By Nabila Abu Bakar
‘Who, what, when, and why should one be concerned with taking a deworming tablet?’. This was the quest I took over the last 3 years as I embarked on my PhD research. Although intestinal parasitic infection has been on a decline over 3 decades in the country, infections continue to persist, particularly among vulnerable communities. My quest took me to a community often missed, which was the residents of low-cost public housing in the Klang Valley.
The urban parasite problem
When we talk about urban living, we often envision modern infrastructures and complete amenities within the hustle and bustle of city life. Yet beneath this fancy façade lies an unsettling public health concern: intestinal parasitic infections (IPIs). These infections, often associated with rural and impoverished settings, are still lurking around the urban population, affecting about one in five people.
Despite modern facilities, urban areas are not immune to the factors that facilitate IPIs. Indiscriminate waste management, overcrowding, and poor sanitation practices are rampant in low-cost housing areas like Projek Perumahan Rakyat (PPRs), contributing significantly to the infection statistics. Recent studies showed that the common parasites that infect urban Malaysians are roundworms (Ascaris lumbricoides) and whipworms (Trichuris trichiura).
As it turns out, this infection does not discriminate against any gender, age, or ethnic group. However, children and residents of low-cost housing projects are at a greater risk of infection due to their abject living conditions and lack of civic mind-ness.
Once, during an engagement with residents from one of the PPRs in Klang Valley, and as I made my way back to my car, I was showered under a stream of curry sauce after being carelessly thrown out from one of the flats. Very few people could claim such an experience, I reckon. On another engagement, a bottle of Vitagen dropped on my head. Again, very few people could make such a claim.
Sadly, this is the harsh reality of today’s many PPRs. It is very common to see rubbish and waste littered (and flying) around their vicinity. High-rise dumping, where unwanted furniture and waste are thrown from the upper floors to the ground, is rampant. Such practice creates a very conducive environment for pests like rodents and wild animals to thrive, as well as tragic deaths due to accidents involving discarded heavy furniture.
The waste collection facilities in these PPRs are also in poor condition and cannot accommodate the amount of waste generated by the residents. As a result, the facilities overflow, forcing residents to discard their waste willy-nilly. This scenario fuels the persistence of intestinal parasites in urban settings, compounded by the lack of understanding of the etiology of the infection among urban inhabitants.
Our modern diet of undercooked meat and fish, sushi, raw vegetables, and unwashed fruits also increases the risk of infection, as microscopic parasitic eggs and/or larvae might be present without us realising it.
A push for change
For the last few years, we have been working closely with PPR residents across Klang Valley to better understand why this infection persists despite basic facilities being provided. As a result, we developed a community-based intervention program called “Bersama Mencegah Jangkitan Parasit,” or CEGAH JaP for short, supported by the Fundamental Research Grant Scheme (FRGS/1/2020/SKK0/UM/02/18) under the Malaysian Ministry of Higher Education, and ThinkCity’s Kita-Untuk-Kita (K2K) Community Grant.
This pilot program was introduced to residents from 3 different age cohorts with fun and engaging activities that incorporate basic knowledge about the causes, risk factors, and preventive measures of IPI with commonly played games like Bingo, musical chairs, and charades. Gross specimens of the parasites were also exhibited to help the participants better grasp the gravity of the infection more effectively and how easy it is to avoid infection with better hygiene practices. This creates a more laid-back and casual manner for the participants to learn new knowledge without the pressure of a traditional classroom setting. Results have been surprising, with more than 70% of participants improved their understanding of the subject.
Often, intestinal parasitic infections are asymptomatic and go undetected for years. However, they can cause general fatigue and tiredness, which are frequently overlooked and affect our quality of life.
Us humans, we are a forgetful lot. We forget to make our health a priority until it’s too late. When it comes to intestinal parasitic infections, an annual RM10, 400mg albendazole is sufficient to eliminate any possibility of infection.
Hence, I ask you this: When was the last time you took a deworming tablet?
The author is currently a 4th Year PhD student at Universiti Malaya. Her research centred around neglected tropical diseases, including intestinal parasitic infections amongst residents of PPRs in Klang Valley, Malaysia. She aspires to elucidate more on this infection with other vulnerable communities.