EXECUTIVE SUMMARY

Background

Gastrointestinal parasite are a significant concern for individual living with HIV as their compromised immune system make them more susceptible to infection

Objective: The overall aim of this study is to assess the prevalence and risk factors of gastrointestinal parasites among HIV patients attending the Bota District Hospital Limbe in other to reduce infection and mortality rate

Method: The study will be a cross-sectional to determine the prevalence and risk factors of gastrointestinal parasite among HIV patients blood and stool samples will be collected.  A sample of 123 participants  will be selected  with the use of structured, pre-tested questionnaire using a convenient sampling technique. Ethical clearance will be obtain from CHITECHMA, an authorization will be obtain from the Regional Delegation of public health of the South West Region and from the Director of the Bota District Hospital Limbe. The data will be analyze using the statistical package R-programming version 4.2.1.

CHAPTER ONE

INTRODUCTION

1.1 Background

Intestinal parasitic infection is a condition in which parasites infect the gastrointestinal tract of humans (Ayesha, B., et al 2016). The presence of these parasites can damage or sicken the host even though in most cases it is self-limiting except in immunocompromised individuals such as persons with Human immune virus (WHO 2016). Intestinal parasitic infections play an important role in the progression of HIV infection, by further disturbing the immune system while it is already engaged in the fight against HIV (Fontanet.A., et al. 2017). The gastrointestinal pathology associated with HIV infection comprises significant enteropathy with increased levels of inflammation and decreased levels of mucosal repair an regeneration (Douek. D. et al 2018).

HIV infection leads to loss of CD4+T cells, which leaves affected individuals mortally susceptible to opportunistic infections.

Many of the opportunistic infections that ultimately plague such individuals involve infectious agents that are normally checked by the mucosal barriers, which include Cryptosporidium spp, Giardia lamblia, Entamoeba histolytica, Ascaris lumbricoides, hookworm infection, Schistosoma spp, Strongyloides stercoralis and Toxoplasma gondii are important cosmopolitant intestinal. Parasites that are common among children and immunocompromised individual (Gbakima.A. et al 2017).

Pathogenic intestinal parasites such as Cryptosporidium, Cyclospora, histolytica and Giardia, can last for months in patients with HIV, causing malabsorption of nutrients, gradual debilitation through dehydration, and metabolic abnormalities and are responsible for severe diarrheal episodes (Nichols.G. et al 2012) the sources of parasitic infections in humans include contaminated soil, food and water sources with human faeces and poor sewage disposal such as use of night soil as fertilizer (Mustafa.M. et al 2017). Fecal oral route is significant in the transmission of parasitic infections via poor personal hygiene and environmental contamination

Nosocomial outbreaks of cryptosporidiosis have also been described, where an individual is infected in hospital (Nichols.G. et al 2012).

Gastrointestinal parasite infections are mostly due to poverty characterized by poor hygienic habits, absence of portable and clean water, absence of good faecal disposal system and poor nutrition. Pathogens responsible for causing diarrhea differ according to geographical location; therefore, laboratory diagnostic evaluations are required to determine their prevalence in each population to provide guidelines for therapy and necessary data for planning and evaluation of HIV-positive patients care and management.

Furthermore, areas with different agro-ecological zones could favour the development of different intestinal parasites. The study area is divided into three agro-ecological zones; highland, midland and lowland, each with different climatic conditions. Therefore, documentation of distribution of intestinal parasites in these three zones is important because the information generated will be useful for implementation of the control and prevention of intestinal parasitic diseases in the area

1.2 Statement of the Problem

GPI are a major health concern that affect many HIV patients worldwide. They can lead to iron deficiency anemia, causing malabsorption of nutrients, gradual weakness through dehydration, and metabolic abnormalities. They are responsible for severe diarrheal (Alakpa.G.E. et al., 2018) common in HIV patients.

Despite the high prevalence of severe diarrhea in HIV patients with gastrointestinalis, there is also much research being carried out on the risk factors and their impact on clinical outcomes. Therefore, there should be a need to assess the prevalence of gastrointestinal parasites and pre-disposing factors in HIV patient attending the Bota District Hospital Limbe to improve our understanding of the diseases and inform clinical management strategies of the diseases

1.3 Research Questions

1.3.1 Main Research Question

What is the Prevalence of Gastrointestinal parasite and risk factors among HIV patients attending the Bota District Hospital Limbe?

1.3.2 Specific Research Questions

• What is the prevalence of gastrointestinal parasites in HIV patient attending the Bota District Hospital Limbe?
• What is are the risk factors associated to gastrointestinal parasites among HIV patients attending the Bota District Hospital Limbe
• What is the relationship between HIV and GIT parasitic infection

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