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CHAPTER 2
REVIEW OF RELATED LITERATURE AND STUDIES
Parasitism
Yeh (2002), Stevens (2010), Encylopaedia Britannica (2015), & ScienceDaily
(2015) defined parasitism as a relationship between two species, a parasite and its host, in
which the parasite benefits, while the host is harmed. Parasitism is one form of
symbiosis, which more generally describes any situation involving a close relationship
between organisms of different species. In most situations, parasites do not kill their host
but in extreme cases, parasites can cause diseases in the host organism; in these
situations, they are well known as pathogens. Yeh (2002) stresses that parasitism is one of
the most common survival strategy among biological organisms, and many species are
characterized by parasitic lifestyles for all or part of their lives.
Intestinal Parasitism
Intestinal parasitism, delineated by The Free Dictionary (2016), is the infestation
of the intestinal lumen and wall by nematodes, cestodes and immature trematodes. As
stressed by Dhanabal, et al. (2014), intestinal parasitic diseases constitute a global health
burden in numerous developing countries mainly due to fecal contamination of food and
water, sympathetic climatic, and environmental and sociocultural factors enhancing
parasitic transmission. Bisht (2011) confirmed in his study that poor sanitation can be a
leading cause of intestinal parasitism. Pearson (n.d.) & Gil (2013) stressed that intestinal
parasitic infections are common in rural or developing areas of Africa, Asia, and Latin
Americas and are less common in developed areas. However, even in countries with

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adequate sanitation, hygiene, and education predominate, some of this parasites play an
important role in triggering diseases in specific groups such as in immunocompromised
individuals and young children.
Akinbo, et al. (2011) states that intestinal parasitic infections of humans are
important threats to healthy living in developing countries. The environment and sociocultural habits of the people could be attributed for the high prevalence of intestinal
parasitic infections in the developing countries. According to Carney, et al. (n.d.), soiltransmitted helminths are usually the common intestinal parasites in the Philippines and
the infection rates of soil-transmitted helminths in Agusan del Norte simply documented
the endemicity of these common intestinal nematodes and the general level of hygiene
and sanitation for this rural area of northeast Mindanao. As what Subido (2005)
emphasized in the article, Fighting Intestinal Parasitism, soil-transmitted helminths are
being harbored by one billion of the worlds human population and in the Philippines
alone, conservative estimates place at least 20 million Filipinos as chronically affected.
Baldo, et al. (2004) conducted a study of intestinal parasitism on children in Metro
Manila, Philippines, found that 73.65% of examined children were infected by intestinal
parasites.
Intestinal Parasites
A parasite is an organism that lives on or inside another organism (the host) and
harms the host, they derive nourishment and protection from other living organisms
(Pearson, n.d.; Foodsafety.gov, 2016). A Dictionary of Nursing (2008) described Ascaris
lumbricoides as a genus of parasitic nematode worms, which is the largest of the human
intestinal nematodes. As stated by Cross (1996) in Barons Medical Microbiology, A.

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lumbricoides is usually found in the small intestines, particularly the jejunum and females
produces as many eggs as 240,000 eggs per day.
Ancylostoma duodenale, according to Fetouh (2003); Beigal, et al. (2000);
Changhua, et al. (1999); & Roberts and Janovy Jr. (2000), is a hookworm that are usually
found tropical and subtropical regions such as those in the Mediterranean region,
Southeast Asia, and Southern Americas. It is usually 8mm to 13mm in length and are
transmitted via the feces of the host. The study of Brinksworth, et al. (2000); & Chilton
and Gasser (1999), these parasites usually feed on human or the hosts blood from the
walls of the intestines, they also break open small blood vessels to obtain the food
requirement they need. A. duodenale also possesses and secretes anticoagulant substances
that helps in the prevention of blood clots from wound with flowing blood.
Necator americanus, according to Loukas et al. (2006) and Hostez et al (2004), is
another specie of nematode or otherwise called as human hookworm. This hookworm is
transmitted via contact with contaminated soil. Behnke, et al (2000) & Romstad, et al
(1998), N. americanus is found in Africa, Asia, and Europe but is predominantly found in
the Americas and the Australia. Globally, N. americanus can be found in tropical
climates. Brusca (2003) described N. americanus as a nematode that has a cylindrical
body and a cuticle with three main outer layers made of collagen and other compounds.
Its length usually ranges from 7mm to 11mm long and the females are usually longer and
larger than the males. According to Roberts, L., & Janovy Jr, J. (2000) and Blaxter
(2000), N. americanus usually habituates the temperate and tropical regions because eggs
require a moist, warm, and shaded environment to hatch. N. americanus feeds in the
blood of their hosts by attaching itself to the hosts intestinal wall to cause bleeding.

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Strongyloides stercoralis prefers the warm and moist soil in the tropics and
subtropics and its most common habitat on its host is on the mucosal lining of the small
intestines, according to Roberts and Janovy (2000). Its length usually ranges from 0.9mm
to 2.5mm long and is transmitted via the feces of the host. Its most definitive hosts are
humans, dogs, and cats and feeds on the hosts tissue of the internal organs which
includes the intestines and the lungs. S. stercoralis causes strongyloidiasis in humans as
what Roberts and Janovy (2000) mentioned.
The nematode, known as the Human Whipworm (Trichuris trichiura), according
to Roberts and Janovy (2000), is one of the most common geohelminths in the world
affecting humans today. This parasite prefers to live in a moist environment in the tropics.
In a study, Bundy (1998) described the life cycle of the parasite when the worm enters its
host as an egg which can be ingested when eating raw, or unwashed and uncooked foods.
The author Matthews (1998) stated on the book An Introduction to Parasitology, that
female whipworms produces at about 5000 eggs per day into the lumen of the host gut.
On the other hand, Forrester (1998) conducted a study in treating whipworm infection, in
the study, the researcher stated that the common effective and cost efficient treatment for
T. trichiura infection are Albendazol and Pyrantel whereas the treatment can also induce
higher growth as well as academic achievement in children suffering from chronic
infection.
Enterobius vermicularis according to Garcia and Brucker (1997); Brusca and
Brusca (2003) & Bogtish and Cheng (1998), is a nematode that is found worldwide and
which infect humans from hundreds of years ago. Its physical characteristic is composed
of a cylindrical body with an outer layer made of collagen and other compounds. It has a

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length of 13mm and has a pointed tail where its common name is derived. Humans are
not its only host. This parasites feed on tissues and blood from the hosts intestines. E.
vermiculasris, like all nematodes, feed more than what is necessary and wastes much of
what is brought in.
Food Handlers
A food handler is a person who directly engages in the handling of food, or who
handles surfaces likely to come in contact with food, for a food business (Australia New
Zealand Standards Code, 2015; National Restaurant Association, 2016). Food handlers
also include anyone who may touch food contact surfaces or other surfaces in rooms
where open food is handled. A food handler must take all reasonable measures not to
handle food or surfaces likely to come into contact with food in a way that is likely to
compromise the safety and suitability of food (Food Standard Agency, n.d.;
Commonwealth of Australia, 2014). Food handlers plays a major role in ensuring food
safety throughout the chain of producing, processing, storage, and preparation.
Mishandling and disregard for hygiene measures on their part may result in food
contamination and its attending consequences (Okojie, O.H., Wagbatsoma, V.A., &
Ighoroge, A.D., 2005).
Hygienic Practices
The human body can provide places for disease-causing germs and parasites to
grow and multiply but it is less likely that germs and parasites will enter the human body
if one is has good personal hygiene habits (Department of Health, 2010). Lynn (2014)
emphasizes that taking good care of ones body in means of good personal hygiene not

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only helps in outward appearances but more importantly it helps in the maintenance of
ones well-being. Johnson (2015) and Datko (2014) stressed that the maintenance of an
individuals personal hygiene is important in many aspects such as in personal, social,
health, psychological, or simply as ones way of life. Maintaining a good standard in
hygiene helps in the prevention of the development and spread of infections, illnesses or
diseases, and foul odors.
In other cultures, poor personal hygiene is considered offensive or a sign of
illness. Maintaining an individuals body clean is vital in combating and preventing
illness. Keeping hands clean by washing it, is an individuals first line of defense in
protecting ones self from illnesses that can be acquired from other person or from the
environment through body contact or contact with contaminated surfaces (Datko, 2014;
Lynn, 2014; Department of Health, 2010). Zapo (2013) stated in an article that practicing
proper hygiene is important to ones mental health and helps the person feel better about
themselves and by skipping daily hygiene practices, the individual is at greater risk of
becoming a victim to different ailments and infectious diseases.
Food Handlers Hygienic Practices
According to Ifeadike, et al. (2014), poor and faulty food handling practices have
been identified as the leading cause of the majority of food-borne diseases. Mudey, et al.
(2012) confirmed in an article that food establishments play a notable role in the food
industry but they may, sometimes, be sources of parasitic and other infections. The
chances of food contamination largely depend on the health status of food handlers and
their hygiene behavior and practices, they, the food handlers, may serve as the
transmission agents and reservoir of infections. Limited health education in some food

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handlers and lack of personal hygiene may be the cause of these infections. Andargie, et
al. conducted a study on intestinal parasitism among food handlers and found that 29.1%
of food handlers were infected with intestinal parasites in Northwest Ethiopia. Isara, et
al. (2009) & Tessema, et al. (2014) conducted studies to determine and assess the
knowledge and practice of food hygiene and safety among food handlers had a satisfying
result that showed there is good knowledge and practice of food hygiene and safety by
food handlers.
Food Hygiene and Safety
There are four Cs of food safety according to Muppala (2011) & SafeFood (n.d.),
Cleaning, Cooking, Chilling, and Cross Contamination. Good food hygiene, according to
the Food Standard Agency (n.d.), is all about controlling harmful bacteria, which can
cause serious illnesses. World Health Organization (2016) defined food hygiene as
conditions and measures necessary to ensure the safety of food from production to
consumption because food can at times become contaminated at any point during
slaughtering or harvesting, processing, storage, distribution, transportation, and
preparation; lack of adequate food hygiene can lead to foodborne diseases and death of
the consumer.
Synthesis
Reviewed literature and studies expresses the need of proper education and the
necessity of good and proper hygienic practices in the prevention of the acquisition of
intestinal parasitism among food handlers and its consumers. Previous researches
identified lack of proper education and knowledge in good hygiene as the number one

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cause of intestinal parasitism among food handlers and consumers. Parasitism is known
as one of the most common survival strategies in the biological environment according to
Yeh (2002) and as what Bisht (2011) confirmed in a study, due to poor hygienic practices
and environmental sanitation, an individual is at risk in becoming a victim of intestinal
parasitism. However, Pearson (n.d.) & Gil (2013) indicated that even individuals who
practice good and proper hygienic practices and adequate environmental sanitation can
also be at risk for intestinal parasitism, especially individuals who are young and those
who are immunocompromised.
Maintaining proper food hygiene and safety is essential in the prevention of
intestinal parasitism. The four Cs of food safety according to Muppala (2011) must be
complied well in order to protect individuals against ailments and illnesses. In handling
food, cleanliness and hand washing is important to avoid the spread of harmful bacteria
or organisms that can put food consumers at risk for infection or diseases. Prepared foods
must be cooked well to keep it from lethal bacteria, parasites, and other disease-causing
organisms and cooked foods must never be reheated more than once. Chilling foods in
the fridge at the right temperature helps in stopping the growth and development of
bacteria. And it is very important to keep the work place or the kitchen clean as always to
stop cross contamination (Muppala, 2011 & Safe Food, n.d.).
The researcher collated all the above-said information for the purpose of
comparing, validating, and documenting agreeing and opposing views and results of
previous related studies. These similarities and differences in views and results about the
correlation of intestinal parasitism and hygienic practices of food handlers will serve as
one of the motivations in this study that will further look on ways in the minimization of

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intestinal parasitism through good and proper individual knowledge and practices on
hygiene and adequate environmental sanitation