CHAPTER V. DISCUSSION
Data collected from Mareba Health Center shows that among the
children who attend a consultation, most were tested positive, having
gastrointestinal or malaria infection with a prevalent rate of 76%.
This research showed that the most prevalent infectious agent
found were yeasts (30%), followed by malaria at trophozoites stage (16%) and
Trichomonas intestinalis (14%). Bacteria and Entamoeba
histolytica were equally found among 8% of the children and white blood
cells among 6%. The presence of white blood cells in the stool explains the
fact that there are unidentified infectious agents which can cause these cells
to come out in the stools. According to Samie et al., (2006), in invasive
amoebiasis, white blood cells can be present in the stool, and in severe cases,
pus can be visible.
The number of children infected with amoeba was lower than
what found in subtropical and tropical countries where the prevalence may
exceed 50%. In my study the percentage of children positively identified was
higher than what found in rural of Senegal. A study done in Nyamata in 2010
and Cameroun in 2007 have shown the similar percentage of children infected by
Trichomonas intestinalis but for Entamoeba histolytica the
percentage was less in our study.
In our study, there were no intestinal helminthes. This is
different to a survey done in 2008 on 8313 children from 30 districts by TRAC
PLUS on helminthes infections where six species of intestinal helminthes were
identified and lead to malnutrition.
The high prevalence of gastrointestinal infections may be due
to the fact that the large number of interviewed parents (>90%) in the area
of the study don't boil water taken by their children due to the local
activities which do not allow them the time and accessibility to find firewood
every time they need to prepare water to their children. Also,
infective stages of bacteria resist to chlorination and require the proper
refrigeration or adequate cooking (Prescott et al., 2005) which are not easy to
apply due to economic reason.
Our research have shown that the highest infection rate was
found in children from 13 months to 5 years (34%) and increase with age
(16-34%) because children become able to go without their parents in
surrounding area where they become exposed to different infectious agents.
This is similar to the research done by Umutoni, 2010 where
the highest rate was found among children between 4-5 years old.
Our results have shown that the majority of the infected
children were moderately underweight. A positive relationship seems to exist
between Trichomonas intestinalis and underweight, as 100% of the
children infected by Trichomonas intestinalis were moderately
underweight. Also, 66.6% of the children with a double infections (bacteria
and yeasts) were also moderately underweight. This is different from the
results found in Northern Rwanda in 2009, where a relationship was only
established with the double worms' infections ( Kaberuka et al.,2009).
As explained by Ali et al., 2008 protozoa and bacteria produce
diarrhoeal diseases by infecting the small or large intestine, or both and
leading to growth failure and malnutrition which in turn would weaken the
immune system, increasing the risk of infections.
Our study shown that the number of young children eat fruits
is very low, and most do not eat vegetables which are the main source of
Vitamin A. In addition to its role in the prevention and treatment of night
blindness, Vitamin A reduces susceptibility and the severity of infectious
diseases. Consequently, Vitamin A improves child survival. The children who are
under this research might be deficient in Vitamin A and are at risk to these
diseases. This is similar to the study done by RIDHS in 2007/2008 which showed
that Rwandese children would suffer from Vitamin A deficiency (RIDHS,
2007/2008).
Consequently children are exposed to many infections due to
the lack of high amount of vitamins found in fruits and might have been exposed
to vitamin A carency. The very low consummation of meat leads to presume that a
high percentage of these children might be anemic, by lack of iron. The results
would then be similar to the results of the study done by Rwanda Interim
Demographic and Health Survey (RIDHS) of 2007/2008 showing that anaemia is a
common manifestation of iron deficiency, which affects 47.5% in children under
five years in Rwanda and is most pronounced (65.5%) in children from six to 23
months of age. This situation can partly be explained by the consumption of a
diet based mainly on cereals and tubers that is a poor source of iron or only
includes iron with low bioavailability.
Also the number of children taking milk and eggs are low which
is in agreement with the finding with the high degree of malnutrition found in
these results and the Rwandese survey. Also, the majority was eating less than
2 times a day.
These lead to the loss of weight, decreasing of immune system,
gastrointestinal infections and malnutrition. Indeed, 8% were wasted and 44%
were underweight. These results show higher percentage of malnutrition among
the children under study higher than the results from RDHS (2005). This
constatation even reinforce the idea that there is a relationship between
malnutrition and gastrointestinal infections.
According to interviewed parents, the nutrition of their
children is not sufficient so they cannot get a balanced diet to their children
for economic reason.
The high prevalence of children with yeast is more than
expected and might be Human Imuno-deficiency Virus positive (HIV+) due to the
loss of body capacity to fight against diseases.
During this research, it has been shown that there are
children suffer from malaria (16%), and the cause is that children are bitten
by mosquito because they do not sleep under mosquito net.
It has been shown that prevalence of malaria infections was
high (16%) because children do not sleep under mosquito net and environment
they live is favorable for Plasmodium malaria reproduction.
Fortunately, most of parents breast their children without giving
anything until 6 months. They breast their children more than five times per
day but the times of breastfeeding decrease when children grow up while the WHO
recommend breastfeeding up to two years.
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