EPA-600/1-80-024
July 1980
HUMAN INTESTINAL PARASITIC INFECTIONS
AND ENVIRONMENTAL HEALTH FACTORS
IN RURAL EGYPTIAN COMMUNITIES
A Report of the U.S.-Egyptian River Nile
and Lake Nasser Research Project
by
F. DeWolfe Miller
Mohamad Hussein
Khalil H. Mancy
Morton S. Hilbert
The University of Michigan
School of Public Health
Ann Arbor, Michigan, U.S.A. U8109
and
The University of Alexandria
High Institute of Public Health
Alexandria, A.R. Egypt
Special Foreign Currency Project No. 03-5^2-1
Project Officer
Walter M. Sanders, III
Environmental Research Laboratory
Athens, Georgia, U.S.A. 30605
ENVIRONMENTAL RESEARCH LABORATORY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
ATHENS, GEORGIA 30605
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DISCLAIMER
This report has "been reviewed by the Environmental Research Laboratory,
U.S. Environmental Protection Agency, Athens, Georgia, and approved for publi-
cation. Approval does not signify that the contents necessarily reflect the
views and policies of the U.S. Environmental Protection Agency, nor does men-
tion of trade names or commercial products constitute endorsement or recomen-
dation for use.
11
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FOREWORD
After centuries of annual flooding and drought, the construction of the
Aswan High Dam has provided effective flow control to the River Nile as it
enters the fertile Egyptian Wile Valley. The dam has resulted in the pro-
duction of hydroelectric power for municipal, agricultural, and industrial
use, and the continuous availability of water has increased agricultural
productivity. Optimum benefits from a project of this magnitude cannot be
fully realized, however, until the major environmental, agricultural, social,
economic, and public health impacts have been incorporated into strategies
for managing the water resources within the basin. In 19755 the U.S. Envi-
ronmental Protection Agency and the Ford Foundation began support of a 5-year,
multifaceted research program conducted by the Egyptian Academy of Scientific
Research and Technology and related institutions and the University of Michi-
gan to provide the information needed for comprehensive water quality manage-
ment in the Nile Valley.
Although the project addresses issues of vital importance to Egypt, the
knowledge gained "also will be of significant benefit to the general scientific
community. For example, water resources management models developed for the
Nile Basin can be applied to some river basins in the United States.
This report, a companion document to Schistosomiasis in Rural Egypt
(EPA-600/1-78-070), describes a survey of common intestinal parasites in the
Nile Delta, Upper Middle Egypt, and Upper Egypt that was part of the public
health portion of the U.S.-Egyptian project.
David W. Duttweiler
Director
Environmental Research Laboratory
Athens, Georgia
111
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PREFACE
The Aswan High Dam was built for the purpose of water storage, river flow
control and hydroelectric power production. The fulfillment of these goals is
of vital importance to Egypt's agricultural and industrial development programs.
This can "be easily realized since the River Nile constitutes 90% of Egypt's
fresh water resources and the present population of 38 million people inhabits
approximately h% of the land with the rest barren desert. Nevertheless, since
its inception, the Aswan High Dam has been under unprecedented attacks in the
news media and scientific literature. It has been blamed for causing serious
ecological perturbation that resulted in reducing the fish population in the
Mediterrean Sea, lowering the fertility of the Nile Valley, and markedly in-
creasing schistosomiasis in Egypt. Our study, Schistosomiasis in Rural Egypt,
however,indicated a marked decline in the disease prevalence over the past HO
years.
These research findings are the outcome of a comprehensive ongoing pro-
ject dedicated to the study of the River Nile and the impacts of the Aswan
High Dam on multipurpose river uses. This includes irrigation, community
water supply, fishing, recreation, transportation, etc. The aim of this pro-
ject is to provide the decision makers in Egypt with river management alterna-
tives compatible with government goals for economic development. This includes
the assessment of trade-offs and predictions of the outcome of each river
resource management alternative. This is a joint project between the Egyptian
Academy of Scientific Research and Technology and the University of Michigan.
The technical and financial support of the U.S. Environmental Protection
Agency, the Ford Foundation, and the World Bank is highly appreciated.
Khalil H. Mancy
Principal Investigator
School of Public Health
University of Michigan
IV
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ABSTRACT
A survey of common intestinal parasites was completed in three areas of
the Egyptian Nile Valley: The Nile Delta, Upper Middle Egypt and Upper Egypt.
The relocated Nubian population was also included. The total sampling includ-
ed 15,66^ persons in ^1 villages. More than 95% attended and approximately
90% provided a stool specimen. Environmental health observations and measures
were made in each of the households from which a family was selected and in
the village environs. Sampling within a study site (which included one or
more villages) was designed in a fashion to provide a probability of selection.
Stool specimens were preserved and examined for parasites and ova at a central
laboratory using the MIFC technique.
The findings indicated a very low prevalence for all helminthic infec-
tions. A low prevalence of Ancylostoma and the Ascaris infections was found.
Important features such as the household stable, the zir (a water
storage container), and cooking fuel were evaluated. Considerable information
on water and wastewater use was developed. Also, a review of the available
information on the parasitic infections of interest and environmental health
conditions for rural Egypt was compiled for the first time. This information
is necessary for the design of accurate parasitic surveillance programs.
This study is the result of a joint effort by the University of Michigan
and the Egyptian Academy of Scientific Research and Technology that was funded
by the U.S. Environmental Protection Agency, The Ford Foundation, and the
World Bank.
v
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CONTENTS
FOREWORD ............................... ill
PREFACE ............................... iv
TABLES ................................ viii
ACKNOWLEDGMENTS ........................... x
CHAPTER
I. INTRODUCTION ........................ 1
Background ........................ 1
The Setting: Egypt .................... 3
II. CONCLUSIONS AND RECOMMENDATIONS ............... 5
III. REVIEW OF LITERATURE .................... 7
Parasites Studied .................... 7
Environmnetal Health Conditions in Rural Egypt ...... 9
IV. MATERIALS AND METHODS .................... l6
Description of the "Downstream" Study ........... l6
Description of the "Nubian" Study ............. 17
Data Acquisition ..................... 18
Specific Data Collected .................. 18
Selection of the Field Survey Sites ............ 19
Data Collection Teams .................. 21
Review of the Facilities and Preparation of Material .... 22
Preservation of Stool and Urine Specimens ......... 2k
Examination of Stool and Urine Specimens ......... 25
Selection of the Sample Population ............ 27
Examination of the Environment and the Population ..... 28
Data Management and Analysis ............... 31
V. RESULTS AND DISCUSSION ................... 33
Parasitic Infections ................... 33
Environmental Factors ................... Ul
The Nubians ........................ U2
The Downstream Study Sites ................ U2
REFERENCES
APPENDIX I. COMPOSITE TABLES SHOWING AN OVERVIEW OF MAJOR SECTORS
OF EGYPT
vx i
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APPENDIX II. HOUSING, WATER SUPPLY, AM) OTHER ENVIRONMENTAL FACTORS . . %
APPENDIX III. ANALYSIS OF ASSOCIATION BETWEEN PERCENT PREVALENCE
OF SELECTED PARASITES AND ENVIRONMENTAL VARIABLES,
AGE, SEX, AND STUDY SITES 82
APPENDIX IV. RAW COUNT DATA FOR HOUSING AND OTHER ENVIRONMENTAL
VARIABLES 12U
TABLES
Number Page
1 Helminthic and Protozoan Parasites Screened for in the Selected
Rural Egyptian Population .................. 2
2 Summary of Prevalence Surveys for Selected Parasites in Egypt . 8
3 Distribution of Examined Population by Source of Water Supply 11
k Distribution of Examined Population, by Type of Housing ..... 12
5 Water and Wastewater Facilities in Upper-Middle Egypt ..... 13
6 Tribe, Location, Village, and Number of Families Selected in
Nubia, I960 ........................ Ik
1 Housing Characteristics, Old Nubia, I960 ........... 15
8 Water Supply and Lighting in Old Nubia, I960 ......... 15
9 Water Supply, Sanitation, and Prevalence of Parasitism in
Rural Egypt ........................ 3^
10 Water Supply by Use and Study Area .............. 36
11 Relation of Water Supply to Parasites in the Nile Delta
(Kafr El Sheikh), 191 6 .................... 37
12 Relationship between Latrine and Infection with Selected
Parasites in the Three "Downstream" Study Areas ....... 39
13 Multiparasitic Infections in the Study Areas .......... kO
Ik Percent Positive of Selected Parasites by Study Area ..... kQ
15 A Comparison of Parasite Prevalence (%) Before and After
Resettlement in Nubia .................... ^1
I.I Environmental Factors
Vlll
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TABLES, CONTINUED
Number Page
1.2 Irrigation and Population ................ 55
II. 1 Housing Variables by Study Sites, Percent of Houses with
Attributes (not including the Nubian study sites) ... 56
II. 2 Distribution of Environmental and Housing Factors in
Egyptian New Nubia, 1977 5 Percent of Houses with
Attributes ...................... 7^
II.3.I Prevalence of Parasitosis in Egyptian Nubia, 1977 .... 78
II. 3. II Age Distribution of Important Parasitic Infections
in Egyptian Nubia, 1977 ................ 79
II. 3. Ill Sex Distribution of Important Parasitic Infections
in Egyptian Nubia, 1977 ................ 80
II.3-IV A Comparison of the Prevalence of Intestinal Helminthic
and Protozoal Infestations (per 100 persons) by Age
and Sex; Nubia, Egypt; 1963 and 1977 8l
III.l Analysis of Association, Kafr El Sheikh (Nile Delta) ... 82
III.2 Analysis of Association, Beni Suef (Upper Middle Egypt) . 98
III.3 Analysis of Association, Aswan (Upper Egypt) llU
IV. 1 Raw Count Data, Beni Suef and Kafr El Sheikh 12h
IV.2 Raw Count Data, Aswan and New Nubia 138
IX
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ACKNOWLEDGMENTS
This work required the examination of almost 15,500 stool specimens
which had been preserved in small 10 cc plastic bottles and shipped to the
parasitology laboratory at the High Institute of Public Health from the
various study sites. The laboratory was directed by Associate Professor
Rashida Barakat, M.D. and supervised by Lecturer Ebtesam Omar, M.D. In
addition, there were seven employees, all doctors of medicine who, as an
extension of their training in parasitology, helped in the examination of
these specimens. To them we are deeply indebted.
x
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CHAPTER I
INTRODUCTION
BACKGROUND
This report is the second and final part of an analysis of data collect-
ed in rural Egypt on parasitic infections and key environmental variables.
The study objectives, study design and methodology have been described in
detail in the first part entitled Schistosomiasis in Rural Egypt: A Report of
U.S.-Egyptian River Nile and Lake Nasser Research Project (Miller et al.,
1978). Salient features of the study design and methodology are included in
this report for purposes of clarity.
The objectives of this study were to obtain information on the prevalence
of helminth and protozoan infections in selected rural Egyptian communities
in collaboration with the River Nile-Lake Nasser Study, a joint University of
Michigan-Egyptian Academy of Scientific Research and Technology project. The
River Nile-Lake Nasser Project's prime objectives have been to evaluate the
overall environmental impact of the Aswan High Dam (AHD).
Diverse disciplines have been incorporated into this project in an
attempt tc obtain an integrated picture of changes occuring in the Egyptian
Nile basin, following the formation of the large man-made lake, Lake Nasser.
It was in this vein that the design of the study reported here was formulated.
The parasites screened for are typical helminth and protozoan infections
of the intestinal tract, common to tropical and semi-tropical areas of the
world and detected by the identification of the characteristic ova, cysts or
tropozoites in stool specimens. Frequently these infections are associated
with water supply and use, as well as waste water disposal practices. It
was felt that basic fundamental knowledge of the current prevalence, distribu-
tion and secular trends were important to determine the magnitude of the water
management schemes now under development as a result of the formation of Lake
Nasser. Furthermore, the implication of changes in prevalence or transmission
of these parasites, directly or indirectly, as a related function of the lake
formation was explored in an attempt to more completely follow the impact of
the High Dam construction in the health of the rural Egyptian population.
Table 1 is a list of these parasites and a brief description of their
principal mode of transmission. Some of these parasites have no direct
relation with water supply, but were included as the methods of examination
used to reveal these infections.
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TABLE 1
HELMINTHIC AND PROTOZOAN PARASITES SCREENED FOR
IN THE SELECTED RURAL EGYPTIAN POPULATION
Pathogen
Helminth
Ascaris lumbricoides
Trichuris trichuris
Enterobius vermicularis
Ancylostoma duodenale
Strongyloides stercoralis
Taenia spp*
Trichostrongylus spp
Hymenolepis _nana
Heterophyes heterophyes
Fasciola hepatica
Fasciola gigantica
roundworm
whipworm
pinworm
hookworm
threadworm
tapeworms
dwarf tapeworm
liver fluke
liver fluke
man/pig-soil-man
man-soil-man
man-man
man-soil-man
man-soil-man
man-cattle/pig-man
man-soil-man
man/rodent-man
man-snail-fish-man
man/sheep-snail-man
man/sheep-snail-man
Protozoans
Giardia lamblia
Entamoeba histolylica
Entamoeba coli
Entamoeba hartmanni
Iodamoeba_ butschlii
Chilomastix mesnili
Trichomonas hominis
Dientamoeba fragilis
Endolimax nana
intestinal flagellate man-man
intestinal amoeba man-man
intestinal amoeba man-nan
intestinal amoeba man-man
intestinal amoeba man-man
intestinal flagellate man-man
genital flagellate man-man
intestinal amoeba man-man
intestinal amoeba man-man
* The ova of this genus are not morphologically differentiable.
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Specifically, the objectives of this study were to:
1. Obtain and critically review all available past information
of the prevalence, distribution, incidence and transmission
of the selected parasites in an effort to establish baseline
and trend data for the rural Egyptian population.
2. Obtain measures and estimates of the point prevalence of the
selected parasites in rural Egyptian communities.
3. Show the changes in the epidemiology of the selected parasites
through comparisons with assessed historical data.
4. In general, collect, assess and analyze environmental health
data in parallel with the parasite surveys in the rural study
sites.
5. Illustrate any village environmental effects on the transmission
of the selected parasites studied.
6. Suggest appropriate needs in light of the findings.
THE SETTING: EGYPT
This study included 41 rural villages in 4 major and separate study areas
in rural Egypt. In order that the reader have a clear picture of the study
areas, and an understanding of the rationale in selecting these sites, the
following notes have been prepared.
Egypt is made up of several distinct sectors. The largest sector is
made up of the eastern and western deserts which account for over 90% of the
land mass. The area is populated rather sparsely by nomads, with few small
settlements. Located in the western desert are several more populated oases.
El Kharga and El Dakhla oases, in what is referred to as the new valley, are
sites of recent agricultural development and currently have a combined popula-
tion of about 76,000 persons. There are also populated settlements along the
western Mediterranean shoreline and along the Suez Canal. The remaining 99%
of the Egyptian population is compressed in the Nile Valley and in the Nile
Delta, 3.5% of the country's land mass. The population density in these
areas has been estimated at 2,400 persons per square mile (Waterbury, 1971).
For the purposes of this study, the Nile Valley has been divided into:
(a) the delta or lower Egypt,
(b) Upper-Middle Egypt, between the delta and Assyut, and
(c) southern or Upper Egypt located between Assyut and the Aswan
High Dam (AHD). Before the AHD was constructed, there existed
a people called Nubians located between Aswan and the Sudanese
border. When the new lake inundated this area, the Nubians were
resettled, en masse, in Kom Ombo, an agricultural plain about
75 km north of Aswan, and in Kheshm El Girba, in the Sudan.
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The population of Egypt has always been predorainatly "rural;" described
by Scott (1937) as persons "whose habits of life bring them into contact with
fields and canals where infestations with parasites may be acquired." In
1937, 11.49 million persons were living in a rural setting; 72% of the total
population of 15.92 million. By 1960, 62% were rural. The rural population
has further declined to 56.1%, according to the last census survey conducted
in 1976 (Capmas, 1976).
The distribution of the Egyptian population is as follows: 60% of the
population resides in Cairo or north of Cairo in the Nile Delta or Lower
Egypt, 23% live in Upper-Middle Egypt, and 12% live in Upper Egypt (Omran,
1973). Males compromise 53% of the total population (Capmas, 1976).
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CHAPTER II
CONCLUSIONS AND RECOMMENDATIONS
The key results of this investigation were; 1) that the parasite infect-
ions Ascaris and Ancylostoma are not elevated to high levels of prevalence
at any of the village studies sites, 2) the high prevalence of Entameoba
infections were present at all study sites, 3) the Nubians have not been
adversely affected by their relocation in respect to the parasites studied
or environmental health conditions which were greatly improved and 4) the
most extensive descriptive data on environmental health conditions for rural
Egyptian villages has been collected and assessed.
Conversations with officials from the Ministry of Health (the Secretary
General of parasitic diseases) in 1975 before the field activities indicated
that hookworm infections were low throughout Egypt, but that Ascaris was quite
common in both the urban and rural sectors. The surprising findings of very
low number of persons infected with Ascaris in the sample remains, in part,
unresolved.
It had been indicated that piperazine had been widely distributed by
the rural health units and centers in the period just previous to the field
collection of specimens. This, in part, may have caused a sharp reduction
in prevalence. Also, in Upper Egypt and in Nubia the prevaling opinion of
the local practitioner was that both Ascaris and Ancylostoma were infrequent
infections. Zawahry's findings in 1964 in Old Nubia are in agreement with
these attitudes, and the results from New Nubia and Aswan are also consistent.
It is with considerable reserve, however, that a figure of 8.4% is presented
as a reasonable estimate of Ascaris infection in the Nile Delta. A more
specialized small scale study aimed at establishing current rural health
programs in the control of Ascaris transmission and concurrent prevalence
surveillance is recommended. The primary design of such a study should be
directed at obtaining the minimum amount of evidence necessary to determine
the order of magnitude of Ascaris infestation in the population.
Based on the assumption that intestinal protozoan infections which have
a fecal-oral route are an indicator of hygienic conditions, the high preval-
ence of the Entameoba infections indicates a strong need in this area. It is
encouraging that E_. histolytic was not found as frequently as did Weir et. al.
(1952). Rather, E_. coli infections were the most frequently identified
Entameoba, at about 10 to 1 ratio. E_. coli is not considered a pathogen and
specific measures for control are not recommended. It is expected that an
increase in water availability and water use would improve the hygienic con-
ditions of the rural Egyptian villager and would result in an improvement
in his/her well being. Indeed, it is water, specifically the supply of clean,
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cheap, ready available water that is wholeheartily recommended. Furthermore,
any system that would increase the quantity, quality and use of water by the
villagers should be considered. Appropriate technology rather than imported
technology should be stimulated to meet these needs. In respect to water use
and appropriate technological developments the household water container, the
zir, must be taken into consideration. As revealed in the descriptive
environmental health data, the zir, the stable and the fuel materials used for
cooking are high priorities for improvement of the immediate environment of
the Egyptian villager. Historical information indicated that the progress
for installing latrines have been fairly well accepted and that standpipes or
latrines are not a novelty in rural Egypt. This is encouraging, although
there still remains a strong need for waste disposal in the sample from Upper-
Middle Egypt.
The Nubians, in terms of parasitosis, were not found to vary greatly from
their fellow Saidis (Upper Egyptians). This is a positive finding in that
following the relocation of the Nubian tribes, it was expected that there would
be a fall in their health status as measured by these studies. The same
recommendations applied, therefore, to the Nubians in that improved water and
hygiene measures are needed.
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CHAPTER III
REVIEW OF LITERATURE
PARASITES STUDIED
There is no previous review of surveys available on the prevalence,
distribution and transmission of these parasites in the Egyptian population.
It is understandable that if historical information can be found, it must be
assessed before a parasitic survey can be planned effectively. The search
for historical data paralleled the assessment of the literature for schisto-
somiasis that has been published in the first part (Miller, et al., 1978).
Like the information found for schistosomiasis, more historical data was
uncovered than had been expected, although there are obvious restrictions on
the interpretation of this past data. Important and fundamental aspects of
the prevalence and distribution of these parasites were locatable. The
principle reasons for restricting the direct comparison of these different
studies are: the differences used in detecting the various parasitic infect-
ions in the excreta, and in the methods used to sample the human population
from which specimens were obtained. Standardization in detection of parasites
and ova in the stool remains to be established and is a recurrent source of
ciiticism. However, sampling methodologies have clearly established that
sample selection, based on probability is necessary before statistical meas-
ures, whether descriptive or analytical, can be applied. The latter aspect
was frequently ignored altogether, where as detection methods were invariably
elaborated on. In Table 2, a summary of the studies, found in the search for
historical data, is given by area, date, author and parasite. Filariasis and
leishmaniasis were not screened for in this project, but were included in
Table 2, not only for completeness but also because of their potential severe
impact on the health status of rural populations in less developed areas.
Both studies by Shawarby, et al. (1965) and Cahill, et al. (1966) had wide
coverage and impressive sample sizes. The reader is referred to these studies
and the others cited in Table 2 for details on prevalence and distribution
that are not shown in the table.
In parallel with the historical findings on human schistosome data, more
surveys were completed in the Nile Delta than in the other sectors of the
country. Also, the Nile Delta had consistently higher prevalences, regardless
of the parasite or year, when compared to any other area of the country. This
was also true for the schistosomes. It is unfortunate that the greater propor-
tion of the rural Egyptian population (59.1%) is located in this same area.
Filariasis and leishmaniasis show very distinctive focal distributions
in the Nile Delta. Both studies are now over a decade old, having been
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completed in the 1960's. Hopefully, surveillance will be continued on these
two important parasitic infections in order to determine if there have been
more recent changes in prevalence or distribution.
Overall, it would appear that hookworm (Ancylostoma) infections are
not as prevalent as the roundworm (Ascaris) infections. Chandler's studies
on hookworm in 195U found considerable variation (8.3% and 36.0%) in different
village sites in the governorate of Qalyubya. This variation was determined
by a single investigator and his respective research team, thus variation due
to methodological differences were most likely minimal, thus indicating a
strong focal distribution for hookworm infections. The differences in
prevalence found between the other investigations support this hypothesis.
However, the only historical data on a country-wide basis for hookworm and
roundworm were made by Scott in the 1930's (Scott, 1937a and Scott 1937b).
The expectation has, and still is, that hookworm would be consistently high,
90% to 100%, in the rural population of Egypt, and Scott (1937c) attempted
to explain why it was not. It is interesting that no cases of hookworm were
seen by Rifaat (1958) or Zawahry (1964) in old Nubia. Furthermore, Scott
(1937a) found roundworm infection lowest in the Aswan area.
ENVIRONMENTAL HEALTH CONDITIONS IN RURAL EGYPT
The following material on environmental health conditions in rural
Egyptian populations also appears in a previous report (Miller, et al., 1978).
Since analytical aspects are included in this report and employ this informa-
tion, this portion of the text is reproduced here for reasons of convenience
for the reader.
The historical information sought for environmental health conditions in
Egypt included the following:
1) General village sanitation
2) Water supply wastewater practices
3) Wastewater practices
4) Housing conditions
5) Refuse or solid waste practices.
Detailed analytical information on these parameters is rather limited for
Egypt as a whole. Several local studies are available, however, for the delta
and for Old Nubia. Data from these studies have been provided in somewhat
greater detail.
Amin and Zaghloul (1959) reviewed the administrative organization of the
EMH environmental services, but provided little data. They did point out that
by 1959, protected rural water supply had been provided to each village
over 1,200 persons. Generally, water was pumped from an underground source to
elevated tanks which supplied a limited number of public water standpipes
(one or more taps fixed to a vertical concrete slab). This water supply
project had been started in the lS40's and by 1960 fairly wide coverage was
obtained. In 1975 all villages had at least one source of water. The goal of
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one standpipe per 300 persons was 90% to 95% completed by this time (Furnia,
1975). This is very impressive when compared with the water supplies available
in the rural villages of other similar developing countries. Installation of
latrines in the rural areas has been less successful (Furnia, 1975).
The major refuse problem in Egyptian villages is animal waste (Headlee,
1933; Weir, et al., 1952). Animal manure is still commonly used for com-
posting and for cooking fuel. The compost heaps and the drying dung cakes
cause a serious sanitation problem by providing ample sites for fly breeding.
For the most part, solid waste in the conventional western sense does not
exist in Egyptian rural villages. Only infrequent isolated litter piles may
noted in typical villages. However, where multistoried housing projects have
been constructed and in urban areas there are extensive solid waste problems.
On the village level very little solid non-organic material is discarded.
This picture is now beginning to slowly change as the population grows and as
more consumer goods become available to the rural populations.
Focusing on the delta, Headlee (1933) made detailed environmental observa-
tions on the rural village of Rushdy, Qalyubia. No clinical data were provided
but excellent maps were made showing the defecation sites in the village.
Samples were taken from these sites and examined for helminthic parasites.
Enterobius, Ascaris, Trichuris, Hymenolepis and Ancylostoma were detected in
the samples.
According to Scott (1937), this indiscriminate habit has important impli-
cations concerning hookworm transmission. If the same defecation sites were
frequented, then hookworm transmission would be favored. However, defecation
sites were scattered and, as Scott (1937) showed, the prevalence of hookworm
was not as high as might be expected.
Headlee (1933) also observed the still common practice of disposing
household wastewater in the village streets and that the presence of a stable
attached to the home contributed to the intense fly problem Farooq, et al.
(1966a) commented that village conditions in the delta had changed little
since Headlee's report.
Weir, et al.'s (1952) study (1952) of the same general area (Sindbis,
Qalyubia) confirmed Headlee's observations. Weir, et al. (1952) also found
that 31% of all the homes in the study area had latrines, out of a total of
4,878 houses examined, and 10% had wells. Flies in the study site were noted
in large numbers. Counts were made monthly on the fly populations. These
counts showed seasonal fluctuations with low numbers in the middle winter
months and high counts for the remainder of the year. Measures were taken
to reduce the fly populations, and it is interesting to note that during a two
year period in the areas where control was maintained, infant mortality was
markedly reduced. This is a very important observation. No other environment-
al measure tested during this study demonstrated any improvement in infant
mortality, indicating the overwhelming importance of flies as vectors of
serious infantile diseases.
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In 1966, Farooq, et al. (1966a), found that 87.6% of the people in
Beheria, in the northwestern delta, 'had piped water, a 77% increase in the
number with piped water since 1952. The exact distribution of people with
or without piped water is shown in Table 3. Ten and one half percent of
the sample used canal water exclusively.
TABLE 3
DISTRIBUTION OF EXAMINED POPULATION BY SOURCE OF WATER SUPPLY
AFTER FAROOQ, et al. (1966)
Water Supply
Number of People
Percentage Distribution
Canal
Piped Water
Other
Not Stated
1248
10466
70
160
10.5
87.6
0.6
1.3
TOTAL
11944
100.0
Table 4, reproduced from Farooq's study, shows the number and distribution
of people by type of house. There were considerable differences between
divisions with an overall 58.5% living in stone or redbrick houses and 40.3%
living in mud or mud brick houses. Farooq, et_ al_. (1966) also determined the
number of persons with a cowshed and the number and distribution of latrines.
They found that just over half of the population do not have cowsheds, 32.9%
have adjoining cowsheds and 14.4% have separated cowsheds. The latter group
was considered to be in a higher economic class than the former two. At these
study sites, 52% of the population was found to have latrines; 10% had
latrines and did not use them (It would be interesting to know just how this
was determined.); and 36.4% did not have a latrine. This indicates that there
is an increase in the number of latrines in the homes since Weir, et al.'s
(1952) time.
As shown in the prevous sections on schistosomiasis, all the above
environmental parameters influenced the transmission of infection, with the
exception of latrines which showed a marginal decrease in prevalence, and
only when age and type of house were controlled for.
In Upper-Middle Egypt only the report by Hassouma (1975) is available on
a rural housing survey. Table 5 is reproduced from this report to the
Egyptian Ministry of Planning. A majority of the houses obtained water from
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public standpipes (54%). However, a significant number (14%) had water piped
to the home. For 12% of the homes, water came from the canals.
Hassouma (1975) also found that 6.4% of the houses were converted to
sewage systems and that 10% had septic tanks. These fascinating observations,
especially the presence of the sewage systems, beg the question "What did the
author use as a definition or 'rural'?" Unfortunately, no answer was provided.
However, over half of the houses surveyed did not have a latrine.
TABLE 4
DISTRIBUTION OF EXAMINED POPULATION BY TYPE OF HOUSING
AFTER FAROOQ, et al. (1966a)
Type of House
Number of People
Percentage Distribution
Stone or Red Brick
Mud Brick or Mud
Other
Not Stated
TOTAL
6988
4811
7
138
11944
58.5
40.3
0.0
1.5
100.0
Upper Egypt
In the area between Assyut and Aswan, only sketchy information exists and
most of what does is centered on the Aswan environment only. In 1965, Aswan
City had no sewage system and the large fertilizer plant (The Kiroa Company)
nearby was inadequately treating its waste-water which was being discharged
into the Nile (Messina, 1970). Other (Eachmann, 1965; Satti, 1970) reporting
to the WHO found the Aswan urban area poorly developed in respect to waste-
water management.
Old Nubia
In 1960, Abdady and Shalash (1966) from the National Research Center,
Cairo, completed a one-year survey on the Nubians which examined the environ-
ment and livestock resources. Selection of families was based on the family
register at each village and selections were representative and proportional
to the 1960 census. It was a well-designed study. Each tribe was represented
and Table 6 shows the number of families selected, by tribe, village and the
location of the village on the eastern or western bank of the Nile. Table 7
shows the housing conditions for each area. Table 8 shows the type of water
supply, lighting and food storage in the house. Whereas this table points
out that no sewage system existed, the general description of the text stated
that toilets were located inside the houses in the Fadiga area, and outside
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for the other two tribes. No numbers were provided on how many were available,
Also included in this discussion was that the hand pumpwells located in the
Fadiga area usually did not function.
TABLE 5
WATER AND WASTE-WATER FACILITIES IN UPPER-MIDDLE EGYPT
AFTER HASSDUMA (1975)
Water Supply
TYPE OF FACILITY
Piped Inside
Piped Outside
Hand Pump Inside
Canal
Faraskour
No. %
36 13.6
106 40.2
120 45.4
2 0.8
VILLAGE
Queaa
No. %
4 1.6
194 74.6
8 3.0
54 20.8
Deshna
No.
48
54
8
24
%
35.8
40.3
6.0
17.9
Waste-Water Disposal
Sewer
Septic Tank
Latrine
None
34
94
134
264
6.5
1.8
25.5
50.2
4
8
219
260
0.8
1.6
36.9
53.1
44
38
46
134
16.7
14.5
17.6
51.1
A description of the village areas was included in the report. In the
Fadiga tribal areas, houses were in rows with 20-30 meters from one row to
the next, spreading out over a 500 by 600 meter area. Houses made of combin-
ations of mud, rock and cane were architecturally similar to the American
Indian hogan with walls extending out to encompass a courtyard, a guest room
and a stable. A characteristic feature of Nubian houses is the decoration of
the walls, both on the inside and outside. There is a prevailing attitude
throughout Egypt that the Nubians are exceptionally tidy and honest.
Floor plans of the old Nubian houses have been prepared by Fernea (1973).
In brief, Egypt has had a progressive plan for the provision of a protect-
ed water supply to the rural areas since the 1940's. A visit to the rural areas
readily confirms the widespread distribution of rural water supply. This
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project's findings indicate fewer persons visiting canlas or unprotected water
courses for their water, but still evident in the rural areas are the women
washing clothes and dishes in the canals, the children bathing in the canals
and the farmer irrigating his fields by ancient methods requiring contact
with canal water. Generally, the sanitation conditions in the villages of
Egypt have improved somewhat since Headlee's study (1933). In terms of
crowding, they may have become worse.
TABLE 6
TRIBE, LOCATION, VILLAGE AND NUMBER OF FAMILIES
SELECTED IN NUBIA, 1960
AFTER ABDADY AND SHALASH (1966)
Tribe
Fadiga
Fadiga
Arab
Arab
Kanoose
Kanoose
Location on
Nile Bank
West
East
West
East
West
East
Village
Ballana
Abu Simbel
As-Sabu' a
As-Sangari
Sarf-Hussein
Kask Tamna
Number of Families Selected
275
170
75
75
75
75
In the following villages, irrigation pumps and canals had been installed:
a) Dikka
b) Al-Alaqi
c) Aniba
d) Tushka
e) Aramna
f) Abu Simbel
g) Ballana
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TABLE 7
HOUSING CHARACTERISTICS, OLD NUBIA, 1960
AFTER ABDADY AND SHALASH (1966)
TRIBE
Fadiga
Arab
Kanoose
House Characteristic
Area Building Material Number
in in- IT -i », o KOOJIIS
Mud Wood Mud
Total Mean Mud Rock Cane Cane Total
234860 528 428 0 16 1 2658
53170 355 0 150 0 0 801
34550 230 0 150 0 0 627
of
Mean
5.9
5.3
4.8
TABLE 8
WATER SUPPLY AND LIGHTING IN OLD NUBIA, 1960
AFTER ABDADY AND SHALASH (1966)
TRIBE
Fadiga
Arab
Kanoose
Water Source Lighting
Small
Canals Nile Pump Electric Kerosene
94 275 76 0 445
0 93 57 0 150
0 10 140 0 150
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CHAPTER IV
MATERIALS AND METHODS
This study is separated into two major subdivisions. The first, termed
the "Downstream Study", is a comparison of environmental and epidemiological
health parameters at different village sites comprised of indigenous rural
populations located downstream from the AHD, excluding the relocated Nubians.
The second, termed the "Nubian Study", is concerned with the Nubian populations
displaced by the formation of Lake Nasser. The results of both investigations
have been analyzed for correlations with environmental and epidemiological
alterations resulting from the construction of the AHD.
DESCRIPTION OF THE "DOWNSTREAM STUDY"
The Downstream Study is designed to assess the impact of the formation of
Lake Nasser on indigenous rural populations in Egypt downstream from the AHD.
The design rationale is based on a comparative approach for which data are
collected from more than one site. Thus it can be determined whether changes
occurring over time or in a given location are unique, and casual relationships
can be developed accordingly.
Three areas have been selected which afford maximum comparability. The
first, from an area likely to be affected by Lake Nasser, are the rural villages
north of the city of Aswan and south of Kom Ombo. The two other areas are
Beni Suef, between the delta and Assyut, and Kafr El Sheikh, in the north
cantral Nile Delta. For the sake of convenience, the three "areas" in which
rural villages were selected for the downstream study are referred to as the
Aswan, Beni Suef, or Kafr El Sheikh study area.
In each of these three governorates, rural villages have been selected
based on: a) how representative the village is of the area; b) accessibility,
c) population composition and size; and d) the presence or absence of a rural
health center or unit. The selection of villages from these three areas was
also based on information obtained from past studies. It was clear from
these studies that Upper-Middle and Upper Egypt had frequently been excluded,
with a far greater number of past surveys being carried out in the delta.
Within the delta, more prevalence information on schistosomiasis was
available for Qalyubia than all the other delta governorates combined. Sites
in Kafr El Sheikh were selected, therefore, to help correct this deficiency
of information. Also, historical data indicated that the northern delta, in
which Kafr El Sheikh is located, had maintained the highest schistosome preva-
lence in rural Egypt. The data from Kafr El Sheikh provided the ultimate
baseline prevalence for this study, as opposed to areas farther south and
geographically more central. Villages were selected in the Beni Suef area as
representative of Upper-Middle Egypt for the simple reason that recent data
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indicated that the distribution of S_. mans on i infections were slowly migrating
south from the Nile Delta into this area (Hussein, 1972; Alamy and Cline, 1977).
Sporadic cases of S. mansoni had been seen in Beni Suef by Hussein (1972). It
was therefore important to determine if S. mansoni cases could still be found
or were increasing."
DESCRIPTION OF THE "NUBIAN STUDY"
This study is designed to measure the changes in the prevalence of
parasites in the Nubian population following displacement due to the formation
of Lake Nasser. The Egyptian Nubians, a population of 45,000 to 50,000 persons,
resided in villages scattered along the banks of the Nile, south of Aswan to
the Egyptian border. This population was displaced by the rising waters of
the new lake in 1964. The Nubians, who were rural in nature and composed of
three different tribes, were moved en masse to Kom Ombo, 40 kms downstream from
the AHD. For all practical purposes, the entire population was resettled in
this area. The new villages bear the same names as those from which the set-
tlers originally came and, in addition, retain their respective locations as
in old Nubia with the Kanoose tribe in the north, the Arab in the middle and
the Fadiga in the south. No other formal arrangement was made by the govern-
ment to have resettlements in other areas. However, there remains an original
Nubian community located on the eastern Nile bank just north of the old Aswan
dam, called Kazan Sharq. This is the southernmost village in Egypt with
the exception of a very small village located on an island in the reservoir
that inundates the area between the old and new dams. No resettlement sites
are present on the lake shore. The high ground surrounding the lake is harsh,
barren and, according to Dazo and Bile's (1971) survey, uninhabited with the
exception of the Abu Simbel community 300 km upstream from the AHD. Although
Abu Simbel does not constitute a rural/agricultural community, it is the only
permanent lake shore site currently inhabited. In 1971, the population of
Abu Simbel was 134 and was comprised mostly of government workers employed
in the maintenance of the Abu Simbel temples. Abu Simbel does not represent
displaced Nubian communities. Observations made during a 5 day trip on Lake
Nasser in May, 1977 confirmed these findings. Earlier in the Review of Liter-
ature, Dazo and Biles (1972) found that 9% of the population there had S_.
haematobium infections. No other helminthic infections were observed.
The Nubian study includes three major sites between which comparative
studies have been made: a) the old, no longer existing Nubian villages of
Kurta, El Malki, and Ballana; b) the correspondingly resettled sites at
Kom Ombo; and c) the original Nubian community, Kazan Sharq, located on
the eastern Nile bank just north of the old Aswan Dam.
(The determination of a change in the distribution of S_. mans on i infections
to the south was an overriding consideration in respect to the selection of
appropriate sites for the surveillance of the other helminthic and protozoan
infections. In addition, there was no historical information that suggested
that by selecting village sites in the Beni Suef area aspects of the distribu-
tion of these other parasites would be missed or overlooked.)
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Abu Simbel had to be excluded because it does not represent the Nubian
population. Also excluded are the lake shore sites which are yet to be develop-
ed, and the Lake Nasser fishermen. As mentioned previously, a joint WHO-EMH
inter-region project (IR-065 RDF/71/217) is currently being organized to in-
vestigate the health status of the Lake Nasser fisherman population.
Definitions for pre- and post-AMD are needed to establish the point in
time for describing "before" and "after" conditions necessary for making
comparisons between studies. Pre-dam is defined as the period before the
discharge of the Nile was controlled by the AHD. Post-dam is defined as
the period from 1961 to the date of this study (1976). The construction of
the AHD was not completed until 1974, but as mentioned earlier, the coffer
dam, constructed to divert the flow of the river around the area where the
AMD's foundations were being laid, was removed in 1964 and the ensuing floods
have since been trapped behind the AHD. The reservoir reached maximum volume
in 1976. The term "significant" is defined as a meaningful increase in the
prevalence of a selected parasite when comparing the results from different
study sites used in this research with results from other villages employed
by other workers. Frequently, the number of cases may be large enough to
demonstrate statistical significance between results differing only in one
or two percentage points. Whereas this would constitute statistical signifi-
cance, it would not be meaningful.
DATA ACQUISITION
The two major categories of data collected were: historical baseline
data and data collected from field studies that included environmental health
data and epidemiological morbidity data for the selected parasites mentioned.
The implementation of the field survey was guided by a program evaluation
review technique (PERT) diagram.
The PERT diagram identified and numbered each individual activity or job
to be carried out. The time in days required to complete each job was estimat-
ed and then each job was placed appropriately in the sequence. Except for
the first, each preceding job or jobs had to be completed before the following
one could be started. Thus, projected dates of completion were calculated.
Moreover, free slack, or the amount of time that a previous job could be
postponed without delaying the overall projected completion time, was estimat-
ed. The estimated time to complete the field activities up to the point of
analysis of the data was 265 days. The actual time for completion was approx-
imately 260 days.
SPECIFIC DATA COLLECTED
The categories for data which were collected are:
1) environmental health parameters:
a) water supply and use
b) sewage disposal
c) housing
d) irrigation practices
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2) epidemiological parameters:
a) age-sex structure of the sample population
b) parasite prevalence.
It may be noted that agricultural irrigation methods have been included
as an environmental health parameter. Generally, irrigation schemes, as such,
do not fall within the realm of environmental health specialties. However,
in Egypt, as in a number of other tropical developing nations, agriculture
practices and especially irrigation methods play a central role in the trans-
mission of many parasitic diseases. Moreover, it is the open canals and
drains which are associated with present day irrigation in Egypt that provide
excellent habitats for snail vectors. For the rural populations of Egypt,
canals long ago became a way of life. The convenience the canals have
provided in the rural villages for domestic water for washing, bathing, swim-
ming, drinking, and ablutions is readily evident to the visitor.
Data acquisition forms (questionnaires) were designed and translated
into Arabic. These forms serve as a list for the various parameters under
study. The original English data forms are included in Appendix 2, in part
one (Miller, et_ al_. , 1978).
Considerable peripheral data are included in the survey listed on the
data forms. As much data as possible were obtained concerning all the environ-
mental parameters in the hope that nothing would be overlooked simply because
it was not requested. Secondly, data were needed to control for certain
variables; for example, age, sex, occupation, etc. Indeed, the study was
originally designed under a much broader scope specified by the needs of the
River Nile - Lake Nasser study of which this work was a part.
SELECTION OF FIELD SURVEY SITES
A total of ten health units and centers were selected in Kafr El Sheikh
and in Beni Suef based on criteria mentioned in the description of the down-
stream study. The name of the health unit or center does not always correspond
to the name of the village from which the sample population was selected.
Sometimes more than one village was sampled by the health unit or center.
This is true also for Aswan and for the Nubian sites.
In Kafr El Sheikh, the selected health units of centers, also termed
"study sites", and their code numbers shown in parenthesis, were:
a) health unit El Agazein (16): only the village El Agazein was
sampled;
b) health center El Hamra (17): only the village El Hamra was
sampled;
c) health unit Mahalet El Kasab (18): only the village Mahalet El
Kasab was sampled;
d) health unit Mahalet Mousa (19): Mahalet Mousa and El Nataf were
sampled;
e) health unit Sheno (20): two villages, Sheno and Reskit El
Shenawi were sampled.
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In Beni Suef, the selected health units or centers and their code numbers
were:
a) health center Barout (11): only the village Barout was sampled;
b) health unit Sherif Pasha (12): only the village Sherif Pasha
was sampled;
c) health unit Naiim (13): two villages, El Amrana and Abu Mousa »
were sampled;
d) health center Beni Adi (14): only the village of Beni Adi was
sampled;
e) health center Ashamant (15): only the village of Ashamant was
sampled.
Both Kafr El Sheikh and Beni Suef are the respective capitals of their
governorates. Kafr El Sheikh is about 2.5 hours' drive north of Cairo,
roughly 140 km, and is located in the central northern sector of the delta.
The northern border of the Kafr El Sheikh province is the Mediterranean Sea.
Almost the same distance to the south of Cairo is Beni Suef. To the north of
Beni Suef is Giza; to the west, the Fayoum; and to the south, Minya. Each
of the villages selected in both Kafr El Sheikh and Beni Suef was an agricultur-
al community typical of the area.
In Aswan the selected health units or centers and their code numbers
shown in parenthesis were:
a) health unit Kazan Sharq (1): the village of Kakhor was sampled;
b) health unit Guzaria (2): the villages Gamma, Omrob and Harrob
were sampled;
c) health center Abu Rish Bahri (3): the villages of Mai Katta and
Mai Lieta were sampled;
d) health unit Ga'afra (4): the villages of El Aratag, Shouna,
Masagien, Falaleha, Omarab, Ali Abu Karime, El Sheikh Garat,
Hedadoun, Hagar and Mahatta were all sampled;
e) health center Bimban (10) the villages of Kenisa, Abu Snarl, Omda,
Mariab, Sheikh Mousa and Kabarra were all sampled.
In the Nubian resettlement area of Kom Ombo, the selected health units
or centers and their code numbers were:
a) health center Ballana (5): the villages of Ballana 1,2, and 3
were sampled;
b) health unit Tushka (6): only the village Tushka was sampled;
c) health center El Malki (7): only the village of El Malki was
sampled;
d) health unit Kurta (8): only the village Kurta 2 was sampled;
e) health center Kalabsha (9): the villages Kalabsha and Abu Khor
were sampled.
The village of Kazan Sharq (1) is one of the most southern villages to
be found in Egypt. This village is comprised of Nubians of the Kanoose
tribe, and it should be pointed out that Kazan Sharq (1) and a few remaining
villages just to the north, are also populated by Nubians who, because of
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their location downstream from the AHD, did not have to be moved when Lake
Nasser began to fill. Rather, this small population of Nubians are living in
the same villages and the same homes that they were living in before the AHD
was built, or, for that matter, from the last century and before.
The villages located at health units and centers 2,3, and 4 are communit-
ies typical of the area between Aswan and the Kom Omba plain and are located
on the eastern bank of the Nile. These communities are characteristically
found in high, dry, barren ground. Because the Nile valley is so narrow in
this area, very little land is available for cultivation, and, therefore,
what is available is far too valuable to build on. The cultivated areas
are always found as a green strip between the village and the river, with
the exception of Hagar in Ga'afra, which is located on a low barren hill next
to the river. In this respect, these villages are unlike the ones in the
Kom Ombo agricultural plain. From the northern point of the Kom Ombo plain,
continuing north, the narrow valley gradually begins to widen as it passes
through the next two governorates, Qena and Sohag. In these sites the
villagers live at a greater distance from the irrigation canals and drains
than villagers located in the delta or in Upper-Middle Egypt. Villages are
found within the cropped area with increasing frequency as one travels north
and east of Aswan into Qena and into Sohag. North of Sohag only a small
fraction of the rural population resides in villages located outside the
cultivated land, and these villages are often bounded on one side by their
fields. The health center Bimban (10), was selected to represent villages
typically built within the cultivated area. Six different villages all
located in Bimban markaz (center) were sampled. The Bimban markaz, seen on
the map in Figure 11, is located on the western bank of the Nile valley,
almost directly west of Daraw. The villages are separated from the Nile and
from the desert to the west by fields of sugar cane and wheat, and by palm
groves, etc.
The selection of the Nubian resettlement villages was based on the
previous study by Zawahry (1964-). Each village that was surveyed in 1964 has
now been surveyed again for this study. They are Ballana (Fadiga) (5), El
Malki (Arab) (7), and Kurta (Kanoose) (8). In addition, two other villages
were selected: Tushka (Fadiga) (6) and Kalabsha (Kanoose) (9), to increase
the overall sample size.
DATA COLLECTION TEAMS
The primary data collection teams at each of the selected health units
or centers were comprised of a physician, a laboratory technician, a sanitar-
ian, one or two nurses and one or more aides. The team was led by the
physician whose responsibility was to implement the collection of data and
to ensure that all activities were completed according to the outlined
procedures (see Appendix 4). The cooperation and employment of the various
health teams was obtained through the Egyptian Minister of Health and through
the respective regional offices of the Director General of Health. The
director-general provided transportation to the sites and local security
approvals, and saw to it that the materials necessary to continue were
received at the study sites. In addition, a field supervisor, typically a
vice-director-general, was assigned to follow the day-to-day progress in the
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in the field and to work closely with the technical field supervisor (the
writer). Aside from developing the plan of operation, acquiring materials,
and training personnel, the role of the technical field supervisor was to
coordinate the work at all levels at each of the twenty field sites.
The Egyptian Minister of Health assigned Dr. Baha Hashen, the director-
general of all rural health services as a team representative from the
ministry to the project. The EMH's services proved to be very helpful in
establishing communications, transporting materials, collecting data, and
obtaining cooperation of primary data collection teams.
The chief administrative team leader, Dr. M. Hussein, Dean of the High
Institute of Public Health at the University of Alexandria, developed the
administrative structure by which the various data teams and members were
employed and paid, and closely followed the day-today developments in the
field. In addition, Dr. Hussein obtained the necessary governorate approvals
and security permits and provided the laboratory space and personnel for the
analysis of the stool and urine specimens at the University of Alexandria.
REVIEW OF FACILITIES AND PREPARATION OF MATERIAL
The location for the examination of families was a rural health unit or
a rural health center. Each health unit (for outpatients only) and each
health center (small scale in-patient facilities available) selected was
assessed for facilities needed for the survey. If facilities or equipment
were lacking, they were obtained by the local field supervisor from the
respective director-general's office. For the most part, these services
were not needed as the health units and centers selected all had the required
facilities and were in working order. These facilities included:
a) a light microscope, monocular model, with at least low power
(16 mm focal length) and high power (4 mm focal length) objectives,
and related equipment - slides, etc. Often these were manufactured
in Czechoslovakia and were similar to Japanese Nikon models;
b) glass pipettes in sufficient quantity;
c) 250 cc glass conical flasks for urine sedimentation;
d) stool pans for the collection of stool specimens;
e) a hand centrifuge;
f) a balance for determination of weight and height.
The balances were made by Detecto Scales, Brooklyn, N.Y., U.S.A.; model
Detecto-medic or similar. Microscopes, balances and hand centrifuges were
placed in the health units and centers by UNICEF about 5 years previously in a
program to update rural medical facilities in Egypt.
The additional materials needed by the health units or centers for the
22
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recording of data and preparation of specimens were:
(1) printed data forms in Arabic;
(2) solution for preservation of stool and urine specimens;
(3) 10 cc plastic specimen vials or bottles;
(U) disposable applicator sticks for transferring stool specimens;
(5) permanent felt-tipped ink pens to label specimen bottles;
(6) a reference or methods guide for the correct procedure to be
followed during the survey.
Printed Data Forms
The data forms for the clinical examination of the family, form code 01;
and the data form for the examination of the house, form code 02; were first
translated into Arabic at the High Institute of Public Health. The same pro-
cedure was used for the environmental forms coded 03 through 12. (All data
forms and the methods guide are included in Appendix 2 and Appendix 3, respect-
ively, of part 1.) The translated forms were reproduced by mimeograph. At
the beginning of the field activities, all forms were reproduced at the High
Institute of Public Health. Over 8,000 forms of 01 and 02 were necessary.
Form 01 had three pages and 02 had four. Therefore, 56,000 sheets of paper
were required just for these two forms. It soon became obvious that delays
would develop if the forms continued to be mimeographed at the High Institute.
Paper, stencils, and staplers were purchased and delivered to the local
director-generals' offices, which took over the responsibility of providing
printed forms.
Data Form Design--
The data forms for the examination of the family were based in part on
the studies by Farooq and Nielsen (1966), Zawahry (1963), and Hussein (1972).
At each health unit, a guide for the correct completion of the data form from
the examination of the family was provided. This guide also included the
correct method by which all procedures were to be carried out for the collect-
ion of field data. The guide served only as a reference and was not a
substitute for instruction.
It should be pointed out, however, that special procedures were taken to
determine age. The determination of age in a highly illiterate population is
prone to error. Measures to minimize errors were adapted from Scott (1937).
Scott (1937) found that it was more accurate to place a person in an age-group
than to estimate the person's exact age. An age group sheet of 5-year age
groups (starting from 0-1) was distributed with the methods guide and instruc-
tion for use was given to the physician. Birth dates were recorded only when
government identification cards could be provided.
An attempt was also made to determine what medication, if any, the
23
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individual had taken in the 360 day period prior to the day of examination.
Only medications for parasitic diseases were recorded. Other medication
received was recorded as "other." Details for the methods of obtaining
the remaining data and data for the housing are described in the methods
guide.
The design for the housing form, code number 02, was adapted from
Mitwally and Sharqawi's (1970) article on measuring housing conditions in
the rural areas of Egypt. For each data form a clear plastic overlay sheet
with an English translation was made. These clear overlays provided an
instant translation of the Arabic data form into English. As a guideline,
the house to be examined by the sanitarian was defined as "the area lived in
by the selected family."
PRESERVATION OF STOOL AND URINE SPECIMENS
It was clear from the beginning that there was considerable variation in
ability to examine stool specimens for parasites and ova between laboratory
technicians at the selected health units and centers. To compensate for the
undesirable variability and to maximize the comparability from one study site
to another, all stool specimens were preserved and sent to the laboratory at
the High Institute. At the "central laboratory" the specimens were examined by
a staff of trained personnel.
To implement this central approach for the examination of the specimens,
a 10 ml translucent polyethylene bottle was provided for each individual at
the selected sites. These bottles were purchased in Cairo and were 2 cm in
diameter, 5 cm tall with a 1 cm opening in the top for which there was an
inner cap and an outer screw cap, all polyethylene. On each bottle, the code
number of the individual, comprised of the health unit number, the family
code number, and the individual's number within the family, and his or her
name was written with black, permanent, felt-tipped pens. Both pens and
bottles performed well over the period of the survey. There was no occasion
when the label came off, and the bottles, which were unbreakable, did not
leak even though an occasional screw top had been deformed during the molding
process.
The procedure for collecting the stool and urine for preservation is out-
lined in the methods guide. Two points should be added: 1) that the urine
specimens were examined at the health units by the laboratory technicians. In
addition, two drops of urine sediment were added to this stool specimen for
preservation and examination later at the central laboratory. In this way a
double check was provided on the examination of urine. The results of the
on site examination were recorded on the data form for the examination of
the family, form 01; 2) the transfer of the stool from the stool pan to
the specimen bottle and the mixing of the stool with the preservative solution
required something cheap and disposable. Broom straws, along with matchsticks
and toothpicks, were all tested unsuccessfully. Very common in Egypt are
small vegetable crates made by hand from palm fronds. The ribs of these
crates were found to split nicely into straight wooden sticks which easily
transferred and mixed the specimens. For preservation, the stool was mixed
24
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with 9.0 to 9.5 cc of merthiolate-formalin solution adapted from the
merthiolate-iodine-formalin concentration technique (MIFC) (Blagg, et al. ,
1955). Ova, cysts and trophozoites in fresh stool specimens collected in
the MIF solution have been successfully preserved without deterioration of
descriptive cytological features for a number of years. The exact period
before deterioration begins is under study at the Naval Americal Medical Research
Unit (NAMRU-3) in Cairo where the technique was first developed. Instead of
adding iodine (Lugol's iodine) at the time of preparation when the specimen was
mixed, as prescribed by this technique, the Lugol's iodine was added after-
wards at the central laboratory just before the ether extraction phase.
This alteration in technique, in addition to the fact that approximately
0.05 ml of urine sediment was being added, did not interfere with the desired
staining intensity. By delaying the addition of Lugol's iodine at the health
unit or center, the amount of materials that had to be delivered was reduced.
This also assured that the Lugol's solution used was fresh, as it begins to
deteriorate as a stain after one week. Thus, the urine was examined twice,
once at the health unit or center and once at the central laboratory.
EXAMINATION OF STOOL AND URINE SPECIMENS
All specimens were collected from each of the study sites and transport-
ed to the parasitology laboratory at the High Institute of Public Health.
/'t the laboratory, a team comprised of nine physicians examined the specimens.
The team was supervised by three senior lecturers of parasitology at the High
Institute.
All specimens received at the laboratory from a particular health unit
or center were grouped together. There was no intended order within the group
and a few specimens at a time were selected for examination from each group.
This quasi-random method helped minimize the biasing effect of individual
ability among the laboratory personnel.
The preparation of a specimen for examination was as follows:
1) the specimen was mixed and poured through a layer of wet gauze into
a labelled centrifuge tube;
2) 0.6 ml of fresh Lugol's iodine was added to the specimen;
3) 4 ml of petroleum ether added in order to increase the specific
gravity of the ova and cyst by extracting the lipid fraction. The
tube was inverted and shaken vigorously;
4) the specimen was centrifuged for 5 minutes at 1500 rpm;
5) the top ether layer and fecal plug, and MIF layer were removed by
suction, leaving the sediment and about 0.1 ml of MIF solution on
top of the sediment;
6) the sediment was resuspended and a drop of this mixture placed one
microscope slide, and covered with a cover slip;
25
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7) the slide was examined for characteristic ova, cysts, and tropho-
zoites;
8) results were entered on a coded specimen examination form, an
example of which is shown below.
Stool Examination Form (Code 15)
Specimen vial number:
Date:
Helminths:
Ascaris lumbricoides 1
Trichuris trichiura 2
Enterobius vermicularis 3
Ancylostoma duodenale 4
Strongyloides stercoralis 5
Taenia sp 6
Trichostrongylus sp 7
H. nana 8
H. heterophyes 9
F. hepatica 10
F_. gigantica 11
S. haematobium 12
S. mansoni 13
Protozoans:
Giardia lamblia 14
E. histolytica 15
E. coli 16
E. hartmanni 17
lodamoeba butschlii 18
Endolimax nana 19
Chilomastix mesnili 20
Trichomonas hominis 21
Dientamoeba fragilis 22
Examined by:
The coded specimen form includes a place for the code numbers, date,
form code and code number of the examiner at the laboratory who examined the
slide and places for indicating the presence of the various parasites screened.
Only one slide for each specimen was examined.
An in-laboratory test was used to obtain data on individual examiner
error. One specimen each day was examined by all members and the results
scored independently. It was requested that the personnel examine the "test"
slide in the same fashion as all other slides. The exam results were not
26
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shown to the personnel, and it was emphasized that this was a procedure to
estimate error rather than a proficiency examination. All laboratory
personnel at the High Institute were closely followed and exhibited
proficiency in the identification of the various parasites. The helminth
ova are easy to identify as they are generally large and very characteristic
in morphology. Proficiency was assured by comparing sample specimens with
the NAMRU-3 laboratory.
SELECTION OF THE SAMPLE POPULATION
A systematic sample was taken at each study site. The unit of selection
was the family. All members of each family in the sample were examined.
From each study site about 200 families were selected systematically from
a list drawn up from the village or villages to be sampled that included all
the families of the village or villages and all the members of each family.
By selecting 200 families per health unit or center, a sample total of
approximately 700 to 900 persons was estimated. The target sample size for
all study sites in both studies was between fourteen and eighteen thousand.
The family list was the sampling frame. For purposes of selecting the sampl-
ing unit (the family), the family was defined as a man, his wife or wives,
and all unmarried offspring. This definition was easy to use and fairly
stable, i.e. the average number of persons per family did not vary greatly
from site to site, though in Upper Egypt, the families were somewhat smaller.
(Note that not all offspring of a selected married female may have been
examined.) All selected family members were accounted for. If a member
did not attend the examination, an explanation of why the member was not
present was stated on the family examination form. No attempt was made to
replace those who would not come, were absent at the time of the survey, or
had died.
To make the selection of the families, an up-to-date list of family names
and members, or sampling frame, was required. Generally, a frame was
available but often out-of-date by four to five years. In order to avoid
delaying the start of the survey, the following procedure was implemented.
The total number of families in the old list was divided by 200. The number
obtained, for example 3.4, was rounded off to the next higher number and
added to one (two or three ir. other cases depending on an estimate of how
many new families would be added). In this example, with a starting list of
680, every fifth family would be selected starting from a random number
between 1 and 5. The frame would immediately begin to be updated, adding
new families at the end of the list, and the examination of the selected
families starting from the first selected and proceeding sequentially was
also begun. The up-dating was always finished long before the examination
of the first selection of families could be completed. The selection of
every fifth family according to this example would result in an under-selection,
i.e. less than 200 would be selected. In this case, about 136 families would
be selected if 120 new families were added to the original list of 680. After
the examination of 136 families, 64 families would have to be reselected
from 664 remaining unselected families by selecting every tenth family. Re-
selection being made without replacement, a total of 202 families would be
selected and examined. This approach was used throughout the study, with
27
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two or more samples (one or more reselections) from each site being taken in
this fashion. Each selected family was circled and serially numbered in the
list of family names and members.
The serial number for the family became the serial code number for that
family. The members of the family were listed serially starting with the
first person examined on the family examination data, form 01. This gave
each individual that was examined in the survey a unique code number compris-
ed of the number of the village, the family serial code number, and the
individual code number within the family. The code number 01,001,01
identifies the first person in the first family selected at the health unit
01, Kazan Sharq. The health unit or center code number and the family serial
code number were used to identify the data froms 01 and the housing data forms
02. The data form 02 was completed for each house of each of the selected
families. These forms were matched with the family 01 forms by coding the
02 forms with the health unit or center number, the house number, and
family serial code number. The same sample size (200 families) was used
throughout the survey, rather than selecting a given proportion of the pop-
ulation at each site. Therefore, the sampling fraction varied from site to
site. This was done for administrative reasons, and because it was desired
that the completion of the survey of the familes and the environment be
roughly during the same period of time at all sites. The reason for this was
that by carrying out the survey at the different sites over the same period
of time, the possibility of seasonal variation of the parameters measured
between the sites would be negated.
It was estimated that 200 families would yield a sample of about 800
individuals. This sample size was felt sufficient to give the estimates of
the various parameters sampled with adequate precision at each site. The
systematic selection of families was used as opposed to a purely random
method for two reasons: 1) the systematic selection more often than not
gives greater precision. With a systematic selection, no isolated groups,
individuals, or houses are left unrepresented in the sample, as might in-
advertently happen with a random selection; 2) the selection of the families
for examination could proceed immediately without waiting for an up-dated
family list. A random sample would be impossible to select before the list
was completed because the added group would not have a known possibility of
being selected in the first round.
EXAMINATION OF THE ENVIRONMENT AND THE POPULATION
Before the survey could begin, each health unit or center had to receive
the necessary materials and the personnel had to review the methods for the
correct filling in of the data forms and the correct method for preparing
the stool and urine specimens. The up-dating of the family list was always
the first activity, followed by the selection of the families. In order to
obtain the cooperation of the village members, a meeting was held with the
village council, the local physician and the field supervisor, to explain
the purpose of the survey and solicit the aid of the council to overcome any
difficulties. On occasion, the director-general of the governorate attended
these meetings. Only after the personnel at the health unit or center showed
proficiency with the different aspects of the data acquisition, was the
23
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examination begun.
Generally, a routine was established where the sanitarian would go
to the selected family's house, complete the housing form and instruct the
family to go to the health unit or center the following day. The instructions
included telling the family members that the information obtained would be
held in strictest confidence and that specimens of stool and urine would be
requested at the health unit or center. At the health unit or center, the
selected family members would be given a numbered stool pan and a numbered
tin cup and requested to provide a specimen of each at some point during the
examination.
By obtaining the specimens from the selected family members at the health
unit or center, proper identification of the specimens could be guaranteed.
This is a unique feature to this survey. Scott (1937), Farooq and Nielsen
(1966), and Zawahry (1963) all obtained their specimens by providing specimen
containers to the heads of the household of each of the families selected.
There were exceptions, most notably at Kurta (8) in the resettled Nubian
area. The water supply in the laboratory at Kurta (8) was the most inadequate
of all the selected sites. The piped water supply was limited to a few hours
a day and frequently failed for periods longer than 48 hours. Water rarely
came to the health unit's laboratory. At Kurta (8), protected water was used
first for drinking and cooking before it went for other purposes.
Because of this lack of water at the health unit, selected family members
refused to give stool specimens. Under the circumstances, the methods of
Scott (1937), Farooq (1966), and Zawahry (1964) were employed. Thus the
correct specimen was obtained. Also, a large metal reservoir was given to
the health unit laboratory so that water could be stored and available to
clean equipment.
Trips to the field to initiate the survey activities were made in early
April, 1976. By May, 1976 all units and centers had begun the collection of
data. After the survey had begun, each field site was repeatedly visited.
During these visits, additional materials were supplied, completed data forms
and prepared specimens were picked up, and, if required, a reselection was
made. This evaluation included the following:
1) a check to see if the names on the completed 01 and 02 forms
corresponded to the names in the family list;
2) a check to see if the correct code numbers were being used;
3) a check to see if the code number on the specimen bottles
corresponded to the code number on the family form 01;
4) a check to see that the housing forms 02 were being correctly
completed. This was done by selecting several completed forms
and going to the respective homes and seeing if the completed
29
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forms agreed with the actual conditions;
5) a check to see if all the families in the village were included in
the family list. This was done by going to the village and randomly
selecting a house to see if the occupants were listed in the book.
On no occasion was a family located that had not been included. It
should be pointed out that 1) the sanitarians are well-trained in
this respect; and 2) they were often residents of the village who
knew the villagers well, and were actually related to many of them;
6) to review any problems or obstacles being met and to resolve them;
7) to review the general progress, and to determine if the health unit
or center was on schedule. Since only part of the working day could
be allotted to the examination of the family members or the environ-
ment at the health unit or center, it was requested that approximately
20 persons per day, or five to six families, be screened at a time.
The examination of the families and their environment at each site,
which was to be completed in about three months, was actually 95%
complete after five months;
8) to review the method of examination of the selected family members.
This was done by observing the completion of the family form 01,
with the physician at the health unit or center during a visit when
examinations were being carried out. First, a family that had been
examined just prior to arrival was recalled and re-examined, while
checking the completed form for discrepancies. Secondly, the com-
pletion of the family form was followed through on a family who had
not been examined. This was especially helpful in detecting errors
in obtaining and preparaing specimens. Idiosyncratic procedures
were noted during this time. Those which did not in themselves
affect the collection of data were usually allowed to continue,
as changing procedure would risk causing errors;
9) confirmation of the methods used at the health unit or center for
completion of the environmental data forms were reviewed in the
same fashion as was employed for checking the housing forms;
10) on occasion, persons or families would come to the health unit or
center requesting to be included in the examination. If the person
was elderly and a relative of a selected family or a village leader
who had not been selected, forms were completed and specimens taken.
No code numbers apart from the health unit number were given to
these individuals. Data from these forms were not included;
11) an inventory of all the materials;
12) one of the most important checks was to see if the specimens of
stool and urine were correctly examined, prepared and labelled.
From the very first it was stressed that the right stool and the
right urine be placed in the right bottle in the corrent manner.
(The correct procedure was outlined for the laboratory technicians
30
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in Arabic.) This procedure was reviewed frequently at the health
units and centers at the time when specimens were being provided
by the selected individuals.
DATA MANAGEMENT AND ANALYSIS
For this study, 3,859 house data forms were executed for the examination
of the dwelling units. An almost equal number were completed for the examina-
tion of the family. About 400 data forms were completed for the various
environmental aspects of the village sites. Exactly 15,665 stool specimens
were received. Ultimately, over 40,000 cards were keypunched.
When raw data in these quantities are obtained, major efforts have to be
made to keep the data from being misplaced, lost, or damaged before it can be
processed. This was aggravated by the distances involved between the 20
different study sites, as well as by the lack of good communication systems.
Invariably, staff at the health units faced problems after actually starting
the survey that were not anticipated during the training phase. Most often
the problem was solved by a change in coding procedure which did not affect
the final accuracy. For example, on the housing form (02), in an unanticipated
situation, the correct answer required the selection of more than one number,
although only a single answer had been anticipated, and only one box had been
provided on the data form. The examiners simply wrote in two numbers, or what-
ever the combination may have been, in the given box. This alteration was
easily handled when the coding sheet was designed. The process was not always
as uncomplicated as this and new combinations necessitated redesigning the
code sheets.
To minimize problems of data management, a complete inventory of the
number and amount of materials delivered and received from each study site
was kept. Before data forms were accepted, they had to be checked for complete-
ness, consistency and accuracy.
All completed forms were packaged and delivered to the Cairo University
Statistics Center. Code sheets were designed, tested, and redesigned. The
final coding sheet for a particular form was reproduced at the center by offset
printing.
Before transferring the data onto code forms, a code book or code key was
developed for each type of data form. The questions on the family examination
form 01 concerning diagnosis and medication received were the only examples of
truly open questions, and required continued updating of the code book. The
greater part of the coding was simply copying a selected number onto the code
sheet.
Coded data were verified on a sample of forms from each site before
punching. Punching formats were designed from the code sheets, i.e. data
were punched directly from the code sheet. At the computer center printed list-
ings of each site were made and checked against a sample of original data forms.
For listing the data on magnetic tape, the punched cards were sorted by site,
family and individual, and a file on magnetic tape was created for each category
of data form.
31
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A series of Fortran IV programs were written at the Cairo University
Statistics Center for use on a Data General 'Nova' computer. These programs
were for:
1) preparing listings of various sub-sets of data;
2) basic tabulations of important variables in the data set. A number
of tabulations were used to follow the work in the central laboratory,
and were designed specifically to detect errors and inconsistencies
made by the laboratory workers;
3) sequencing, matching, and renumbering of specimen data;
4) validating and examining the consistency of coded data;
5) eliminating duplicates in the specimen data; and
6) writing the data set onto magnetic tape files.
The complete data set stored on magnetic tape was transferred to the
University of Michigan's computing center for continued analysis. At the
University of Michigan, the Michigan Terminal System (MTS) and the Michigan
Interactive Data Analysis System (MIDAS) were used to:
1) re-edit various sub-sets of data based on the results of verification
programs run in Egypt;
2) match and merge the data from the family examination with the data
from the specimen forms and housing forms for the creation of a master
data file; and
3) to complete, following step number two, the descriptive analysis and
the assessment of relationships between variables in the data were
completed.
Adjustment Scheme
Since the sampling fraction and the age structure of the sample varied
from study site to study site, an estimate of prevalence made by simply adding
together all those infected and dividing by the total number sampled in a given
area, for example in Kafr El Sheikh, would be incorrectly weighted. To adjust
for this, a procedure was formulated using a series of MIDAS commands. An
estimated number infected was calculated for each age-sex group for each
site in a given area of study. The age-sex specific prevalence at each site
was used to make these estimates. The estimated numbers infected in each age
group for each site were added together and divided by the sum total of the
population of all villages studied in the area. This result was the adjusted
age-specific prevalence. The sum of all these estimated to be infected,
divided by the total population from all sites, equalled the overall adjusted
prevalence for a given area. Sex-specific adjusted prevalences were calculated
using the same procedure, but selecting only male or female cases.
32
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CHAPTER V
RESULTS AND DISCUSSION
PARASITIC INFECTIONS
The general overall crude prevalence in the samples of the four major rural
study areas; the north central delta, Upper-Middle Egypt, Upper Egypt, and New
Nubia has been determined. Table 9 is a master table showing the percent
positive by each village site for all parasites screened for in the examination
of the stool. This table also includes data obtained on the presence and type
or absence of a latrine and whether or not it was used, and data on the number
of persons per house. A separate table, Table 10 , was prepared to show the
distribution of water supply in the different study areas or regions. The
number of persons per standpipe (a public spigot) by village, however, is
given in Table 9•
It should be noted that the different categories in Table 10 are not
mutually exclusive. Each cell in the table could reach 100%. The percentages
shown simply indicate a preference of water source. For example; in the first
column, 90% of the population in Kafr El Sheikh stated that their drinking
water was obtained from public standpipes; 19.4% cited the canal as a source
or at least 9.4% obtained drinking water from both sources. (When significant
tests were used to determine if the source of water was related to the
prevalence of a specific parasite, this "overlap" was corrected for by select-
ing a program which created exclusive categories and eliminated cases which
had claimed more than one source.)
The results of Table 10 clearly demonstrate the demand for protected
water sources. The corresponding figures in Table 9 show the number of
persons per standpipe and reveal the intense use placed on these sources. The
lowest number of persons per standpipe was 85; some villages had no piped sources
at all, and the overall means of 407 persons per standpipe in the downstream
study sites is somewhat higher than that suggested by Furina (1975). Obvious-
ly such an intense competition for protected water supplies limit its useful-
ness and potential benefit. Although the data in Table 11 do not strongly
suggest a relationship between the prevalence of the helminthic and protozoan
parasites, except for the schistosomes, every attempt should be made to improve
and expand this service.
The infection of the sample with helminthic parasites was found to be
remarkably low, as can be seen in Table 9. The prevalence of hookworm,
H. nana (dwarf tapeworm), Taenia (beef or pork tapeworm), and Enterobius
(pinworm) were low in all study areas including the Nubians. Ascaris was
only moderately elevated in the Nile Delta study sites (8.4%) but not elsewhere.
The Entamoeba infections were by far the most prevalent and were found consist-
33
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^^
TJ
3
C
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u
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co c
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3- u
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rH C
J- C
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CO C
CO
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Ascaris lumbricoide
Ancylostoma doudena
D C
3 e
M £
3 C
t -
3 C
M C
3 C
r u
3 C
3 r
3 C
r c
3 C
M u
H C
-) C
3 C
3 C
3 C
0 u
3 C
H r
3 C
Chilomastix mesnili
o e
3 <
3 C
3 C
t C
3 C
3 C.
3 C
D C
3 C
V C
3 C
0 C
3 C
T C
3 C.
^ C
3 <
3 C.
3 C
n c
3 C
H C
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to
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J3
10
fj
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cu
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C)
3 C
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3 C
3 C
3 e
3 C
3 C
3 e
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 <
3 C
3 C
3 C
3 C
3 C
3 C
Endolimax nana
M r-
3 -
M C
3 "
3 C-
3 C
3 C
3 i-
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3 «•
M f
3 "
M u
3 r
3 C
3 C
3 ;
3 r
M U
3 C
D C
3 f
3 C
3 r
Entamoeba hartmanni
•< v
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H (
L
1 '
3 <
3 c
H <
0 I
H t
S
H <
i
T C
H -
C
n c
3 C
t r
H c
C
T *•
3 t
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3 L
r> e
3 c
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c
Lntamoeba coli
±
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n
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2 c
3"
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n c
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t
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N C
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r
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3 U
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Entamoeba histolyti
•. r
S U
0 C
r ;
0 C
n p
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r> z
D r
") C
n r
D C
T r
H r
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M ^
0 r
0 f
D C
H C
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to
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fc,
re
Enterobius vermicul
H C
3 C
3 C
t C
3 C
- C
H C
T r
1 C
t C
-t C
3 r
H C
M C
H C
*• C
3 <
f L
H C
- C
3 C
M C
H C
Fasciola gigante
3 t
3 C
3 C
3 ;
3 C
3 <
3 C
H C
3 C
M C
3 C
H r
3 C
3 C
3 C
3 C
3 <
r> c
3 C
3 C
3 C
3 C
3 C
Fasciola hepatica
3 C
3 L
3 C
t I
3 L
3 C
3 <
3 '
3 C
3 1
3 '
r
H C
3 C
M e
3 C
3 C
3 .
3 C
3 r
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3 <
3 t
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Giardia lamblia
n t
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0 C
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71 t
X) t
H L
3 C
n <
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H
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71 L
N C
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Heterophyes heterop]
3 r
3 r
3 C
M L
3 r
fr C
3 r
3 C
3 r
3 C
3 r
N r
3 r
M -
3 r
M C
3 C,
3 ;
3 r
O C
3 r
3 C
3 r
lodamoeba butschlii
o e
H e
^ c
M C
C
n r
H r
0 C
H C
0 t
H C
M C
H k
H C
H .
t c
H .
C
0 C
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f C
H :
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H C
M C
H tl
|
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rt
Schistosoma haemato]
0 0
D O
O O
M O
O
- 0
H O
3 O
M O
- 0
0 0
0 o
0 O
M 0
t O
o o
t o
N
n o
r> o
M O
T O
M O
3 O
n o
0 0
V
1-
t—
f
2
r
Schistosoma mansoni
Strontrvloides stern
rH O C
CM O C
to o c
oo o e
CO 0 C
rH O C
CM O C
HOC
rH 0 C.
O O C
CM O C
O O C
r- rH C
o o c
rH 0 C
CM O C
O CM C
O O C
* 0 C
HOC
in o c
o o c
CO H C
o o c
Taenia sp.
Trichomanas homilis
3 C
3 C
3 U
3 C
3 C
3 C
3 f
3 C
3 C
3 C
3 r
3 C
3 r
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 C
3 r
Trichostrongylus sp,
1 r-
> c
3 C
> C
4 C
3 C
* C
3 C
3 r-
3 C
M C,
3 C
H C
3 r
3 C
3 r
3 r
3 C
* ^
3 r
r> r
1 C
3 C
H r
Trichuris trichiura
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to & in
n
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3OOHOCOCO
3 Ol
CM
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CM
MOrHocnoom
HOHOCDOHC71J-CM
en 3°
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roococoooo
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co ^f m GO
CO
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O CD rH
m
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-ttorr>a»r»oo.^'*/>fo
CM U>
-------
TABLE 10
Water Supply By Use and Study Area
WATER USE
Drinking
Bathing
Laundry
Utensils
Animals
AND SOURCE
- courtyard tap
public standpipe
handpump-yard
handpump-outside
canal or drain
Nile
- courtyard tap
public standpipe
handpump-yard
handpump-outside
canal or drain
Nile
- courtyard tap
public standpipe
handpump-yard
handpump-outside
canal or drain
Nile
- courtyard tap
public standpipe
handpump-yard
handpump-outside
canal or drain
Nile
- courtyard tap
public standpipe
handpump-yard
h an dp ump - outs i de
canal or drain
Nile
PERCENTAGE DISTRIBUTION
Nile Delta Middle Nile Upper Nile
Kafr El Sheikh Beni Suef Aswan
4.21
90.0
0.0
0.0
19.4
0.0
4.2
78.0
0.0
0.0
66.5
0.0
2.2
62.7
0.0
0.0
64.3
0.0
1.8
61.8
0.0
0.0
63.5
0.0
0.6
2.6
0.0
0.0
61.2
0.0
0.3
8.3
1.3
15.9
0.8
0.0
0.2
8.2
1.1
15.3
1.8
0.0
0.2
5.4
1.1
11.9
7.4
0.0
0.2
4.9
1.1
11.8
6.6
0.0
0.0
0.1
0.0
0.7
8.1
0.0
0.0
61.3
10.9
3.1
0.6
24.3
0.0
61.3
10.9
3.1
0.6
24.3
0.0
61.3
10.9
3.1
0.6
24.3
0.0
61.3
10.9
3.1
0.6
24.3
A
Nl"
The different categories are not mutually exclusive. No information
36
-------
TABLE 11
Relation of Water Supply to Parasites
in the Nile Delta (Kafr El Sheikh), 1976
INFECTION
WATER SUPPLY
PERCENT PREVALENCE BY WATER USE
Utensil
Drinking Bathing Laundry Cleaning
Ascaris lumbricoides
House Conn.
Standpipe
Canal
7.
11.
13.
1
5
7
7.
11.
14.
1
2
0
7.
11.
12.
1
9
3
7
11
12
.1
.6
.9
Ancylostoma duodenale
En t amoeba
Entamoeba
House Conn.
Standpipe
Canal
coli
House Conn.
Standpipe
Canal
histolytica
House Conn.
Standpipe
Canal
0.
0.
4.
42.
32.
33.
7.
2.
4.
0
8
2*
9
1
7
1
3
2
0.
0.
4.
42.
32.
33.
7.
2.
3.
0
4
7;';
9
0
6
1
4
7
0.
0.
4.
42.
31.
35.
7.
2.
3.
0
4
1"
9
1
2
1
6
3
0
0
4
42
30
35
7
2
3
.0
.4
.0*
.9
.9
.5
.1
.6
.2
Giardia lamblia
House Conn.
Standpipe
Canal
0.
5.
4.
0
3
2
0.
5.
3.
0
6
7
0.
4.
5.
0
7
7
0
4
5
.0
.7
.6
Schistosoma haematobium
House Conn.
Standpipe
Canal
13.
19.
33.
3
2
3
13.
20.
32.
3
0
8
13.
18.
34.
3
2
6
13
18
34
.3
.0
.6
Schistosoma mansoni
House Conn.
Standpipe
Canal
6.
12.
24.
7
3
7
6.
12.
21.
7
8
4
6.
11.
22.
7
9
1
6
11
22
.7
.7
.0
Significant, chi square 0.05 or less.
37
-------
ently high in all study sites.
It became apparent very early in the examination of the stool specimens
that the helminthic infections, Ascaris and Ancylostoma were being detected
at a frequency much lower than expected. A quick glance at Table 2 shows
that both infections were much higher in the past. The expectation that
higher frequencies should be observed resulted in a close evaluation of the
MIFC technique and its employment. The MIFC protocol was reviewed as well as
the cytological features of the respective ova. Both aspects were found to
be correctly used, as neither method truly qualifies as a technically diffi-
cult procedure. Furthermore, the genus Entamoeba was readily and frequently
identified in the specimens as well as the helminth S. mansoni. Specimens
obtained elsewhere and known to be positive for either Ascaris or Ancylostoma
were correctly identified without fail using the MIFC procedure. The con-
clusion is that these two helminthic infections, Ascaris and Ancylostoma,
have decreased in our sample sites over the period of a decade. (The time
span between this study and the most recent historical data is 10 years.)
As was pointed out, direct comparisons between prevalence studies in
Egypt are limited. However, the differences seen between this study and
past studies in regard to these two helminthic infections is dramatic and
too great to be explained on methodological differences alone. The past
evidence clearly points to a much higher prevalence. Assuming that the
sample sites studied here were not freakishly typical, and the prevalence for
these two parasites have indeed fallen, then the most probable explanation
for decreases in the infections is the wholesale distribution of pharmaceuti-
cals such as piperazine. All rural health centers and units stock this drug
and prescribe it frequently at little or no cost to the patient. Furthermore,
this drug was frequently sited on the data forms as having been prescribed
within the previous year of the study.
The exposed foot is the classic portal of entry by the infective larvae
of Ancylostoma. For a number of years now, cheap plastic footwear has been
available to the population in general and especially to the lower social-
economic classes. The use of this footwear breaks the hookworm transmission
cycle. The readily observable use of plastic footwear, of any kind, through-
out rural Egypt has no doubt contributed to a decline in the prevalence of
this infection.
There were significant differences between study sites in a given area.
Notable is the hookworm distribution in Aswan where the non-desert villages
of Bimban (10) had more hookworm (1.2%) than any of the other "desert type"
villages. Also interesting is the decrease in Ascaris infection outside the
delta. Although the prevalences are much lower, the distribution still
parallels that found previously by Scott (I937a), i.e. decreasing from north
to south. No significant differences were seen between sexes or age for
Ascaris infections. Prevalence in the very young ages were as high as the
older ages. Unique age or sex distributions were not noted for any of the
parasites investigated. (The tables depicting age-sex prevalence relationships
and other descriptive aspects are included in an appendix for tables.) This
rather unusual arrangement for tables was prepared because of the very large
number of tables prepared for this report, greater than one hundred. The
38
-------
vast majority of these tables are basically descriptive and include tables
with information on the environmental parameters that were also measured.
Specific information sought for from these tables should be made by subject
as each table's heading is indexed on the front pages of the table appendix.
The presence of a latrine was significantly associated with a reduced
prevalence in Ascaris infection, Kafr El Sheikh and Beni Suef, but not in
Aswan. Table 12 shows these results in addition to five other selected
parasites. Generally, the results were not encouraging. Only in one other
case was the presence of a latrine favorable, i.e. for E_. coli infections in
Beni Suef.
The high prevalence of the Entamoeba species indicates that personal
hygiene for the populations sampled is still inadequate. The quality of water
supply did not relate well to the prevalence of these organisms either.
(See table appendix on parasitic infections and water supplies.) This may be
a reflection of limited water supply and use.
TABLE 12
Relationship Between Latrine and Infection With Selected Parasites
in the Three "Downstream" Study Areas
PERCENT POSITIVE
Kafr El Sheikh Beni Suef Aswan
PARASITE Latrine Latrine Latrine
Yes No Yes No Yes No
A. lumbricoides 8.0 12.0 0.7 3.2 3.9 2.1
Ancylostoma 1.4 1.1 4.0 2.6 0.3 0.3
H_. nana 2.4 1.1 1.0 1.2 5.7 4.7
G_. lamb 11 a 6.5 5.1 3.5 3.4 10.9 6.4
Entamoeba coli 40.5 33.0 39.4 49.4 37.2 31.4
E. histolytica 4.5 3.7 6.0 5.4 7.2 5.2
Table 13 shows the percentage of persons infected with any single para-
site and any two or more parasites. The sampled population from Beni Suef
had consistently higher numbers of positives than the other two downstream
locations sampled.
Table 14 is a summary of the percent positive in all four study areas.
The table was constructed to give the reader a quick overview of the findings
for eight of the more prominent parasitic infections screened for in this
study.
39
-------
TABLE 13
Multiparasitic Infections in the Study Areas
NUMBER OF
INFECTIONS
Any one parasite
Any two parasites
Any three parasites
Any four parasites
Any five parasites
PERCENT POSITIVE/CASES
Kafr El Sheikh Beni Suef Aswan
42.7/1557
20. I/ 731
5.2/ 188
0.9/ 31
O.I/ 5
53.2/1518
44.5/1271
14. 5/ 414
3.2/ 91
0.4/ 11
42.7/1227
15. 6/ 449
3.7/ 107
l.O/ 28
O.I/ 4
TABLE 14
Percent Positive of Selected Parasites By Study Area
PARASITE Kafr
Ascaris lumbricoides
Enterobius vermicularis
Ancylostoma duo den ale
Taenia sp.
Hymenolepis nana
Giardia lamblia
Entamoeba histolytica
Entamoeba coli
El Sheikh
8.4
1.3
1.5
0.1
2.3
6.2
4.5
39.2
AREA
Beni Suef
2.1
2.1
3.3
1 case
1.0
3.5
5.8
44.8
Aswan
3.1
1.0
0.4
2 cases
5.2
9.0
5.5
34.8
Nubia
2.3
1.4
0.3
0.0
5.5
9.7
7.5
48.6
The results of the Nubian study were based on methodologies and sampling
sites used by Zawahry in 1964 (as described in the methods section) just
prior to their relocation in Kom Ombo. This design was selected in order to
strengthen the validity of comparisons between the results of these two
studies.
Table 15 shows the prevalence for the same eight parasites mentioned
above and the respective prevalence levels before and after relocation. No
40
-------
cases of hookworm infection were seen in Old Nubia (Table 2). Seven cases
were detected by this study; perhaps as results of the increase in sample
size over the one in 1964 by a factor of four.
TABLE 15
A Comparison of Parasite Prevalence (%)
Before and After Resettlement in Nubia
PARASITE
1964
1976
Ascaris lumbricoides
Hymenolep is nana
Enterobius vermicularis
Taenia sp.
Entamoeba histolytica
Entamoeba coli
Giardia lamblia
6.6
7.7
0.1
0.1
3.2
34.3
2.7
2.3
5.5
1.4
0.0
7.5
48.6
9.7
After Zawahry, 1964.
Overall, there was very little meaningful change in the prevalence of
these parasitic infections. Except for Entamoeba, the prevalence levels were
favorably low before and after resettlement. It was expected that the in-
creased crowding necessitated by the resettlement plan would result in an
increase in a number of communicable infections including the parasite dis-
eases mentioned here. The slight increases seen in the protozoan infections
may be a result of this change in living conditions. This increase can only
be considered alarming if it indicates a continued upward trend. Follow-up
surveillance is needed however, before this can be determined.
ENVIRONMENTAL FACTORS
Critical environmental measures such as water supply and water disposal
were analyzed in the previous section under Parasitic Infections in a brief
attempt to establish a relationship or association between these two variables.
There are other interesting descriptive features concerning the water, waste-
water and other environmental variables that were measured and should be
elaborated on. (The details of the environmental data can be found in the
appendix for tables; subheading Environmental Measures.)
The outstanding features, however, are the fact that protected water
supplies are present in almost every Egyptian village, and more rural houses
41
-------
in the sample had a latrine than did not. Two of the three village stand-
pipes relied heavily on ground water raised by handpumps. Only the villages
of Kazan Sharq (1) did not have some type of protected source and were forced to
carry from the river bank. Even here, public standpipes were being installed
as the field activities for this study were closing in the fall of 1976.
THE NUBIANS
In terras of water, wastewater and housing, the Nubians benefited by
their relocation to Kom Ombo enormously. All the new houses have electricity
or have readily available points for connections into the village supply.
Many homes, especially in Kurta (8), sprout television antennae. (Most
villages of rural Egypt now have at least one television set, usually located
at a village tea house. Small cheap battery-driven radios are also common
and provide the creative environmental health worker with an important mech-
anism for the development of environmental health education and awareness.)
All Nubian homes have latrines and the only source of water for the new
Nubian homes is from public standpipes. Furthermore, the Nubains now have
access to the medical care system through the rural health centers and units
found throughout the resettlement area. Schools, social centers and club
buildings have also been provided. The mere fact that the Nubians are no
longer a remote population, difficult to travel to, and remote from the
mainstream of Egypt's overall development, is an environmental improvement in
itself. It is unfortunate that many Nubians have voiced a desire to return
to old Nubia by establishing new settlements along the shores of Lake Nasser.
To do so would: (1) dangerously expose them to schistosomiasis transmission
via the Lake Nasser fishermen who have been found to have a high prevalence
of this infection in their own groups (Dazo and Biles, 1971); and (2) to
provide a mechanism of malaria transmission from the Sudan into the down-
stream populations of rural Egypt (not to mention the devastating effect
malaria would no doubt have on their own populations).
THE DOWNSTREAM STUDY SITES
Upper-Middle Egypt (Beni Suef) had more persons per standpipe and fewer
homes with latrines than did the other two downstream study areas, 928 and
64.6% respectively. It is interesting that the multiparasitic infections
(Table 13) are higher in this area also.
The typical village house in the three downstream study sites was made
of mud brick with a packed earth floor. Stone, red brick, or mud and red
brick were also common. Few houses examined stood alone. Many were bound
on three sides (65.2% in El Hamra (17), Kafr El Sheikh) and reflect the close
housing patterning necessitated by a limited amount of agricultural land,
characteristic of Egyptian villages, towns and cities. Actually, crowding
(persons per room) is less severe in the rural areas than in the urban ones.
(Obtained from the results of comparing figures from this study with data
collected by the 1960 census; Capmas.) Although conditions have changed since
1960, the direction has been entirely toward the urban centers. Severe
crowding conditions in the home could not be described for Aswan and Nubia
even if the rooms of these homes were small. The stable (used for chickens,
42
-------
rabbits, ducks, goats, etc.), when located within the confines of the house
(typically adjoining the courtyard), 'is a serious environmental hazard. Most
homes in Kafr El Sheikh or Aswan had them inside. The Nubian homes were
designed with inside stables.
The stable floors are intense fly-breeding areas and are used in some
homes as a handy and secluded location for defecating (Headlee, 1933).
It is obvious that the transmission of a number of communicable diseases,
including several infections not measured by this study, could be enhanced
by the presence of the stable. The stable is an important site for improve-
ment and must be included in environmental health programs. Currently, they
are not.
Related to the stable and domestic animals is cooking with dried dung
cakes. A detailed assessment was made on what different types of fuels were
used for cooking. Dung alone was used most frequently in Beni Suef, and
dung in combination with some other fuel (kerosene or charcoal) was by far
the most commonly sited source of cooking fuel. Fewer studied homes in
Aswan cooked with dung than in the other downstream sites. It appeared that
if other cooking fuel, besides dung, could be obtained it was preferred.
Every attempt should be made to help the villager exercise this preference.
Animal waste may frequently be dumped in the street, in the yard or
stable (where it originated), or sometimes in the canals. The street, where
all village household wastewater is disposed, also is the most common site for
dumping animal waste material. In the dry, hot south of Upper Egypt, desica-
tion remedies a sizable proportion of this problem. In the delta, especially
during the wetter months, the unpaved village streets may become almost septic
and impassable.
An encouragable number of homes were painted (inside, outside, or both)
and many had electricity. The villages of Aswan, of course, benefitted most
from the nearby location of the High Dam, but the results indicate that rural
electrification programs are extensive and most likely growing. There was at
least one or more television sets in every village.
The pit latrine was the type of latrine most frequently seen and by far
the major of these latrines were sited as inside the house. Only in Bimban
(10) were latrines most often located in the stable. Some had latrines and
did not use them, especially in Mahalet Moussa (19), Kafr El Sheikh (17.0%).
The shortage of water for the home is interesting. Throughout the
country-side, and seen also in urban locations where people congregated, are
zirs or large earthenware water containers. These containers hold about
20 liters, have tapering pointed bottoms, and are slightly porous. Because
of the pointed ends, various types of support structure are necessary, for
the vessel will not otherwise stand. Furthermore, the vessel is supported
so that the pointed tip does not touch the ground. The zir when full,
"sweats", that is, small amounts of water seep through the pores and blankets
the vessel in a wet film of water that collects at the pointed tip and is
used for drinking. The "sweating" also provides a measure of coolness to the
container due to rapid evaporation in the hot and dry climate of Egypt.
43
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Water for drinking is also obtained directly from within by, more often than
not, a tin can. Some zirs have lids.
Over 95% of the homes studied had zirs and used them to store water
collected either from standpipes, handpumps, canals or other sources. Even
homes with piped in water supplies (for example, a single tap in the court-
yard) would use the zir to store the family's water supply. One might wonder
why water would be stored in an earthenware zir when a piped source is
available. The reasons are (1) because the water supply via the pipe is
erratic; (2) the water from the zir is cooler; and (3) in the opinion of the
rural Egyptian who has been drinking from the zir all of his or her life—
water tastes best from a zir. All water that comes into the house, where it
was used for drinking, cooking, washing, laundry, etc., passes through the
zir storage container. From personal observation, it seemed that bigger
houses and families had more zirs. The investigators were often told that
the dried pit of the apricot would be ground into powder and added to the
turbid water of the zir, apparently as a coagulant. These points are made
because any health improvement program must consider the hygienic character-
istics of the zir, and the role it plays in the rural Egyptian household.
44
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APPENDIX II.2
Distribution of Environmental and Housing Factors
in Egyptian New Nubia, 1977
Percent of Houses with Attributes .,,
Ballana Tushka El Malki Kiirta Kalabsha Nubia
t % * * % %
HOUSE CONSTRUCTION MATERIAL
1 stone or red brick 94.9 95.5 95.0 100.0 99.5 97.0
2 mid brick 4.6 4.0 3.5 0.0 0.5 2.5
3 wood or reed 0.5 0.0 0.0 0.0 0.0 0.1
4 combinations 0.0 1.5 1.5 0.0 0.0 0.4
Number 197 201 200 200 199 997
FLOOR CONSTRUCTION
1 earth 41.9 4.5 4.5 0.0 0.5 10.2
2 concrete 56.1 6.0 0.5 39.8 92.5 38.8
3 tile 0.5 0.0 0.5 0.0 5.5 1.2
4 152 0.0 85.1 87.5 57.2 0.0 46.2
5 other combinations 1.5 4.5 7.0 3.0 1.5 3.5
Number 198 201 200 201 199 999
LIGHTING
1 electricity 39.3 39.7 10.6 S3.7 57.4 40.1
2 kerosene 60.7 60.3 65.8 46.3 42.1 55.0
3 1§2 0.0 0.0 21.6 0.0 0.0 4.3
4 other 0.0 0.0 1.5 0.0 0.5 0.4
Number 196 199 199 201 197 992
TELEVISION
present 3.1 1.6 0.6 20.1 6.2 6.6
Number 196 190 179 199 194 958
NUMBER OF ROCMS
one 7.1 5.6 13.0 2.0 0.0 5.5
two 22.7 13.1 30.0 38.3 33.8 27.6
three 26.8 46.5 18.5 13.9 64.1 33.9
four 32.3 32.8 30.5 25.9 1.5 24.6
five 9.1 1.5 7.0 16.9 0.0 6.9
more than five 2.0 0.5 1.0 3.0 0.5 1.4
Number 198 198 200 201 198 995
NUMBER OF PERSONS LIVING IN HOUSE
one 8.3 8.0 12.4 43.3 16.8 17.9
two 7.8 13.5 15.5 25.9 20.8 16.8
three 12.4 10.0 15.5 11.4 9.1 11.7
four 13.5 15.0 11.3 7.5 13.2 12.1
five 17.1 16.0 12.9 6.0 10.2 12.4
Six 15.0 11.0 10.8 2.5 7.6 9.3
seven 9.3 8.0 9.8 1.0 6.6 6.9
eight 6.7 9.5 4.1 0.5 4.1 5.0
more than eight 9.7 9.0 7.7 1.5 11.6 8.0
Number 193 200 194 201 197 985
74
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ii.2.2 (continued)
All
Ballana Tushka El Malki Kiixta Kalabsha Nubia
* t * I t I
PERSONS PER RDCM
less than one 15.6 17.6 19.2 69.7 28.5 30.5
one 50.0 46.6 46.6 24.7 34.7 40.5
two 21.4 29.5 20.7 5.1 21.8 19.6
three 8.9 3.1 9.3 0.5 8.3 6.0
four 3.1 0.0 2.6 0.0 6.2 2.4
more than four 1.0 3.2 1.5 0.0 0.5 1.2
Number 192 193 193 198 193 969
COOKING FUEL
1 gas 2.1 0.5 0.0 55.2 5.5 12.8
2 oil 94.9 1.0 18.5 5.0 94.5 42.4
3 wood 2.6 0.0 0.5 0.0 0.0 0.6
4 dung 0.0 0.5 0.0 3.5 0.0 0.8
5 253 0.5 0.5 75.5 0.0 0.0 15.3
6 combinations of dung with
any other fuel 0.0 96.0 3.5 34.4 0.0 27.0
7 other 0.0 1.5 2.0 2.0 0.0 1.1
Number 195 201 200 201 199 996
SCREENS
present 4.1 7.9 1.5 4.5 5.5 4.7
Number 194 191 196 200 199 980
MDSQUITO NETS
present 1.0 10.4 1.0 0.0 3.6 3.7
Number 192 193 197 71 193 846
OWNERSHIP
1 own 15.9 1.0 0.5 0.0 l.S 3.7
2 rent 48.7 8.0 4.0 99.5 68.3 45.6
3 no information 35.4 91.0 95.5 0.5 30.2 50.6
Number 195 201 200 201 199 996
LOCATION OF STABLE
1 inside 94.4 74.9 96.0 92.0 99.0 91.3
2 outside 1.0 10.8 1.5 2.0 0.0 3.0
3 152 0.0 11.8 0.0 0.0 0.0 2.3
4 none 4.6 3.6 2.5 6.0 1.0 3.5
Number 195 195 199 201 199 989
STABLE CLEANING
1 daily 99.0 3.1 98.0 99.0 97.5 79.4
2 weekly 1.0 3.6 1.0 1.0 2.5 1.8
3 monthly 0.0 86.2 1.0 0.0 0.0 17.4
4 never 0.0 7.2 0.0 0.0 0.0 1.4
Number 192 195 196 198 198 979
75
-------
II.2.3
(continued)
Ballana TUshka El Malki
* * *
Kurta Kalabsha
t %
All
Nubia
ANIMAL WASTE MATERIAL DISPOSAL
1 stable
2 yard
3 street
4 canal
5 roof
6 none
Number
WATER SOURCE
1 public
2 private ground well
3 surface
Number
DRINKING
1 piped inside
2 piped outside
3 hand pump inside
4 canal
5 drain
BATHING
1 piped inside
2 piped outside
3 hand pump inside
4 canal
5 drain
6 lake or pond
LAUNDRY
1 piped inside
2 piped outside
3 hand pump inside
4 canal
5 drain
6 lake or pond
UTENSILS
1 piped inside
2 piped outside
3 hand pump inside
4 canal
5 drain
6 lake or pond
ANIMALS
1 piped inside
2 piped outside
3 hand pump inside
4 canal
5 drain
6 lake or pond
1.5
1.5
96.9
0.0
0.0
0.0
194
97.3
2.1
0.5
188
N=199
0.5
93.0
0.0
0.0
0.0
0.0
92.0
0.0
0.0
0.0
0.0
0.0
92.5
0.0
0.0
0.0
0.0
0.0
92.5
0.0
0.0
0.0
0.0
0.0
57.8
0.0
0.0
0.0
0.0
2.5
0.0
0.0
0.0
0.0
97.5
199
74.4
25.1
0.5
199
WATER
N=199
4.9
97.5
0.0
97.5
0.0
0.0
97.5
0.0
97.5
0.0
0.0
0.0
97.5
0.0
97.5
0.0
0.0
0.0
96.5
0.0
97.5
0.0
0.0
0.0
6.4
0.0
96.1
0.0
0.0
2.5
0.5
95.0
0.0
0.5
1.5
199
98.0
0.0
2.0
199
SUPPLY
N=200
1.0
98.0
0.0
0.0
0,0
1.0
97.5
0.0
0.0
0.0
0.0
0.5
97.5
0.0
0.0
0.0
0.0
0.5
97.5
0.0
0.0
0.0
0.0
1.0
97.5
0.0
0.0
0.0
0.0
0.5
0.0
10.0
88.0
0.0
1.5
200
98.9
1.1
0.0
184
4.6
1.0
0.0
0.5
3.6
90.4
197
95.9
4.1
0.0
197
N=199 N=200
0.5
88.6
0.5
8.0
0.5
1.0
88.6
0.5
8.0
0.5
0.5
0.5
88.6
0.5
8.0
0.5
0.5
0.5
88.6
0.5
8.0
0.5
0.5
1.0
87.6
0.5
8.0
0.5
1.0
99.5
0.0
0.5
0.0
0.0
99.5
0.0
0.5
0.0
0.0
0.0
99.5
0.0
0.5
0.0
0.0
0.0
99.0
0.0
0.5
0.0
0.0
0.5
0.0
0.0
1.5
99.5
0.5
0.0
2.3
0.6
40.1
17.9
0.8
38.2
989
92.8
6.6
0.5
967
N«=997
0.7
95.3
0.1
21.4
0.1
0.4
95.0
0.1
21.4
0.1
0.1
0.2
95.1
0.1
21.4
0.1
0.1
0.2
94.8
0.1
21.4
0.1
0.1
0.5
49.8
0.1
21.3
19.9
0.1
76
-------
ii.2.4 (continued)
All
Ballana Tushka El Malki Kiirta Kalabsha Nubia
* t t i t t
STORAGE OF WATER
1 metal 0.0 0.0 0.0 0.5 l.S 0.4
2 ceramic 100.0 100.0 98.0 97.5 98.0 98.7
3 combinations and others 0.0 0.0 2.0 2.0 0.5
Number 192 196 200 197 199 984
KASTEWATER DRAINAGE
1 concrete
2 pipe
3 tile
4 earth
5 other
Number
LATRINE
present
Number
LOCATION OF LATRINE
1 inside
2 outside
3 stable
Number 191 192 194 200 198 975
TYPE OF LATRINE
1 borehole 2.1 0.0 0.5 1.7 1.0 1.1
2 pit 3.7 2.6 0.5 97.8 99.0 40.5
3 masonary walls 94.1 97.4 99.0 0.6 0.0 58.5
Number 187 192 193 178 199 949
COVER FOR LATRINE
present
Number
PRESENCE OF WATER CARRIAGE IN LATRINE
present
Number
57.6
0.0
37.7
4.9
0.0
191
97.9
190
100.0
0.0
0.0
4.1
0.0
0.0
95.9
0.0
196
98.0
196
99.0
0.5
0.5
12.0
0.5
0.5
86.9
0.0
199
98.5
199
98.5
1.5
0.0
2.1
0.5
0.0
0.0
97.4
194
99.5
196
98.0
2.0
0.0
2.5
0.5
2.0
0.5
94.4
197
100.0
199
100.0
0.0
0.0
15.5
0.3
7.9
40.0
38.4
977
98.8
980
99.1
0.8
0.1
60.2
191
ATRINE
0.0
189
98.0
196
94.8
192
98.0
198
2.1
194
12.5
192
0.0
200
100.0
199
1.0
199
74.2
976
19.3
974
77
-------
APPENDIX II.3, Table I
Prevalence of Parasitosis lit Egyptian Nubia, 1977
Parasite
Ascaris
lumbricoides
Trichuris
trichiura
Enterobius
vermicularis
Ancylostoma
duodena le
Strongyloides
stercoralis
Taenia
sp.
Trichostrongylus
sp.
Hymenolepis
nana
H. heterophyes
H. hepatica
F. gigantica
Giardia
lamblia
Entamoeba
histolytica
Entamoeba
coli
Entamoeba
hartmanni
lodamoeba
butschlii
Endolimax
nana
Chilomastix
oesnili
Trichcmonas
hodlnis
Dienttnoeb*
fragilis
Ballona TUshka
N-496 N-669
No. » No. t
PCs Pos Pos Pos
9 1.8 IS
0.0 1
7 1.4 17
0.0 3
1 0.2 1
0.0
1 0.2
25 5.0 57
0.0
0.0
1 0.2 1
57 11.5 1
31 6.3 46
262 52.8 311
6 1.2 12
6 1.2 9
1 0.2 2
1 0.2 4
0.0
0.0
2.2
0.1
2.S
0.4
0.1
0.0
0.0
8.5
0.0
0.0
0.1
0.1
6.9
46.5
1.8
1.3
0.3
0.6
0.0
0.0
El Mallei
N-519
No. I
Pos Pos
10 1.9
1 0.2
9 1.7
1 0.2
6 1.2
0.0
1 0.2
34 6.6
2 0.4
0.0
0.0
46 8.9
41 7.9
223 43.0
5 1.0
7 1.3
0.0
0.0
0.0
0.0
Kurta Kalabsha
N-466 N-478
No. t No. t
Pos Pos Pos Pos
13 2.8 13
0.0
2 0.4 3
2 0.4 1
6 1.3 41
0.0
1 0.2 3
18 3.9 11
1 0.2
2 0.4
0.0
26 5.6 36
39 8.4 41
196 42.1 284
1 0.2 5
7 1.5 13
0.0 1
2 0.4
0.0
0.0
2.7
0.0
0.6
0.2
8.6
0.0
0.6
2.3
0.0
0.0
0.0
7.5
8.6
59.4
1.0
2.7
0.2
0.0
0.0
0.0
All Nubia
N-2628
No. *
Pos Pos
60
2
38
7
55
-
6
145
3
2
2
256
198
1278
29
42
4
7
-
-
2.3
0.1
1.4
0.3
2.1
0.0
0.2
S.5
0.1
0.1
0.1
9.7
7.5
48.6
1.1
1.6
0.2
0.3
0.0
0.0
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-------
Appendix III.l Table I
Kafr El Sheikh: Percent Prevalence of Selected Parasites by Latrine
Latrine
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 3396 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 3396 OF = 1
Hymenolepis nana
Positive
Number
Percent
Negative
Number
Percent
N = 3396 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 3396 DF = 1
Present
245
8.0
2800
92.0
Absent
42
12.0
309
88.0
Chi-Square Significance = 0.0124,
43
1.4
3002
98.6
4
1.1
347
98.9
Chi-Square Significance = 0.6790,
74
2.4
2971
97.6
4
1.1
347
98.9
Chi-Square Significance = 0.1264,
197
6.5
2848
93.5
18
5.1
333
94.9
Chi-Square Significance = 0.3285,
Total
287
8.5
3109
91.5
Statistic = 6
47
1.4
3349
98.6
Statistic =0.
78
2.3
3318
97.9
Statistic = 2
215
6.3
3181
93.7
Statistic= 0.
.2502
17129
.3361
95497
80
z
-------
III.l Table I (continued)
Latrine
Parasite
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 3396 OF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 3396 DF = 1
Present
136
4.5
2909
95.5
Absent
13
3.7
338
96.3
Chi-Square Significance = 0.5089,
1232
40.5
1813
59.5
116
33.0
235
67.0
Chi-Square Significance = 0.0072,
Total
149
4.4
3247
95.6
Statistic =0.43634
1348
39.7
2048
60.3
Statistic = 7.2216
83
-------
Appendix III.l Table II
Kafr El Sheikh: Percent Pr»val«nc* of Selected Parasites by Sex
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 3640 OF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 3640 DF = 1
Hymenolepis nana
Positive
Number
Percent
Negative
Number
Percent
N = 3640 DF = 1
Entameoba histolytica
"Positive
Number
Percent
Negative
Number
Percent
N = 3640 DF = 1
Entameoba coli
Positive
Numbe r
Percent
Negative
Number
Percent
Sex
Male
145
7.9
1684
92.1
Chi -Square Significance
26
1.4
1803
98.6
Chi-Square Significance
121
6.6
1708
93.4
Chi-Square Significance
Dl
5.0
1738
95.0
Chi-Square Significance
718
39.3
mi
60.7
Female
162
8.9
1649
91.1
= 0.2694,
30
1.7
1731
98.3
= 0.5646,
105
5.8
1706
94.2
= 0.3067,
72
4.n
1739
96.0
= 0.1448,
708
39.1
1103
60.9
Total
307
8.4
3333
91.6
Statistic = 1 .
56
1.5
3584
98.5
Statistic - 0.
226
6.2
3414
93.8
Statistic = 1 .
163
4.5
3477
95.5
Statistic = 2.
1426
39.2
2214
60.8
2199
33ie
0449
1261
N = 3640
DF = 1 Chi-Square Significance = 0.9203. Statistic *0.10022-1
84
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-------
Appendix 11 I.I Table V
Kafr El Sheikh. Percent-.Prevalence of Selected Parasites by Type of
Water* Supply: Piped-in Drinking Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entarr.eoba coli
Positive
fiurcoer
Percent
Negative
Nuroer
Percent
N = 357 DF = 1
Yes
1
7.1
301
87.8
Chi -Square Significance =
6
1.7
337
98.3
Chi-Square Significance =
18
5.2
325
94.8
Chi-Square Significance =
9
2.6
334
97.4
Chi-Square Significance =
no
32.1
233
67.9
Chi-Square Significance =
No
42
12.2
13
92.9
0.5654,
0
14
100
0.6177,
0
14
100
0.3791,
1
7.1
13
92.9
0.3152,
6
42.9
8
57.
0.3983,
Total
43
12.0
314
88.0
Statistic = 0.33051
6
1.7
351
98.3
Statistic = 0.24908
18
5.0
339
95.0
Statistic = 0.77370
10
2.8
347
97.2
Statistic = 1.0089
116
32.5
241
1 67.5
Statistic = 0.71356
90
-------
Appendix 11 I.I Table VI
Kafr El Sheikh. Percent Prevalence of Selected Parasites by Type of
water Supply: Mpea-in Batning water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Yes
42
12.2
301
87.8
Chi-Square Significance
6
1.7
337
98.3
Chi-Square Significance
18
5.2
325
94.8
Chi-Square Significance
9
2.6
334
97.4
Chi-Square Significance
110
32.1
233
67.9
Chi-Square Significance
No
1
7.1
13
92.9
= 0.5654,
0
14
100
= 0.6177,
0
14
100
= 0.3791,
1
7.1
13
92.9
= 0.3152,
6
42.9
8
57.1
= 0.3983,
Total
43
12.0
314
88.0
Statistic = 0.33051
6
1.7
351
98.3
Statistic = 0.24908
18
5.0
339
95.0
Statistic = 0.77370
10
2.8
347
97.2
Statistic = 1.0089
116
32.5
241
67.5
Statistic = 0.71356
91
-------
Appendix 11 I.I Table VII
Kafr El Sheikh. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Laundry Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 357 OF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Yes
42
12.0
301
87.8
Chi -Square Significance =
6
1.7
337
98.3
Chi-Square Significance =
18
5.2
325
94.8
Chi-Square Significance «
9
2.6
334
97.4
Chi-Square Significance =
no
32.1
233
67.9
Chi-Square Significance
No
1
7.1
13
92.9
0.5654,
0
14
100
0.6177,
0
14
100
0.3791,
1
7.1
13
92.9
0.3152,
6
42
8
57
= 0.3983
Total
43
12.0
314
88.0
Statistic = 0.33051
6
1.7
351
98.3
Statistic = 0.24908
18
5.0
339
95.0
Statistic = 0.77370
10
2.3
347
97.2
Statistic = 1.0089
116
.9 32.5
241
.1 67.5
, Statistic = 0.71356
92
-------
Appendix III.1 Table VIII
Kafr El Sheikh. Percent Prevalance of Selected Parasites by Type of
of Water Supply: Piped-in Utensil Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Numoer
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 357 . DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Numbe r
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Yes
42
12.2
301
87.8
Chi -Square Significance
6
1.7
337
98.3
Chi -Square Significance
18
5.2
325
94.8
Chi -Square Significance
9
2.6
334
97.4
Chi -Square Significance
110
32.1
233
67.9
Chi -Square Significance
No
1
7.1
13
92.9
= 0.5654,
0
14
100
= 0.6177,
0
14
100
= 0.3791,
1
7.1
13
92.9
= 0.3152,
6
42.9
8
57.1
= 0.3983,
Total
43
12.0
314
88.0
Statistic = 0.33051
6
1.7
351
98.3
Statistic = 0.24908
18
5.0
339
95.0
Statistic = 0.77370
10
2.8
347
97.2
Statistic = 0.0089
116
32.5
241
67.5
Statistic = 0.71356
93
-------
Appendix III.l Table IX
Kafr El Sheikh. Percent Prevalence of Selected Parasites by Type of
Water Supply: Drinking Water Piped Outside
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Yes
13
13.7
82
86.3
Chi -Square Significance
4
4.2
91
95.8
Chi -Square Significance
4
4.2
91
95.8
Chi -Square Significance
4
4.2
91
95.8
Chi -Square Significance
32
33.7
63
66.3
Chi-Square Significance
No
30
11.5
232
88.5
= 0.5666,
2
0.8
260
99.2
= 0.0251,
14
5.3
248
94.7
= 0.6655,
6
2.3
256
97.7
= 0.3311
84
32.1
178
67.9
= 0.7723,
Total
43
12.0
314
88.0
Statistic = 0.32839
6
1.7
351
98.3
Statistic = 5.0137
18
5.0
339
95.0
Statistic = 0.18693
10
2.8
347
97.2
, Statistic = 0.94443
116
32.5
241
67.5
Statistic = 0.83740 -1
94
-------
Appendix 11 I.I Table X
Kafr El Sheikh. Percent Prevalence of Selected Parasites by Type of
Water Supply: Bathing Water Piped Outside
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylpstoma duodenal e
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Giardia Iambi i a
Positive
N umbe r
Percent
Negative
Number
Percent
N = 357 DF = 1
Entatneoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba col i
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Yes
15
14.0
92
86.0
Chi -Square Significance
5
4.7
102
95.3
Chi -Square Significance =
4
3.7
103
96.3
Chi-Square Significance
4
3.7
103
96.3
Chi-Square Significance
36
33.6
71
66.4
Chi-Square Significance
No
28
11.2
222
88.8
= 0.4535,
1
0.4
249
99.6
0.0040,
14
5.6
236
94.4
= 0.4614,
6
2.4
244
97.6
= 0.4826,
80
32.0
170
68.0
= 0.7611,
Total
43
12.0
314
88.0
Statistic = 0.56194
6
1.7
351
98.3
Statistic = 8.2790
18
5.0
339
95.0
Statistic = 0.54241
10
2.8
347
97.2
Statistic = 0.49293
116
32.5
241
67.5
Statistic = 0.92422 -1
95
-------
Appendix III.1 Table XI
Kafr El Sheikh. Percent Prevalence of Selected Parasites by Type of
Water Supply: Laundry Water Piped Outside
Parasite
As can's lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
N umbe r
Percent
N = 357 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Yes
15
12.3
107
87.7
Chi -Square Significance
5
4.1
117
95.9
Chi -Square Significance
7
5.7
115
94.3
Chi -Square Significance
4
3.3
118
96.7
Chi -Square Significance
43
35.2
79
64.8
Chi -Square Significance
No
28
11.9
207
88.1
= 0.9166,
1
0.4
234
99.6
= 0.0105,
11
4.7
224
95.3
= 0.6651,
6
2.6
229
97.4
* 0.6936,
73
31.1
162
68.9
= 0.4236,
Total
43
12.0
314
88.0
Statistic = 0.10957 -1
6
1.7
351
98.3
Statistic = 6.5560
18
5.0
339
95.0
Statistic = 0.18735
10
2.8
347
97.2
Statistic = 0.15525
116
32.5
241
67.5
Statistic = 0.64033
96
-------
Appendix III.l Table XII
Kafr El Sheikh. Percent Prevalence of Selected Parasites by Type of
Water'Supply: Utensil Uater Pi pad Outside
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 357 DF - 1
Yes
16
12.9
108
87.1
Chi -Square Significance
5
4.0
119
96.0
Chi -Square Significance
7
5.6
117
94.4
Chi-Square Significance
4
3.2
120
96.8
Chi-Square Significance
44
35.5
80
64.5
Chi-Square Significance
No
27
11.6
206
88.4
= 0.7162,
1
0.4
232
99.6
= 0.0117,
11
4.7
222
95.3
= 0.7040,
6
2.6
227
97.4
= 0.7228,
72
30.9
161
69.1
= 0.3252,
Total
43
12.0
314
88.0
Statistic = 0.13215
6
1.7
351
98.3
Statistic = 6.3582
18
5.0
339
95.0
Statistic = 0.14436
10
2.8
347
97.2
Statistic = 0.12586
116
32.5
241
67.5
Statistic = 0.96808
97
-------
Appendix III.2 Table
Beni Suef:
I
Percent Prevalence of Selected Parasites by Latrine
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 2473 DF = 1
Ancylostoma duodena le
Positive
Number
Percent
Negative
Number
Percent
N = 2473 DF = 1
Hymenolepis nana
Positive
Number
Percent
Negative
Number
Percent
N = 2473 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N « 2473 DF * 1
Entampeba histolytica
Positive
Number
Percent
Negative
Number
Percent
Latrine
Present Absent
917
99.3
6
0.7
1501
96.
49
3.
Chi-Square Significance =
886
96.0
37
4.0
1509
97.
41
2.
Chi-Square Significance =
914
99.0
9
1.0
1531
98.
19
1.
Chi-Square Significance =
891
96.5
32
3.5
1498
96.
52
3.
Chi-Square Significance =
868
94.0
55
6.0
1467
94.
83
5.
Total
2418
8 97.8
55
2 2.2
0.00, Statistic = 16.777
2395
4 96.8
78
6 3.2
0.0606, Statistic = 3.5210
2445
8 98.9
28
2 1.1
0.5687, Statistic = 0.32488
2389
6 96.6
84
4 3.4
0.8817, Statistic = 0.22162-1
2335
6 94.4
138
4 5.6
N = 2473
DF = 1
Chi-Square Significance = 0.5268. Statistic = 0.40055
98
-------
III.2 Table I (continued)
Parasite
Latrine
Present Absent
Total
Entamoeba colj^
Positive
Number
Percent
Negative
Number
Percent
N = 2473 OF = 1
559
60.6
364
39.4
784
50.6
766
49.4
Chi-Square Significance « 0.00,
1343
54.3
1130
45.7
Statistic = 23.333
Appendix III.2 Table II
Beni Suef: Percent Prevalence of Selected Parasites by Sex
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 2854 DF = 1
Ancylostoma duodenal e
Positive
Number
Percent
Negative
Number
Percent
N = 2854 DF = 1
Hymenolepis nana
Posi ti ve
Number
Percent
Negative
Number
Percent
N = 2854 DF = 1
Male
24
1.6
1435
98.4
Chi-Square Significance
58
4.0
1401
96.0
Chi-Square Significance
18
1.2
1441
98.8
Chi-Square Significance
Female
35
2.5
1360
97.5
= 0.1049,
35
2.5
1360
97.5
= 0.0274,
11
0.8
1384
99.2
= 0.2358,
Total
59
2.1
2795
97.9
Statistic = 2,
93
3.3
2761
96.7
Statistic = 4.
29
1.0
2825
99.0
Statistic = 1.
.6295
.8643
.4053
99
-------
III.2 Table II (continued)
Parasite Male Female Total
Giardia lamblia
Positive
Number 53 47 100
Percent 3.6 3.4 3.5
Negative
Number 1406 1348 2754
Percent 96.4 96.6 96.5
N = 2354 DF = 1 Chi-Square Significance = 0.7020. Statistic = 0.14639
Entameoba histolytica
Positive
Number 87 78 155
Percent 6.0 5.6 5.8
Negative
Number 1372 1317 2689
Percent 94.2 94.0 94.4
N = 2854 DF = 1 Chi-Square Significance = 0.6707. Statistic = 0.18077
Entameoba coli
Positive
Number 641 637 1278
Percent 43.9 45.7 44.8
Negative
Number 818 758 1576
Percent 56.1 54.3 55.2
N = 2854 DF = 1 Chi-Square Significance = 0.3532, Statistic = 0.86204
100
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Appendix III.2 Table V
Beni Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Drinking Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1125 OF = T
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
No
17
1.5
1094
98.5
Chi -Square Significance
40
3.6
1071
96.4
Chi-Square Significance
46
4.1
1065
95.9
Chi-Square Significance
54
4.9
1057
95.1
Chi-Square Significance
443
39.9
668
60.1
Yes
0
14
100
= 0.6409,
0
14
100
= 0.4697,
0
14
100
= 0.4369,
1
7.1
13
92.9
= 0.6939
8
57.1
6
42.9
Total
17
1.5
1108
98.5
Statistic = 0.21751
40
3.6
1035
96.4
Statistic = 0.52263
46
4.1
1079
95.9
Statistic = 0.60437
55
4.9
1070
95.1
, Statistic = 0.15439
451
40.1
674
59.9
N = 1125 DF = 1 Chi-Square Significance = 0.1901. Statistic = 1.7167
106
-------
Appendix 111.2 Table VI
Beni Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Bathing Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Ancvlostoma duodenale
Posi ti ve
number
Percent
Negative
Nurrber
Percent
li = 1125 DF = 1
Giardia lamblia
Positive
N umber
Percent
,'Jegative
IJumoer
Percent
,',' =1125 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N =1125 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
No
17
1.5
1094
98.5
Chi -Square Significance
40
3.6
1071
96.4
Chi -Square Significance
46
4.1
1065
95.9
Chi-Square Significance
54
4.9
1057
95.1
Chi-Square Significance
443
39.9
668
60.1
Yes
0
14
100
= 0.6409,
0
14
100
= 0.4697,
0
14
100
= 0.4369,
1
7.1
13
92.9
= 0.6939,
8
57.1
6
42.9
Total
17
1.5
1108
98.5
Statistic = 0.21751
40
3.6
1035
96.4
Statistic = 0.52263
46
4.1
1079
95.9
Statistic = 0.60437
55
4.9
1070
95.1
Statistic = 0.15489
451
40.1
674
59.9
N = 1125
DF = 1
Chi-Square Significance = 0.1901, Statistic = 1.7167
107
-------
Appendix III.2 Table VII
Beni Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Laundry Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
No
17
1.5
1094
98.5
Chi -Square Significance
40
3.6
1071
96.4
Chi -Square Significance
46
4.1
1065
95.9
Chi-Square Significance
54
4.9
1057
95.1
Chi-Square Significance
443
39.9
668
60.1
Yes
0
14
100
= 0.6409,
0
14
100
= 0.4697,
0
14
100
= 0.4369,
1
7.1
13
92.9
= 0.6939,
8
57.1
6
42.9
Total
17
1.5
1103
98.5
Statistic = 0.
40
3.6
10S5
96.4
Statistic = 0.
46
4.1
1079
95.9
Statistic = 0.
55
4.9
1070
95.1
Statistic - 0.
451
40.1
674
59.9
21751
52263
60437
15489
N = 1125
DF = 1
Chi-Square Significance = 0.1901. Statistic - 1.7167
108
-------
Appendix III.2 Table VIII
Beni Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Utensil Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Numoer
Percent
N = 1125 DF = 1
Ancvlostoma duodenale
Positive
Numoer
Percent
Negative
Number
Percent
N = 1125 DF = 1
Gnardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba histolytica
Posi five
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Ho
17
1.5
1094
93.5
Chi -Square Significance
40
3.6
1071
96.4
Chi -Square Significance
46
4.1
1065
95.9
Chi-Square Significance
54
4.9
1057
95.1
Chi-Square Significance
443
39.9
668
60.1
Chi-Square Significance
Yes
0
14
100
= 0.6409,
0
14
100
= 0.4697,
0
14
100
= 0.4369,
1
7.1
13
92.9
= 0.6939,
8
57.1
6
42.9
= 0.1901,
Total
17
1.5
1108
98.5
Statistic = 0.21751
40
3.6
1085
96.4
Statistic = 0.52263
46
4.1
1079
95.9
Statistic = 0.&0437
55
4.9
1070
95.1
Statistic = 0.154S9
451
40.1
674
59.9
Statistic = 1.7167
109
-------
Apoendix III.2 Table IX
Beni Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Drinking Water Piped Outside
Parasite
Ascaris lurnbricoides
Positive
N umber
Percent
Negative
Number
Percent
N = 1125 OF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1125 OF = 1
Giardia Iambi ia
Positive
Number
Percent
Negative
Number
Percent
U = 1125 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N =1125 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
Ho
11
1.3
814
98.7
Chi -Square Significance =
27
3.3
798
96.7
Chi-Square Significance =
40
4.8
785
95.2
Chi-Square Significance =
36
4.4
789
95.6
Chi-Square Significance =
312
37.8
513
62.2
Yes
6
2.0
294
98.0
0.4176,
13
4.3
237
95.7
0.3956,
6
2.0
294
98.0
0.0329,
19
6.3
281
93.7
0.1755,
139
46.3
161
53.7
Total
17
1.5
1108
98.5
Statistic = 0.65699
40
3.6
1085
96.4
Statistic = 0.72168
46
4.1
1079
95.9
Statistic = 4.5517
55
4.9
1070
95.1
Statistic = 1.8356
451
40.1
674
59.9
N = 1125 DF = 1 Chi-Square Significance = 0.0100. Statistic = 6.C417
110
-------
Appendix III.2 Table X
Beni Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Bathing Water Piped Outside
Parasite No Yes Total
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N =1125 OF = 1
13
1.6
819
98.4
Chi-Square Significance
4
1.4
289
98.6
= 0.8118,
17
1.5
1108
98.5
Statistic = 0.56684 -1
Ancylostoma duodenale
POST tive
Number 27 13 40
Percent 3.2 4.4 3.6
Negative
Uumoer 805 280 1085
Percent 96.8 95.6 96.4
fj = 1125 OF =_ 1 Chi-Square Significance = 0.3435. Statistic = 0.89735
Giardia lamblia
POST tive
Number 41 5 46
Percent 4.9 1.7 4.1
Negative
Number 791 288 1079
Percent 95.1 98.3 95.9
N = 1125 DF = 1 Chi-Square Significance = 0.0166, Statistic = 5.7339
Entameoba histolytica
Postive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entaneoba coli
Positive
Number
Percent
Negative
Number
Percent
N - 1125 DF = 1
37
4.4
795
95.6
Chi-Square Significance
318
33.2
514
61.8
Chi-Square Significance
18
6.1
275
93.9
= 0.2469
133
45.4
160
54.6
= 0.312,
55
4.
1070
95.
, Statistic =
451
40.
674
59.
Statistic = 4
9
1
1.3408
1
9
.6399
111
-------
Appendix III.2 Table XI
Bern' Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Laundry Water Piped Outside
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1125 OF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N =1125 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
No
13
1.5
847
98.5
Chi -Square Significance
27
3.1
833
96.9
Chi -Square Significance
41
4.8
819
95.2
Chi-Square Significance
39
4.5
821
95.5
Chi-Square Significance
324
37.7
536
62.3
Yes
4
1.5
261
98.5
= 0.9980,
13
4.9
252
95.1
= 0.1746,
5
1.9
260
98.1
= 0.0384,
16
6.0
249
94.0
= 0.3212,
127
47.9
138
52.1
Total
17
1.5
1108
98.5
Statistic = 0.65'J18 -5
40
3.6
1085
96.4
Statistic = 1 .8427
46
4.1
1079
95.9
Statistic = 4.2865
55
4.9
1070
95.1
Statistic = 0.98397
451
40.1
674
59.9
N = 1125
DF = 1
Chi-Square Significance = 0.0029, Statistic = 8.8617
112
-------
Appendix III.2 Table XII
Bern' Suef. Percent Prevalence of Selected Parasites by Type of
Water Supply: Utensil Water Piped Outside
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1125 DF = 1
Entameoba coli
Positive
Number
Pe rcent
Negative
Number
Percent
N = 1125 DF = 1
No
13
1.5
863
98.5
Chi-Square Significance
27
3.1
849
96.9
Chi-Square Significance
41
4.7
835
95.3
Chi-Square Significance
39
4.5
837
95.5
Chi-Square Significance
331
37.8
545
62.2
Chi-Square Significance
Yes
4
1.6
245
98.4
= 0.8889
13
5.2
236
94.8
= 0.1078
5
2.0
244
98.0
= 0.0602
16
6.4
233
93.6
=0.2025,
120
48.2
129
51.8
= 0.0031
Total
17
1.5
1108
98.5
, Statistic = 0.19520 -1
40
3.6
1085
96.4
, Statistic = 2.5862
46
4.1
1079
95.9
, Statistic = 3.5307
55
4.9
1070
95.1
Statistic = 1.6242
451
40.1
674
59.9
, Statistic = 8.7438
113
-------
Appendix 111.3 Table I
Aswan: Percent Prevalence of Selected Parasites by Latrine
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1715 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1715 DF = 1
Hymenolepis nana
Positive
Number
Percent
Negative
Number
Percent
N = 1715 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1715 DF = 1
Latrine
Present Absent
43
3.9
1061
96.1
13
2.1
598
97.9
Chi -Square Significance = 0.0486,
3
0.3
1101
99.7
2
0.3
609
99.7
Chi-Square Significance = 0.8389,
63
5.7
1041
94.3
29
4.7
582
95.3
Chi-Square Significance = 0.3980,
120
10.9
984
89.1
39
6.4
572
93.6
Chi-Square Significance = 0.0022,
Total
56
3.3
1659
96.7
Statistic = 3.8891
5
0.3
1710
99.7
Statistic = 0.41817-1
92
5.4
1623
94.6
Statistic = 0.71432
159
9.3
1556
90.7
Statistic = 9.4124
114
-------
III.3 Table I (continued)
Parasite
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1715 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 1715 DF * 1
Latrine
Present Absent
80
7.2
1024
92.8
32
5.2
579
94.8
Chi-Square Significance = 0.1068,
411
37.2
693
62.8
192
31.4
419
68.6
Chi-Square Significance = 0.0159,
Total
112
6.5
1603
93.5
Statistic = 2.6008
603
35.2
1112
64.8
Statistic = 5.8125
115
-------
Appendix III.3 Table II
Aswan. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in"Drinking Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 169S OF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1693 DF = 1
Giardia lanblia
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba histolytica
Positive
Humber
Percent
Negative
Number
Percent
N = 1693 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
No
33
2.2
1493
97.8
Chi -Square Significance
5
0.3
1521
99.7
Chi -Square Significance
124
8.1
1402
91.9
Chi -Square Significance
80
5.2
1446
94.8
Chi -Square Significance
504
33.0
1022
67.0
Chi -Square Significance
Yes
16
9.3
156
90.7
= 0.0000,
0
172
100
= 0.4522,
24
14.0
148
86.0
= 0.0102,
16
9.3
156
90.7
= 0.289,
81
47.1
91
52.9
= 0.0002,
Total
49
2.
1649
•97.
Statistic =
5
0.
1693
99.
Statistic =
148
8.
1550
91.
Statistic =
96
5.
1602
94.
9
1
28.118
3
7
0.56523
7
3
6.5981
7
3
Statistic = 4.7765
585
34.
1113
65.
Statistic =
5
5
13.542
116
-------
Appendix III.3 Table III
Aswan, percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Bathing Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N =1698 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1693 DF = 1
Entameoba histolytica
Positive
Numbe r
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entaneoba coli
Positive
Number
Percent
Negative
Number
Percent
f{ = 1698 DF = 1
Ho
33
2.9
1495
97.8
Chi -Square Significance
5
0.3
1523
99.7
Chi-Sauare Significance
124
8.1
1404
91.9
Chi-Square Significance
80
5.2
1448
94.8
Chi-Square Significance
505
33.0
1023
67.0
Chi-Square Significance
Yes
16
2.2
154
90.6
= 0.0000,
0
170
100
= 0.4551,
24
14.1
146
85.9
= 0.0085,
16
9.4
154
90.6
= 0.0253,
80
47.1
90
52.9
= 0.0003,
Total
49
9.4
1649
97.1
Statistic = 28.709
5
0.3
1693
99.7
Statistic = 0.
148
8.7
1550
91.3
Statistic = 6.
96
5.7
1602
94.3
Statistic = 5.
585
34.5
1113
65.5
Statistic = 13
55793
9273
0019
.295
117
-------
Appendix 111.3 Table IV
Asv»an. Percent Prevalence of Selected Parasites by Type of
Water Supply: Piped-in Laundry Water
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Ancy 1 p s toma d uode na 1 e
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
No
33
2.2
1495
97.8
Chi-Square Significance
5
0.3
1523
99.7
Chi-Square Significance
124
8.1
1404
91.9
Chi-Square Significance
80
5.2
1448
94.8
Chi-Square Significance
505
33.0
1023
65.5
Chi-Square Significance
Yes
16
9.4
154
90.6
= 0.0000,
0
170
100
= 0.4551,
24
14.1
146
85.9
= 0.0085,
16
9.4
154
90.6
= 0.0253,
80
47.1
90
67.0
= 0.0085,
Total
49
2.
1649
97.
Statistic =
5
0.
1693
99.
Statistic =
148
8.
1550
91.
Statistic =
96
5.
1602
94.
Statistic =
585
34.
1113
52.
Statistic =
9
1
28.709
3
7
0.55793
7
3
6.9275
7
3
5.0019
5
9
13.295
118
-------
Appendix III.3 Table V
Aswan. Percent Prevalence of Selected Parasites by Type of
Water Supply: Water Piped in for Utensils
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N = 1693 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
M - 1698 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
No
33
2.2
1495
97.8
Chi -Square Significance
5
0.3
1523
99.7
Chi -Square Significance
124
8.1
1404
91.9
Chi-Square Significance
80
5.2
1448
94.8
Chi-Square Significance
505
33.0
1023
67.0
Chi-Square Significance
Yes
16
9.4
154
90.6
= 0.0000
0
170
100
= 0.4551
24
14.1
146
85.9
= 0.0085
16
9.4
154
90.6
= 0.253,
80
47.1
90
52.9
= 0.0003
Total
49
2.
1649
97.
, Statistic =
5
0.
1693
99.
, Statistic =
148
8.
1550
91.
, Statistic =
96
5.
1602
94.
Statistic = 5
5S5
34.
1113
65.
, Statistic =
9
1
28.709
3
7
0.55793
7
3
6.9275
7
3
.0019
5
5
13.295
119
-------
Appendix III.3 Table VI
Aswan. Percent Prevalence of Selected Parasites by Tyfe of
Mater Supply: Drinking Mater Pined Outsl'te
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Numbe r
Percent
N = 1638 DF = 1
Ancylostoma duodenale
Positive
Number
Percent
Negative
Number
Percent
N =1698 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N =1698 DF = 1
No
25
3.1
789
96.9
Chi -Square Significance
2
0.2
812
99.8
Chi -Square Significance
79
9.7
735
90.3
Chi -Square Significance
59
7.2
755
92.8
Chi-Square Significance
308
37.8
506
62.2
Chi-Square Significance
Yes
24
2.7
860
97.3
= 0.6613,
3
0.3
881
99.7
= 0.7219,
69
7.8
815
92.2
= 0.1656,
37
4.2
847
95.8
= 0.0063,
277
31.3
607
68.7
= 0.0048,
Total
49
2.9
1649
97.1
Statistic = 0.19199
5
0.3
1693
99.7
Statistic = 0.12664
148
8.7
1550
91.3
Statistic = 1.9222
96
5.7
1602
94.3
Statistic = 7.4520
585
34.5
1113
65.5
Statistic = 7.9358
120
-------
Appendix III.3 Table VII
Aswan. Percent Prevalence of Selected Parasites by Type of
Water Supoly: Bathino Water Pippd Outsit
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Ancylostoma duodenal e
Positive
Numoer
Percent
Negative
Number
Percent
N = 1698 DF = 1
Giardia lamblia
Positive
Number
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba histolytica
Positive
Number
Percent
Negative
Number
Percent
N = 1698 OF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N = 1693 DF = 1
No
25
3.0
796
97.0
Chi -Square Significance
2
0.2
819
Chi-Square Significance
79
9.6
742
90.4
Chi-Square Significance
59
5.7
762
92.8
Chi-Square Significance
309
37.5
512
62.4
Chi-Square Significance
Yes
24
2.7
853
97.3
= 0.7044,
3
0.3
874
= 0.7082,
69
7.9
808
92.1
= 0.2002,
37
7.2
840
95.8
= 0.0082,
276
31.5
601
68.5
= 0.0075.
Total
49
2.9
1649
97.1
Statistic = 0.14397
5
0.3
1693
Statistic = 0.14004
148
8.7
1550
91.3
Statistic = 1.6408
96
4.2
1602
94.3
Statistic = 7.0002
585
34.5
1113
65.5
Statistic = 7.1392
121
-------
Appendix III.3 Table VIII
Aswan. Percent Prevalence of Selected Parasites by Type of
Water Supply: Laundry Water Piped Outside
Parasite
Ascaris lumbricoides
Positive
Number
Percent
Negative
Number
Percent
fl = 1693 DF = 1
Ancylostoma duodenal e
Positive
Uumbe r
Percent
Negative
Number
Percent
fi = 1693 DF = 1
Giardia Iambi ia
Positive
Number
Percent
Negative
Number
Percent
N =1698 DF = 1
Entameoba histolytjca
Positive
N umbe r
Percent
Negative
Number
Percent
N = 1698 DF = 1
Entameoba coli
Positive
Number
Percent
Negative
Number
Percent
N =1698 DF = 1
No
25
3.0
796
97.0
Chi-Square Significance
2
0.2
819
99.8
Chi-Square Significance
79
9.6
742
90.4
Chi-Square Significance
59
7.2
762
92.8
Chi-Square Significance
309
37.6
512
62.4
Chi-Square Significance
Yes
24
2.7
853
97.3
= 0.7044,
3
0.3
874
99.7
= 0.7032,
69
7.9
808
92.1
= 0.2002,
37
4.2
840
95.8
= 0.0082,
276
31.5
601
68.5
= 0.0075,
Total
49
2.9
1649
97.1
Statistic = 0.14397
5
0.3
1693
99.7
Statistic = 0.14004
148
8.7
1550
91.3
Statistic = 1.6409
96
5.7
1602
94.3
Statistic = 7.0002
585
34.5
1113
65.5
Statistic = 7.1392
122
-------
Appendix III.3 Table IX
Aswan. Percent Prevalence of Selected Parasites by Type of Water
Siinnly: Utensil UHer Piped Outside
Parasite No Yes Total
Ascans lumbricoides
Positive
Number
Percent
Negative
Number
Percent
N = 1698 OF = 1
25
3.0
796
97.0
Chi-Square Significance
24
2.7
853
97.3
= 0.7044,
49
2.9
1649
97.1
Statistic = 0.14397
Ancylostoma duodenale
Positive
Number 23 5
Percent 0.2 0.3 0.3
Negative
Number 819 874 1693
Percent 99.8 99.7 99.7
N = 1698 DF = 1 Chi-Square Significance = 0.7082, Statistic = 0.14004
Giardia lamblia
Positive
Number
Percent
Negati ve
Number
Percent
N = 1698 DF = 1
79
9.6
742
90.4
Chi-Square Significance
69
7.9
808
92.1
= 0.2002,
148
8.7
1550
91.3
Statistic - 1.6409
Entameoba histolytica
Positive
Number 59 37 96
Percent 7.2 4.2 5.7
Negati ve
Number 762 840 1602
Percent 92.8 95.8 94.3
N =1693 Of = 1 ^Chi-Square Significance - 0.0082, Statistic * 7.00D2
Entameoba coli
Posi ti ve
Number
Percent
Negati ve
Number
Percent
N = 1698 OF * 1
309
37,
512
62.
.6
,4
Chi-Square Significance
276
31
601
68
* 0.
.5
.5
0075,
585
34
1113
65
Statistic =
.5
.5
7.
,1392
123
-------
APPENDIX IV. 1
TABLE I
Construction Material of House, Raw
Counts, for Beni Suef and Kafr El Sheikh
Study site code
Beni Suef
Material
Stone or red
Brick
Mud Brick
Wood or Reed
Mud and red
Brick
11
B
95
0
2
12
22
123
1
55
13
5
120
1
81
14
8
181
0
8
15
8
11?
0
65
Kef r El
16
51
139
0
7
17
9
182
0
2
18
20
161
0
5
Sheikh
19
46
141
0
10
20
25
152
3
35
Mud Brick and
Wood or Reed
Ko information
Total
107 201 212 197 199
02500
199 199 191 197 215
TABLE II
Structure Attachment of House, Raw
Counts, for Beni Suef and Eafr El Sheikh
Study site code
Beni Suef Kafr El Sheikh
Attachment 11 12 13 14 15 16 17 18 19 20
Detached
One Side only
Two Sides
Three Sides
21343
10 10 41 10 8
50 51 117 61 43
42 139 50 122 144
No information 30101
Total 107 201 212 197 199
17 0 17 33 17
42 8 29 70 26
124 57 99 91 168
15 125 43 3 0
19304
199 199 191 197 215
124
-------
APPENDIX IV.1
TABLE III
.Number of houses with Painted walls,
Raw Counts, for Beni Suef and Kafr El Sheikh
Painted
Exterior
Interior
None
Exterior and
Interior
No information
Total
11
4
8
82
13
0
10?
Study Bite code
Beni Suef
12 1J 14 15 16
1
27
148
23
2
201
4
16
19
166
7
212
4
6
168
18
1
197
2
14
124
54
5
199
3
36
152
8
0
199
Kafr El
1? 18
7
21
163
6
2
199
11
32
120
25
3
191
Sheikh
19 20
6
57
109
22
3
197
9
25
177
3
1
215
IV. 1 TABLE IV
Number of Houses with Staircase, Raw
Counts, for Beni Suef and Kafr El Sheikh
Staircase
Fixed
Mobile
None
11
72
12
18
Study site code
Beni Suef Kafr El
12 13 14 15 16 1? 18
152
15
31
138
12
55
102
20
69
119
48
28
132
57
3
180
8
10
87
59
35
Sheikh
19 20
16
151
28
119
68
20
No infornation 53764
Total 1O7 201 212 197 199
7 1 10 2 8
199 199 191 197 215
125
-------
APPENDIX IV.1
TABLE
Number of Houses by Type of Roof Material,
Raw Counts, for Beni Suef and Kafr El Sheikh
Roof
Material
Reed and Mud
Wood, Reed and
Mud
Concrete
Wood
Reed
Mud
Concrete and Wood
Concrete and Reed
Concrete and Mud
Concrete, Wood
and Reed
Wood and Reed
No information
11
34
1
3
10
9
40
0
0
0
0
7
0
Total 10?
Study Bite
Beni Suef
12 13 14 15
60
6
1
23
81
6
0
0
0
0
23
0
201
20
0
3
43
22
1
6
0
0
0
105
1
212
0
0
2
143
31
0
0
0
0
0
19
0
197
15
109
1
1
9
3
0
1
1
0
6
1
199
code
16
0
158
24
3
0
2
2
0
0
2
4
0
199
Kafr
17
0
6
10
7
1
0
0
0
0
0
174
0
199
El
18
38
45
17
4
1
0
1
1
0
1
57
1
191
Sheikh
19
0
0
27
9
4
0
6
1
0
0
149
0
197
20
1
1
17
5
4
173
0
2
10
0
0
0
215
IV.1
TABLE VI
Number-of Rouses by Roof condition. Raw
Counts, for Beni Suef and Kafr El Sheikh
Roof
Condition
11
Study site code
Beni Suef Kafr El Sheikh
12 15 14 15 16 1? 18 19 20
Permeable 41 13 90 161 10
Son-permeable 56 18? 119 29 162
Ho information 10 1 3 7 27
Total 10? 201 212 19? 199
170 195 156 165 170
22 3 32 22 25
7 1 3 10 20
199 199 191 197 215
126
-------
APPENDIX IV. 1 TABLE VII
Number of Houses by Storage location of Cooking and
Heating Feul, Raw Counts, for Beni Suef and Kafr El Sheikh
Storage
of Fuel
Materials
None present
Roof
Stable
Storage Room
Yard
Bo of and Stor-
age Room
Roof and Yard
No information
11
4
88
4
0
8
1
1
1
Total 107
IV. 1
Study site
Beni Suef
12 13 14 15
1
178
5
1
17
1
0
0
201
2
168
9
0
31
0
1
1
212
1
145
0
0
51
0
0
0
197
2
190
1
0
4
1
0
1
199
code
16
0
199
0
0
0
0
0
0
199
Kafr El
17 18
0
195
1
0
3
0
0
0
199
1
18?
2
4
0
0
0
1
191
Sheikh
19 20
0
187
1
5
4
0
0
0
197
0
203
3
1
8
0
0
0
215
TABLE VIII
Dumber of Houses
Raw Counts, for
Floor
Construction
Tile and Wood
Earth
Concrete
Tile
Wood
Earth and
Concrete
Earth and Tile
Earth and Wood
by Type of Floor Construction,
Beni Suef and Kafr El Sheikh
Study site
Beni Suef
11
0
91
4
5
2
0
2
0
Earth, Concrete,
Tile 0
No information
3
12
0
162
1
11
0
1
13
0
1
12
13
0
185
0
6
0
5
14
0
0
2
14
0
179
2
8
1
0
6
0
0
1
15
0
157
0
12
0
1
28
0
0
1
code
16
3
172
4
13
1
0
1
1
2
2
Kafr El
17
0
194
2
1
0
1
0
0
0
1
18
1
170
2
9
0
2
4
0
0
3
Sheikh
19
8
161
1
18
1
2
0
1
1
4
20
0
204
3
3
1
2
0
1
1
0
Total 107 201 212 197 199 199 199 191 197 215
127
-------
APPENDIX IV.) TABLE IX
Number of Houses by the number of windows, Haw Counts,
for Beni Suef and Eafr El Sheikh
Number of
Windows
1
2
3
4
5
6
7
8
9
10 or more
No information
Total
TV. I
11
29
27
9
13
4
10
0
0
1
2
12
107
Study site code
Beni Suef Kafr El Sheikh
12 13 14 15 16 1? 18 19 20
54
31
26
19
9
4
0
2
1
2
53
201
43
47
44
28
9
10
3
3
0
3
22
212
63
33
14
8
6
1
1
2
1
1
67
197
50
47
40
16
9
4
0
0
0
0
33
199
2
7
14
70
48
18
23
13
2
2
0
199
59
63
26
13
7
5
0
1
0
1
24
199
12
36
35
41
13
19
14
6
5
5
5
191
12
29
26
56
30
17
18
3
2
4
0
197
3^
35
36
29
20
18
9
12
2
15
5
215
TABLE X
Number of Houses by Type of Lighting, Raw Counts,
for Beni Suef and Kafr El Sheikh
Lighting
Electricity
Kerosene
Other
Electricity
and Kerosene
11
30
71
1
1
Study site
Beni Suef
12 13 14 15
^5
149
2
0
67
142
1
0
0
195
1
0
73
123
2
0
code
16
100
95
0
4
Kafr El
17 18
14
176
0
9
58
130
0
0
Sheikh
19 20
4
192
1
0
0
213
2
0
No information 45211 00300
Total 10? 201 212 197 199 199 199 191 197 215
128
-------
APPENDIX IV.1 TABLE XI
Number of Houses with Television, Raw Counts,
for Beni Suef and Kafr El Sheikh
Study site code
Beni Suef Eafr El Sheikh
Television 11 12 13 14 15 16 1? 18 19 20
Present 4 5 5 1 7 64951
Not Present 95 172 201 195 190 193 192 177 192 214
No information 10 24 612 03500
Total 107 201 212 197 199 199 199 191 197 215
IV. I TABLE XII
Number of Houses by Number of Rooms in House,
Raw Counts, for Beni Suef and Kafr El Sheikh
Number of Rooms
in House 11
1
2
3
4
5
6
7
8 or more
No information
12
29
16
21
10
7
0
6
6
Study Bite code
Beni Suef Zafr El Sheikh
12 13 14 15 16 17 18 19 20
48
47
41
21
14
8
7
9
6
26
55
61
29
16
9
7
6
3
64
51
46
16
9
4
4
2
1
1
15
32
48
56
27
16
22
2
3
60
94
34
5
2
1
0
0
58
69
43
17
2
2
1
2
5
4
34
44
50
20
14
10
12
5
3
5
15
18
24
47
65
20
0
8
38
43
48
20
30
9
19
0
Total 107 201 212 197 199 199 199 191 197
129
-------
APPENDIX IV.1
TABLE XIII
Number of Houses by Nuaber of Occupants in House,
Raw Counts, for Beni Suef and Kafr El Sheikh
Number of
Occupants
1
2
3
4
5
6
7
8
9
10 or more
11
5
5
7
15
25
13
10
7
7
12
Ho information 1
Total
IV. 1
107
Study site code
Beni Suef Kafr El Sheikh
12 13 14 15 16 17 16 19 20
10
18
22
23
23
24
24
11
13
31
2
10
16
24
18
27
33
19
26
12
25
2
201 212
30
36
24
31
26
20
14
7
5
2
2
197
10
14
18
54
25
24
21
12
16
19
6
199
6
28
35
26
38
25
27
8
4
2
0
199
6
15
29
35
31
23
1?
12
17
4
0
199
1
6
9
17
11
25
22
20
13
65
2
191
17
33
23
30
21
27
8
14
9
7
8
197
8
38
26
31
J4
26
18
15
11
7
1
215
TABLE XIV
Number of Houses by Presence and Location
of Stable, Raw Counts, for Beni Suef and
Kafr El Sheikh
Stable
Inside
Outside
None
11
69
5
31
Beni Suef
12 13 14
148
3
46
130
10
69
66
5
102
Study
15
184
3
10
site code
Kafr El
16 17 18
150
6
39
140
5
18
120
15
52
Sheikh
19 20
105
8
82
14?
9
42
No information 44322
Total 107 201 212 197 199
4 J6 4 2 7
199 199 191 197 215
130
-------
APPENDIX I V.I TABLE XV
Number of Houses with Waste Container, Raw
Counts, for Beni Suef and Kafr El Sheikh
Wcste
Container
Yes
No
No information
Total
IV. 1
Beni Suef
11
2
95
10
107
12
29
170
2
201
13
2
209
1
212
14
1
191
5
197
Study site code
Kafr El
15
0
198
1
199
16
4
194
1
199
17
3
193
3
199
18
6
179
6
191
Sheikh
19
3
191
3
197
20
60
139
16
215
TABLE XVI
Number of
waste, Raw
Aninal
Waste
Material
Stable
Yard
Street
Canal
Roof
None
No information
Houses by
Counts,
method of disposal of
for Beni Suef and Kafr
Study site
Beni Suef
11
10
-12
n
3
58
14
3
12
1
2
9
0
60
115
14
1?
98
1
9
2
0
98
4
14
i
2
1
0
83
107
3
15
-;o
28
0
7*
72
2
code
16
3
0
171
1
0
13
11
animal
El Sheikh
Kafr El
17
1
1
144
0
0
19
34
18
0
9
62
42
5
67
6
Sheikh
19
3
2
17
86
2
85
2
20
89
2
26
1
1
80
16
Total 107 201 212 197 199 199 199 191 197 215
131
-------
APPENDIX IV.1 TABLE XVII
Number of Houses "by Type of Cooking Fuel, Raw
Counts, for Ben Suef and Kafr El Sheikh
Cooking
Fuel
Wood and Dung
Oil, Wood and
Dung
Gas
Oil
Wood
Dung
Gas and Oil
Gas and Wood
Gas and Dung
Gas, Oil, and
Wood
Oil and Wood
No information
Total
IV. 1
11
5
0
6
10
4
74
0
1
0
0
1
6
107
Study site
Beni Suef
12 13 14 15
14
8
3
41
0
70
1
1
0
0
16
47
201
0
0
1
1
0
143
3
0
5
0
0
59
212
83
0
2
29
73
1
0
3
0
0
3
3
197
72
24
0
6
3
87
0
1
0
1
1
4
199
code
16
27
109
0
8
5
0
0
0
0
2
27
21
199
Kafr El Sheikh
1? 18 19
22
53
1
5
5
27
0
0
1
0
74
11
199
40
34
2
4
2
2
0
2
0
0
38
67
191
57
0
0
1
0
4
0
1
0
0
126
8
197
20
1
0
2
21
1
16
2
0
1
0
0
171
215
TABLE XVIII
Number of
Raw Counts
Stable
Cleaning
Daily
Weekly
Monthly
Never
No information
Total
11
82
4
0
18
3
107
Houses
, for
Beni
Cleaning
Suef and
Study site
Beni Suef
12 13 14 15
101
32
18
30
20
201
86
34
25
2
65
212
41
46
1
6
102
197
63
80
36
11
9
199
of Stable
Kafr El
code
16
174
2
0
2
20
199
Sheikh
Kafr El Sheikh
17 18 19
140
2
2
9
46
199
118
19
0
35
19
191
110
0
1
82
2
197
20
147
29
0
17
21
215
132
-------
APPENDIX IV.1
TABLE XIX
Number of Houses by Type of Approach, Raw
Counts, for Beni Suef and Kafr El Sheikh
House
Approach
lion-earth:
Clean
Littered
Dry
Wet
Earth:
Clean
Littered
Dry
Wet
No information
Total
11
46
0
60
0
0
0
0
0
1
107
Study site code
Beni Suef
12 13 14 15 16
84
0
1
2
15
0
0
0
99
201
207
0
2
0
1
1
0
0
1
212
178
1
12
1
0
0
0
0
5
197
68
0
96
34
0
0
0
0
1
199
166
9
12
10
1
0
0
0
1
199
Kafr Zl
17 18
1
0
175
7
0
0
0
1
15
199
163
0
5
20
1
0
0
0
2
191
Sheikh
19 20
1
0
2
0
0
0
0
0
194
197
26
6
179
0
0
0
1
0
3
215
IV.I
Ownership
TABLE
XX
Number of Houses Owned and Rented, Raw Counts,
for Beni Suef and Kefr El Sheikh
11
Study site code
Beni Suef Kafr El Sheikh
12 13 14 15 16 17 18 19 20
Own 2 15 2 4 12
Rent 96 179 207 1^9 185
No information 9734-2
Total 107 201 212 197 199
4 2 9 19 2
195 192 179 163 199
0 5 3 15 4
199 199 191 197 215
133
-------
APPENDIX IV.1
TABLE XXI
Storage of Water by Number of Houses,
Eaw Counts, for Beni Suef and Kafr El Sheikh
Material
Metal
Earthenware
Ceramic
Metal and
Ceramic
Metal and
Earthenware
No information
Total
IV. 1
11
1
107
0
0
0
2
110
Study site code
Beni Suef
12 1J 14 15 16
0
193
0
0
0
0
193
0
209
1
1
0
1
212
0
197
0
0
0
0
197
0
192
1
0
1
3
197
2
186
0
11
0
0
199
Kafr El
1? 18
1
189
8
0
0
1
199
3
166
0
0
0
1
190
Sheikh
19 20
2
195
0
1
0
1
199
2
215
1
0
0
0
218
TABLE XXII
Wastewater
Raw 'Counts,
Material
Concrete
Pipe
Brick
Tile
Earth
Other
Ho information
11
0
2
2
1
102
1
2
Drainage by Number
for Beni Suef and
Beni
12 13
0
1
0
0
188
2
2
6
1
0
2
193
7
3
Suef
14
0
2
0
0
15
180
0
of Houses,
Kafr El Sheikh
Study site code
Kafr El
15 16 1? 18
1
0
0
0
0
190
6
0
10
98
5
86
0
0
2
0
0
0
0
193
4
5
0
2
7
173
1
2
Sheikh
19 20
2
1
0
0
195
0
1
4
42
1
1
160
9
1
Total
110 193 212 197 197
199 199 190 199 218
134
-------
APPENDIX IV.1
TABLE XXIII
Number of Houses with Latrin,
Raw Counts, for Beni Suef and
Kafr El Sheikh
Latrine
11
Study site code
Beni Suef Kafr El Sheikh
12 1? 14 15 16 1? 18 19 20
Present 22 54 51 35 119
Not Present 69 112 159 160 12
No information 19 2? 2 2 66
Total 110 193 212 197 197
196 154 151 147 196
3 23 37 16 19
0 22 2 36 3
199 199 190 199 218
IV.I
TABLE XXIV
Number of Houses Using Latrine,
Raw Counts, for Beni Suef and
Kafr El Sheikh
Latrine Use
11
Study site code
Beni Suef Kafr El Sheikh
12 13 14 15 16 1? 18 19 20
Yes 24 52 49 33 119
No 31 100 159 54 7
No information 55 41 4 110 71
Total 110 193 212 197 197
195 153 149 122 199
4 13 38 52 16
0 33 3 25 3
199 199 190 199 218
APPENDIX IV.I
TABLE XXV
Number of Houses with Covered Latrine,
Raw Counts, for Beni Suef and Kafr El Sheikh
Latrine Cover 11
Study site code
Beni Suef Kafr El Sheikh
12 13 14 15 16 17 18 19 20
Yes 7 49 48 10 11?
No 38 100 159 61 6
No information 65 44 5 126 74
Total 110 193 212 197 197
157 145 150 4 193
41 20 37 162 19
1 34 3 53 6
199 199 190 199 218
135
-------
IV.1
TABLE XXVI
Latrine Type by Number of Houses,
Raw Counts, for Beni Suef and
Kafr El Sheikh
Latrine Type
Borehole
Pit
Masonry Walls
Pit and Masonry
11
2
1?
2
0
Study site code
Beni Suef
12 13 14 15 16
0
54
3
0
0
38
15
0
4
6
24
0
1
114
1
0
3
144-
54
0
Kafr El Sheikh
1? 18 19 20
1
93
39
9
19
116
1?
0
10
60
76
0
13
157
34
1
Walls
No information 89 136 159 163
81
Total
110 193 212 197 197
18 57 38 53 13
199 199 190 199 218
APPENDIX IV.I
TABLE XXVII
Presence of Water Carriage in Latrine by Number
of Houses, Raw Counts, for Beni Suef and Kafr El Sheikh
Water Study site code
Carriage in Beni Suef Kafr El Sheikh
Latrine 11 12 13 14 15 16 17 18 19 20
Yes 01100
No 52 155 56 79 118
No information 58 37 155 118 79
Total 110 193 212 197 197
00110
194 158 179 174 217
5 41 10 23 1
199 199 190 199 218
TABLE XXVI11
Number of Houses with Septic Tank, Raw
Counts, for Beni Suef and Kafr El Sheikh
Septic
Tank
11
Study site code
Beni Suef Kafr El Sheikh
12 13 14 15 16 17 18 19 20
Yes 06600
No 52 149 51 78 118
No information 58 38 155 119 79
Total 110 193 212 197 19?
20110
192 158 183 177 217
5 41 6 21 1
199 199 190 199 218
136
-------
APPENDIX IV. 1 TABLE XXIX
Number of Houses with Cesspool, Raw
Counts, for Beni Suef and Kafr El Sheikh
Study site code
Beni Suef
Cesspool
Yes
No
No information
Total
11
0
52
58
110
12
21
136
36
193
13
4
5^
154
212
14
6
70
121
19?
15
1
116
80
197
Kafr El
16
32
162
5
199
17
13
14J
43
199
18
135
49
6
190
Sheikh
19
13
163
23
199
20
2
216
0
218
I V.I TABLE XXX
Latrine Location by Number of Houses,
Raw Counts, for Beni Suef and Kafr El Sheikh
Latrine
Location
Inside
Outside
Stable
No information
Total
11
16
2
0
92
110
Study site code
Beni Suef
12 13 14 15 16
42
2
0
149
193
50
4
0
158
212
32
3
0
162
197
116
2
0
79
197
188
1
2
8
199
Kafr El
17 18
142
9
0
48
199
150
1
0
39
190
Sheikh
19 20
143
12
0
44
199
5
206
0
7
218
APPENDIX IV. I TABLE XXXI
Number of Houses with Latrine Superstructure,
Raw Counts, for Beni Suef and Kafr El Sheikh
Latrine Study site code
Super- Beni Suef Kafr El Sheikh
Structure 11 12 13 1* 15 16 17 18 19 20
Yes 251 22 0 41340
No 18 146 50 54 117 190 154 179 174 218
No information 90 42 161 121 80 5 44 8 21 0
Total 110 193 212 197 197 199 199 190 199 218
137
-------
APPENDIX IV.2
TABLE I
Number of Houses by Construction Material,
Raw Counts, for Aswan and New Nubia
Construction
Material
Stone or
Redbrick
Mud Brick
Wood or Reed
Hud and Red
Brick
Red Brick,
Wood or Reed
Red Brick,
Mud Brick,
Wood or Reed
Mud Brick,
Wood or Reed
1
20
150
1
17
0
1
0
No information 3
Total
192
Aswan
2 3
19
27
0
178
0
0
0
0
224
77
2
0
40
2
-I
1
0
123
Study site code
New Nubia
4 10 5678
0
185
0
2
0
0
0
23
210
5
181
3
0
0
0
0
2
191
187
9
0
0
0
0
0
2
198
192
7
0
1
0
c
0
2
202
190
7
0
2
1
0
0
0
200
200
0
0
0
0
0
0
1
201
9
198
1
0
0
0
0
0
1
200
TABLE II
Number of Houses by Structure
Raw Counts, for Aswan and New
Structure
Attachment
Detached
1
15
One Side only 73
Two Sides
Three Sides
69
10
No Information25
Total
192
Aswan
2 3
12
55
89
68
0
224
5
16
42
60
0
123
Study site
4 10
18
72
80
12
28
210
6
27
105
53
0
191
Attachment,
Rubia
code
5
2
8
62
123
3
198
New Nubia
678
1
2
28
168
3
202
7
10
52
131
0
200
2
14
62
122
1
201
9
0
3
49
1*6
2
200
138
-------
APPENDIX IV.:
TABLE III
Number of Houses with Painted Walls,
Raw Counts, for Aswan and New Nubia
Fainted
Vails
Exterior
Interior
Kone
Exterior and
Interior
No information
Total
1
11
11
27
136
7
192
Aswan
? 3
5
14
52
151
2
224
32
64
4
23
0
123
Study site code
4 10 5
30
55
99
0
26
210
13
30
148
0
0
191
68
30
98
0
2
198
New Nubia
678
2
39
156
0
3
202
1
2
7
185
5
200
4
15
173
7
2
201
9
3
145
1
50
1
200
TABLE IV
Number of Houses with Staircase, Raw
Counts, for Aswan and New Nubia
Study site code
Aswan
Staircase
Fixed
Mobile
None
1
27
4
141
2
1.3
6
203
3
14
2
106
4
0
2
178
10
14
68
109
5
3
0
194
New Nubia
6
0
1
197
7
2
1
193
8
2
0
198
9
0
11
137
Ko information 20 0 1 30 0
Total 192 224 123 210 191
14412
198 202 200 201 200
139
-------
APPENDIX IV.2
TABLE V
Number of Houses by Type of Roof Material,
Raw Counts, for Aswan and New Nubia
Roof
Material
Reed and Mud
Wood, Reed and
Kud
Concrete
Wood
Reed
Kud
Concrete and
Wood
Concrete and
Mud
Concrete, Wood
and Reed
Wood and Reed
1
2
0
15
4
2
128
1
2
<
0
0
No information 38
Total
192
Aswan
2 3
13
0
7
9
14
164
1
1
0
5
10
224
37
30
1
1
3
50
0
0
0
0
1
123
Study site
4 10
1
0
2
8
5
171
0
0
0
0
23
210
0
0
2
2
183
4
0
0
0
0
0
191
code
5
0
0
188
5
3
1
0
0
0
0
1
198
New Eubia
678
0
0
190
1
3
4
1
0
0
0
3
202
3
2
173
1
0
0
8
1
3
2
7
200
0
0
191
3
2
0
0
0
0
0
5
201
9
0
0
192
2
0
0
1
0
0
0
5
200
TABLE VI
Number of Houses
Raw Counts, for
Roof
Condition
Permeable
Non-permeable
1
33
55
No information104
Aswan
2 3
91
132
1
89
32
2
by Condition
Aswan and New
Study site
4 10
180
6
24
174
15
2
of Roof,
Nubia
code
5
12
185
1
New Nubia
678
3
192
7
10
184
6
58
4
139
9
5
192
3
Total
192 224 123 210 191
198 202 200 201 200
140
-------
APPENDIX IV.? TA5LE VII
Number of Houses by Storage location of Cooking
and Keating Fuel, Raw Counts, for Aswan and New Nubia
Storage of
Fuel Material
Roof
Stable
Storage Room
Yard
Roof and
Storage Room
No information
Total
1
7
6
3
115
0
61
192
Aswan
2 3
24
23
7
168
1
1
224
9
19
76
19
0
0
123
Study site
4 10
99
53
30
4
0
24
210
16
53
63
?7
0
2
191
code
5
137
4
16
39
0
2
198
New Nubia
678
129
36
1
27
1
8
202
5
1
2
192
0
0
200
4
59
0
133
0
c
>
201
9
68
3
0
125
0
4
200
TABLE VIII
Number of
Raw Counts
Floor
Construction
Earth
Concrete
Tile
Wood
Earth and
Concrete
Earth and Tile
Earth and Wood
1
108
42
14
0
6
2
0
Earth, Concrete,
Tile 0
No Information 20
Total
192
Houses
, for
Aswan
2 3
60
2
12
1
56
42
0
45
6
224
112
0
0
0
0
0
10
0
1
123
by Type of Floor Construction,
Aswan and New Nubia
Study site
4 10
176
4
0
2
0
1
0
0
27
210
182
7
2
0
0
0
0
0
0
191
code
5
82
111
1
0
0
0
0
0
4
198
New Nubia
678
9
11
0
0
171
5
2
4
2
202
9
1
1
0
175
0
?
10
1
200
0
80
0
0
115
0
4
0
2
201
9
1
184
11
0
0
0
0
0
4
200
141
-------
APPENDIX IV.2
TABLE IX
Number of Houses by Number of Windows,
Raw Counts, for Aswan and New Nubia
Number
of Windows
1
2
3
4
5
6
7
6
9
10 or more
1
16
16
20
1?
8
4
1
1
3
4
No information102
Total
192
Aswan
2 3
22
36
29
25
16
21
3
9
0
5
58
224
0
15
3
33
18
29
1
9
0
1
14
123
Study site code
4 10 5
20
21
7
7
1
3
0
0
0
1
150
210
55
56
26
24
1
2
1
2
0
2
22
191
15
4-3
52
32
12
19
12
6
1
3
3
198
New Nubia
678
11
26
66
36
3
1?
31
2
1
0
9
202
25
58
37
38
7
1?
11
4
0
1
2
200
7
73
24
24
3
15
25
22
4
4
0
201
9
0
68
126
3
0
0
0
0
0
0
3
200
TABLE X
Number of
Raw Counts
Lighting
Electricity
Kerosene
Other
Electricity
and Kerosene
Kerosene and
Other
1
90
90
0
0
0
No information 12
Houses by Type
, for Aswan and
Aswan
2 3
179
44
1
0
0
0
55
52
0
9
7
0
of Lighting,
Hew Nubia
Study site code
4 10 5
85
99
1
0
0
25
27
164
0
0
0
0
77
118
0
0
0
3
New Nubia
678
79
120
0
0
0
3
21
131
3
43
1
1
108
93
0
0
0
0
9
113
83
1
0
0
3
Total
192 224 123 210 191
198 202 200 201 200
142
-------
APPENDIX IV.?
TABLE XI
Number of Houses with Televisions, Raw
Counts, for Aswan and New Nubia
iitudy site code
Aswan
Television 1 2 3 4- 10
New Nubia
56789
Present 9 36 1 6 5
Not Present 154 185 121 159 186
Wo information 29 3 1 45 0
Total 192 224 12? 210 191
6 3 2 40 12
189 186 1?8 159 182
3 13 20 2 6
198 202 200 201 200
TABLE XII
Number of Houses by Number of Rooms in
House, Raw Counts, for Aswan and New Nubia
Number
of Rooms
1
2
3
4
5
6
7
8 or more
No information
1
1?
62
53
20
11
8
3
7
11
Aswan
2 3
11
43
42
39
29
25
14
19
2
0
6
4
18
16
36
9
34
0
Study site code
4 10 5
0
13
21
53
45
20
20
15
23
48
57
41
22
7
3
3
10
0
14
44
53
64
18
1
1
2
1
New Nubia
678
11
26
92
65
3
0
0
0
5
26
6C
37
61
14
0
1
1
0
4
77
28
52
34
2
2
2
0
9
0
67
127
3
0
0
0
1
2
143
-------
APPENDIX IV.2
TABLE XIII
Number of Houses by Number of Occupants,
Raw Counts, for Aswan and New Nubia
Number of
Occupants
1
2
3
4
5
6
7
8
9
10 or more
No information
Total
1
B
16
24
32
39
19
18
8
2
4
22
192
Aswan
2 3
9
11
15
32
46
19
20
30
17
24
1
224
3
4
8
9
13
16
10
11
8
33
8
123
Study site
4 10
29
28
29
36
27
19
11
5
2
1
23
210
TABLE
23
26
34
22
19
15
13
12
8
17
2
191
XIV
code
5
16
15
23
26
33
29
18
13
8
11
6
198
New Nubia
678
16
27
19
30
32
22
16
19
8
10
3
202
24
30
30
22
25
21
19
8
6
9
6
200
87
52
23
15
12
5
2
1
2
2
0
201
9
33
41
18
26
20
15
13
8
11
12
3
200
Number of Houses by presence of Stable,
Eaw Counts, for Aswan and New Nubia
Stable
Inside
Outside
None
1
114
20
40
Aswan
2 3
178
6
34
81
27
14
Study site
4 10
149
21
15
64
52
7?
code
5
183
2
9
New Nubia
678
146
21
6
191
3
=i
185
4
12
9
197
0
2
No information 18 6 1 25 2
Total 192 224 123 210 191
4 29 "I 0 1
198 202 200 201 200
144
-------
APPENDIX IV.2
TABLE XV
Number of Houses by Presence of Waste Container
in House, Raw Counts, for Aswan and New Nubia
Waste
Container
Study site code
Aswan New Nubia
1234 10 56789
Present 9 199 3 72 49
None 79 25 120 112 140
No infonnation104 0 0 26 2
Total 192 224 123 210 191
7 184 161 0 34
182 13 37 199 165
95221
198 202 200 201 200
TABLE XVI
Number of Houses by Location of Animal Waste
Disposal, Raw Counts, for Aswan and New Nubia
Animal
Waste
Material
Stable
Yard
Street
Canal
Roof
None
No information
1
4
9
94
0
0
29
56
Aswan
2 3
56
7
33
0
0
127
1
25
27
66
0
0
5
0
Study site code
4 10 5
14
6
169
0
0
0
21
16
67
23
0
1
82
2
3
3
187
0
0
0
5
New Nubia
678
5
0
0
0
0
193
4
5
1
189
0
1
3
1
1
0
20
176
0
3
1
9
9
2
0
1
7
178
3
Total
192 224 123 210 191
198 202 200 201 200
145
-------
APPENDIX IV.2
TABLE XVII
Number of Houses by Type of cook fuel
employed, Raw Counts, for Aswan and Mew Nubia
Cooking
Fuel
1
Wood and Dung 1
Oil, Wood, and
Dung 0
Gas
Oil
Wood
Dung
Gas and
Gas and
Gas and
Gas, Oil
3
142
4
4
Oil 1
Wood 1
Dung 0
.Wood 5
No Information 31
Total
Stable
Cleaning
Daily
Weekly
Monthly
Never
192
Number of
Raw Counts
1
108
36
2
3
No information 43
Total
192
Aswan
2 3
1
0
16
39
2
0
2
5
54
3
102
224
26
30
0
19
4
0
0
1
3
20
20
123
Study site
4 10
0
1
0
153
27
7
0
0
0
0
22
210
TABLE
0
0
0
145
42
0
0
1
0
0
3
191
XVIII
code
5
0
0
4
184
5
0
0
0
0
1
4
198
New Nubia
678
0
0
1
2
0
0
2
1
10
1
185
202
0
5
0
37
1
0
3
1
0
151
2
200
0
0
111
10
0
7
4
0
57
0
0
201
9
0
0
11
188
0
0
0
0
0
0
1
200
Houses by Frequency of Stable Cleaning,
, for Aswan and New Nubia
Aswan
2 3
167
27
0
1
29
224
6
68
35
1
11
123
Study site
4 10
56
69
61
1
23
210
2
100
20
12
57
191
code
5
189
2
0
0
7
198
New Nubia
678
6
7
168
14
7
202
192
2
2
0
4
200
196
2
0
0
3
201
9
193
5
0
0
2
200
146
-------
APPENDIX IV.2
TABLE XIX
Number of Houses by Type of Approach to
Houses, Raw Counts, for Aswan and New Nubia
House
Approach
Non-Earth:
Clean
Littered
Dry
Wet
Earth :
Clean
Littered
Dry
Wet
Ko information
Total
1
11
4
170
0
1
0
0
0
6
192
Aswan
2 3
218
0
0
0
1
1
0
0
4
224
1
0
10
0
0
0
0
0
112
12?
Study site code
4 10 5
48
42
98
1
0
0
0
0
21
210
90
33
64
1
0
0
0
0
3
191
18?
3
2
0
0
0
0
0
6
198
New Nubia
678
1
3
0
0
1
93
1
1
102
202
0
0
0
0
0
99
0
0
101
200
200
0
0
0
0
0
0
0
1
201
9
2
0
0
0
1
0
0
0
197
200
TABLE XX
Number of Houses by Ownership, Raw
Counts, for Aswan and New Nubia
Aswan
Ownership 123
Study site code
4 10 5
New Nubia
6789
Own 77 27 7 8 9
Rent 113 196 106 181 177
No information 2 1 10 21 5
Total 192 224 123 210 191
31 1 1 0 3
95 16 8 200 136
72 185 191 1 61
198 202 200 201 200
147
-------
APPENDIX IV.2 TABLE XXI
Nuober of Houses by Type of Water Storage
Container, Raw Counts, For Aswan and New Nubia
Water
Storage
Metal
Earthenware
Ceramic
Other
Metal and
Ceramic
Metal and
Earthenware
Ceramic and
"Earthenware
No information
Total
1
0
20
0
1
0
0
0
1
22
2
2
149
45
0
11
3
12
1
223
Study site code
Aswan New Nubia
3 4 10 5678
1
120
0
0
1
0
0
1
122
10
170
6
0
0
0
0
24
210
0
190
0
0
0
0
0
1
191
0
192
0
0
0
0
0
7
199
0
1%
0
0
0
0
0
3
199
0
196
0
0
4
0
0
0
200
1
192
2
0
0
1
0
4
200
9
3
195
0
0
0
0
0
2
200
TABLE XXII
Number of Houses by Type of Wastewater Drainage,
Raw Counts, for Aswan and New Nubia
Wastewater
Drainage
Concrete
Pipe
Brick
Title
Earth
Other
Ho information
1
1
0
0
0
0
6
15
2
6
0
0
0
209
2
6
Study site code
Aswan New Nubia
3 4 10 56?8
0
2
1
1
84
30
5
2
1
2
1
176
3
25
0
0
0
0
190
0
0
110
0
0
72
9
0
8
8
0
0
0
188
0
3
24
1
0
1
173
0
1
4
1
0
0
0
189
6
9
5
1
0
4
1
186
3
Total 22 223 123 210 190 199 199 200 200 200
148
-------
APPENDIX IV.2 TABLE XXIII
Number of Houses by Presence of Latrine, Raw
Counts, for Aswan and New Nubia
Study site code
Aswan
Latrine
Present
Not Present
Ixo information
Total
1
5
2
15
22
2
201
7
15
223
3
15
89
19
123
4
48
73
89
210
10
%
94
0
190
5
186
4
9
199
New Nubia
6
192
4
3
199
7
196
3
1
200
a
195
1
4
200
9
199
0
1
200
TABLE XXIV
Number of Houses by Latrine Use, Raw Counts,
for Aswan and New Nubia
Study site code
Aswan New Nubia
Latrine Use 1234 10 56789
Yes 2 200 15 49 95 187 191 196 187 199
No 1 5 106 68 95 35290
No information 19 18 2 93 0 93241
Total 22 223 123 210 190 199 199 200 200 200
APPENDIX IV.2 TABLE XXV
Number of Houses by Presence of a Cover for the
Latrine, Raw Co-ants, for Aswan and New Nubia
Latrine
Cover
Present
Not Present
No information
Total
1
0
1
21
22
2
196
7
20
223
Aswan
3
15
106
2
123
Study site code
New Nubia
4 10 5678
43
69
98
210
95
95
0
190
115
76
8
199
192
4
3
199
194
4
2
200
24
168
8
200
9
199
0
1
200
149
-------
TABLE XXVI
Number of Houses by Type of Latrine, Raw
Counts, for Aswan and New Nubia
Type of
Latrine
Bore hole
Pit
Pit with
Masonry Lining
No information
Total
1
0
1
0
21
22
Aswan
2 3
11
168
21
23
223
0
7
9
107
123
Study site code
New Nubia
4 10 5678
4
46
1
159
210
1
0
94
95
190
4
7
176
12
199
0
5
187
7
199
1
1
191
7
200
3
174
1
22
200
9
2
197
0
1
200
TABLE XXVII
Number of Houses
Raw Counts, for
Lstrine
Location
Inside
Outside
Stable
Nc information
Total
1
3
0
0
19
22
2
17?
23
1
22
223
Aswan
3
7
2
0
114
123
by Location
Aswan and New
4
19
22
0
169
210
of Latrine,
Nubia
Study site code
New Nubia
10 5678
17
1
65
107
190
191
0
0
8
199
190
1
1
7
199
191
3
0
6
200
196
4
0
0
200
9
198
0
0
2
200
150
-------
TECHNICAL REPORT DATA
(Please read Instructions on the reverse before completing)
1 REPORT NO.
EPA-600/1-80-024
3. RECIPIENT'S ACCESSIOt*NO.
•4 TITLE AND SUBTITLE
Human Intestinal Parasitic Infections and Environmen-
tal Health Factors in Rural Egyptian Communities
5, REPORT DATE
July 1980
6. PERFORMING ORGANIZATION CODE
7 AUTHOR(S)
F.D. Miller,
8. PERFORMING ORGANIZATION REPORT NO.
M. Hussein, K.H. Mancy, and M.S. Hilbert
9 PERFORMING ORGANIZATION NAME AND ADDRESS
University of Michigan
Ann Arbor, Michigan 1*8109
University of Alexandria
Alexandria, A.R. Egypt
10. P
AM ELEMENT NO.
11. CONTRACT/GRANT NO.
Special Foreign Currency
Project No. 03-5^2-1
12. SPONSORING AGENCY NAME AND ADDRESS
Environmental Research Laboratory—Athens GA
Office of Research and Development
U.S. Environmental Protection Agency
Athens, Gerogia 30605
13. TYPE OF REPORT AND PERIOD COVERED
Final
14. SPONSORING AGENCY CODE
EPA/600/01
15. SUPPLEMENTARY NOTES
First report in series: Schistosomiasis in Rural Egypt (EPA-600/1-78-070)
16 ABSTRACT
A survey of common intestinal parasites was completed in three areas of the
Egyptian Nile Valley: The Nile Delta, Upper Middle Egypt and Upper Egypt. The re-
located Nubian population was also included. The total sampling included 15,66U
persons in kl villages. More than 95% attended and approximately 90% provided a
stool specimen. Environmental health observations and measures were made in each of
the households from which a family was selected and in the village environs. Sam-
pling within a study site (which included one or more villages) was designed to pro-
vide a probability of selection. Stool specimens were preserved and examined for
parasites and ova at a central laboratory using the MIFC technique.
The findings indicated a very low prevalence for all helminthic infections. A
low prevalence of Ancylostoma and the Ascaris infections was found.
Important features such as the household stable, the zir (a water storage con-
tainer), and cooking fuel were evaluated. Considerable information on water and
wastewater use was developed. Also, a review of the available information on the
parasitic infections of interest and environmental health conditions for rural Egypt
was compiled for the first time.
7.
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
b.IDENTIFIERS/OPEN ENDED TERMS
c. COSATI Field/Group
Disease Vectors
Infectious Diseases
Parasites
Public Health
06F
13B
3. DISTRIBUTION STATEMENT
RELEASE TO PUBLIC
19. SECURITY CLASS (ThisReport!
UNCLASSIFIED
21. NO. OF PAGES
161
20. SECURITY CLASS (Thispage)
UNCLASSIFIED
22. PRICE
EPA Form 2220-1 (9-73)
151
SUSGPO: 1980—657-146/0503
------- |