DR Fardowsa Mohamed Adam Last Update

UNIVERSITY OF
SOMALIA
‫جا معة الصو مال‬
Mogadishu - Somalia
‫مقديشو – الصومال‬
E-mail: info@uniso.edu.so
Mogadishu - Somalia
THE RISK FACTORS ASSOCIATED HYMENOPLEPSIS NANA AMONG UNDER FIVE YEARS OF
AGE AT BANDIR HOSPITAL IN WADAJOR DISTRICT
BY
Fardowsa Mohamed Adam

ID:
“A RESEARCH THESIS SUBMITTED TO THE FACULTY OF MEDICINE AND SURGERY IN

PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF
BACHELOR OF MEDICINE AND BACHELOR SURGERY (MBBS) OF UNIVERSITY OF SOMALIA
2021
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STUDENT DECLARATION
I declare that this senior project entitled the risk factors associated hymenoplepsis nana among
under five years of age at bandir hospital in wadajor district is result of my own work and effort
and my own research except as cited in the references the senior project has not been accepted
for any degree and is not concurrently submitted in candidaure of any other degree
Name of the Candidate:
Fardowsa Mohamed Adam
Signature: Date: / /
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APPROVAL SHEET
We certify that this research has been done by Fardowsa Mohamed

Adam under our supervision And is now ready for the submission to the
department of school of Medicine and Health Science
Supervisor
Dr. Jamal Hussein Mohamud

Signature:
Date: / /
Associate Dean of MBBS:
Dr. Mariam Omar Salaad
Signature: Date: / /
Dean, faculty of medicine and Health science:
Dr. Yasin Ahmed Nur
Signature: _______ Date: / / _______
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DEDICATION
This study is wholeheartedly dedicated to our beloved parents, who have been our source of
inspiration and gave us strength when we thought of giving up, whom continually provide their
morale, spiritual, financial support. To our brothers, sisters, relatives, mentor, friends and
classmates who shared their words of advice and encouragement to finish this study.
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ACKNOWLEDGEMENTS
In the name of Allah, the most merciful, and the most compassionate all praise due to Allah, the I and
the world and prayers peace and upon Mohammed his servant and messenger, the first and forms, I
must acknowledge my limitless thanks to Allah, the ever-magnificent, the ever thank for his help and
bless, I am totally sure this work world have never become truth without this guidance. I owe a deep
debt of gratitude to our university for giving us on opportunity to complete this work, I am grateful to
some people who worked hard with me from the beginning till the completion of the present research
particularly my supervisor Dr. Jamal Hussein Mohamud who has been always generous during all
phases of the research, also I thanks to my family, first my dear mother Dahabo Adam Ahmed. And
my dear brother Feisal Mohame Adam, I would like to take this opportunity to say warm thanks to all
my beloved friends who have soon support along the way of doing my thesis.
I also would like to express my wholehearted thanks to my family for their generous support they
provided me throughout my entire life and particularly through the process of pursuing the bachelor
degree. Because of their unconditional love and prayers, I have the chance to complete thesis.
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ABSTRACT
Background: Hymenolepis nana is the smallest of all tapeworms found in humans and is
appropriately described as the dwarf tapeworm. It is the only cestode that does not require an
intermediate host to develop into its infective stage. A common intermediate host, however, is
the grain bettle. Adult worms can be found in the proximal ileum of the small intestine and are
usually only a couple of centimeters long. Only the scolex is attached to the mucosa of the small
intestine, and after about two weeks, the gravid segments will drop off into the lumen. General
Objective To investigate the risk factors associated with hymenoplepsi nana among under fiver
year child in benadir hospital. in wadajir district, Mogadishu, Somalia. Research design: The
study was conducted through cross-sectional descriptive study design, which means that the
sample will taken from the study population and the information was obtain at the same time on
a particular point in time. Data collection procedure In this study the methods and the material
we are used questionnaire as to get feedback from respondents in Hodan district, A
Questionnaire consisting of questions with open and closed- ended questions was administered to
every study participant. Data analysis procedure After data was understandably studied, edited
and summarized qualitatively and quantitatively, the data was thereafter be presented in tables
and counted. Data was analyzed and processed electronically using statistical package for social
scientists (SPSS) version 20 to analyze, Study on risk factors associated with hymenoplepsis
nana among under fiver year child in benadir hospital Major findings. Indicate the respondent 41
(56.2%) were mentioned Male while majority of 32 (43.8%) were mentioned Female, the
majority of the respondents were 37 (50.6) 15-20 years of age while 10 (13.6%) 20-30 Years
of age, were the
respondents were 13 (18%) between 30-40 years and while 5 (6.8%) were above 50 years of age.
the majority of respondents 40 (54.8%) were selected University while were respondents were 21
(28.8%) Secondary level and 12 (16.4%) were answered Informal. Recommendations: Integrating
methods of controlling Intestinal parasitic infection especially, H.nana which include health
education so as to ensure health practices and to reduce risk factors for transmission of H.nana,
Wash your hands with soap and warm water after using the toilet, changing diapers, and before
preparing foods
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Table of Contents
DECLARATION .......................................................................................................................................... ii
APPROVAL SHEET ................................................................................................................................... iii
DEDICATION ............................................................................................................................................. ⅳ
ACKNOWLEDGEMENTS .......................................................................................................................... v
ABSTRACT................................................................................................................................................... ⅵ
CHAPTER ONE ........................................................................................................................................... 1
INTRODUCTION ........................................................................................................................................ 1
1. 0 Introduction ........................................................................................................................................ 1
1.1 Background ......................................................................................................................................... 1
1.2 Statement Problem .............................................................................................................................. 3
1.3 General Objective ............................................................................................................................... 4
1.4 Specific objectives .............................................................................................................................. 4
1.5 Research Questions ............................................................................................................................. 4
1.6 Significance of the study ..................................................................................................................... 4
1.7 Scope of the study ............................................................................................................................... 5
1.8 Definition of Key Terms ..................................................................................................................... 5
1.9 Conceptual Frame Work ..................................................................................................................... 6
CHAPTER TWO .......................................................................................................................................... 7
LITERATURE REVIEW ............................................................................................................................. 7
2.1 introduction ......................................................................................................................................... 7
2.2 Theoretical over view of Hymenolepis nana ...................................................................................... 7
2.3 causes of hymenoplepsis nana .......................................................................................................... 10
2.4 Risk factor that contributes of Hymenolepis nana infections in children ......................................... 13
2.5 socio-economic factors hymenoplepsi nana: .................................................................................... 18
2.6 Summary ........................................................................................................................................... 21
CHAPTER THREE .................................................................................................................................... 23
RESEARCH METHODOLOGY ................................................................................................................ 23
3.1 INTRODUCTION ............................................................................................................................ 23
3.2 Research design ................................................................................................................................ 23
3.3 Population of the study ..................................................................................................................... 23
3.4 Study area.......................................................................................................................................... 23
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3.5 Sample size determination ................................................................................................................ 24
3.6 Sampling procedure .......................................................................................................................... 24
3.7 Research instruments ........................................................................................................................ 25
3.8 Data collection procedure ................................................................................................................. 25
3.9 Data analysis procedure .................................................................................................................... 25
Inclusion and exclusion criteria ........................................................................................................ 25
3.10 Quality control ................................................................................................................................ 26
3.11 Ethical consideration ....................................................................................................................... 26
CHAPTER FOUR ....................................................................................................................................... 27
DATA PRESENTATION, ANALYSIS AND FINDINGS ........................................................................ 27
List of tables
Table 4.1 Respondent by Gender ............................................................................................................ 27

Table 4.2 Respondent by age .................................................................................................................. 28
Table 4.3 Level of education................................................................................................................... 29
Table 4.4 Respondents Occupation ......................................................................................................... 30
Table 4.5 Respondents by Marital status ................................................................................................ 31
Table 4.6 causes of hymenoplepsi nana are parasitic infection .............................................................. 32
Table 4.7 Hyminolepis nana is transmitted by? ...................................................................................... 33
Table 4.8 The risk of H.nana infection increase among the age group ................................................... 34
Table 4.9 H. nana infections are generally less severe than by other causes of helminthic or protozoal
infection .................................................................................................................................................. 35
Table 4.10 Which sex group H.nana infection is more prevalent ........................................................... 36
Table 4.12 What type of water do you use? ............................................................................................ 38
Table 4.13 Do you believe that H.nana infection is common disease in Somalia? ................................. 39
Table 4.14 Have you ever met someone with suffering Hymenolepiasis? ............................................. 40
Table 4.15 people living overcrowded area is a one of the risk factors of H.nana ................................ 41
Table 4.16. which of the following are the sign and symptoms of H.nana infection? ............................ 42
Table 4.17. Do you believe socioeconomic factors and lack of parent education are strong influences on
the high prevalence rate of H.nana infection........................................................................................... 43
Table 4.18 Hymenolepis nana are more prevalent in developing countries with warm ......................... 44
Temperature ............................................................................................................................................ 44
Table 4.19 Hymenolepiasis is widespread in developing countries where human feces ........................ 45
are allowed to mix with food or water .................................................................................................... 45
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Table 4.20 people living river and less socioeconomic condition are lead to occur H.nana ................... 46
LIST OF FIGURES
Figure 4.1 Respondent by Gender: ............................................................................................ 27
Figure 4.2 Respondent by age .................................................................................................... 28
Figure 4.3 Level of education. ................................................................................................... 29
Figure 4.4 Respondents Occupation. ......................................................................................... 30
Table 4.5 Respondents by Marital status. .......................................................................... 31
Figure 4.6 causes of hymenoplepsi nana are parasitic infection. ............................................. 32
Figure 4.7 Hyminolepis nana is transmitted by? ...........................................................................33
Figure 4.8 The risk of H.nana infection increase among the age group. .................................... 34
Figure 4.9 H. nana infections are generally less severe than by other causes of helminthic or
protozoal infection. ................................................................................................................... 35
Figure 4.10 Which sex group H.nana infection is more prevalent…........................................ 36
Table 4.11 Most people who risks Hymenolepiasis is primary school children… ..............37
Figure 4.11 Most people who risks Hymenolepiasis is primary school children… ................. 37
Figure 4.12 What type of water do you use? ............................................................................... 38
Figure 4.13 Do you believe that H.nana infection is common disease in Somalia? ................... 39
Figure 4.14 Have you ever met someone with suffering Hymenolepiasis? ............................... 40
Figure 4.15 people living overcrowded area is a one of the risk factors of H.nana ......41
Table 4.16. which of the following are the sign and symptoms of H.nana infection? .................42
Figure 4.17. Do you believe socioeconomic factors and lack of parent education are strong
influences on the high prevalence rate of H.nana infection… ..................................................... 43
Table 4.18 Hymenolepis nana are more prevalent in developing countries with warm
Temperature ................................................................................................................................. 44
Figures 4.19 Hymenolepiasis is widespread in developing countries where human feces. ........45
figures 4.20 people living river and less socioeconomic condition are lead to occur H.nana .... 46
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CHAPTER FIVE ........................................................................................................................................ 47
MAJOR FINDINGS, CONCLUSION, AND RECOMMENDATIONSC ............................................. 47
5.1 Introduction ..................................................................................................................................... 47
5.2: Major findings.................................................................................................................................. 47
5.3: Conclusion ....................................................................................................................................... 48
5.5: Recommendations ............................................................................................................................ 48
REFERENCES ....................................................................................................................................... 50
APPENDIX A: QUESTIONNAIRE ....................................................................................................... 53
APPENDIX B: MAP OF SOMALIA ..................................................................................................... 58
APPENDIX C: MAP OF MOGADISHU ............................................................................................... 59
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Risk factors associated with hymenoplepsis nana among under fiver year child in Benadir
hospital.
CHAPTER ONE
INTRODUCTION
1. 0 Introduction
In this chapter will contain Background, Problem Statement, General objective, Specific
objectives, Research questions, Significance of the study, Scope of the study, Content of the study,
Geographical study, Time of the study, Definition key terms Conceptual Frame Work.
1.1 Background
Hymenolepis nana is the smallest of all tapeworms found in humans and is appropriately
described as the dwarf tapeworm. It is the only cestode that does not require an intermediate
host to develop into its infective stage. A common intermediate host, however, is the grain
bettle. Adult worms can be found in the proximal ileum of the small intestine and are usually
only a couple of centimeters long. Only the scolex is attached to the mucosa of the small
intestine, and after about two weeks, the gravid segments will drop off into the lumen. This
release will allow eggs to enter into the host's feces, and thereby contanimating the external
environment. Some eggs, however, may remain in the small intestine making autoinfection a
likely probability (WHO 2010).
In Globally: Hymenolepis nana, the dwarf tapeworm, is the smallest tapeworm commonly infect
both human beings and rodents This cestode belongs to a large family known as Hymenolepididae.
Hymenolepis nana has a cosmopolitan distribution and is Although the parasite has a wide
distribution, in countries with warm climates It exists in Egypt, Sudan, Portugal, Spain, Sicily,
India, Japan, South America, Cuba and parts of Eastern Europe, Mediterranean region, Africa,
south east Asia. The infection is more frequently seen in children although adults are also infected,
causing Hymenolepiasis. Discovered by Theodor Bilharz in Cairo in 1851 and the first identified
as human parasite by Von Siebold in 1852. In 1906, Stiles identified an identical parasite with a
rodent host and named it Hymenolepis fraterna. Morphological characteristics were used for
taxonomy identification and H. nana was known to have hooks and linear reproductive organs. H.
diminuta has no hooks and reproductive organs arranged in a triangular formation (Schantz, 2006).
After accidental ingestion, eggs will travel to the small intestine of their hosts where they will
hatch in the duodenum. The oncosphere will infiltrate the villa of the intestinal lining, and soon
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hospital.
after will become a cysticercoid larva. After four to five days, this infective larva will break free
into the lumen of the small intestine and travel to the ileum where it will reattach itself to the
intestinal mucosa. Within the next five days it will develop into a full adult worm. Besides humans,
the house mouse is another possible definitive host (Schantz, 2006).
Humans and other animals become infected when they intentionally or unintentionally eat material
contaminated by insects. H. nana is the only cestode that parasitizes humans without requiring an
intermediate host. It is possible for the worm's entire life cycle to be completed in the bowel, so
infection can persist for years. H diminuta is a cestode of rodents infrequently seen in humans.
In (Grassi B, 1887) demonstrated that transmission from rat to rat did not require an intermediate
host. latter In 1921, Seaki demonstrated direct cycle of transmission H.nana in human;transmission
without an intermediate host. In addition to the direct cause nichool and Minchin demonstrated
that fleas can serve as intermediate host between humans (RC., 2000).
If a person ingests eggs (from contaminated fingers, water, food or soil), oncospheres (hexacanth
larvae) hatch in the small intestine (Chero JC, 2007.) Eggs are immediately infective when passed
with the stool and cannot survive more than 10 days in the external environment (Gerald D.
Schmidt, 2009) Hymenolepiasis is the cestode that most commonly infects humans, especially
primary school aged children. In contrast, only a few hundred human infections with the rodent
tapeworm, Hymenolepiasis most frequently occurs in warm, dry regions of the developing world,
where exposure to human feces results in hand-to-mouth infection. Direct person-toperson spread
of H nana may occur. H.nana infection has a cosmopolitan distribution with the highest
prevalence and heaviest parasite burden among children in warm, arid climates with
poor sanitation conditions (WHO 2005)
Also Hymenolepiasis is one of the wide spread diseases in the southern region of Kazakhstan and
Uzbekistan. It was detected in 18.9% among infected by other Helminthiasis; including 13%
among children (Abdiev, 2007). The cases of Hymenolepiasis are registered in both urban and
rural areas of the country. Thedisease is a typical children Helmenthiasis. Hymenolepiasis plays a
very important role in the regional pathology in the southern region of Kazakhstan and Uzbekistan.
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hospital.
(Drinov, 1998) Hymenolepiasis were caused by tapeworm Hymenolepis nana, which parasites in
children‟s intestinal. Because of biological peculiarities of Hymenoliepis nana, Hymenolepiasis

becomes one of the hard-to-cure Helminthiasis. The head of Hymenolepis nana is easily detached
from the body of parasite staying in intestines of a host and therefore begun producing segments.
The majority of infections occur as autoinfection as a result of contamination of food or water by
humans, usually children, excreting viable eggs in their feces.
In Africa: Hymenolepis nana is among the most common intestinal parasitic infections causing a
Public health threat in poor communities in Sub-Saharan Africa (Evans AC, 1995)nThe present
study was conducted to determine the prevalence of H. nana infections among primary school
children of displacement communities In Khartoum state, Sudan across-sectional survey was
conducted in May 2013 in displacement camps, Khartoum state,Sudan. A simple random sample
of primary school children from the displacement camps, aged between 6 and 12 years, were
included. Information was collected by presenting a questionnaire and taking 500 fresh stool
specimens which were examined microscopically for the presence of eggs, using direct saline and
formal-ether concentration techniques. Hymenolepis nana is probably the commonest human

cestode, owing to its wide distribution, particularly in crowded areas, such as Nigeria and Uganda.
in Somalia the different states but no actually date about these parasite in Somalia. Intestinal
parasitic infection is common and is considered non-critical in a healthy individual. However, in
an Immunocompromised patient the disease may become chronic. The aims of the present study
were to determine the prevalence of H. nana infections among primary school children and to
identify the associated risk factors primary school children in Hodan district. Mogadishu Somalia
1.2 Statement Problem

The world‟s population is infected with intestinal Hyminolepis nana, making infections with these
organisms one of the most common cestode in humans with infection prevalence highest among
children (Schantz, 2006). Hymenolepis nana parasitic Infection is most common in children aged
4-10 years, indry, warm regions of the developing world. H nana infection affects millions of
people, primarily children, worldwide. Estimated rates of infection in various regions range from
0.1-58%. It is estimated to have 50-75 million carriers of H. nana with 5 to 25% prevalence in
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hospital.
children worldwide, which can be as high as 50% in children between 1-4 years of age (Ortiz JJ,
2002).
These problems (poor sanitation and hygiene, contaminated food and water) cause African
children‟s to suffer H.nana infection includes Somalia, After invalidation of central former
government of Somalia all public services including health service such as central laboratory and
other infrastructures were out of function.
1.3 General Objective

To investigate the risk factors associated with hymenoplepsi nana among under fiver year child
in benadir hospital. in wadajir district, Mogadishu, Somalia.
1.4 Specific objectives

1. To Determine causes of hymenoplepsi nana among under fiver year child in benadir hospital.
2. To Determine risk factors hymenoplepsi nana among under fiver year child in benadir hospital.
3. To investigate socio-economic factors hymenoplepsi nana among under fiver year child in
benadir hospital.
1.5 Research Questions

1. What are the causes of hymenoplepsis nana among under fiver year child in benadir hospital.?
2. What is (are) the risk factor hymenoplepsis nana among under fiver year child in benadir hospital
?
3. What are the socio-economic factor hymenoplepsi nana among under fiver year child in benadir
hospital?
1.6 Significance of the study

This research identify the effect and the best investigations of the study of intestinal parasite of
hymenoplepsi nana among under fiver year child in benadir, and bring an updated knowledge
about Hymenolepis Nana and that it useful for enhancing community awareness about
Hymenolepis nana. The date used by the professionals in health to design the better way to
minimize the effect of Hyminolepis nana.
1.7 Scope of the study
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hospital.
The scope provides for the boundary of the research
1. Contents scope risk factors associated with hymenoplepsi nana among under fiver year child in
benadir hospital.
2. Geographical scope: benadir hospital wadajir district –Mogadishu-Somalia
3. Time scope: April 202 up to July 2020
1.8 Definition of Key Terms

menolepis nana : also known as „dwarf tapeworm,‟ is the smallest
tapeworm found in the intestines of dogs, rats and humans
is a disease that cause Hymenolepis species
Helminthes: commonly known as parasitic worms, are large multi cellular
organisms, which when mature can generally be seen with the naked eye.
Arthropod: A large division of Articulate, embracing all those that have
jointed legs.
living animal or plant from which a parasite obtains nutrition.

1.9 Conceptual Frame Work
Independent variable
socio-economic factors hymenoplepsi

nana:
poverty
Preventive measures
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causes of hymenoplepsis nana:
 worm of family cestoda,
hospital.
 genus hymenolepis and species nana
Dependent variable
Risk factors of infection with H. nana include:
 absence of proper sanitation

 contact with environments contaminated hymenople
with human feces psis nana
 inadequate treatment of excreta and waste,
CHAPTER TWO:
LITERATURE REVIEW
2.1 introduction
This chapter contains the theoretical review about what has been done the other researchers this
study or other related study and also, Research gaps and Summary.
2.2 Theoretical over view of Hymenolepis nana
The genus Hymenolepis contains in excess of 400 species, virtually all of which are found in
higher vertebrates (Voge, 1973). Two species of Hymenolepis are of particular interest. H. nana
commonly knows a dwarf tapeworm, is parasite of children. It is found in rats and mice. It is
cosmopolitan in distribution, but is more common in the warm that in cold climates (Heyneman,
1957).
The adult worm lives in human intestine, often in large numbers. H. diminuta is a parasite of
rodents, rats in particular, but it has been reported from humans on rare occasions. Both species
are widely used as a model system for study of cestode biology (Smyth, 1994,1997).
H. nana differs from almost all other tapeworms in being able to complete its entire life cycle in a
single host. In this it radically progressive, having broken away from the age-old tapeworm custom
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hospital.
of utilizing intermediate hosts (Voge, 1973). It can, however, still revert to the habits of its
ancestors and develops in fleas and grain beetles. When the eggs are ingested by humans, rats or
mice, the oncospheres begin to crawl actively inside their shells, and escapes in the lumen of
intestine (Zeibig, 1997).
Adult worm of H.nana is one of the small intestine cestodes infecting man. It is small and thread
like measuring 1-4cm length with a maximum diameter of 1mm. the worms may be present in
large number (from 1.000 to maximum of 8.000). Life span of adult worm is short (about 2
weeks). The scolex (head) is globular, has 4 suckers and is provided with a short retractile
rostellum armed with a single row of hook let‟s numbering 20 to 30. The rostellum remains
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hospital.
invaginated in the apex of the organ . The rostellar hook lets are shaped like tuning forks. The neck
is long. A gravid proglottid contains fertilized eggs, which are sometimes expelled with the feces
(Cameron, 1956). However, most of the time, the egg settles in the microvilli of the small intestine,
hatch, and the larvae can develop to sexual maturity without ever leaving the host (Olsen, 1974).
An intermediate host is optional; H. nana can go through its life cycle with only one host or can
also go through the normal two-host cycle (Roberts, 2000). The life cycle can be described as:
1)eggs are ingested by definitive hosts 2)eggs hatch in the duodenum, releasing oncosphere and
lie in the lymph channels of the villi 3) oncosphere develops into a cysticercoids,
which has a tail and a well formed scolex, and it attaches to the small intestine and matures into
an adult 4a)gravid proglottids then release and pass out through feces along with eggs 4b)or eggs
can hatch and infect original host and start cycle over or (5)eggs can be ingested by insects or
rodents (Roberts and Janovy, 2000). The dwarf tapeworm like all other tapeworms lacks a
digestive system and feeds by absorption on nutrients in the intestinal lumen (Cameron, 1956).
They have nonspecific carbohydrate requirements and it seems like they will absorb whatever is
being passed through the intestine at that time (Cameron, 1956). When it becomes an adult, it will
attach to the intestinal walls with its suckers and toothed rostellum and have its segments reaching
out into the intestinal space to absorb food (Roberts and Janovy, 2000).
Hymenolepis nana, like all tapeworms, contain both male and female reproductive structures in
each proglottid (Roberts and Janovy, 2000). This means that the dwarf tapeworm like other
tapeworms is hermaphroditic (Cameron, 1956). Each segment contains 3 testes and a single ovary.
When a proglottid becomes old and unable to absorb any more nutrition, it is released and is passed
through the host's digestive tract (Roberts and Janovy, 2000). This gravidproglottid contains the
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hospital.
fertilized eggs, which are sometimes expelled with the feces (Cameron, 1956). However, most of
the time, the egg may also settle in the microvilli of the small intestine, hatch, and the larvae can
develop to sexual maturity without ever leaving the host (Olsen, 1974). (Cameron, 1956; Olsen,
1974; Roberts and Janovy Jr., 2000) Hymenolepis nana usually will not cause deaths unless in
extreme circumstances and usually in young children or in people who have weakened immune
systems. In some parts of the world, individuals that are heavily infected are a result of internal
autoinfection (Olsen, 1974).
The worms mature into a life form referred to as a "cysticercoid" in the insect; in H. nana, the
insect is always a beetle. Humans and other animals become infected when they intentionally or
unintentionally eat material contaminated by insects. In an infected person, it is possible for the
worm's entire lifecycle to be completed in the bowel, so infection can persist for years if left
untreated. H. nana infections are much more common than H. diminuta infections in humans
because, in addition to being spread by insects, the disease can be spread directly from person to
person by eggs in feces. When this happens, H. nana oncosphere larvae encyst in the intestinal
wall and develop into cysticercoids and then adults. These infections were previously common in
the southeastern USA, and have been described in crowded environments and individuals confined
to institutions. However, 11 the disease occurs throughout the world. H. nana infections can grow
worse over time because, unlike in most tapeworms, H. nana eggs can hatch and develop without
ever leaving the definitive host. The methods of infection and the of immunity are interconnected.
When cysticercoids is ingested, is little development of immunity, and during autoinfection the
number of worms may become large. In contrast, eggs are ingested; immunity usually development
rapidly. Most infections do not have many worms and therefore can have no symptoms. Patients
with more than 15,000 eggs per gram of stool may experience cramps, diarrhea, irritability,
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hospital.
anorexia, or enteritis caused by cystercoids destroying the intestinal villi in which they develop
(Schantz P. M., 2006).
2.3 causes of hymenoplepsis nana:
most common in children aged 4-10 years; in dry, warm regions of the least developed world. H.
nana infection affects millions of people, primarily children, worldwide. Understanding the
prevalence of intestinal parasites, such as Hymenolepiasis, in endemic areas may contribute to a
better knowledge of the risk factors for infestation in different ecological situations. Because
Hymenolepiasis is apparently transmitted fecal-orally and is very common, this parasite appears
to be an appropriate indicator for the overall level of intestinal parasitism in different populations.
H. nana is the most common cestode infection in humans (Smyth J. D., 1994). Estimates of the
numbr of human infections range from 20 million (Andreassen, 1998) to between 45 and 75 million
(Pawlowski, 1984) worldwide. The prevalence of H. nana is very common in countries with
warmer, arid climates ( B a i l y , 1 9 9 6 ) and is endemic in many tropical and sub-tropical
countries (Pawlowski, 1984). For instance, a survey of primary school age children in Zimbabwe
documented an infection rate of 21% to 24% (Mason and Patterson,
1994). The prevalence of H. nana in 14 villages in the Trarza region of Mauritania, Africa, ranged
from 10.8% to 58.6% (WHO, 1995). In refugees in Juba, Sudan, the prevalence was 11% including
infections in young children aged 4 – 14 years. H. nana infection was found to be more common
among stunted children than properly nourished children (p This finding agrees with studies done
among school children in Brazil (Tsuyuoka R, 1999), Mexico (Quihui-Cota L, 2004), and with an
in-depth study done among Egyptian children (Khalil HM, 1991). Symptoms seen in
H. nana infections are generally less severe than by other causes of helminthic or protozoal
diarrhoea, but are significantly associated with abdominal pain and gastrointestinal symptoms
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hospital.
(Mirdha BR, 2002). It has also been suggested that H. nana may cause epidemics in institutions
for children (Mirdha BR 2002). H. nana infection is therefore an important topic for public health
particularly in communities with high prevalence rates of the parasites. Hymenolepis nana is the
most prevalent parasite tapeworms (Magalhaes Soares JR, 2013). It is a cosmopolitan parasite by
its distribution and it is more prevalent in warm climates (Malheiros AF, 2014). Hymenolepis nana
occurs by the faecal-oral route, accounting for higher prevalence in young children and
adolescents with poorly developed hygiene ). Estimates of the viability of H. nana eggs in the
external environment range from 17 hours (Yan and Norman, 1995) to 10 days (Pawlowski, 1984),
suggesting the transmission of H. nana via environmental contamination may be lower than by the
transfer of eggs on contaminated hands and/or food shared between children (Pawlowski, 1984).
Accidental ingestion of an intermediate host infected with the resting cysticercoid stage is an
alternative route of transmission (Gibson, 1998), although this is considered a rare occurrence by
some (Andreassen, 1998).
Search Results
2.3.1 worm of family cestoda,

worm of family Cestoda is a class of parasitic worms in the flatworm phylum (Platyhelminthes).
Most of the species—and the best-known—are those in the subclass Eucestoda; they are ribbon-
like worms as adults, known as tapeworms.The adult tapeworm has a scolex (head) a short neck
and a strobila (segmented body) formed of proglottidsH. nana is one of the causal agent of
diarrhoea in Burkina Faso ( (Poda, 2007). It was
detected several times in the hospitals (Ouermi et al.,2012; Cissé et al., 2011), and
during the studies (Dianou et al., 2004; Poda et al., 2006; Zida et al., 2014; Sangaré et
al., 2015). Therefore, the children of primary school age and adolescents in developing countries
are the most exposed. the presence of an infected person in a crowded concession is a contributing
factor to its expansion. Contamination may also be in primary schools. In Burkina Faso, there
are small markets in primary schools where students buy food. The hygienic conditions are not
met in these small businesses (sales places, lack of water for washing hands, absence of hygiene
of the sellers). These businesses contribute to maintaining transmission of H nana (Zongo et al.,
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2006 (al., 2006).
2.3.2 genus hymenolepis and species nana

Dwarf tapeworm (Hymenolepis nana, also known as Rodentolepis nana, Vampirolepis nana,
Hymenolepis fraterna, and Taenia nana) is a cosmopolitan species though most common in
temperate zones, and is one of the most common cestodes (a type of intestinal worm or helminth)
infecting humans, especially children. Indeed, a study in Iran showed that people who ate at the
restaurants were the most exposed to intestinal parasites including H. nana (Sharif, 2015). In
addition, children playing areas are not protected and often encounter animal and/or human feces.
It is endemic in Asia, Africa, Easter this study presented the distribution of H. nana among primary
schools in Burkina Faso. It helped to know the current situation of H. nana infection among
students. But it should continue to include other socioeconomic factors and extend the
investigations to other community members. For now, awareness campaign should be made to
school children. The fight against this
parasite could be integrated into the control program against neglected tropical diseases.n and
Southern Europe and Brazil (Huda Thaher, 2012; Malheiros et al., 2014). Infections due to H. nana
are often asymptomatic when the level of infection is low (Mirdha and Samantray, 2002; Huda
Thaher, 2012). But when the level of infection is heavy and chronic, these infections can cause
diarrhoea, abdominal pain, headaches and dizziness (Mirdha and Samantray, 2002; Huda Thaher,
2012). Infections due to H. nana are associated with low absorption of vitamin B12 in the
intestines (Mohammad and Hegazi, 2007). Relationship between sex of the host and H. nana had
also been studied in different parts of the world. (at., 1991) reported (3.0%) prevalence of H. nana
in schoolboys between the ages of 5-13 years in the city of Abha. Menan et al. (1997) reported that
the male subjects were more infected than female. According to Washburn et al. (1965) the
heterogeneous nature of the sex chromosomes in males causes sex differences in parasite
resistance. According to this deleterious recessive alleles, normally masked in the homogonous
sex, would show their effects in the heterogametic sex, which has only one fully functional
chromosome. Sex steroids may directly affect parasites growth, development and may influence
immune response.
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2.4 Risk factor that contributes of Hymenolepis nana infections in children
age group may be at higher risk because they're more likely to play in less hygiene substances.
more prevalent in developing countries with warm temperatures

year-round.
allowed to mix with food or water. Overcrowding. In Somalia, especially Mogadishu city there is
a lot of overcrowded populations that may facilitate spreading of Hymenolepaisis which may lead
massive infection.
measures of disease.(Borphi, 2002)
Environmental, socio-economic, demographic and hygiene-related behaviour is known to

influence the transmission and distribution of intestinal parasitic infections. Prevalence of H.nana
is related more too inadequate environmental sanitation and personal hygiene than to climate.
Socio-economic factors as well as unpredictable factors such as food insecurity, droughts, and
floods contribute to the problem (WHO, 2011).
Unavailability of safe domestic water and low education on sanitation also contribute to
transmission (AMREF, 2009) H.nana a gains entry into the intestines through the mouth from
ingested faeces, or contaminated water or hands. Poor personal hygiene, garbage disposal and poor
disposal of excreta are significant for this oral-faecal infection (Blessman et al.,
2002).
Transmission may also be through mechanical vectors such as beetles and tribulum al., 2008)
whereby insect may carry the infective cysts from contaminated sites or
dirty latrines and cause contamination of food or water. Many tropical developing countries lack
adequate supply of clean domestic water, contamination may occur at the source of water or at
home due to poor sanitation (UNICEF, 2009).
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Lack of or availability of poor sanitation facilities in many environments, both in rural and urban
localities account for a large number of intestinal infections on a global scale For example, h. nana
is thought to infect 10% of the world‟s population and to produce more deaths than any other
parasite, except those caused by malaria and schistosomiasis. Although it has a worldwide
distribution, infection rates are highest in warm climates and exceed 50% in areas where the level
of sanitation is low, form example, in city slums. For reasons apparently unrelated to exposure,
symptomatic h. nana is less common in women (Plorde, 1994).
Poor sanitation also leads to the endemicity of such infections as ancylostomiasis, ascariasis,
trichuriasis, giardiasis, balantidiasis, necatoriasis and coccidiosis among other intestinal infections
(WHO, 1964; Plorde, 1994; Lucas, 1995; Montressor, 2001)
Poor communal and personal hygiene habits are also accountable for the transmission of many
protozoan and helminthic infections. For example, symptomatic amoebiasis is usually sporadic,
the result of direct person-to-person faecal-oral spread under conditions of poor personal and
communal hygiene brought about by the contamination of water and food by infected persons who
are carriers of infective cysts and who do not wash hands after visiting the toilets and before eating
food. Thus, man acquires amoebiasis by ingesting food or water contaminated with viable, mature,
infective cysts derived from infected human carrier faeces, since there are no known animal
reservoirs. Venereal transmission appears to be particularly common among male homosexuals,
presumably the result of oral-anal sexual contact. Food- and water-borne spread occur,
occasionally in epidemic form. Such outbreaks, however, are seldom as explosive as those
produced by pathogenic intestinal bacteria (Cheesbrough, 1981; Plorde, 1994; Chiodini et al.,
2001).
The exposure event is related to the host‟s behaviour and the household environment, which are
further influenced by the cultural and economic circumstances of the community (al. (. e., 1998) .
It was noted that intestinal nematodes are distributed in tropical and sub-tropical regions though
not evenly but reflect prevailing socioeconomic and sanitary conditions of affected areas
(Freedman, 1992 ) Intestinal cestode infections are generally high due to difficulty in carrying out
adequate inspection of beef carcasses (Kaethe, 1992).
2.4.1 absence of proper sanitation
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Adequate sanitation, together with good hygiene and safe water, are fundamental to good health
and to social and economic development. That is why, in 2008, the Prime Minister of India quoted
Mahatma Gandhi who said in 1923, ―sanitation is more important than independence‖.
Improvements in one or more of these three components of good health can substantially reduce
the rates of morbidity and the severity of various diseases and improve the quality of life of huge
numbers of people, particularly children, in developing countries. Although linked, and often
mutually supporting, these three components have different public health characteristics. This
paper focuses on sanitation. It seeks to present the latest evidence on the provision of adequate
sanitation, to analyse why more progress has not been made, and to suggest strategies to improve
the impact of sanitation, highlighting the role of the health sector. It also seeks to show that
sanitation work to improve health, once considered the exclusive domain of engineers, now
requires the involvement of social scientists, behaviour change experts, health professionals, and,
vitally, individual people. Throughout this paper, we define sanitation as the safe disposal of
human excreta . The phrase ―safe disposal‖ implies not only that people must excrete hygienically
but also that their excreta must be contained or treated to avoid adversely affecting their health or
that of other people.
Lack of sanitation leads to disease, as was first noted scientifically in 1842 in Chadwick's seminal
―Report on an inquiry into the sanitary condition of the labouring population of Great Britain‖. A
less scientifically rigorous but nonetheless professionally significant indicator of the impact on
health of poor sanitation was provided in 2007, when readers of the BMJ (British Medical Journal)
voted sanitation the most important medical milestone since 1840. The diseases associated with
poor sanitation are particularly correlated with poverty and infancy and alone account for about
10% of the global burden of disease. At any given time close to half of the urban populations of
Africa, Asia, and Latin America have a disease associated with poor sanitation, hygiene, and water.
Of human excreta, faeces are the most dangerous to health. One gram of fresh faeces from an
infected person can contain around which illustrates the importance of particular interventions,
notably the safe disposal of faeces, in preventing disease transmission.
2.4.2 contact with environments contaminated with human feces
Humans can be exposed to pathogens from poorly managed animal feces, particularly in
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communities where animals live in close proximity to humans. This systematic review of peer-
reviewed and gray literature examines the human health impacts of exposure to poorly managed
animal feces transmitted via water, sanitation, and hygiene (WASH)-related pathways in low- and
middle-income countries, where household livestock, small-scale animal operations, and free-
roaming animals are common. We identify routes of contamination by animal feces, control
measures to reduce human exposure, and propose research priorities for further inquiry. Exposure
to animal feces has been associated with diarrhea, soil-transmitted helminth infection, trachoma,
environmental enteric dysfunction, and growth faltering. Few studies have evaluated control
measures, but interventions include reducing cohabitation with animals, provision of animal feces
scoops, controlling animal movement, creating safe child spaces, improving veterinary care, and
hygiene promotion. Future research should evaluate: behaviors related to points of contact with
animal feces; animal fecal contamination of food; cultural behaviors of animal fecal management;
acute and chronic health risks associated with exposure to animal feces; and factors influencing
concentrations and shedding rates of pathogens originating from animal feces (WHO 2003).
several pathogens of zoonotic origin are associated with acute gastrointestinal symptoms that can
arise from contact with animal feces.5 Children may experience long-term growth shortfalls after
exposure to these pathogens, and pregnant women and the immunocompromised may also
experience severe and/or long-term adverse health effects after infection with pathogens carried in
animal feces.6−9 Approximately one-third of deaths among children under five years due to
diarrhea in the Global Burden of Disease 2015 report are attributed to pathogens that can be found
in animal feces.10 While some studies seek to identify a relationship between animal contact and
diarrhea, not all etiologies of diarrhea are transmitted through animal feces. While many important
viral enteropathogens (e.g., rotavirus) have limited zoonotic transmission, animal feces may play
an important role in the transmission of some important etiologies of childhood diarrhea, such as
Cryptosporidium, which substantially contributes to the childhood burden of diarrheal disease and
has been associated with severe acute and long-term clinical manifestations, including child
growth faltering.11 Unlike rotavirus, there is currently no vaccine for Cryptosporidium and
treatment options are limited and often unavailable in developing countries. Thus, preventive
measures for such zoonotic pathogens are important for reducing disease burden. Though the total
contribution of zoonotic transmission is unknown, it may be substantial, and it may vary by the
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virulence and animal host(s) of the specific etiologic agent, geographic and cultural context, and
environmental conditions (WHO 2003).
2.4.3 inadequate treatment of excreta and waste,
Human excreta and the lack of adequate personal and domestic hygiene have been implicated in
the transmission of many infectious diseases including cholera, typhoid, hepatitis, polio,
cryptosporidiosis, ascariasis, and schistosomiasis. The World Health Organization (WHO)
estimates that 2.2 million people die annually from diarrhoeal diseases and that 10% of the
population of the developing world are severely infected with intestinal worms related to improper
waste and excreta management (Murray and Lopez 1996; WHO 2000a). Human excreta-
transmitted diseases predominantly affect children and the poor. Most of the deaths due to
diarrhoea occur in children and in developing countries (WHO 2009).
Proper excreta disposal and minimum levels of personal and domestic hygiene are essential for
protecting public health. Safe excreta disposal and handling act as the primary barrier for
preventing excreted pathogens from entering the environment. Once pathogens have been
introduced into the environment they can be transmitted via either the mouth (e.g. through drinking
contaminated water or eating contaminated vegetables/food) or the skin (as in the case of the
hookworms and schistosomes), although in many cases adequate personal and domestic hygiene
can reduce such transmission. Excreta and wastewater generally contain high concentrations of
excreted pathogens, especially in countries where diarrhoeal diseases and intestinal parasites are
particularly prevalent. Therefore for maximum health protection, it is important to treat and contain
human excreta as close to the source as possible before it gets introduced into the environment.
Although the principal focus of the guideline documents examined in this book is water, in many
settings other disease transmission pathways are at least as important. In microbiological terms,
the traditional approach of examining each guideline area in isolation ignores the inter-related
pathways and also the root of the problem, namely excreta and inadequate hygiene (Nematian J,
2004).
2.5 socio-economic factors hymenoplepsi nana:

Lower socio-economic status (SES) is also a risk factor for IPIs (Nematian J, 2004). We have taken
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rented house as a proxy measure of SES which is also positively associated with IPIs. The effect
of SES on risk of infectious diseases in general, and parasitic infections in particular, is complex
in nature and could be attributed to several other factors such as lack of access to clean water, poor
hygienic environment, lack of access to education due to financial constraints and overcrowded
conditions (Houweling TA, 2003)
Also there is no Mass Drug Administration had been successful approach in the control of
Intestinal Parasitic Helminthes (IPHs) The high prevalence of worm infections, for example, has
been attributed to many factors involving the interaction of biotic and abiotic factors (Magambo
et al., 1998) and socioeconomic factors. In the tropics, toilet construction and usage have been
suggested as effective control measures (Cheesbrough, 1998) but this still calls for further research
as this has been found not to be very protective especially when the environment is faecally
contaminated (Haswell-Elkins et al., 1989).
In circumstances where the toilets are not easy to clean (Chadiwana et al., 1989), the water table
is high (Muchiri et al., 2001) and when the toilet is provided and not used (Faecham et al., 1983)
the transmission of helminthic infection is not effectivelycontrolled through provision of toilets.
The public health and socio-economic implications of infections with intestinal parasites are
enormous, especially in third world countries (Rao, 2002). Indeed, in these countries, many hours
of productive working life of workers and employees are lost are lost while they seek treatment or
through absenteeism from workplaces (World Bank, 1999). This is due to the general malaise and
other ill-health effects produced by infections with intestinal parasites (Cheesbrough, 1981).
Infections with intestinal parasites cause a vicious cycle, especially in endemic areas such as slums
(Katz and Hotez, 2004).
Infected persons have lowered output and, thus, cannot either pursue education or engage in
gainful employment to improve the standard of living or maintain a healthy state. This leads to
further poor health and vulnerability to other infections (Monto et al., 1991; Plorde, 1994).
Poverty and poor health are inseparably linked. (Organization, 2008)Poverty has many dimensions
– material deprivation (of food, shelter, sanitation, and safe drinking water), social exclusion, lack
of education, unemployment, and low income – that all work together to reduce opportunities,
limit choices, undermine hope, and, as a result, threaten health. (D., 2009)Poverty has been linked
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to higher prevalence of many health conditions, including increased risk of chronic disease, injury,
deprived infant development, stress, anxiety, depression, and premature death. According to Moss,
socioeconomic factors that affect impoverished populations such as education, income inequality,
and occupation, represent the strongest and most consistent predictors of health and mortality.
(Organization., 2008)
Along with these social conditions, "Gender, education, occupation, income, ethnicity, and place
of residence are all closely linked to people's access to, experiences of, and benefits from health
care.. The prevalence of H. nana in remote communities in northwest Australia is remarkably high,
55%. The transmission is due mostly from human to human contact and auto-infection. In 2006, a
study in rural Mexico found that 25% of the children ages 6-10 in twelve schools were infected
with H. nana. The study indicates that socioeconomic factors and lack of parent education are
strong influences on the high prevalence rate. Recommendations were made to include mothers in
de-worming campaigns because drugs alone were not eliminating the parasites (Peter R.
Mason,2004).
2.5.1 Poverty
Poverty is a state or condition in which a person or community lacks the financial resources and
essentials for a minimum standard of living. Poverty means that the income level from employment
is so low that basic human needs can't be met. Poverty-stricken people and families might go
without proper housing, clean water, healthy food, and medical attention. Each nation may have
its own threshold that determines how many of its people are living in poverty. overty is not having
enough material possessions or income for a person's needs. Poverty may include social, economic,
and political elements.
Absolute poverty is the complete lack of the means necessary to meet basic personal needs, such
as food, clothing and shelter. The threshold at which absolute poverty is defined is always about
the same, independent of the person's permanent location or era.
On the other hand, relative poverty occurs when a person cannot meet a minimum level of living
standards, compared to others in the same time and place. Therefore, the threshold at which relative
poverty is defined varies from one country to another, or from one society to another.[3] For
example, a person who cannot afford housing better than a small tent in an open field would be
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said to live in relative poverty if almost everyone else in that area lives in modern brick homes,
but not if everyone else also lives in small tents in open fields (for example, in a nomadic tribe).
Governments and non-governmental organizations try to reduce poverty. Providing basic needs
to people who are unable to earn a sufficient income can be hampered by constraints on
government's ability to deliver services, such as corruption, tax avoidance, debt and loan
conditionalities and by the brain drain of health care and educational professionals. Strategies of
increasing income to make basic needs more affordable typically include welfare, economic
freedoms and providing financial services.
2.5.2 Preventive measures
Prevention is the best method to avoid diseases due to biological factors. A risk assessment is
important in prevention planning. If control of the biological factor cannot be achieved at the
source, an attempt should be made to reduce the exposure by, for instance, ventilation, or
interrupting the path of exposure between the biological factor and the worker, for instance by
Also, rules and regulations are often of great importance for implementing preventive actions. An
example of this is a political resolution to end tuberculosis, adopted by the United Nation General
Assembly 26th September 2018 (see the UN logo in the photo above). Tuberculosis is a problem
for several occupational Groups; miners as well as health personnel, and the resolution will be of
importance for many workers. You can read more about this process here In the following text,
we will give other examples of preventive actions for work-related infectious diseases. During the
fourth week of this course you will learn about prevention of respiratory diseases that can be caused
by biological factors.Hand hygiene: During a normal working day, the hands will be contaminated
with several bacteria and other infectious agents from contact with other humans, infected surfaces,
foods or animals. Hand hygiene is the most effective intervention to reduce transmission of
infections and resistant germs, and hence of utmost importance in the prevention of infectious
diseases. This is especially true in health care services due to clinical encounters with patients who
have different kinds of infections, but it is also true in other settings where workers are exposed to
infectious agents
2.6 Summary
This chapter consist theoretical review, objectives , research gap and summary. The genus
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Hymenolepis contains in excess of 400 species, virtually all of which are found in higher
vertebrates (Voge, 1973). Two species of Hymenolepis are of particular interest. H. nana
commonly knows a dwarf tapeworm, is parasite of children. It is found in rats and mice. It is
cosmopolitan in distribution, but is more common in the warm that in cold climates (Heyneman,
1957).
Infection is most common in children aged 4-10 years; in dry, warm regions of the least developed
world. H. nana infection affects millions of people, primarily children, worldwide. The adult worm
lives in human intestine, often in large numbers. H. diminuta is a parasite of rodents, rats in
particular, but it has been reported from humans on rare occasions. Both species are widely used
as a model system for study of cestode biology (Smyth, 1994,1997). Hymenolepis nana, like all
tapeworms, contain both male and female reproductive structures in each proglottid (Roberts and
Janovy, 2000). This means that the dwarf tapeworm like other tapeworms is hermaphroditic
(Cameron, 1956). Hymenolepis nana occurs by the faecal-oral route, accounting for higher
prevalence in young children and adolescents with poorly developed hygiene. The public health
and socio-economic implications of infections with intestinal parasites are enormous, especially
in third world countries (Rao, 2002).
H. nana eggs are frequently spherical or ovoid with a thin hyaline shell and measure 30-47 μm in
diameter. The oncosphere with its 3 pairs of hooklets lies in the center of the egg and is separated
from the outer shell by sizeable space. The oncosphere has an internal membrane with polar
thickenings from which arise 4 to 8 filaments extending into the space between it and the colorless
hyaline shell (Mahmoud MS, 2011). Hymenolepis nana infection is most often asymptomatic.
Heavy infections with H. nana can cause weakness, headaches, anorexia, irritability, abdominal
pain, itching around the anus and diarrhea. Hymenolepiasis is usually asymptomatic in adults. But
prolonged infection or multiple tapeworms especially in children can cause more severe
symptoms. In symptomatic patients, the symptoms were mild and non-specific such as pruritus
ani, abdominal pain, diarrhea, anorexia, headache, and dizziness (Sirivichayakul C, 2000)
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Treatment
Safe and effective medication is available for treatment of both urinary and intestinal
schistosomiasis. Praziquantel, a prescription medication, is taken for 1-2 days to treat infections
caused by all schistosome species The drug currently recommended for treatment is praziquantel,
which can be given as a single dose, but other drugs such as metrifonate, artesunate, and
mefloquine have also been evaluated. On average, the standard dose of praziquantel cures around
60% of people at one to two months after treatment (high quality evidence), and reduces the
number of schistosome eggs in the urine by over 95% (high quality evidence). Metrifonate, an
older drug no longer in use, had little effect when given as a single dose but an improved effect
when given as multiple doses two weeks apart. Two trials compared three doses of metrifonate
with the single dose of praziquantel and found similar effects
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 INTRODUCTION
This chapter focuses on research methodology including research design, study population, study
area, sample size, sampling procedure, research instrument, data collection, data analysis,
Inclusion and exclusion criteria, Quality control and ethical considerations.
3.2 Research design

The study was conducted through cross-sectional descriptive study design, which means that the
sample will be taken from the study population and the information was obtain at the same time
on a particular point in time. because the cross sectional study is depth investigation of an
individual, group institution or phenomena. The cross sectional helps to the researchers to study
multiple entities in depth in order to gain insight into the larger case and to describe and explain
rather than predict a phenomenon. also this method
is less time consuming than case control or cohort study and also inexpensive, quick picture of
prevalence of exposure and outcome.
3.3 Population of the study

The study population was risk factors associated with hymenoplepsis nana among under fiver
year child in benadir hospital. This children age was chosen because of their age since food
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contamination transmitted Hymenolepis nana reach its maximum intensity at this age and from
medical centers records most of the children falling in that range are those in that children age.
3.4 Study area

Hodan district is one of the 17 districts of Banadir region and it is located in the middle east of
capital city. Bordered in the north-west by Afgoe district lower Shebelle region, Halwadag district
in the east, Wabari district in the south east, and Deynele in the north side. The district is divided
in to 4 Branches:
1- Taleh, 2. Ka‟an, 3. October, 5. Ahmed gurey,
Somali Sudanese, Egyptian hospitals Hanano hospital, shaafi hospital, digfeer

hospital also known Erdogan hospital located in Hodon district, Mogadishu – Somalia.
Hodan district is one of the seventeen districts in banadir region, it has border with
Wadajir district to the south direction and taredisho district to the west, daynile district to
the north and holwadag district to the east direction.
3.5 Sample size determination

Slovenes‟ formula was used in this study to calculate the appropriate sample size. A total of 90 of
primary school aged children with stool examination in two selective hospitals Hospitals. the
researchers used non probability sampling. To determine the ideal of sample size for a population,
the study was used Slovene‟s
formula
n= N/ [1+ (N*e^2)], Where;
n=sample size,
N=population size and,
e= margin of error of 5%.
n=90/ [1+ (90*0.0025)] = 73
Respondents = 73
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3.6 Sampling procedure

The sampling procedure that was used in this study non-probability sampling procedure
particularly convenient sampling technique. This means that the researcher selected the people
who seem they have knowledge about prevalence of Hymenolepis and who suitable responses
from the study questionnaire.
3.7 Research instruments
The research instruments was conducted through questionnaire as the main tool for collecting data.
Questionnaire a collection of items to which a respondent is expected to react in writing. The selections of
these tools have been guided by the nature of data to be collected the time available as well as the objectives
of the study
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3.1 Data collection procedure

In this study the methods and the material we used questionnaire as to get feedback from
respondents in Hodan district, A Questionnaire consisting of questions with open and closed-
ended questions was administered to every study participant. Researcher will get an authority letter
from the collage of health science of Jazeera University, to make the authorization of carrying out
a research about prevalence Hymenolepis nana infection among primary school children in wadajir
distract in Egyptian and Somali Sudanese hospitals.
3.2 Data analysis procedure
After data was understandably studied, edited and summarized qualitatively and quantitatively, the
data was thereafter be presented in tables and counted. The totals was converted into numbers to
enable me to analyze and describe the data systematically to reach logical conclusions on the effect
of the study variables. Editing of data was used to check for errors and slips to ensure accuracy
and reliability of data. Data was analyzed and processed electronically using statistical package
for social scientists (SPSS) version 20 to analyze, Study on risk factors associated with
hymenoplepsis nana among under fiver year child in benadir hospital
3.3 Inclusion and exclusion criteria

3.3.1 Inclusion criteria
This research the target for the under five years child reside in wadajir and attended benadir
hospital. in wadajir district.
3.3.2 Exclusion criteria
Above 5 years children.primary school aged children not reside wadajir district
3.4 Quality control

3.4.1 VALIDITY
All interviews conducted in the local language to ensure accuracy and consistency.
Questionnaires frequently be checked after completing the interviews. The data noticed very carefully and
systemically. The privacy of the respondents will be strictly be maintained. Validity
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is a measure of the truth of accuracy of acclaim, it refers to how far a data collection
instrument actually measures what it is suppose to measure. Validity has two aspects:
first that the instrument does in fact measure the concept it is intended to measure and
second that it is measures accurately((Burns2007).
3.4.2 RELIABILITY
The researchers test method and conduct pretest for instrument and test conducted
after one week in the same manner, to know if the respondents provide the same result.
Reliability arises from the stability and consistency of the measurement and provides
an indication of the random error in the measurement (Burns and Grove 2005). In order
to ensure reliability of the measuring instrument, closed ended questions are used in
most cases. Thus, if the same questions are administered to the same study participant
at different times,
3.5 Ethical consideration

To carry out this study, the researchers use both individual and institutional data. Thus,
the data collected will keep its confidentiality and the information gathered for this
organization only be used for an academic purpose. The respondents inform the
content and aim of the research before administration of any instrument as we
maintained the above sections.
3.8 LIMITATIONS OF THE STUDY

The research will have some limitations that have listed below:
 Some journals, magazines and books needs to be purchased online, this was barrier to get access
to the required information
 Lack of security and instability in the town
 There is no sufficient internet access as well as resources, cost, time and lack of libraries and
documentation canters in the town.
 The language is assumed to be the greatest barrier in getting the most correct answers for the
questionnaire for the respondents.
 The effects of COVID-19
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hospital.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND FINDINGS
4.0 Introduction
This chapter presents findings and indicates how data was collected, presented, interpreted, and
analyzed. The findings of this chapter are consistent with research questions. Fortunately,
questionnaires were distributed and the questionnaires returned from the respondents. In order to
analysis the data percentages and frequency distribution tables and graphs were used. The
questionnaires were contained of 20 questions which intended to collect the necessary information
for the research.
Table 4.1 Respondent by Gender:
Frequency Percent
56%
Male 41
Female 32 44%
Total 73 100.0
Table 4.1 indicate the respondent 41 (56%) were mentioned Male while majority of 32 (44%)
were mentioned Female.
60%
50%
40%
30% 56%
44%
20%
10%
0%
Male Famele
Figure 4.1 Respondent by Gender:
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hospital.
Table 4.2 Respondent by age

Respondents Frequency Percent
15-20 37 50%
20-30 10 14%
30-35 13 18%
35-40 13 18%
Total 73 100%
Table 4.2 the majority of the respondents were 37 (50%) 15-20 years of age while 10 (14%)
20-30 Years of age, were the respondents were 13 (18%) between 30-40 years and while
13(18%) were above 50 years of age.
50%
17%
14%
6%
15-20 20-30 30-35 35-40
Figure 4.2 Respondent by age
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hospital.
Table 4.3 Level of education

Frequency Percent
University 40 55%
Secondary school 21 29%
Informal 12 16%
Total 73 100
Table 4.3 the majority of respondents 40 (55%) were selected University while were
respondents were 21 (29%) Secondary level and 12 (16%) were answered Informal.
50%
29%
16%
University Secondary school Informal
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hospital.
Figure 4.3 Level of education
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hospital.
Table 4.4 Respondents Occupation

Frequency Percent
Household 20 27%
Employee 16 22%
Student 37 51%
Total 73 100
Table 4.4 shows the respondent were Household is represented by 20 (27%) while the of
respondent 16 (22%) Employee and the majority of respondent were 37 (51%) were answered
Student.
51%
27%
22%
Household Employee Student
Figure 4.4 Respondents Occupation
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hospital.
Table 4.5 Respondents by Marital status

Frequency Percent
single 39 53%
Married 24 33%
Divorced 10 14%
Total 73 100
Table 4.5 indicate the majority of respondent 39 (53%) single, 24 (33%) were mentioned
married and while 10 (14%) Were mentioned Divorced.
53%
33%
14%
Single Married Divorced
Figure 4.5 Respondents by Marital status
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hospital.
Table 4.6 causes of hymenoplepsi nana are parasitic infection

Frequency Percent
Strongly agree 31 42%
Agree 27 37%
Strongly disagree 11 15%
Disagree 4 6%
Table 4.6 indicate the majority of the respondent Strongly agree 31 (42%) were respondents
while the respondent agree 27 (37%) were the respondents Strongly disagree 11 (15%) and were
the respondents disagree 4 (6%).
42%
37%
15%
6%
Strong Agree Agree Strong Disagree Disagree
Figure 4.6 causes of hymenoplepsi nana are parasitic infection
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hospital.
Table 4.7 Hyminolepis nana is transmitted by?

Frequency Percent
fecally contaminated foods 32 44%
Water contaminated with 25 34%

feces
Unwashed hands 11 15%
All Above 5 7%
Table 4.7 indicate the majority of the respondent fecally contaminated foods 32 (44%) were
respondents, while the respondent Water contaminated with feces 25 (34%), while the
respondent 11(15%) Unwashed hands and were the respondents strongly disagree 5 (7%) All
Above
44% 15%
7%
34%
fecally Water contaminated Unwashed hands All Above

contaminated foods with feces
Figure 4.7 Hyminolepis nana is transmitted by?
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hospital.
Table 4.8 The risk of H.nana infection increase among the age group
Frequency Percent
14-11 20 27%
10-6 13 18%
less than 6 40 55%
Total 73 100
Table 4.8 the respondents were 20 (27%) 14-1 while 13 (18%) 10-6 and the majority of the
respondents were 40 (55%) less than 6
55%
27%
15%
14-11 10--6 less than 6
Figure 4.8 The risk of H.nana infection increase among the age group
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hospital.
Table 4.9 H. nana infections are generally less severe than by other causes of helminthic or
protozoal infection
Frequency Percent
Yes 41 56%
No 32 44%
Total 73 100%
Table 4.9 indicate majority of the respondent 41 (56.%) were mentioned Yes while of 32
(44%) were mentioned No.
60%
50%
40%
30% 56%
44%
20%
10%
0%
YES NO
Figure 4.9 H. nana infections are generally less severe than by other causes of helminthic or
protozoal infection
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hospital.
Table 4.10 Which sex group H.nana infection is more prevalent

Frequency Percent
36%
Male 26
female 47 64%
Total 73 100%
Table 4.10 indicate the respondent 26 (35.6%) were mentioned Male while majority of 47
(64.4%) were mentioned Female.
70%
60%
50%
40%
64%
30%
20% 36%
10%
0%
Male Famele
Figure 4.10 Which sex group H.nana infection is more prevalent
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hospital.
Table 4.11 Most people who risks Hymenolepiasis is primary school children;
Frequency Percent
63%
Yes 46
No 27 37%
Total 73 100%
Table 4.10 indicate majority of the respondent 46 (63%) were mentioned Yes while of 26 (37%)
were mentioned No.
70%
60%
50%
40%
30%
63%
37%
20%
10%
YES NO
0%
Figure 4.11 Most people who risks Hymenolepiasis is primary school children
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hospital.
Table 4.12 What type of water do you use?

Frequency Percent
4
Untreated 3
treated 70 96
Total 73 100.0
Table 4.12 indicate of the respondent 46 (63%) were mentioned Untreated while majority of the
respondents of 26 (37%) were mentioned treated
100%
90%
80%
70%
60%
96%
50%
40%
30%
20%
10%
4%
0%
Untreated treated
Figure 4.12 What type of water do you use?
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hospital.
Table 4.13 Do you believe that H.nana infection is common disease in Somalia?
Frequency Percent
34%
Yes 25
No 48 66%
Total 73 100%
Table 4.13 indicate of the respondent 46 (34%) were mentioned yes while majority of the
respondents of 48 (66%) were mentioned No.
66%
70%
60%
50%
40% 34%
30%
20%
N
10% O
0% Y
E
YES NO S
Figure 4.13 Do you believe that H.nana infection is common disease in Somalia?
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hospital.
Table 4.14 Have you ever met someone with suffering Hymenolepiasis?
Frequency Percent
70
Yes 51
No 22 30
Total 73 100.0
Table 4.13 indicate the majority respondent 51 (70%) were mentioned Yes while of the
respondents of 48 (65.8%) were mentioned No.
70%
60%
50%
40%
70%
30%
20%
30%
10%
0%
YES NO
Figure 4.14 Have you ever met someone with suffering Hymenolepiasis?
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hospital.
Table 4.15 people living overcrowded area is a one of the risk factors of H.nana
Frequency Percent
82%
Yes 60
No 13 17%
Total 73 100.0
Table 4.15 indicate the majority respondent 60 (82.2%) were mentioned Yes while of the
respondents of 13 (17.8%) were mentioned No.
70%
60%
50%
40%
70%
30%
20%
30%
10%
0%
YES NO
Figure 4.15 people living overcrowded area is a one of the risk factors of H.nana
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hospital.
Table 4.16. which of the following are the sign and symptoms of H.nana infection?
Frequency Percent
Diarrhea 31 42%
Gastrointestinal discomfort 27 37%
poor appetite and weakness 11 15%
All Above 4 5%
Total 73 100
Table 4.16 indicate the majority of the respondent diarrhea 31 (42%) were respondents while
the respondent Gastrointestinal discomfort 27 (37%) were the respondents poor appetite and
weakness 11 (15%) and were the respondents All Above 4 (5%).
42%
37%
15%
5%
Diarrhea Gastrointestinal poor appetite and All Above

discomfort weakness
Table 4.16. which of the following are the sign and symptoms of H.nana infection?
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hospital.
Table 4.17. Do you believe socioeconomic factors and lack of parent education are strong
influences on the high prevalence rate of H.nana infection
Frequency Percent
74
Yes 54
No 19 26
Total 73 100.0
Table 4.15 indicate the majority respondent 54 (74%) were mentioned Yes while of the
respondents of 19 (26%) were mentioned No.
80%
70%
60%
50%
40% 74%
30%
20%
26%
10%
0%
YES NO
Figure 4.17. Do you believe socioeconomic factors and lack of parent education are strong
influences on the high prevalence rate of H.nana infection.
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hospital.
Table 4.18 Hymenolepis nana are more prevalent in developing countries with warm
Temperature
Frequency Percent
Agree 28 38%
Disagree 4 5%
while the respondent agree 28 (38.4%) were the respondents Strongly disagree 11 (15%) and
were the respondents disagree 4 (5%).
41%
38%
15%
5%
Figure 4.18 Hymenolepis nana are more prevalent in developing countries with warm
Temperature
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hospital.
Table 4.19 Hymenolepiasis is widespread in developing countries where human feces

are allowed to mix with food or water
Frequency Percent
Strongly agree 29 40
Agree 27 37
Strongly disagree 9 12
Disagree 8 11
Total 73 100
while the respondent agree 27 (37%) were the respondents Strongly disagree 9 (12%) and were
the respondents disagree 8 (11%).
40% 12%
11%
37%
Table 4.19 Hymenolepiasis is widespread in developing countries where human feces

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hospital.
Table 4.20 people living river and less socioeconomic condition are lead to occur H.nana
Frequency Percent
Agree 41 56%
Disagree 5 7%
Total 73 100
Table 4.20 indicate the respondent Strongly agree 14 (19.%) were respondents while the
majority of the respondent agree 41 (56.2%) were the respondents Strongly disagree 10
(14%)and were the respondents disagree 5 (7%).
40%
37%
12%
11%
Figure 4.20 people living river and less socioeconomic condition are lead to occur H.nana
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hospital.
CHAPTER FIVE
FINDINGS, CONCLUSION, AND RECOMMENDATIONSC.
5.1 Introduction
This chapter focuses on the summary of the results of the research study on previous chapters;
Chapter four was presented, analyzed and discussed using the data obtained from the field. Based
on findings on the previous chapters, findings, conclusion, Recombination.
5.2 : findings.
Indicate the respondent 41 (56.2%) were mentioned Male while majority of 32 (43.8%) were
mentioned Female, the majority of the respondents were 37 (50.6) 15-20 years of age while 10
(13.6%) 20-30 Years of age, were the respondents were 13 (18%) between 30-40 years and while
5 (6.8%) were above 50 years of age. the majority of respondents 40 (54.8%) were selected
University while were respondents were 21 (28.8%) Secondary level and 12 (16.4%) were
answered Informal. the respondent were Household is represented by 20 (27.3%) while the of
respondent 16 (22%) Employee and the majority of respondent were 37 (50.6%) were answered
Student. the majority of respondent 39 (53.4%) single, 24 (32.9%) were mentioned married and
while 10 (13.7%)Were mentioned Divorced. the majority of the respondent Strongly agree 31
(42.5%) were respondents while the respondent agree 27 (37%) were the respondents Strongly
disagree 11 (15%) and were the respondents disagree 4 (5.5%). the respondents were 20 (27.4%)
14-1 while 13 (17.8%) 10-6 and the majority of the respondents were 40 (54.8%) less than 6.
majority of the respondent 41 (56.2%) were mentioned Yes while of 32 (43.8%) were mentioned
No. the respondent 26 (35.6%) were mentioned Male while majority of 47 (64.4%) were
mentioned Female. indicate majority of the respondent 46 (63%) were mentioned Yes while of 26
(37%) were mentioned No. indicate of the respondent 46 (63%) were mentioned Untreated while
majority of the respondents of 26 (37%) were mentioned treated. indicate of the respondent 46
(34.2%) were mentioned yes while majority of the respondents of 48 (65.8%) were mentioned No.
`the majority respondent 51 (70%) were mentioned Yes while of the respondents of 48 (65.8%)
were mentioned No. the majority respondent 60 (82.2%) were mentioned Yes while of the
respondents of 13 (17.8%) were mentioned No. indicate the majority of the respondent diarrhea
31 (42.5%) were respondents while the respondent Gastrointestinal discomfort 27 (37%) were the
respondents poor appetite and weakness 11 (15%) and were the respondents All Above 4 (5.5%).
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hospital.
the majority respondent 54 (74%) were mentioned Yes while of the respondents of 19 (26%) were
mentioned No. the majority of the respondent Strongly agree 30 (41%) were respondents while
the respondent agree 28 (38.4%) were the respondents Strongly disagree 11 (15%) and were the
respondents disagree 4 (5.6%). the respondent Strongly agree 14 (19.2%) were respondents while
the majority of the respondent agree 41 (56.2%) were the respondents Strongly disagree 10
(13.7%) and were the respondents disagree 5 (6.9%).
5.3 : Conclusion
The study showed that the risk factor and socioeconomic factors that contribute of Hymenolepis
nana infections in children. complex in nature and could be attributed to several factors such as
lack of access to clean water, poor hygienic environment, lack of access to education due to
financial constraints and overcrowded conditions. The observed high prevalence of H.nana could
partly due to poor health education and poor hygiene & sanitation, Also there is no Mass Drug
Administration had been successful approach in the control of Intestinal Parasitic Helminthes
(IPHs). contamination of water and food by infected persons who are carriers of infective cysts
and who do not wash hands after visiting the toilets and before eating food and drinking untreated
water are significantly associated with the acquirement of Hymenolepis nana infection. children
in this study.
5.5: Recommendations
The researchers of this study suggest the following recommendations:
 Integrating methods of controlling Intestinal parasitic infection especially

 H.nana which include health education so as to ensure health practices and to reduce risk
factors for transmission of H.nana
 Wash your hands with soap and warm water after using the toilet, changing diapers, and before
preparing foods.
 It is recommended and requested for the government to educate the people about the source,
transmission and preventive measures of Hymenolepiasis
 Educate the general public in personal hygiene, particularly thorough hand washing with soap
and warm water after using the toilet and before handling food, and Use safe drinking water.
 Avoid eating contamination food and water.
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hospital.
 Avoid contamination elements which use eating and drinking.

 Avoid unwashed hands.
 Wash, peel or cook all fruits and vegetables.

 Wash hands with water and soap after using the toilet and before preparing food or eating.
 Quit the habit of putting fingers in your nose and mouth. The microscopic parasite eggs are
sometimes found under fingernails and can easily be ingested
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hospital.
REFERENCES
Abdiev, T. M. (2007). Situation dueto helmintnicnprotozoa diseases in Uzbekistan.
Andreassen, J. (1998). Intestinal Tapeworms. In Topley and Wilsons:
Microbiology and Microbial Infections. (J. P. F. E. G. Cox, Ed.) London.
Baily, G. C. (1996). Intestinal Cestodes. In Manson's Tropical Diseases. (G. G. Cook, Ed.) London.
Cameron, T. (1956). Parasites and Parsitism. NY.
Castillo R, G. P. (1991). Effect of treatment on serum antibady to Hymenolepis nana detected by

enzyme linked immunosorbent assay.
Chero JC, S. M. (2007.). Hymenolepis nana infection: symptoms and response to nitazoxanide in
field conditions. (R. Soc, Trans.)
D., C. L. (2009). National Collaborating Centre for Aboriginal Health. Health Inequalities and
Social determinants of Aboriginal People's Health. (University of Victoria, ).
Drinov, I. V. (1998). The prevention of mass infection and parasitic diseases of the man by
medical remedies.
Evans AC, S. L. (1995). Not by drugs alone the fight against parasiticn helminthes. World health
forum.
Gerald D. Schmidt, J. J. (2009). Foundations of Parasitology.
Grassi B. (1887). Entwicklungscyclus der Taenia nanna. Heyneman, V. a. (1957).
Houweling TA, K. A. (2003). Measuring health inequality among children in developing countries
Kaethe. (1992).
Khalil HM, e. S. (1991). Recent study of Hymenolepis nana infection in Egyptian children.
Khalil, H. M. (1991). Recent study of Hymenolepis nana infection in Egyptian children. Journal
of the Egyptian Society of parasitology.
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Magalhaes Soares JR, F. C. (2013). Extanding helminths control beyond STH and
schistosomiaisis: The case of Human Hymenolepiasis. Mahmoud MS, A. E. (2011). Advanced
Approach in Differentiation Study in Hymenolepis nana and H. Diminuta by Scanning Electron
Microscopy. . Acta Parasitologica Globalis.
Malheiros AF, M. P. (2014). Prevalence of Hymenolepis nana in indigenous Tapiré Ethnic group
from the Brazilian Amazon.
Mirdha BR, S. J. (2002). Hymenolepis nana: A common cause of paediatric diarrhoea in urban
slum dwellers in India.
Nematian J, N. E. (2004). Prevalence of intestinal parasitic infections and their relation with socio-
economic factors and hygienic habits in Tehran primary school students.
Organization, W. H. ( 2008). Commission on Social Determinants of Health.
Organization., W. H. (2008). Commission on Social Determinants of Health. Closing the Gap in a

Generation- Health equity through action and the social determinants of health. Ortiz JJ, F. L.
(2002). Comparative clinical studies of nitazoxanide, albedazole and praziquantel in the treatment
of ascariasis, trichuriasis and hymenolepiasis in the children from Peru. (R. S. Hyg, Trans.).
Pawlowski, P. W. (1984). Cestodiases: Taeniasis, Diphyllobothriasis, Hymenolepiasis and Others.
In Tropical and Geographical Medicine. (K. S. Mahmoud., Ed.) New york.
Peter R. Mason, B. A. (1994). ―Epidemiology of Hymenolepis nana Infections in Primary School

Children in Urban and Rural Communities in Zimbabwe.‖ (Vol. 80). The Journal of Parasitology.
Poda. (2007). Quihui-Cota L, V. M.-C. (2004). Prevalence and intensity of intestinal
parasitic infections in relation to nutritional status in Mexican school children.

RC., M. A. ( 2000). Hymenolepiasis and Miscellaneous Cyclophyllidiases. (N.
R. Meyers WM, Ed.) Washington DC: Armed Forces Institute of Pathology.
Roberts, L. J. (2000). Foundations of Parasitology. MA: Mcgraw-Hill Higher
Education.
Schantz, P. M. (2006). ―Tapeworms (Cestodiasis).‖ (Vols. Vol.25, iss.3, ).
Gastroenterology Clinics of North America.
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Schantz, P. M. (2006). ―Tapeworms (Cestodiasis).‖ Gastroenterology Clinics

of North America. (Vol. 25). Sharif. (2015).
Sirivichayakul C, R. P.–A. (2000). Hymenolepis nana infection in Thai
children. J Med Asso.
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hospital.
APPENDIX A: QUESTIONNAIRE
I‘m Fardowsa Mohamed Adam student at the University of Somalia (UNISO). I‘m conducting a
research on ‗Study on risk factors associated with hymenoplepsis nana among under fiver year
child in benadir hospital., as part of fulfilment for the Bachelor Degree Programme in Laboratory
at (UNISO Thank you very much for your time and cooperation. We greatly appreciate the help
of your organization and yourself in furthering this research endeavor.
SECTION (A): SOCIO -DEMOGRAPHIC DATA
1) Gender
a) Male
b) Female
2) Age
a. 15-20( )
b. 20-30( )
c. 30-35( )
d. 35-40( )
3. level of Education
a. University( )
b. Secondary school( )
c. Informal( )
4. Occupation
a. Household ( )
b. Employee ( )
c. Student ( )
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hospital.
5. marital status
A. single ( )
B. Married( )
C. Divorced( )
SECTION (B): causes of hymenoplepsi nana among under fiver year child in benadir
hospital.
6. causes of hymenoplepsi nana are parasitic infection
a) Strongly agree
b) Agree
c) Strongly disagree
d) Disagree
7. Hyminolepis nana is transmitted by?
a) fecally contaminated foods
b) Water contaminated with feces
c) Unwashed hands
d) All Above
8. The risk of H.nana infection increase among the age group
a) 14-11
b) 10-6
c) less than 6
9. H. nana infections are generally less severe than by other causes of helminthic or protozoal
infection
a) yes
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hospital.
b) no
10. Which sex group H.nana infection is more prevalent
a) female
b) male
Section C: risk factors hymenoplepsi nana among under fiver year child in benadir
hospital
11. Most people who risks Hymenolepiasis is primary school children;
12. What type of water do you use?
a) Untreated
b) Treated
13. Do you believe that H.nana infection is common disease in Somalia?
a) Yes
b) No
14. Have you ever met someone with suffering Hymenolepiasis?
a) Yes
b) No
15. people living overcrowded area is a one of the risk factors of H.nana
a. Yes
b. No
a) Yes
b) No
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hospital.
Section D: socio-economic factors hymenoplepsi nana among under fiver year child in
benadir hospital.
16. which of the following are the sign and symptoms of H.nana infection?
a) diarrhea
b) Gastrointestinal discomfort
c) poor appetite and weakness
d) All Above
17. Do you believe socioeconomic factors and lack of parent education are strong influences on
the high prevalence rate of H.nana infection
a) Yes
b) No
18. Hymenolepis nana are more prevalent in developing countries with warm
temperature
a) Strongly agree
b) Agree
d) Disagree
19. Hymenolepiasis is widespread in developing countries where human feces
a) Strongly agree
b) Agree
d) Disagree
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hospital.
20. people living river and less socioeconomic condition are lead to occur H.nana
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hospital.
a) Strongly agree
b) Agree
d) Disagree
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hospital.
APPENDIX B: MAP OF SOMALIA
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hospital.
APPENDIX C: MAP OF MOGADISHU
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UNIVERSITY OF

Fardowsa Mohamed Adam

“A RESEARCH THESIS SUBMITTED TO THE FACULTY OF MEDICINE AND SURGERY IN

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Name of the Candidate:

Fardowsa Mohamed Adam

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We certify that this research has been done by Fardowsa Mohamed

Dr. Jamal Hussein Mohamud

Associate Dean of MBBS:

Dr. Mariam Omar Salaad

Dean, faculty of medicine and Health science:

Dr. Yasin Ahmed Nur

Signature: _______ Date: / / _______

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Table 4.1 Respondent by Gender ............................................................................................................ 27

Figure 4.1 Respondent by Gender: ............................................................................................ 27

Figure 4.2 Respondent by age .................................................................................................... 28

Figure 4.3 Level of education. ................................................................................................... 29

Figure 4.4 Respondents Occupation. ......................................................................................... 30

Table 4.5 Respondents by Marital status. .......................................................................... 31

Figure 4.6 causes of hymenoplepsi nana are parasitic infection. ............................................. 32

Figure 4.7 Hyminolepis nana is transmitted by? ...........................................................................33

Figure 4.10 Which sex group H.nana infection is more prevalent…........................................ 36

Figure 4.12 What type of water do you use? ............................................................................... 38

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poor sanitation conditions (WHO 2005)

children‟s intestinal. Because of biological peculiarities of Hymenoliepis nana, Hymenolepiasis

formal-ether concentration techniques. Hymenolepis nana is probably the commonest human

1.2 Statement Problem

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1.3 General Objective

1.4 Specific objectives

1.5 Research Questions

1.6 Significance of the study

1.7 Scope of the study

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The scope provides for the boundary of the research

2. Geographical scope: benadir hospital wadajir district –Mogadishu-Somalia

3. Time scope: April 202 up to July 2020

1.8 Definition of Key Terms

tapeworm found in the intestines of dogs, rats and humans

is a disease that cause Hymenolepis species

Helminthes: commonly known as parasitic worms, are large multi cellular

Arthropod: A large division of Articulate, embracing all those that have

living animal or plant from which a parasite obtains nutrition.

socio-economic factors hymenoplepsi

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Risk factors of infection with H. nana include:

 absence of proper sanitation

2.2 Theoretical over view of Hymenolepis nana

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autoinfection (Olsen, 1974).

(Schantz P. M., 2006).

2.3 causes of hymenoplepsis nana:

prevalence of intestinal parasites, such as Hymenolepiasis, in endemic areas may contribute to a

Signature: _ Date: / / _