In this chapter will focus on the living condition and parasitic and infectious diseases.   In order to perform the literature review, various articles were search from the online database which is Google Scholar. The sources of these articles are come from published journal such as Clinical /Experimental Rheumatology 2017, PLOS, American Journal Of Microbiology and Pub Med. The journal also been search in the journal of american medical association and from the university library online database.  The lists of articles selected are related and relevant to the study that will be performed

2.1 Migrant worker

  According to Malaysia labor department, there are increasing number of the migrant worker that come into this country. This is because of the high demand in the industry. Hiring migrant worker is a lot cheaper than hiring local. Malaysia is an excellent country to study the main features and effects of regional labor mobility. It has advanced faster and more steadily than its two more populous neighbors Indonesia and the Philippines. In addition, the remarkable and rapid improvements in education created relative shortages for unskilled workers needed in low-skill sectors such as agriculture, construction, and low-tech manufacturing. These outlines led to excess demand for unskilled labor which was met with willing workers, not only from these two neighboring countries but also from other countries in Asia, including Thailand, India, Bangladesh, Nepal, Myanmar, and Cambodia (Carpio et al., 2015).

2.2 Socio Demographic

Socio demographic can influenced individual on the risk to get disease .It include gender, nationality, age, and education.  

2.2.1 Gender

Gender has a major influence on outcome from a range of infectious diseases, starting from the beginning of life. Overall, morbidity and mortality rates are higher in males than in females throughout life. In humans, females reportedly mount stronger humoral and cellular immune responses to infection or antigenic stimulation than do males (Muenchhoff & Goulder, 2014).



2.2.2 Nationality

  According to world bank Philippine, Indonesia, Bangladesh and Myanmar categorize as Lower middle income which explained the migration into other country (World Bank ,2017) .In middle-income countries, risks for chronic diseases also cause the largest share of deaths, although risks such as unsafe sex and unsafe water and hygiene also cause a larger share of burden of disease than in high-income countries low-income countries, somewhat few risks are liable for a large percentage of the high number of deaths and loss of healthy years. These risks usually act by growing the incidence or severity of infectious diseases. The leading risk factor for low-income countries is underweight, which represents about 10% of the total disease burden. In combination, childhood underweight, micronutrient deficiencies such as iron, vitamin A and zinc. The joint burden from these nutritional risks is almost corresponding to the entire disease and injury burden of high-income countries (WHO, 2009).

2.2.3 Age

 Demographic and geographical factors such as gender, age, family size and the region where the people live may effect on the risk of malaria transmission. It was observed that the positive malaria diagnostic rate decreases with age and risk of malaria increased per unit increase in family size (Gunathilaka, Abeyewickreme, Hapugoda, & Wickremasinghe, 2016).

2.2.4 Education

Education is a key indicator of socioeconomic status. The relationship is higher education leads to better health, while better health leads to higher education. For an example, good health in childhood enhances cognitive functions and reduces school absenteeism and early drop-out rates, and as such children with better health can be expected to attain higher educational levels and therefore be more productive in the future. On the other hand, ill-health in the population is related to the fact that not everybody has a high level of education, a higher occupational class, or a high income level. As concerns infectious disease, a study that conducted from the Region of Madrid, proved that mortality from infections among individuals with elementary or less education was higher than that of men and women with tertiary level education. Parents’ education levels, meanwhile, affect not only their own health outcomes but also those of their children. Maternal educational attainment has been shown to be associated with positive health outcomes of children as a consequence of better health, literacy, and exploitation of health services due to access and information about precautionary actions such as vaccination. (ECDC Report, 2013)

2.3 Living Condition

Living condition such as hygiene, household, food source and how the food stored can contributed to the parasitic infection.

2.3.1 Hygiene

The practise of hand washing practice is importance as it prevent from contaminating especially food. The practice of non-antibacterial soap with hand hygiene education interventions is efficacious for preventing both gastrointestinal and respiratory illnesses(Aiello, Coulborn, Perez, & Larson, 2008). Beside hand washing,a generally good hygiene practise as for an example not drinking dirty water and not wearing shoes was recorded in the previous study , which undoubtedly impacts on parasitic worms. Sanitation and hygiene practise have proven to be substantial contributors to a sustainable control of soil-transmitted helminthiasis, schistosomiasis, diarrhea, and other fecal-orally transmitted diseases (Schmidlin et al., 2013).

2.3.2 Food

Vegetables are essential ingredients in diet. Many kinds of vegetables are consumed raw and provide benefit nutrients as vitamins, fiber and ash for human body. However, these vegetables may be a possible source of infection if contaminated. Assessment of hygienic-sanitary quality of vegetables is not only based on chemical safety contain of pesticide and hormone residues, heavy metals but also biological safety such as bacteria and parasites. parasites during the planting transportation, post-harvest or unhygienic cooking. Which may lead to parasitic infection. Usage of fresh stool as fertilizer is still popular in among farmer may increase the risk of infection (Le Quynh Chau et al., 2014). Contamination of soil with animal wastes and increased application of inadequately composted manures to soil in which vegetables are grown also play a role in parasite contamination to green vegetables (El Said Said, 2012).Beside vegetable meat also can be the factor of parasitic infection if not cook well. The parasites that can be found on the fresh meat samples are identified as Echinococcus spp,Taenia spp,Entamoeba hystolytica, Cryptosporidium spp, Trichinella spiralis and Toxoplasma gondii. The parasites were found as cysts, oocysts, and eggs (Mgbemena, Ebe, Nnadozie, & Iloanya, 2015).


2.3.3 Household

Giardia transmission occurs through the ingestion of the Infective cyst stage shed in human or animal faeces. Some infections are relapsing due to re-infection from an ongoing source, possibly an asymptomatic household member. Treatment of asymptomatic Giardia infection in certain circumstances, for example food handlers, day care nurseries and recurrent infection in a household (Waldram, Vivancos, Hartley, & Lamden, 2017) .


 Based  on the data held by World Health Organization (WHO), STH have been identified as one of 17 neglected tropical diseases, with more than 24% of the world’s population infected with roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale) primarily through soil contaminated by human feces. Soil-transmitted helminth (STH) (68.3%) infections were more prevalent compared to protozoan infections (25.5%). Of the three common intestinal nematodes, A. lumbricoides (43.3%) infections were the most frequently identified, followed by hookworm (13.1%) and T. trichiura (9.5%) (Sahimin et al., 2016)


The intestinal nematode Ascaris lumbricoides is one of the most common causes of infection among the soil-transmitted helminths (STH). Common in the tropics and sub-tropics, it is estimated that more than one-quarter of the world population is infected with this helminth.The highest case is found in children, especially in those with a high worm burden. A. lumbricoides can lead to reduced physical fitness, growth retardation, and respiratory and gastrointestinal problems.

  Infection occurs through the oral intake of eggs, usually contained in soil or food. Adult worms live in the lumen of the small intestine where the female lays unembryonated eggs which are excreted with the feces. In the open, the eggs have to go through three stages of development in order to become infectious; a time during which they are exposed to environmental conditions. When embryonated eggs are swallowed by a human host, the larvae hatch in the small intestine, have a short migratory phase (venous system, liver, lungs, trachea, esophagus) after which they return to the small intestine where they mature and mate (Schule et al., 2014)


2.4.2 Trichuris Trichiura

T. trichiura infection occurs after digestion of embryonated eggs from the soil. The eggs hatch inside the human intestine and release larvae. The larvae mature and the adult females living in the small intestine begin to reproduce and they will lay egg. The eggs are excreted together with the feces and undergo embryonation, the temperature-dependent development to the infective stage. During the development in the soil, the eggs are wide-open to environmental factors such as rain, soil humidity, and soil temperature, which can favour or hinder their development. For T. trichiura eggs the upper temperature limit for survival is about 37–38?C. Beyond this threshold, the eggs will not develop to the infective stage.(Manz et al., 2017)


There are two type of hookworm that usually caused and infection that will be Necator americanus and Ancylostoma duodenale, which commonly transmitted through contact with contaminated soil especially, fecal to oral transmission is much more common than penetration of the skin (Tan et al., 2017). The present study has identified the prevalence of hookworm infections among migrant workers in Malaysia. The prevalence of N. americanus among infected workers and provided the first evidence for A. duodenale infections in Malaysia. Our study has identified in the case of N. americanus age as a risk factor and in the case of A. duodenale, period of residence in Malaysia (Sahimin et al., 2017)

2.5 Protozoa

2.5.1 Giardia Lamblia

Giardia lamblia is a flagellate protozoa, is one of the most common pathogenic gastrointestinal parasites known infecting humans. It has a global distribution affecting about 280 million cases annually in both developing and developed countries. In acknowledgement of the burden of disease caused by the parasite. Cysts are transmitted through the fecal or oral route due to ingestion of contaminated food or water. Clinical manifestations of giardiasis usually appear 1-2 weeks after infection and may range from asymptomatic carrier state to acute fulminating diarrhea or chronic persistent diarrhea, abdominal pain, vomiting, malabsorption and weight loss. It may cause chronic post-infectious complications, plus irritable bowel syndrome. Diagnosis of giardiasis is frequently based on detection of trophozoites or cysts by microscopic examination of stool samples(Shahat, Sallam, Gad, & Abdallah, 2017).

2.5.2 Entamoeba Spp.

Entamoeba histolytica is a protozoan parasite responsible for amoebic dysentery and amoebic liver abscess. Possible hosts are most usually exposed to E. histolytica through contaminated food and water sources, which puts 50 million humans at risk for amebic dysentery and liver abscesses yearly, with around 70,000 deaths global. The life cycle of E. histolytica involves host digestion of tetra-nucleated cysts that undergo several divisions to produce eight trophic amoebae through a process known as excystation. The mature trophozoite can colonize the colon ,where it divides by binary fission and feeds on bacteria, host cells, and host cell debris(Chuang et al., 2017).About 10% of the world’s population are infected with the Entamoeba species, but pathogenic E. histolytica constitute only 10% of these infestations and the residual 90% are infected by non-pathogenic E. dispar. The approval of E. dispar as a distinct but closely related protozoan species has had profound implications on the epidemiology of amoebiasis, since most asymptomatic infestations found worldwide are now caused by non-invasive amoeba. Furthermore, it is formally accepted that E. histolytica comprises two distinct species, the potentially invasive E. histolytica and the non-invasive commensal E. dispar. Hence, species–specific diagnosis cannot be made because cysts and trophozoites of both species cannot be distinguished microscopically(Yimer, Zenebe, Mulu, Abera, & Saugar, 2017)