U.S. ARMED FORCES MEDICAL JOURNAL HEALTH SURVEY IN PACIFIC pared with 64.5 percent for Palau and a much lower percentage of4 19.3 for the Marshall Islands. On the following islands or atolls less than 5 percent of the stool examinations were positive: Ngulu,. Lib, Aur, Mejit, Likiep, Utirik, Tabal, and Kwajalein. Over 75: percent of the stool examinations were positive on Eauripik, Na morik, Saipan, Elato, Tinian, Kayangel, Faraulep, Woleai, Satawal Ifalik, and Lamotrek (table 6). Variations of prevalence rates by age and sex wereslightly different for each species. Hookworm and Ascaris show opposite tenden- tFi oo Table 6. econ ort or Distribution of islands by percent of stools Percent of positive| stools Total Saipan Palau district district Under 5 §to9 8 4 - 2 - 6 4 10 to 24 4 - 1 3 26 to 49 50 to 74 5 7 1 - 4 § 2 ll 2 8 1 islands 75 and over Islands district for protozoa. The most prevalent intestinal parasites were hookworm, Trichuris or whipworm, and Ascaris or roundworm. Hookworm was found in 23.1 percent of the stools, Trichuris in 22.3 percent, and Ascaris in 17.2 percent. The relative importance of the three species varied from district to district. In the Saipan district Ascaris had the greatest prevalence, with Trichuris ranking second and hookworm third. The rank order in the Palau district was just the reverse, while in the Marshall Islands district Trichuris was the most. prevalent, hookworm ranked nonexistent (table 7). Table 7. second, and Ascaris was Percentage of positive stools by parasitic infestation 1208 Total Saipan district Each individual examined was given a stool box practically Stools were examined by the simple flotation technic with a concentrated sugar solution used for ova of helminths and flukes. Direct normal saline smears were used to determine the presence of protozoancysts. Whenprotozoancysts were Indicated by the smears, iron-hematoxylin stains were madefor positive identification. Kahn tests. Kahn tests were given to 16,320 inhabitants, nearly three fourths of the population of the Saipan, Palau, and Marshall Islands districts The Kahn-test technic was not uniform throughout the portion of the survey reported here. Originally, the three-tube test was utilized. Later, using this same Kahnantigen, only the second dilution was used. Approximately 50 percent of the Kahntests were positive, with little difference between the sexes (tables 8 and 9), The Palau district had by far the highest proportion of positives—65.4 percent as compared with 38.1 percent for the Marshall Islands district and 30.4 percent for the Saipandistrict. Wide variation occurred among the islands, paralleling the variation between the districts. Tabal Island in the Marshall Islands Table 8. Percent positive ‘Parasitic infestation ‘had slightly higher rates among females. The actual procedure of obtaining the sample of stool specimens resulted in a haphazard rather than a representative cross section of “and requested to submit a fecal specimen. The number of specimens obtained varied greatly. After the specimens were received, some had to be rejected because of contamination from the specimen wrappings and others because of inadequacy of the specimen, The remaining specimens were examined for ova of the helminth or platyhelminth group. On some of the specimens, examinations were made . Marshall number of worm was more prevalent among males, while: Trichuris and Ascaris the population. positive for intestinal parasites ws cies with respect to age. The former increased with age while the Jatter decreased. Trichuris showed little change by age. Hook- Palau district Marshall Islands district All parasites 52.4 79,3 64.5 19.3 Hookworm Trichuris Ascaris Other 21 22,3 17.2 2.8 26, 2 40. 6 44.2 5.6 34.0 22.0 16.8 L4 6.8 11.0 .3 2.9 Distribution of islands by percent of positive Kahn reactions — Percent of positive Totalnum-| er of Kahns islands Saipan district Palau district 25 to 49 2 W 1 - 6 50 to 74 13 2 7 Under 25 75 and over 7 - 7 Marshall Islands district li - 1209