title: A tale of two communities: intestinal polyparasitism among Orang Asli and Malay communities in rural Terengganu, Malaysia.
abstract: Intestinal parasitic infections (IPIs) are still major health problems in many developing countries including Malaysia, particularly in the poor and socioeconomically deprived rural and remote communities in Peninsular Malaysia. This study was conducted to determine the prevalence of IPIs and to identify the key factors associated with intestinal polyparasitism as well as to evaluate the knowledge, attitude and practices (KAP) on IPIs among rural Orang Asli and Malay communities in Terengganu, Malaysia.
  
  
  
  A cross-sectional study was conducted among 340 participants (165 Orang Asli and 175 Malay) aged ≤ 15 years from the Hulu Terengganu and Kemaman districts of Terengganu. Faecal samples were examined for the presence of intestinal parasites by using direct smear, formalin-ether sedimentation, trichrome stain, modified Ziehl Neelsen stain, in vitro cultivation in Jones' medium, Kato Katz and Harada Mori techniques. Demographic, socioeconomic, environmental and behavioural information of the participants and their KAP for IPIs were collected by using a pre-tested questionnaire.
  
  
  
  Overall, 149 (90.3 %) Orang Asli and 43 (24.6 %) Malay children were infected by at least one parasite species. The overall prevalences of intestinal polyparasitism among the Orang Asli and Malay were 68.5 % (113/165) and 14.3 % (25/175), respectively. Multiple logistic regression analysis showed that using unsafe water supply as a source for drinking water, the presence of domestic animals, not wearing shoes when outside, not washing vegetables before consumption, not washing hands after playing with soil, indiscriminate defecation and the low level of mother's education were the key risk factors for intestinal polyparasitism among the Orang Asli, while working mothers and the presence of domestic animals were the risk factors among the Malay children. Almost all the Malays were well aware about the IPIs while Orang Asli respondents had a poor level of related awareness.
  
  
  
  This study demonstrates that IPIs are highly prevalent in rural Terengganu, Malaysia. Community awareness about IPIs was found to be imperative in protecting Malay children from these infections. An integrated control programme for the prevention and control of IPIs is highly recommended for these communities, with a special emphasis on the Orang Asli population.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Fatin Nur
authors.initials: FN
authors.lastname: Elyana
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. halmekhlafi@yahoo.com.|Endemic and Tropical Diseases Unit, Medical Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia. halmekhlafi@yahoo.com.|Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. halmekhlafi@yahoo.com.
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Al-Mekhlafi
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. init@um.edu.my.
authors.forename: Init
authors.initials: I
authors.lastname: Ithoi
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Awatif M
authors.initials: AM
authors.lastname: Abdulsalam
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Salwa
authors.initials: S
authors.lastname: Dawaki
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Nabil A
authors.initials: NA
authors.lastname: Nasr
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Wahib M
authors.initials: WM
authors.lastname: Atroosh
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Mohamad Hafiz
authors.initials: MH
authors.lastname: Abd-Basher
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Mona A
authors.initials: MA
authors.lastname: Al-Areeqi
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Hany
authors.initials: H
authors.lastname: Sady
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Lahvanya R
authors.initials: LR
authors.lastname: Subramaniam
authors.affiliation: Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, 42300, Selangor, Malaysia.|Department of Medical Laboratory Technology, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, 42300, Selangor, Malaysia.
authors.forename: Tengku Shahrul
authors.initials: TS
authors.lastname: Anuar
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Yee Ling
authors.initials: YL
authors.lastname: Lau
authors.affiliation: Department of Parasitology and Medical Entomology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia.
authors.forename: Norhayati
authors.initials: N
authors.lastname: Moktar
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.|Centre for Research and Innovation, Taylor's University, Subang Jaya, 47500, Selangor, Malaysia.
authors.forename: Johari
authors.initials: J
authors.lastname: Surin
mesh_terms: D000818:Animals; D060085:Coinfection / Q000453:epidemiology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology* / Q000517:prevention & control; D008296:Malaysia / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population
keywords: Intestinal parasitic infections; KAP; Malay; Malaysia; Neglected tropical diseases; Orang Asli; Polyparasitism; Soil-transmitted helminths