On survey methodology
Random sampling method was adopted for the present survey wherein five schools and two localities were selected to find the incidence of intestinal helminths in the population of Jamnagar.
On significant observation
- The age group found maximum in 10 to 20 years: The reason obviously is that the majority portion of survey sample was belonging to high school going age group. A published data also favors above findings that rate of incidence is high in age groups 10 to 20 years, 20 to 30 years and decreases from 31 to 50 years and 51 to 65 years. Also, a study conducted to find incidence of anemia concludes that severe to moderate type of anemia is predominant in adolescent age group, i.e., 10 years and 19 years, wherein the stated cause found was worm infestation.
- Maximum were male in gender and Hindu in religion. The study does not bear relevancy with gender and religion. It denotes the dominancy of population in the area of survey.
- Education in maximum was up to secondary level as the majority of sample was from schools hence the findings. With the secondary level education, subjects at least were aware of measures of personal hygiene but still were not practicing.
- The dominancy of rural habitat with 77.77% reflects improper sanitation, drainage facilities, poor hygiene maintenance, etc., as reasons for infestations.
- Occupation showed majority as students followed by one-third of sample as laborer. The sample size was largely from schools hence the findings. Contact with contaminated soil, waste, etc., is also a major source of infection, hence data in this category was felt necessary to note.
- Socioeconomic status was lower and lower middle in the study. Socioeconomic status mainly determines quality of food and living standards. The data made to arrive on the reason as may be the deficient nutrients in the diet lowered the immune system making the patients susceptible to many infections.
Causative organism in the study found in maximum patients were Ascaris lumbricoides with 71.43%, especially fertilized ova found in 71.11%; followed by infestation of Enterobius vermicularis in 19.05%, while Hymenolepis nana in 6.35%. Patients of Ancylostoma duodenale and Trichuris trichiura were each in 1.59%. This shows the endemic status of A. lumbricoides in the area of survey.
is commonest intestinal nematode of human beings and affects more than one billion people worldwide.[4
] The feces with fertilized ova is the carrier of infection, whereas feces of unfertilized ova is not infectious.[5
Utpadaka Nidana is mainly that which imply the probable source of contamination and suggests maintenance of poor personal hygiene which helps parasites to thrive on host.
Maximum reported feco-oral contamination and nail biting habit was found in 95.24%, followed by irregular bathing habits in 90.45%, no regular brushing habits in 82.54%, habit of consumption of low branded ice candies in 74.60% with maintenance of poor personal hygiene, and in 57.14%, there was history of use of public toilet facilities.
Vyanjaka Nidana here in the context means those which create a favorable environment for parasites to grow.
Data obtained from the study illustrate Pishtanna sevan in 82.54%, habit of eating stale food in 80.95%, liking toward Madhura and Amla Rasa in 79.34%, Guda sevan in excess quantities in 76.19%, not properly cleaned Parnashaka eating habit in 77.77%, habit of eating uncooked or raw grains while cleaning in 69.84%, habit of eating without proper digestion of previously taken meal Adhyashana in 68.25%, habit of eating mud particularly from the banks of lakes and of the roots of lotus plants in 66.66%, and habit of Diwaswaapa in 58.73%.
The potentiating etiological factors are suggestive of the following:
Agni Dushti - Habit of eating stale food in 80.95%, habit of eating uncooked or raw grains while cleaning in 69.84%, habit of eating without proper digestion of previous meal Adhyashana in 68.25%, and habit of eating clay particularly from the banks of lakes and of the roots of lotus plants in 66.66%.
Kapha Prakopa - Pishtanna sevan in 82.54%, Madhura and Amla Rasa in 79.34%, use of Guda in excess quantities was reported in 76.19%, and habit of Diwaswaapa in 58.73%.
Krimi and its signs and symptoms
- Data clearly illustrate that four each symptoms of Shleshmaja and Purishaja were found in percentages above 50%. But the percentages are higher in Purishaja Krimi lakshanas. Thus, A. lumbricoides produces symptoms of both the Krimis, i.e., Shleshmaja and Purishaja. This confirms the hypothesis that the Krimis should be graded as Udara Krimi. Above data are suggestive of Agni Dushti and Aam formation hampering digestion.
- Data also support that A. lumbricoides interferes with proper digestion and absorption of food. This can be said on the basis of visible food particles in stool in maximum patients.
- The data are also suggestive that maximum numbers of patients, i.e., 76.74% are in mild or “grade 1” anemia, while 2.33% signify severe grade of anemia. This implies Ascaris as a potent cause of anemia. The symptoms of Pandu were found clinically in 91.11%, which suggest that these patients are at risk to alter the objective parameter if left untreated and if Nidana Parivarjan is not practiced.
- Data reveal five lakshana of Purishaja variety above 50% and two of Shleshmaja variety thus may be considered as of Purishaja variety.
- Improper consistency of stool is suggestive of hampered digestion and passage of specific worms is the specific diagnostic feature of a particular helminth which is also mentioned in Purishaja Krimi lakshana as Gudat Nishkraman. Sushruta has mentioned a characteristic feature of Purishaja Krimi as those which travel down toward the anus.
- The data suggest values of hemoglobin percentage within normal range and is not suggestive of anemia, which specifies clearly that the patients of E. vermicularis are least causative for the anemia.
- Purishaja Krimi lakshana are found maximum, so may be considered as a variety of Purishaja Krimi.
- Clinical features according to modern parasitology include diarrhea; the study also supports the above as in maximum patients, consistency of stool was drava with increased frequency.
- Normal values of hemoglobin concentration were noted.
Probable Samprapti (pathogenesis)
Fills the channels by material which tissue cannot assimilate causing Bala, Varna, Agni Nasha; hampering nutrition of the host leading to Udara Krimi as etiopathological cause of Pandu .
Probable Samprapti (Pathogenesis)