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Theaimofthisstudywastoestimatetheprevalenceanddistributionofspeciesofintestinalpara-sitesintheBalkansontheexampleofKosovarandSerbianresidentsfromtheregionofGnjilaneineasternKosovo,wheretheepidemiologyofintestinalparasiticinfectionsremainsunknown.Para-sitologicalexaminationofstoolspecimenswasperformedin2017and2018.Stoolsampleswerecollectedfromasymptomaticschool-childrenaged6–17years:530KosovarsfromthemunicipalityofKaçanikand310SerbsfromthemunicipalitiesofKamenicaandStrpce.Eachpatientprovidedtwostoolsamplescollectedeverysecondday,fixedinSAFpreservativeand70%spiritusvini,transpor-ted to the Department of Epidemiology and Tropical Medicine at the Military Institute of Medicine in Poland,andtestedbylightmicroscopyusingthreediagnosticmethods:directsmearinLugol’ssolu-tion,decantationindistilledwater,andFülleborn’sflotation.Atotalof101Kosovarchildren(19.1%ofthestudygroup)werefoundtobeinfectedwithintestinalparasites:nematodes(n=20),cestodes(n=2),trematodes(n=2),andprotozoa(n=79).Only13Serbianchildren(4.2%)werefoundtobeinfectedwith nematodes (n=4), cestodes (n=3), and protozoa (n=6).Giardia intestinaliswas themostprevalent intestinalparasite inbothgroups (14,9%vs.1.9%children).Theprevalenceofasymptomaticparasitic infectionswassignificantlyhigherinKosovarsincomparisontotheSerbslivinginthesameregionofeasternKosovo.Thisfactshowsthattheremaybesignificantdifferencesinthequalityofhealthcareandsanitationaswellasfeedhygienebetweenthesetwocommunities.Keywords:helminths;protozoa;children;epidemiology;Kosovo
Introduction
Despite a spectacular advance in the diagnosis and management of diseases, intestinal parasitic infections remain amajor publichealth issueglobally(KeiserandUtzinger,2010). It isestimatedthatmore than twobillionpeopleworldwideare infectedwithatleastonespeciesofintestinalparasiteandoverfivebillionpeopleliveincountrieswherehelminthsandprotozoaareendemic(Kuciket al.,2004).Theriskofinfectionisparticularlyhighinareaswithpoorsanitationbecausepoorhygieneand the lackofadequate
sanitationfacilitiesencouragethespreadoffoodandwaterbornediseases(Hotezet al.,2007).Thereareanumberfactorswhichfacilitatethespreadofparasiticinfectionsbothinthedevelopingandtheindustrializedworld;theseincludelowsocioeconomicsta-tus, mass migrations, and the presence of hosts in ecosystems (reservoirsofparasites)(Aliet al.,2014;Ojhaet al.,2014).Thespectrumofclinicalsymptomsinparasiticinfectionsisextremelywideandmayvary fromasymptomaticcases throughdiarrheastocachexialeadingtosevereanemia(KorzeniewskiandKurpas,2016).Microscopicexamination isstill thegoldstandard for the
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diagnosisofintestinalhelminthsandprotozoamakingitpossibletodetectparasitesattheirdifferentdevelopmentalstages(cysts,trophozoites, larvae, ova) (Myjak et al., 2011). In Europe, highratesofparasiticinfectionsarereportedfromthecountrieswhichare listed in the third and fourth quartile according to gross domes-ticproductpercapita(GDP$1809–$17630)(HotezandGur-with,2011);Kosovoranksinthe4thquartile.TheexactprevalenceofparasiticinfectionsinKosovoisnotclearbecausethecountrylacksorganizedepidemiologicalscreening.In2001,astudywasconductedtoestablishtheetiologyofdiarrheain45Kosovarchil-dren(KosovskaMitrovica). It revealed that40%of thediarrheacasesinthestudygroupwereassociatedwithGiardia intestina-lis (Quamilèet al.,2011).Anotherstudyaimedatassessing theprevalenceofparasiticinfectionsinKosovowasconductedbytheauthorsofthepresentarticlein2015.Thestudygroupconsistedof632Kosovars(childrenandadults)livinginthemunicipalityofKaҫaniklocatedinsouthernKosovo.Wefoundthat12%ofthestudy population had asymptomatic parasitic infections, mainly Giardia intestinalis infection(10%oftheinfectedindividuals)(Ko-rzeniewskiandAugustynowicz,2017).Kosovohasapopulationofaround2millionpeople.ThemajorityofitsresidentsareAlbanian,but therearealsosomesignificantethnicminorities living in thecountry,ofwhichtheSerbianminorityisthelargest(140,000).Theaimofthisstudywastoassesstheprevalenceanddistribu-tionofspeciesofintestinalparasitesintheBalkansontheexam-pleofKosovarandSerbianresidentsfromtheregionofGnjilaneineasternKosovo,wheretheepidemiologyofintestinalparasiticinfectionsremainsunknown.
Material and Methods
Study population In total, 840 asymptomatic school-children, aged 6 – 17 years,
amajorityofstudiesintotheprevalenceofintestinalparasitesinhumans that are carried out in Europe are primarily focused on the incidence of Cryptosporidiumspp.andGiardiaspp.SerbiaisoneofthecountriesparticipatinginIPIsurveillance(thenumberofreportedgiardiasiscasesinthecountryfellfrom4.6/100,000in2005to1.1/100,000in2014)(Plutzeret al.,2018).Unfortunately,thereisnoreliabledataavailableastotheprevalenceofintestinalparasiticinfectionsinKosovo.
Conclusion
Current epidemiology of intestinal parasites in Kosovo is un-known. The study involved asymptomatic Kosovar and Serbianschool-children living in thesameecosystemof theGnjilane re-gion (easternKosovo)anddemonstrated that theprevalenceofintestinalparasiticinfectionsinKosovarsissignificantlyhigherincomparison to Serbian children, whichmay be the evidence ofsome differences in the quality of health care and sanitation as wellasfeedhygienebetweenthesetwocommunities.
Acknowledgements.
Thisstudywassupportedandco-fundedby theMinistryofSci-ence and Higher Education in Poland (project No. 518/2018,2018–2019).Theauthorsaregrateful toMrs.DianaReka,Mr.EnverKamishiandDr.ZoranPerićfortheirexcellenttechnicalas-sistance and supervision in patient recruitment and collection of biologicalsamples.