ﺯﻟﻳﺗﻥ‬
‫)‪Salem et al (2007‬‬ ‫‪7.2‬‬ ‫ﺍﻟﻣﺭﺿﻰ ﺍﻟﻠﻳﺑﻳﻳﻥ ﻓﻲ ﺳﺭﺕ‬
‫‪Sadaga and Kassem‬‬
‫‪12.7‬‬ ‫ﺃﻁﻔﺎﻝ ﺍﻟﻣﺩﺍﺭﺱ ﺍﻻﺑﺗﺩﺍﺋﻳﺔ ﻓﻲ ﺩﺭﻧﺔ‬
‫)‪(2007‬‬
‫)‪Kassem et al (2007‬‬ ‫‪10.29‬‬ ‫ﺍﻷﻁﻔﺎﻝ ﻭﺣﺪﻳﺜﻲ ﺍﻟﻮﻻﺩﺓ ﻓﻲ ﻣﺴﺘﺸﻔﻰ ﺳﺮﺕ‬
‫)‪Saleh (2007‬‬ ‫‪1.28‬‬ ‫ﻣﺮﺿﻰ ﺍﻟﻌﻴﺎﺩﺍﺕ ﻓﻲ ﺳﺒﻬﺎ‬
‫( ‪)2007 Ben Mousa et al‬‬ ‫‪2.0‬‬ ‫ﺃﻁﻔﺎﻝ ﺍﻟﻣﺩﺍﺭﺱ ﻓﻲ ﻁﺭﺍﺑﻠﺱ‬
‫)‪Gelani et al (2009‬‬ ‫‪1.76‬‬ ‫ﺍﻟﺴﻜﺎﻥ ﻋﺸﻮﺍﺋﻲ ﻭﺍﺩﻱ ﻣﺨﻴﻢ ﺍﻟﺸﺎﻁﺊ‬
‫ﺍﻷﻁﻔﺎﻝ ﺍﻟﺬﻳﻦ ﻳﻌﻴﺸﻮﻥ ﻓﻲ ﺍﻟﻤﻨﺎﻁﻖ ﺍﻟﺮﻳﻔﻴﺔ ﺍﻝﻣﺨﺘﻠﻔﺔ ﻣﻦ ﻭﺍﺩﻱ‬
‫‪Saada et al (2013).‬‬ ‫‪3.1‬‬
‫ﺍﻟﺸﺎﻁﺊ‬

‫‪29‬‬
‫)‪Present study (2016‬‬ ‫‪5.0‬‬ ‫ﺍﻷﻁﻔﺎﻝ ﻋﺸﻮﺍﺋﻲ ﻓﻲ ﺳﺒﻬﺎ‬

‫‪ 2-3‬ﺍﻟﻣﻧﺎﻗﺷﺔ‬
‫ﺗﻌﺩ ﺇﺻﺎﺑﺔ ﺍﻹﻧﺳﺎﻥ ﺑﺎﻹﻣﺭﺍﺽ ﺍﻟﻁﻔﻳﻠﻳﺔ ﺇﺣﺩﻯ ﺍﻟﻣﺷﺎﻛﻝ ﺍﻟﺷﺎﺋﻌﺔ ﻓﻲ ﺍﻟﻌﺎﻟﻡ ﻭﺧﺎﺻﺔ‬
‫ﻓﻲ ﺍﻟﻣﻧﺎﻁﻕ ﺍﻻﺳﺗﻭﺍﺋﻳﺔ ﻭﺍﻟﺷﺑﻪ ﺍﻻﺳﺗﻭﺍﺋﻳﺔ‪ ،‬ﻓﻣﻧﺫ ﻗﺭﻭﻥ ﺍﻷﻣﺭﺍﺽ ﺍﻟﻁﻔﻳﻠﻳﺔ ﺗﺳﺑﺏ‬
‫ﺍﻋﺗﻼﻻﺕ ﺑﺎﻟﺻﺣﺔ ﺍﻟﻌﺎﻣﺔ‪ ،‬ﻭﺗﻌﺗﻣﺩ ﻧﺳﺑﺔ ﺍﻧﺗﺷﺎﺭ ﺍﻏﻠﺏ ﺍﻟﻁﻔﻳﻠﻳﺎﺕ ﻋﻠﻰ ﺍﻟﺑﻳﺋﺔ ﻏﻳﺭ‬
‫ﺍﻟﻧﻅﻳﻔﺔ ﻭﺍﻟﻌﺎﺩﺍﺕ ﻏﻳﺭ ﺍﻟﺻﺣﻳﺔ ﻟﻺﻧﺳﺎﻥ ﻭﻅﺭﻭﻑ ﺍﻟﻣﻧﺎﺥ ﻭﻣﺳﺗﻭﻯ ﺍﻟﺳﻛﺎﻥ ﺍﻻﻗﺗﺻﺎﺩﻱ‬
‫ﻭﺍﻻﺟﺗﻣﺎﻋﻲ ) ‪.(Chandler and read, 1961‬‬
‫ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ﻋﺎﻟﻣﻳﺔ ﺍﻟﺗﻭﺯﻳﻊ ﻭﺗﻭﺟﺩ ﻣﻧﺗﺷﺭﺓ ﺣﻭﻝ ﺍﻟﻌﺎﻟﻡ‪ ،‬ﺑﻧﺳﺑﺔ‬
‫‪(Smyth,1994)%30-1‬ﻓﻲ ﺩﺭﺍﺳﺎﺕ ﻣﻳﺩﺍﻧﻳﺔ ﺃﺟﺭﻳﺕ ﺣﻭﻝ ﺍﻟﻌﺎﻟﻡ ﺃﻅﻬﺭﺕ ﻧﺳﺑﺔ‬
‫ﺇﺻﺎﺑﺔ ﻣﻥ ‪ ،%25-2‬ﻭﻫﺩﺍ ﻳﻌﺗﻣﺩ ﻋﻠﻰ ﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ ﺍﻟﻣﻔﺣﻭﺻﺔ ﻭﺍﻟﻭﻋﻲ ﺍﻟﺻﺣﻲ‬
‫)ﺍﻟﺑﻳﺋﻲ( ﻭﺣﺎﻟﺔ ﺍﻟﻣﻧﺎﺥ )‪(Faust et al., 1970‬‬
‫ﺃﻅﻬﺭﺕ ﻧﺗﺎﺋﺞ ﻫﺩﻩ ﺍﻟﺩﺭﺍﺳﺔ ﺍﻟﺣﺎﻟﻳﺔ ﻭﺟﻭﺩ ‪ 10‬ﺇﺻﺎﺑﺎﺕ ﺑﺎﻟﺟﻳﺎﺩﻳﺎ ﻻﻣﺑﻳﻠﺑﺎ ﻓﻲ ﺍﻟﻣﺭﺿﻰ‬
‫ﺍﻟﻡ ﺕﺭﺩﺩﻳﻥ ﻋﻠﻰ ﺍﻟﻣﺧﺗﺑﺭ ﺍﻟﻣﺭﻛﺯﻱ ﻟﻣﺩﻳﻧﺔ ﺳﺑﻬﺎ ﻭﻁﻼﺏ ﻣﺩﺍﺭﺱ ﺍﻟﺗﻌﻠﻳﻡ ﺍﻷﺳﺎﺳﻲ ﻟﻣﺩﻳﻧﺔ‬
‫ﺳﺑﻬﺎ ﻣﻥ ﺍﻟﻌﻣﺭ ) ‪ (10-1‬ﺳﻧﻭﺍﺕ ) ‪ (200‬ﺣﺎﻟﺔ ﻭﺑﺫﻟﻙ ﻛﺎﻧﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺍﻟﻛﻠﻳﺔ ‪%5‬‬
‫ﺑﻳﻥ ﺍﻟﺟﻧﺳﻳﻥ ﺣﻳﺙ ﻛﺎﻥ ﺍﻟﺫﻛﻭﺭ ﺃﻋﻠﻰ ﻧﺳﺑﺔ ﻣﻥ ﺍﻹﻧﺎﺙ ﻭﻛﺎﻧﺕ ﺍﻟﻧﺳﺑﺔ ‪3.09،%6.79‬‬
‫‪.(1994‬ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ‬ ‫‪ %‬ﻋﻠﻰ ﺍﻟﺗﻭﺍﻟﻲ ﻭﻫﻲ ﺿﻣﻥ ﺍﻟﻣﻌﺩﻝ ﺍﻟﺫﻱ ﺫﻛﺭﻩ ﺳﻣﻳﺙ)‬
‫ﺍﻟﻣﺗﺣﺻﻝ ﻋﻠﻳﻬﺎ ﺃﻋﻠﻰ ﻣﻥ ﺍﻟﻧﺳﺑﺔ ﺫﻛﺭﺗﻬﺎ ﺯﻳﻧﺏ ) ‪(2013‬ﻭﻟﻛﻥ ﺗﻠﻙ ﺍﻟﺩﺭﺍﺳﺔ ﻣﻘﺗﺻﺭﺓ‬
‫ﻋﻠﻰ ﺗﻼﻣﻳﺫ ﻣﺩﺭﺳﺔ ﺍﻟﺧﻠﻭﺩ ﻭﺍﻟﻳﺭﻣﻭﻙ ﻟﻠﺗﻌﻠﻳﻡ ﺍﻷﺳﺎﺳﻲ ﺑﺣﻲ ﺍﻟﺛﺎﻧﻭﻳﺔ ﺑﻣﻧﻁﻘﺔ ﺳﺑﻬﺎ ﻭﺍﻟﺗﻲ‬
‫ﻛﺎﻧﺕ ﺗﺳﺎﻭﻱ‪.%2.5‬ﺣﻳﺙ ﺃﻥ ﺍﻷﻁﻔﺎﻝ ﺃﻛﺛﺭ ﻋﺭﺿﺔ ﻟﻺﺻﺎﺑﺔ )‪Bogitch and ،1998‬‬
‫‪(cheng‬ﻭﻫﻲ ﻛﺫﻟﻙ ﺃﻋﻠﻰ ﻣﻥ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺍﻟﺗﻲ ﺗﺣﺻﻠﺕ ﻋﻠﻳﻬﺎ ﺻﺎﻟﺣﺔ )‪.(2008‬‬

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‫ﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ‪ 6-5‬ﺳﻧﻭﺍﺕ ﻛﺎﻧﺕ ﻟﺩﻳﻬﻡ ﻣﻌﺩﻝ ﺇﺻﺎﺑﺔ ‪ %10‬ﻭﻫﺩﻩ ﺍﻟﻧﺳﺑﺔ ﺃﻋﻠﻰ ﻣﻥ ﺍﻟﻔﺋﺔ‬
‫ﺍﻟﻌﻣﺭﻳﺔ ‪ 8-7‬ﺳﻧﻭﺍﺕ ﺣﻳﺙ ﻛﺎﻥ ﻣﻌﺩﻝ ﺍﻹﺻﺎﺑﺔ ‪.%7.8‬ﻭﻛﺫﻟﻙ ﺃﻋﻠﻰ ﻣﻥ ﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ‬
‫‪10-9‬ﺳﻧﻭﺍﺕ ﻭﻳﻌﻭﺩ ﺳﺑﺏ ﺍﻻﺧﺗﻼﻑ ﺇﻟﻰ ﺃﻥ ﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ ﺍﻷﻛﺑﺭ ﻋﻣﺭﺍ ﻟﺩﻳﻬﺎ ﻭﻋﻲ‬
‫ﺻﺣﻲ‪.‬‬
‫ﺑﺸﻜﻞ ﻋﺎﻡ‪ ،‬ﻓﻲ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ‪ ،‬ﻛﺎﻥ ﺍﻷﻭﻻﺩ ﺃﻋﻠﻰ ﻣﻌﺪﻝ ﺍﻧﺘﺸﺎﺭ ﺑﺎﻟﺠﻴﺎﺭﺩﻳﺎ ﻣﻦ ﺍﻟﺒﻨﺎﺕ‬
‫ﻭﻛﺎﻥ ﺍﻟﻔﺮﻕ ﺑﻴﻦ ﺍﻟﺠﻨﺴﻴﻦ ﻣﻌﻨﻮﻱ ) ‪ .(.. ... = p‬ﻗﺪ ﻳﻜﻮﻥ ﻫﺬﺍ ﺑﺴﺒﺐ ﺍﻷﻧﺸﻄﺔ ﻓﻲ ﺍﻟﻬﻮﺍء‬
‫ﺍﻟﻄﻠﻖ ﻣﺘﻜﺮﺭﺓ ﻣﻦ ﺍﻷﻭﻻﺩ ﻭﺍﻟﺤﺼﻮﻝ ﻋﻠﻰ ﻣﺰﻳﺪ ﻣﻦ ﺍﻟﺘﻌﺮﺽ ﻟﻤﺼﺪﺭ ﺍﻟﻌﺪﻭﻯ‬
‫ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﺑﺎﻟﻤﻘﺎﺭﻧﺔ ﻣﻊ ﺍﻟﻔﺘﻴﺎﺕ‪ .‬ﻭ ﻓﻲ ﻋﺪﺓ ﺩﺭﺍﺳﺎﺕ ﺃﺧﺮﻯ ﻭﺟﺪ ﺇﻥ ﺍﻷﻭﻻﺩ ﺃﻛﺜﺮ ﻋﺮﺿﺔ‬
‫ﻟﻺﺻﺎﺑﺔ ﻣﻦ ﺍﻟﻔﺘﻴﺎﺕ‬
‫)‪ .(Abdulrahman et al .,1990:Mahmud et al., 1995 :Ahmad et al., 2006‬ﺗﺨﺘﻠﻒ‬
‫ﻧﺘﺎﺋﺞ ﺍﻟﺪﺭﺍﺳﺔ ﺍﻟﺤﺎﻟﻴﺔ ﻋﻦ ﺍﻟﺪﺭﺍﺳﺎﺕ ﺍﻷﺧﺮﻯ ﻓﻲ ﻟﻴﺒﻴﺎ ‪2009:Al-Fellani et al., 2005 :‬‬
‫‪ ( Gelani et al Saada et al. 2013: Ben Mousa et al .,2007).,‬ﻭﺍﻟﺘﻲ ﺃﻓﺎﺩﺕ ﺇﻥ‬
‫ﺍﻧﺘﺸﺎﺭ ‪ G.lamblia‬ﻓﻲ‬
‫ﺍﻹﻧﺎﺙ ﺃﻛﺜﺮ ﻣﻦ ﺍﻟﺬﻛﻮﺭ ﻭﺍﻻﺧﺘﻼﻑ ﻓﻲ ﻣﻌﺪﻻﺕ ﺇﻳﺠﺎﺑﻴﺔ ﻟﻴﺴﺖ ﺫﺍﺕ ﺩﻻﻟﺔ ﺇﺣﺼﺎﺋﻴﺔ‪.‬‬
‫ﺫﻛﺮ ﻣﺒﻴﺾ ﻭﺁﺧﺮﻭﻥ ) ‪ (59‬ﻭ ‪ Almerie‬ﻭﺁﺧﺮﻭﻥ ) ‪ (15‬ﺃﻥ ﺍﻟﻔﺘﻴﺎﺕ ﺍﻟﻤﺼﺎﺑﺔ‬
‫‪ G.lamblia‬ﺍﻛﺜﺮ ﻣﻦ ﺍﻷﻭﻻﺩ ‪.‬ﻭﻓﻲ ﺍﻟﻤﺴﺢ ﺍﻟﻮﺑﺎﺋﻲ ﻟﻤﺮﺽ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﻓﻲ ﺍﻟﺒﺤﺮﻳﻦ‬
‫ﻭﺳﻮﺭﻳﺎ ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ ﺑﻴﻦ ﺃﻁﻔﺎﻝ ﺍﻟﻤﺪﺍﺭﺱ‪ ،‬ﻟﻢ ﺗﺠﺪ ﻓﺮﻗﺎ ﻛﺒﻴﺮﺍ ﺑﻴﻨﻬﻤﺎ‪ .‬ﻓﻲ ﺣﻴﻦ ﺃﻥ ﻣﻌﻈﻢ‬
‫ﺍﻟﺪﺭﺍﺳﺎﺕ ﺍﻷﺧﺮﻯ ﻭﺟﺪ ﺍﺧﺘﻼﻑ ﻓﻲ ﺍﻧﺘﺸﺎﺭ ﻣﺮﺽ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﺑﻴﻦ ﺍﻟﺠﻨﺴﻴﻦ ) ‪.(64-60‬‬
‫ﻭﺟﺪﺕ ﺍﻟﻌﺪﻳﺪ ﻣﻦ ﺍﻟﺪﺭﺍﺳﺎﺕ ﺃﻥ ﻣﻌﺪﻝ ﺍﻧﺘﺸﺎﺭ ﻣﺮﺽ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﻳﺮﺗﻔﻊ ﺧﻼﻝ‬
‫ﻣﺮﺣﻠﺔ ﺍﻟﻄﻔﻮﻟﺔ‪ ،‬ﻭﻳﺒﺪﺃ ﻓﻘﻂ ﻓﻲ ﺍﻻﻧﺨﻔﺎﺽ ﺧﻼﻝ ﻣﺮﺣﻠﺔ ﺍﻟﻤﺮﺍﻫﻘﺔ ﺍﻟﻤﺒﻜﺮﺓ ) ‪،(65 ،55‬‬
‫ﻭﻳﻔﺘﺮﺽ ﻛﻤﺎ ﻫﻮ ﺍﻛﺘﺴﺐ ﻣﻨﺎﻋﺔ ﻭﻗﺎﺋﻴﺔ‪.‬‬
‫ﻓﻲ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ‪ ،‬ﻭﺍﻷﻁﻔﺎﻝ ﺍﻟﺬﻳﻦ ﺗﺘﺮﺍﻭﺡ ﺃﻋﻤﺎﺭﻫﻢ ﺑﻴﻦ ‪ 6-5‬ﺳﻨﻮﺍﺕ ﻣﻦ ﺍﻟﻌﻤﺮ‬
‫ﻳﻜﻮﻥ ﺃﻛﺜﺮ ﻋﺪﻭﻯ ﺏ ‪ G.lamblia‬ﻣﻦ ﺍﻟﺠﻤﺎﻋﺎﺕ ﺍﻟﺬﻳﻦ ﺗﺘﺮﺍﻭﺡ ﺃﻋﻤﺎﺭﻫﻢ ﺑﻴﻦ ﺃﺧﺮﻯ‪.‬‬
‫ﻭﻟﻌﻞ ﻫﺬﺍ ﻫﻮ ﻷﻧﻪ ﻓﻲ ﻫﺬﻩ ﺍﻷﻁﻔﺎﻝ ﻓﻲ ﺳﻦ ﻣﺴﺘﻘﻠﺔ ﺗﻤﺎﻣﺎ ﻓﻲ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻤﺮﺣﺎﺽ ﻭﺃﻛﺜﺮ‬
‫ﺍﻧﺨﺮﺍﻁﺎ ﻓﻲ ﺃﻧﺸﻄﺔ ﻓﻲ ﺍﻟﻬﻮﺍء ﺍﻟﻄﻠﻖ ﺍﻟﻤﺨﺘﻠﻔﺔ ﺍﻟﺘﻲ ﻗﺪ ﺗﺆﺩﻱ ﺇﻟﻰ ﺍﻧﺘﻘﺎﻝ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ) ‪.(66‬‬
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‫ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻭﻗﺎﻝ ﺃﺣﻤﺪ ) ‪ (57‬ﺃﻋﻠﻰ ﻧﺴﺒﺔ ﺍﻧﺘﺸﺎﺭ ‪ (٪1.81 ) G.lamblia‬ﻓﻲ ‪12-7‬‬
‫ﺳﻨﻮﺍﺕ ﺍﻷﻁﻔﺎﻝ ﺍﻟﻘﺪﻳﻤﺔ ﻓﻲ ﺳﺒﻬﺎ‪ ،‬ﻟﻴﺒﻴﺎ‪ .‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻓﻘﺪ ﺗﻢ ﺍﻹﺑﻼﻍ ﻋﻦ ﺍﺭﺗﻔﺎﻉ ﺣﺎﻻﺕ‬
‫ﺍﻹﺻﺎﺑﺔ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ) ‪ ٪24.9‬ﻭ ‪ (٪5.8‬ﺑﻴﻦ ﺍﻷﻁﻔﺎﻝ ﻓﻲ ﺳﻦ ‪ 12-4‬ﺳﻨﻮﺍﺕ ﻓﻲ ﺍﻟﻴﻤﻦ‬
‫‪ (63‬ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ‪.‬‬ ‫‪ 15‬ﻋﺎﻣﺎ ﻓﻲ ﺍﻟﺒﺮﺗﻐﺎﻝ )‬ ‫‪ 6‬ﺇﻟﻰ‬ ‫)‪ ،(67‬ﻭﻣﻦ‬
‫ﺍﻟﻤﻈﺎﻫﺮ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻟﺪﺍء ﺍﻟﺠﻴﺎﺭﺩﻳﺎﺕ ﻗﺪ ﺗﺘﺮﺍﻭﺡ ﺑﻴﻦ ﺍﻹﺳﻬﺎﻝ ﻭﺍﻹﻣﺴﺎﻙ ﻭﺍﻟﻐﺜﻴﺎﻥ ﻭﺁﻻﻡ‬
‫ﻓﻲ ﺍﻟﺒﻄﻦ‪ ،‬ﻭﺍﻧﺘﻔﺎﺥ ﺍﻟﺒﻄﻦ‪ .‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻓﺈﻥ ﺍﻟﻌﺪﻳﺪ ﻣﻦ ﺍﻟﻤﺮﺿﻰ ﺍﻟﻤﺼﺎﺑﻴﻦ ‪G.lamblia‬‬
‫ﺗﻔﻌﻞ ﺍﻷﻋﺮﺍﺽ ﻏﻴﺮ ﻣﻮﺟﻮﺩﺓ‪ .‬ﻫﺆﻻء ﺍﻷﻓﺮﺍﺩ ﻏﻴﺮ ﻣﺘﻨﺎﻅﺮﺓ ﻭﺍﻟﻌﻮﺍﺋﻞ ﺍﻟﺨﺎﺯﻧﺔ ﻣﻬﻤﺔ‬
‫ﻻﻧﺘﺸﺎﺭ ﺍﻟﻌﺪﻭﻯ‪ ،‬ﻭﺃﻗﻞ ﺍﺣﺘﻤﺎﻻ ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ ﺍﻟﻌﻼﺝ ﻧﻈﺮﺍ ﻟﻌﺪﻡ ﻭﺟﻮﺩ ﺃﻋﺮﺍﺽ‬
‫ﺳﺮﻳﺮﻳﺔ )‪(68‬‬
‫ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ‪ ،‬ﻓﻲ ﺍﻟﻮﺍﻗﻊ‪ ،‬ﻭﺟﺪﺕ ﺍﻟﺸﻜﻮﻯ ﺍﻷﻛﺜﺮ ﺷﻴﻮﻋﺎ ﺑﻴﻦ ﺍﻷﻁﻔﺎﻝ ﺍﻟﻤﺼﺎﺑﻴﻦ‬
‫ﺏ ‪ G.lamblia‬ﺁﻻﻡ ﻓﻲ ﺍﻟﺒﻄﻦ‪ .‬ﻭﻛﺎﻥ ﻫﺬﺍ ﺍﻻﻛﺘﺸﺎﻑ ﻳﺘﻔﻖ ﻣﻊ ﺍﻟﻨﺘﻴﺠﺔ ﻣﻦ‬
‫)‪ Minvielle ،Moolasart (69‬ﻭﺁﺧﺮﻭﻥ ) ‪ ،(70‬ﻳﻮﻧﺲ ﻭﺁﺧﺮﻭﻥ ) ‪ ،(41‬ﻭﺳﻠﻴﻢ‬
‫ﻭﺁﺧﺮﻭﻥ ) ‪ ،(18‬ﺍﻟﺬﻱ ﻻﺣﻆ ﺁﻻﻡ ﻓﻲ ﺍﻟﺒﻄﻦ ﺃﻛﺜﺮ ﺍﻷﻋﺮﺍﺽ ﺷﻴﻮﻋﺎ ﺑﻴﻦ ﺍﻟﻤﺮﺿﻰ‬
‫ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﻓﻲ ﺗﺎﻳﻼﻧﺪ‪ ،‬ﻣﺼﺮ ﻭﺍﻷﺭﺟﻨﺘﻴﻦ ﻭﺑﺎﻛﺴﺘﺎﻥ ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ‪.‬‬

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 ‫* ﺍﻟﻔﺼﻞ ﺍﻟﺮﺍﺑﻊ‬
‫ﺍﻻﺳﺘﻨﺘﺎﺟﺎﺕ ﻭﺍﻟﺘﻮﺻﻴﺎﺕ‬

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 ‫‪ -5‬ﺍﻻﺳﺗﻧﺗﺎﺟﺎﺕ ﻭﺍﻟﺗﻭﺻﻳﺎﺕ‬
‫‪ 1-5‬ﺍﻻﺳﺗﻧﺗﺎﺟﺎﺕ ‪-:‬‬
‫ﻣﻥ ﺧﻼﻝ ﺍﻟﺩﺭﺍﺳﺔ ﺍﻟﺗﻲ ﺃﺟﺭﻳﺕ ﺍﺳﺗﻧﺗﺞ ﺍﻟﺗﺎﻟﻲ ‪:‬‬
‫ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ﺑﻳﻥ ﺗﻼﻣﻳﺫ ﻣﺩﺍﺭﺱ ﺍﻟﺗﻌﻠﻳﻡ ﺍﻷﺳﺎﺳﻲ ﻭﺍﻷﻁﻔﺎﻝ ﺍﻟﻣﺗﺭﺩﺩﻳﻥ ﻋﻠﻰ ﺍﻟﻣﺧﺗﺑﺭ‬
‫ﺍﻟﻣﺭﻛﺯﻱ ﻟﻣﺩﻳﻧﺔ ﺳﺑﻬﺎ ﻛﺎﻧﺕ ‪.%5‬‬
‫ﻻﻣﺑﻠﻲ ﺗﺻﻳﺏ ﺍﻟﺫﻛﻭﺭ ﻭﺍﻹﻧﺎﺙ ﻋﻠﻰ ﺣﺩ ﺳﻭﺍء ﻭﻟﻛﻥ ﺍﻟﺫﻛﻭﺭ ﻫﻡ ﺃﻛﺛﺭ ﻋﺭﺿﺔ‬
‫ﺍ‬ ‫ﺍﻟﺟﻳﺎﺭﺩﻳﺎ‬
‫ﻟﻺﺻﺎﺑﺔ ﻣﻥ ﺍﻹﻧﺎﺙ ﺣﻳﺙ ﻛﺎﻧﺕ ﻧﺳﺑﺔ ﺍﻹﺻﺎﺑﺔ ‪ %3.09، %6.79‬ﻋﻠﻰ ﺍﻟﺗﻭﺍﻟﻲ ‪.‬‬
‫ﺍﻟﻔﺋﺎﺕ ﺍﻟﻌﻣﺭﻳﺔ ﺍﻷﻛﺛﺭ ﻋﺭﺿﺔ ﻟﻺﺻﺎﺑﺔ ﻫﻲ ﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ‪ 6-5‬ﺳﻧﻭﺍﺕ ﺣﻳﺙ ﺑﻠﻎ ﻣﻌﺩﻝ‬
‫ﺍﻹﺻﺎﺑﺔ ‪ %10‬ﻭﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ﺍﻷﻗﻝ ﻋﺭﺿﺔ ﻟﻺﺻﺎﺑﺔ ﻫﻲ ﺍﻟﻔﺋﺔ ﺍﻟﻌﻣﺭﻳﺔ ‪ 10-9‬ﺳﻧﻭﺍﺕ‬
‫ﺣﻳﺙ ﺑﻠﻎ ﻣﻌﺩﻝ ﺍﻹﺻﺎﺑﺔ ‪.%1‬‬

‫‪ 2-‬ﺍﻟﺗﻭﺻﻳﺎﺕ ‪-:‬‬
‫‪- 1‬ﻋﻼﺝ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻣﺻﺎﺑﺔ‪.‬‬
‫‪-2‬ﺿﺭﻭﺭﺓ ﺍﻟﻛﺷﻑ ﻭﺇﺟﺭﺍء ﺍﻟﺗﺣﺎﻟﻳﻝ ﺑﺷﻛﻝ ﺩﻭﺭﻱ ﻭﻣﺳﺗﻣﺭ‪.‬‬
‫‪-3‬ﻧﺷﺭ ﺍﻟﻭﻋﻲ ﺍﻟﺻﺣﻲ ﻭﺇﻋﻁﺎء ﺍﻟﻣﺣﺎﺿﺭﺍﺕ ﺗﺛﻘﻳﻔﻳﺔ ‪.‬‬
‫‪-4‬ﺍﻟﻧﻅﺎﻓﺔ ﺍﻟﺷﺧﺻﻳﺔ ﻭﺩﻟﻙ ﺑﻐﺳﻝ ﺍﻟﻳﺩﻳﻥ ﺟﻳﺩﺍ ﻗﺑﻝ ﺗﻧﺎﻭﻝ ﺍﻟﻭﺟﺑﺎﺕ ﺍﻟﻐﺫﺍﺋﻳﺔ ﻭﻋﺩﻡ‬
‫ﺍﺳﺗﺧﺩﺍﻡ ﺍﻷﺩﻭﺍﺕ ﺍﻟﻣﺷﺗﺭﻛﺔ‪.‬‬
‫‪ -5‬ﺿﺭﻭﺭﺓ ﺷﺭﺏ ﺍﻟﻣﺎء ﺍﻟﻧﻅﻳﻑ ﻭﺗﻧﺎﻭﻝ ﺍﻟﻐﺩﺍء ﺍﻟﺻﺣﻲ‪.‬‬
‫‪ -6‬ﻧﻭﺻﻲ ﺑﺈﺟﺭﺍء ﺩﺭﺍﺳﺔ ﺃﻭﺳﻊ ﻟﺗﺣﺩﻳﺩ ﻣﺩﻱ ﺍﻧﺗﺷﺎﺭ ﻫﺩﺍ ﺍﻟﻁﻔﻳﻠﻲ ﺑﻣﺩﻳﻧﺔ ﺳﺑﻬﺎ‪.‬‬

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 ‫ﺍﻟﻤﺨﻠﺺ‬
‫ﺃﺟﺮﻳﺖ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ ﻋﻠﻰ ﺍﻷﻁﻔﺎﻝ ﺍﻟﻤﺘﺮﺩﺩﻳﻦ ﻋﻠﻰ ﺍﻟﻤﺨﺘﺒﺮ ﺍﻟﻤﺮﻛﺰﻱ ﻟﻤﺪﻳﻨﺔ ﺳﺒﻬﺎ‬
‫ﻭﺗﻼﻣﻴﺬ ﻣﺪﺍﺭﺱ ﺍﻟﺘﻌﻠﻴﻢ ﺍﻷﺳﺎﺳﻲ ) ‪ (200‬ﺣﺎﻟﺔ ﻓﻲ ﺍﻟﻔﺘﺮﺓ ﻣﺎﺑﻴﻦ ‪2015-11-9‬ﻡ ﺇﻟﻰ ‪-14‬‬
‫‪2016-3‬ﻡ‪ .‬ﺣﻴﺚ ﻛﺎﻥ ﻋﺪﺩ ﺍﻟﺬﻛﻮﺭ ‪ 103‬ﺣﺎﻟﺔ ﻭﻋﺪﺩ ﺍﻹﻧﺎﺙ ‪ 97‬ﺣﺎﻟﺔ‪ ،‬ﻭﺗﺘﺮﺍﻭﺡ‬
‫ﺃﻋﻤﺎﺭﻫﻢ ﺑﻴﻦ ﺳﻨﺔ ﺇﻟﻰ ‪ 10‬ﺳﻨﻮﺍﺕ‪ .‬ﻓﺤﺼﺖ ﻣﺴﺤﺎﺕ ﻣﻦ ﻋﻴﻨﺎﺕ ﺍﻟﺒﺮﺍﺯ ﻣﺒﺎﺷﺮﺓ ﺑﺎﺳﺘﺨﺪﺍﻡ‬
‫ﻣﺤﻠﻮﻝ ﺍﻻﻳﻮﺩﻳﻦ ﻟﻠﺘﻌﺮﻑ ﻋﻠﻰ ﻭﺟﻮﺩ ﻁﻔﻴﻞ ﺍﻟﺠﻴﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ‪.Giardia lamblia‬‬
‫ﻛﺎﻧﺖ ﻧﺴﺒﺔ ﺍﻹﺻﺎﺑﺔ ﺍﻟﻜﻠﻴﺔ ﺑﺎﻟﻄﻔﻴﻠﻲ ﻓﻲ ﻣﺪﻳﻨﺔ ﺳﺒﻬﺎ ‪) %5‬ﺍﻟﻤﻔﺤﻮﺻﻴﻦ ‪ 200‬ﺣﺎﻟﺔ‬
‫ﻭﺍﻟﻤﺼﺎﺑﻴﻦ ﻣﻨﻬﻢ ‪10‬ﺣﺎﻻﺕ( ﺍﻟﺬﻛﻮﺭ ﺃﻛﺜﺮ ﻋﺮﺿﺔ ﻟﻺﺻﺎﺑﺔ ﻣﻦ ﺍﻹﻧﺎﺙ ﺣﻴﺚ ﻛﺎﻧﺖ ﻧﺴﺒﺔ‬
‫ﺇﺻﺎﺑﺔ ﺍﻟﺬﻛﻮﺭ ‪) %6.79‬ﺍﻟﻤﻔﺤﻮﺻﻴﻦ ‪ 103‬ﺣﺎﻟﺔ ﻭﺍﻟﻤﺼﺎﺑﻴﻦ ﻣﻨﻬﻢ ‪ 7‬ﺣﺎﻻﺕ( ﻭﻧﺴﺒﺔ‬
‫ﺇﺻﺎﺑﺔ ﺍﻹﻧﺎﺙ ﻫﻲ ‪)%3‬ﺍﻟﻤﻔﺤﻮﺻﺎﺕ ‪97‬ﺣﺎﻟﺔ ﻭﺍﻟﻤﺼﺎﺑﺎﺕ ﻣﻨﻬﻢ ‪3‬ﺣﺎﻻﺕ( ﻭﺍﻟﻔﺌﺎﺕ‬
‫‪ 6-5‬ﺳﻨﻮﺍﺕ ﻫﻢ ﺃﻛﺜﺮ ﻋﺮﺿﺔ‬ ‫ﺍﻟﻌﻤﺮﻳﺔ ﺍﻟﻤﺼﺎﺑﺔ ﺗﺨﺘﻠﻒ‪ ،‬ﺣﻴﺚ ﺃﻥ ﺍﻟﻔﺌﺎﺕ ﺍﻟﻌﻤﺮﻳﺔ‬
‫ﻟﻺﺻﺎﺑﺔ ﺣﻴﺚ ﻛﺎﻧﺖ ﻧﺴﺒﺔ ﺍﻹﺻﺎﺑﺔ ‪ %10‬ﺗﻠﻴﻬﺎ ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺮﻳﺔ ‪ 8-7‬ﺳﻨﻮﺍﺕ ﻭﻣﻦ ‪2-1‬‬
‫ﺳﻨﺔ ﺣﻴﺚ ﻛﺎﻧﺖ ﻧﺴﺒﺔ ﺍﻹﺻﺎﺑﺔ ‪% 5.7%7.89‬ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ ﺑﻴﻨﻤﺎ ﻛﺎﻧﺖ ﺍﻗﻞ ﻧﺴﺒﺔ ﺇﺻﺎﺑﺔ‬
‫ﻓﻲ ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺮﻳﺔ ﻣﻦ ‪10-9‬ﺳﻨﻮﺍﺕ ﻭﻛﺎﻧﺖ ﻧﺴﺒﺔ ﺍﻹﺻﺎﺑﺔ ‪. %1‬‬
‫ﻭﻛﺎﻥ ﻛﻞ ﺍﻷﻁﻔﺎﻝ ﺍﻟﻤﺼﺎﺑﻴﻦ ﺏ ‪ G.lamblia‬ﻟﺪﻳﻬﻢ ﺍﺛﻨﻴﻦ ﺃﻭ ﺛﻼﺛﺔ ﺃﻋﺮﺍﺽ ﻓﻲ ﺍﻟﺠﻬﺎﺯ‬
‫ﺍﻟﻬﻀﻤﻲ‪ .‬ﻛﺎﻥ ﺍﻷﻟﻢ ﻓﻲ ﺍﻟﺒﻄﻦ ﻣﻦ ﺍﻷﻋﺮﺍﺽ ﺍﻷﻛﺜﺮ ﺷﻴﻮﻋﺎ ﻣﻦ ﺑﻴﻦ ) ‪ (٪100‬ﺍﻷﻁﻔﺎﻝ‬
‫ﺍﻟﻤﺼﺎﺑﻴﻦ‪.‬‬

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 ‫ﺍﻟﻣﺭﺍﺟﻊ‬

‫ﺍﻟﻣﺭﺍﺟﻊ ﺍﻟﻌﺭﺑﻳﺔ‬

‫ﺍﻟﺧﺎﻟﺩﻱ‪،‬ﻧﻬﺎﺩ ﻭﻟﻰ ﻋﺯﻳﺯ) ‪.(1996‬ﺩﺭﺍﺳﺔ ﻣﻳﺩﺍﻧﻳﺔ ﻋﻥ ﻁﻔﻳﻠﻳﺎﺕ ﺍﻟﻘﻧﺎﺓ ﺍﻟﻬﺿﻣﻳﺔ ﻓﻲ ﺍﻹﻧﺳﺎﻥ ﻣﺟﻠﺔ‬
‫ﻗﺎﺭﻳﻭﻧﺱ ﺍﻟﻌﻠﻣﻳﺔ)‪،(1996‬ﺍﻟﻌﺩﺩ ﺍﻷﻭﻝ ﻭﺍﻟﺛﺎﻧﻲ ﺹ‪.29‬‬

‫ﻅ ) ‪.(1994‬ﺍﻷﺩﻭﺍﺭ‬ ‫ﺍﻟﻣﻧﺳﻲ‪،‬ﻋﺭﺳﺎﻥ ﻭﺟﻪ ﷲ‪،‬ﻧﺯﺍﺭ ﻓﺅﺍﺩ ﻭﺍﻟﻌﺯﺍﻡ‪،‬ﻋﻘﺎﺏ ﻭﺍﻟﺷﺎﻋﺭ ﻋﺑﺩ ﺍﻟﺣﻔﻲ‬

‫ﻭﺍﻟﻁﻔﻳﻠﻳﺎﺕ ﻣﻧﺷﻭﺭﺍﺕ ﺩﺍﺭﺍﻟﻣﺳﺗﻘﺑﻝ )‪.(67 -66‬‬

‫ﺍﻟﺳﻭﻳﺣﻠﻲ‪،‬ﺍﺑﻭﺑﻛﺭ ﺇﺑﺭﺍﻫﻳﻡ ﻭﻣﺭﺍﺩ‪،‬ﻋﺑﺩ ﺍﻟﺭﺣﻣﺎﻥ ﺷﻔﻳﻕ ) ‪.(1995‬ﻋﻠﻡ ﺍﻟﻁﻔﻳﻠﻳﺎﺕ ﻟﻠﻛﻠﻳﺎﺕ ﻭﺍﻟﻣﻌﺎﻫﺩ‬

‫ﺍﻟﻌﻠﻳﺎ‪.‬ﻣﻧﺷﻭﺭﺍﺕ‪،ELGA‬ﻣﺎﻁﺎ )‪.(76-64‬‬

‫ﺑﺻﻣﺔﺟﻲ‪،‬ﺧﺎﻟﺩ )‪.(1990‬ﻋﻠﻡ ﺍﻟﻁﻔﻳﻠﻳﺎﺕ ﺍﻟﻁﺑﻳﺔ‪ ،‬ﺟﺎﻣﻌﺔ ﺍﻟﻌﺭﺏ ﺍﻟﻁﺑﻳﺔ‪،‬ﻟﻳﺑﻳﺎ‪.(111-106) ،‬‬

‫ﺭﺑﻳﻊ‪،‬ﺍﻟﺳﻳﺩ ﺻﺎﻟﺢ ﺣﺳﻳﻥ ) ‪.(1997‬ﺍﻷﻣﺭﺍﺽ ﺍﻟﺗﻲ ﺗﻧﺗﻘﻝ ﻣﻥ ﺍﻟﺣﻳﻭﺍﻥ ﺇﻟﻰ ﺍﻹﻧﺳﺎﻥ )ﺍﻷﻣﺭﺍﺽ‬
‫ﺍﻟﻣﺷﺗﺭﻛﺔ(‪،‬ﻣﻧﺷﻭﺭﺍﺕ ﺟﺎﻣﻌﺔ ﺍﻟﻣﻠﻙ ﺳﻌﻭﺩ‪،‬ﺍﻟﺭﻳﺎﺽ‪.257،‬‬

‫ﻁﻌﻳﻣﺔ‪،‬ﺍﺣﻣﺩ ﻋﺑﺩﷲ )‪.(2005‬ﻁﻔﻳﻝ ﺍﻟﺟﻳﺎﺭﺩﻳﺎ ﻻﻣﺑﻠﻳﺎ ‪ .‬ﺍﻟﺟﺎﻣﻌﺔ )ﺟﺎﻣﻌﺔ ﺳﺑﻬﺎ(‪.31-30،13،‬‬

‫ﻋﺯﺍﻟﺩﻳﻥ‪،‬ﺍﺣﻣﺩ)‪،(1986‬ﺟﻬﺎﺯ ﺍﻟﺿﻡ ﻓﻲ ﺻﺣﺗﻪ ﻭﻣﺭﺿﻪ‪،‬ﻣﻧﺷﻭﺭﺍﺕ ﺩﺍﺭ ﺍﻟﻛﺗﺎﺏ ﺍﻟﻠﺑﻧﺎﻧﻲ‪،‬ﻣﻛﺗﺑﺔ‬

‫ﺍﻟﻣﺩﺭﺳﺔ ‪،‬ﻟﺑﻧﺎﻥ‪.(358-357).‬‬

‫ﻣﺣﻣﺩ ﺑﺷﻳﺭ ﺭﺍﺷﺩ) ‪.(2000‬ﺃﻣﺭﺍﺽ ﺍﻟﺩﻳﺩﺍﻥ ﻭﺍﻟﻁﻔﻳﻠﻳﺎﺕ ‪،‬ﺍﻟﺩﺍﺭ ﺍﻟﺩﻭﻟﻳﺔ ﻟﻼﺳﺗﺛﻣﺎﺭﺍﺕ ﺍﻟﺛﻘﺎﻓﻳﺔ‬
‫‪،‬ﺍﻟﻁﺑﻌﺔ ﺍﻷﻭﻟﻰ‪،‬ﻣﺻﺭ‪.(163).‬‬

‫ﻣﻧﻅﻣﺔ ﺍﻟﺻﺣﺔ ﺍﻟﻌﺎﻟﻣﻳﺔ )‪. (1981)(WHO‬ﻋﺩﻭﻯ ﺍﻷﻭﻟﻳﺎﺕ ﻭﺍﻟﺩﻳﺩﺍﻥ ﺍﻟﻣﻌﻭﻳﺔ ‪،‬ﺗﻘﺭﻳﺭ ﻣﺟﻣﻭﻋﺔ‬
‫ﻋﻠﻣﻳﺔ ﺑﻣﻧﻅﻣﺔ ﺍﻟﺻﺣﺔ ﺍﻟﻌﺎﻟﻣﻳﺔ‪ ،‬ﺳﻠﺳﻠﺔ ﺍﻟﺗﻘﺎﺭﻳﺭ ﺍﻟﻔﻧﻳﺔ ﺭﻗﻡ‪. 666‬‬

‫‪ 2-5‬ﺍﻟﻣﺭﺍﺟﻊ ﺍﻷﺟﻧﺑﻳﺔ‬

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