BRIEF REPORTS PARASITIC INFECTIONS IN FINGER-SUCKING SCHOOL AGE CHILDREN Olufunmilayo Ajoke Idowu, PhD,* Omolayo Babatunde, BSc,* Temidayo Soniran, MSc,* and Adekunle Adediran, MB BS† Abstract: Prevalence of parasites, acquired by the fecal-oral route, was recorded in 80% of primary school children with a finger-sucking habit, which was higher than that in nonfinger-sucking children. About 85% of the children did not wash their hands after defecation. The toilet facility available to the children also affected the infection pattern in finger- sucking children who used pit latrines recording higher prevalence of parasites. Key Words: parasites, infections, finger-sucking, children Accepted for publication February 15, 2011. From the *Department of Biological Sciences, University of Agriculture, Abeokuta, Nigeria; and †Department of Pediatrics Federal Medical centre, Abeokuta, Nigeria. The authors have no funding or conflicts of interest to disclose. Address for correspondence: Olufunmilayo Ajoke Idowu, PhD, Alabata road, PMB 2240, Abeokuta, Ogun 110001 Nigeria. E-mail: tomiwo2@gmail.com. Copyright © 2011 by Lippincott Williams & Wilkins DOI: 10.1097/INF.0b013e31821e8449 F inger sucking (FS) is a common habit among many children. It is common with children 2 years of age and may signal hunger, fatigue, sleep, teething, and shyness. 1 School age children are often the group that has the highest parasitic infection rate as well as the highest worm burden, which contribute greatly to the contamination of the environment. 2 The sucking habit of children may be one of the key means of completing the fecal-oral life cycle of some intestinal parasites. Availability of safe water for drinking and washing hand is important for promoting health in schools. 2 Effective hand washing includes the use of warm water, soap, and a clean dry towel. Ukoli 3 reported that the use of drugs for the treatment of fecal-orally transmitted parasites is limited if the conditions promoting transmission are not removed. Parasitic infections in children can promote malnutrition and retard the growth of the children. It can affect the weight and height of these children through impaired digestion, malabsorption, and poor growth rate. 4,5 The effect of parasitic infection on cognitive func- tion in children has been reported. 6 This study investigates whether FS is a risk factor for parasitic infection among school children. MATERIALS AND METHODS Study Area. The study was conducted in 6 randomly selected primary schools in Abeokuta, Ogun State Capital in the southwest of Nigeria. Abeokuta is an urban settlement that is densely popu- lated consisting of civil servants and traders. The town has social amenities such as electricity and pipe-borne water. The majority of residents belong to the Yoruba ethnic group. Ethical Clearance and Informed Consent. The written approval was obtained from the ethical committee of the Local Government Area, whereas the school authorities, parents, and pupils gave verbal and written informed consent to participate. Sampling Method. Semi-structured questionnaires were given to selected pupils from randomly selected schools (using a balloting method). All FS pupils from each school were enrolled and, for each FS child enrolled in the study, a nonfinger-sucking (NFS) child living under similar conditions was also enrolled. Informa- tion was also obtained from parents and teachers on the age and FS habit of pupils, toilet facilities at home and school, academic performance of pupils, previous treatment for fecal-oral parasitic infections, access to good water, and eating habits of the pupils. Height and weight of each pupil were obtained using meter rule and weighing scale, respectively. Specimen Collection. Enrolled pupils were directed to defecate into the clean papers, and small portions of the fresh stool samples were collected in well labeled universal tubes in paper bags and taken to the laboratory for investigation. Examination of Stool Samples. Physical observation of stool sam- ples was carried out immediately after receipt in the laboratory. Presence of blood stains, mucus, and stool consistency were observed. Direct wet examination of stool sample in saline solution was done using a compound microscope to observe the mobility of the parasites. Formal ether concentration technique was also used for the concentration of the parasites in each stool sample. Data Analysis. Data obtained were analyzed using Epi6-info ver- sion 6.04 7 (CDC, Atlanta GA). RESULTS We enrolled 100 randomly selected pupils, including 50 FS pupils and 50 NFS pupils. Five different fecal-orally transmitted parasites were observed in the study of which Entamoeba histo- lytica (33%) was the most prevalent parasite; others were Ascaris lumbricoides (23%), Enterobius vermicularis (17%), Trichuris trichiura (14%), and Giardia duodenalis (12.8%) (Table 1). The frequency of fecal-orally transmissible infection among FS pupils was 94% (47 pupils) as compared with 66% (33 pupils) of NFS pupils (P  0.05). Infection was significantly higher among female (82%) than male (46%) pupils in the NFS group; however, there was no significant difference between sex and infection among children who sucked their fingers. Treatment of infection as a measure of controlling fecal- orally transmitted parasites had no beneficial effect on finger suckers. The prevalence of infection among finger suckers who had previously treated for helminth infection and pupils who had not been treated for helminth infection was similar. The NFS group exhibited some level of reduced prevalence among previously treated pupils as compared with the untreated pupils. The type of toilet facilities was also observed to influence distribution of infections. FS significantly increased the frequency of infection among those using a pit latrine (97%) as compared with NFS children using a pit latrine (70%) (P = 0.019); however, there was no significant difference between FS (90%) and NFS (59%) children using the water closet (P = 0.22). DISCUSSION In this study on the risk factors associated with FS in the transmission of intestinal parasites, the highest prevalence of infection was found for Entamoeba histolytica (33%), whereas G. duodenalis (13%) had the lowest prevalence. A similar study among school children in the eastern part of Nigeria reported 4.9% prevalence of infection with A. lumbricoides, 2.5% with hookworm, and 0.7% with T. trichiura. 8 Although G. duodenalis is prevalent in children, the present study is also in agreement with that of Houmsou et al 9 who reported the lowest prevalence of infection with G. duodenalis in the middle belt region of Nigeria. In various previous studies carried out in Abeokuta, a high prevalence of intestinal helminths, especially A. lumbricoides was reported among school children. 10,11 T. trichiura infections is known to have similar conditions influencing its ende- micity and that of A. lumbricoides. 12 A higher frequency of infection was observed among FS pupils (94%) than NFS pupils (66%). FS creates a route of transmission for these parasites and has contributed to the ob- served high prevalence of infection. There have been reported cases of indiscriminate defecation leading to fecal contamination The Pediatric Infectious Disease Journal • Volume 30, Number 9, September 2011 www.pidj.com | 791