SUMMARY Funding: Ensign College-Students Research Award Program of Bob and Lynette Gay 
Keywords: Parasites, contamination, vegetables, market, Ghana SUMMARY Introduction: Fresh vegetables are an important source of vital nutrients. Poor farming practices and improper 
washing put consumers at risk of parasitic infections. This study explored the presence of parasitic contamination of 
commonly-consumed vegetables procured from two markets in Ghana. It also explored the decontamination effects 
of washing vegetables with different concentrations of saline solution. Method: Vegetables were procured from two major open markets in Koforidua, Ghana. Vegetables were thoroughly 
washed twice using 0.0%, 0.45%, 0.9%, 1.5% concentrations of saline solutions. The deposits were examined under 
the light microscope for the presence of parasites. Smears were made from sediments, stained and observed with 
Fluorescence microscope to detect any spores or oocysts of Microsporidium sp., and Cryptosporidium sp. Result: Three hundred and sixty of five types of vegetables were procured. Two hundred and seven (57.5%, 95% 
Confidence Interval 52.2% - 62.7%) were found to be contaminated with at least one type of parasite. The extent of 
vegetable contamination was 97.2% (90.3-99.7) of spring onions, 70.8% (58.9-81.0) of lettuce and 50.0% (38.0-
62 0) of tomatoes
The commonest parasites were Strongyloides stercoralis (36 4% 31 4-41 6) Balantidium coli Method: Vegetables were procured from two major open markets in Koforidua, Ghana. Vegetables were thoroughly 
washed twice using 0.0%, 0.45%, 0.9%, 1.5% concentrations of saline solutions. The deposits were examined under 
the light microscope for the presence of parasites. Smears were made from sediments, stained and observed with 
Fluorescence microscope to detect any spores or oocysts of Microsporidium sp., and Cryptosporidium sp. p
y p
y
p
p
yp
p
p
Result: Three hundred and sixty of five types of vegetables were procured. Two hundred and seven (57.5%, 95% 
Confidence Interval 52.2% - 62.7%) were found to be contaminated with at least one type of parasite. The extent of 
vegetable contamination was 97.2% (90.3-99.7) of spring onions, 70.8% (58.9-81.0) of lettuce and 50.0% (38.0-
62.0) of tomatoes. The commonest parasites were Strongyloides stercoralis (36.4%, 31.4-41.6), Balantidium coli 
(13.6%, 10.2-17.6) and Cryptosporidium oocyst (11.1%, 8.1-14.8). Parasite recovering rates were 57.5% (52.2-62.7) 
and 42.2% (37.1-47.5) after first and second washings respectively. Conclusion: The level of parasite contamination is high and consumption of raw vegetables procured from these 
markets carry a high risk of parasite infection. Washing vegetables twice with saline was not effective for parasite 
removal. Improved approaches for washing vegetables before consumption are needed. Original Article Original Article Catherine Kudah1, Simon Sovoe1 and Frank Baiden1,2 voe1 and Frank Baiden1,2 
Ghana Med J 2018; 52(2): 88-93 
doi: http://dx.doi.org/10.4314/gmj.v52i2.5 Ghana Med J 2018; 52(2): 88-93 
doi: http://dx.doi.org/10.4314/gmj.v52i2.5 1Epidemiology Unit, Ensign College of Public Health, Akosombo, Kpong, Ghana, 2Department of Clinical 
Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, 
Keppel St, London WC1E 7HT, United Kingdom 1Epidemiology Unit, Ensign College of Public Health, Akosombo, Kpong, Ghana, 2Department of Clinical 
Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, 
Keppel St, London WC1E 7HT, United Kingdom Corresponding author: Catherine Kudah 
Conflict of interest: None declared Corresponding author: Catherine Kudah 
Conflict of interest: None declared Parasitic contamination of commonly consumed vegetables in two markets in 
Ghana Parasitic contamination of commonly consumed vegetables in two markets in 
Ghana INTRODUCTION infestation.3 Bad hygienic practice during transport, pro-
cessing and preparation by handlers including consum-
ers could also contribute to vegetable contaminations. Other factors which affect the susceptibility of the pub-
lic to foodborne diseases include food consumption pat-
terns, such as the increase in the number of people eat-
ing meals prepared in restaurants, canteens and fast food 
outlets as well as from street food vendors who do not 
always observe optimal food safety. Fresh vegetables are a major source of vital nutrients. Consumption is promoted for the vitamins, minerals, 
dietary fiber, and antioxidants it provides. Traditional 
practices in the cultivation, manuring and harvesting of 
vegetables in many parts of sub-Saharan Africa remains 
an area of concern. The use of sewage and other form of 
liquid waste during cultivation are potential source of 
contamination with the eggs and larvae of parasitic in-
fections. Human infection occurs through consumption 
of raw vegetables.1, 2 In developing countries, the diarrhea diseases of food or 
hydrous origin have been reported to kill about 
2.2million people annually.4 It is common in Ghana to 
see farmers cultivate vegetables near gutters and other 
waste water disposal routes. Epidemiological studies have indicated that in areas of 
the world where helminthic diseases are endemic and 
where raw untreated waste water is used to irrigate veg-
etables generally eaten uncooked, the consumption of 
such waste irrigated vegetables may lead to parasitic www.ghanamedj.org  Volume 52 Number 2 June 2018 88 Original Article The consumption of raw vegetables has been implicated 
in a number of outbreaks of diarrheal diseases. Out-
breaks associated with diseases like giardiasis, amoebia-
sis, cyclosporiasis and cryptosporidiosis have been re-
ported with high levels of morbidity and mortality in 
parts of the country.2 The supernatant was removed and the residue carefully 
collected in the test tube by tapping the bottom of the 
tube and transferring unto labeled clean slides for exam-
ination purposes. A drop of the sediment was applied on 
the center of a clean grease-free labeled slide. A clean 
cover slip was placed gently to avoid air bubbles and 
over flooding. The preparation was examined under a 
light microscope using X10 and X40 objectives 
(OLYMPUS CX21). The sediment was mixed with a 
drop of Lugol's Iodine solution and examined as in sim-
ple smear for the purpose of parasite confirmation. Two 
(2) slides were prepared for each sediment. METHODS Sediment smears were stained for the purpose of Fluo-
rescence microscopy to detect any oocysts and spores of 
Microsporidium sp., and Cryptosporidium sp. Two 
slides were prepared for each sediment for fluorescence 
staining.6 A thin smear of the sediment was done, air 
dried and fixed with methanol for 3 minutes. The slides 
were stained with Auramine O-phenol for 20 minutes, 
after which the slides were washed with distilled water, 
and then differentiated in 0.5 % hydrochloric acid-
ethanol solution for 3 minutes. The slides were rinsed in 
distilled water and counter stained with 0.5% potassium 
per manganate for 30 seconds. The slides were rinsed 
with water; air dried, and examined microscopically 
using 40x objective lens of fluorescence microscope 
(ZEISS). Pictorial guide from “District Laboratory Prac-
tice in Tropical Medicine” were used. Parasites were 
recorded as either present or not. The parasites were 
counted as well.5 Data Analysis 
D Data was recorded on specially-designed study record 
forms. This was subsequently entered into Excel work-
sheet. Frequencies were run on all variables to check for 
errors and inconsistency. These were corrected through 
checking with the original entry on the record forms. It 
was exported into STATA version 14.0 (StataCorp Lp). Chi square tests were done to test for associations be-
tween presence of parasite and (market type, vegetable 
types and the different saline concentrations). The 95% 
confidence intervals were constructed around the identi-
fied levels of contamination. Ethical approval for the study was obtained from the 
Institutional Review Board of the Ensign College of 
Public Health. Each particular vegetable in a given level of concentra-
tion was washed twice i.e. first and second wash. The 
processing for analysis (saline preparation, autoclaving 
and staining) followed standard guidelines as described 
in laboratory standard operation manuals which was 
adapted from “District Laboratory Practice In Tropical 
Medicine”.5 Personal safety precautions were taken dur-
ing every procedure. Study sites Koforidua in the Eastern Region of Ghana is a major 
centre for the trade in vegetables. Many outlining areas 
in the municipality are under small and large-scale 
vegetable cultivation. The produce from these farms are 
transported to the main markets in Koforidua for sale. Traders, most of whom come from Accra buy bulk 
quantities of these vegetable for retail in markets in Ac-
cra. This study involved analysis of vegetables procured 
from the Central and Agartha markets in Koforidua. Fresh-delivered vegetables were conveniently picked by 
traditional buying methods from sellers who were told 
the purchased vegetables will be analyzed without any 
identifiers as to the persons from whom they were pur-
chased. Laboratory preparation Each vegetable type was transported to the laboratory in 
plastic bags. First, the edible part was separated from 
non-edibles parts according to household practice. About 150-200g of cabbage was weighed and chopped; 
carrot and spring onion were chopped; the leafy part of 
lettuce were separated; and tomatoes were washed with 
150 ml of different concentrations of saline concentra-
tions (0.0%, 0.45%, 0.9%, 1.5%NaCl) prepared after 
being autoclaved. The washing water was left for 12 
hours for it to sediment after using gauze to remove 
visible particles, the top water was discarded, and the 
remaining water was centrifuged at 1500 rpm for five 
minutes. INTRODUCTION This study explored the presence of parasitic contamina-
tion of commonly-consumed vegetables procured from 
two markets in Ghana and examined the extent to which 
washing with different concentrations of saline solutions 
is able to remove the contaminants. www.ghanamedj.org  Volume 52 Number 2 June 2018 RESULTS A total of 360 samples of salad vegetables which in-
cluded tomatoes (72), carrot (72), lettuce (72), cabbage 
(72), spring onion (72) were bought from two major 
market sites between January and March 2017. www.ghanamedj.org  Volume 52 Number 2 June 2018 89 Original Article sp. oocyst (11.1%, 8.1-14.8), flagellates (7.8%, 5.2-
11.0) and Fasciola egg (7.2%, 4.8-10.4) (Table 1). They were examined for parasitological contamination 
at the Regional Hospital Laboratory, Koforidua. The 
period of sample collection coincided with the dry sea-
son in Eastern Region of Ghana. Two hundred and sev-
en (57.5%, 95% Confidence Interval 52.2% - 62.7%) 
samples were identified to be contaminated with at least 
one type of parasite. No oocyst of Microsporidium sp. was detected during 
the fluorescence microscopy. Only oocyst of Cryptos-
poridium sp. was detected. Strongyloides stercoralis 
larvae were detected in all the vegetable types except 
tomatoes. Fasciola egg was found only in lettuce. Some 
amount of Cryptosporidium sp. oocyst and Balantidium 
coli were found in all the vegetable types. Flagellates 
were recovered from cabbage, carrot, tomatoes and not 
in lettuce and spring onion (Table 1). These include 97.2% (90.3-99.7) of spring onions, 
70.8% (58.9-81.0) of lettuce, 50.0% (38.0-62.0) of to-
matoes, 43.1% (31.4-55.3) of cabbage and 26.4% (16.7-
38.1) of carrot. RESULTS The types of parasites identified were 
Strongyloides stercoralis larvae (36.4%, 31.4-41.6), 
Balantidium coli (13.6%, 10.2-17.6), Cryptosporidium Table 1 Types of vegetable and parasite contaminants Table 1 Types of vegetable and parasite contaminants  
Vegetable Type 
Number 
Examined 
Strongyloides 
stercoralis 
n(%) 
Balantidium coli 
n (%) 
Fasciola egg 
n (%) 
Flagellate                                                
n (%) 
Cryptosporidium 
oocyst  n (%) 
Cabbage 
72 
8 (11.1) 
21 (29.2) 
0 (0) 
10 (13.9) 
12 (16.7) 
Lettuce 
72 
39 (54.2) 
3 (4.2) 
26 (36.1) 
0 (0) 
15 (20.8) 
Carrot 
72 
14 (19.4) 
2 (2.8) 
0 (0) 
3 (4.2) 
4 (5.6) 
Spring onion 
72 
70 (97.2) 
1 (1.4) 
0 (0) 
0 (0) 
8 (11.1) 
Tomatoes 
72 
0 (0) 
22 (30.6) 
0 (0) 
15 (20.8) 
1 (1.4) 
Total  
360 
131 (36.4) 
49 (13.6) 
26 (7.2) 
28 (7.8) 
40 (11.1) 
n = number of vegetable type contaminated 
 
Table 2 Parasitic contamination per market, vegetable type and effect of washing with different concentrations of 
saline solutions c contamination per market, vegetable type and effect of washing with different concentrations o Table 2 Parasitic contamination per market, vegetable type and effect of washing with different concentrations of 
saline solutions Variables (n= 360) 
Total 
Positive (% with 95% CI) 
chi-square 
p-value 
Market 
 
 
15.5612 
< 0.001 
Agartha 
180 
122 (67.8%, 60.4-74.5) 
 
 
Main Market 
180 
85  (47.2%, 39.8-54.8) 
 
 
Vegetable Type 
 
 
88.0477 
< 0.001 
Cabbage 
72 
31 (43.1%, 31.4-55.3) 
 
 
Lettuce 
72 
51 (70.8%, 58.9-81.0) 
 
 
Carrot 
72 
19 (26.4%, 16.7-38.1) 
 
 
Spring Onion 
72 
70 (97.2%, 90.3-99.7) 
 
 
Tomatoes 
72 
36 (50.0%, 38.0-62.0) 
 
 
Saline Concentration after first wash (g/dl) 
 
 
1.7619 
0.623 
0 
90 
50 (55.6%, 44.7-66.0) 
 
 
0.45 
90 
57 (63.3%, 52.5-73.2) 
 
 
0.9 
90 
49 (54.4%, 43.6-65.0) 
 
 
1.5 
90 
49 (54.4%, 43.6-65.0) 
 
 
Total  
360 
207 (57.5%, 52.2-62.7) 
 
 
Saline Concentration after second wash (g/dl) 
 
 
3.9170 
0.271 
0 
90 
40 (44.4%, 34.0-55.3) 
 
 
0.45 
90 
43 (47.8%, 37.1-58.6) 
 
 
0.9 
90 
37 (41.1%, 30.8-52.0) 
 
 
1.5 
90 
32 (35.6%, 25.7-46.3) 
 
 
Total  
360 
152 (42.2%, 37.1-47.5) bles and parasitic contamination showed no significant 
difference (p value =0.623). The parasitic contamination rate among the different 
vegetable types; tomatoes, cabbage, lettuce, spring on-
ion and carrot were reasonably high. The test of associa-
tion between the vegetable types and parasitic contami-
nation was very significant different (p value < 0.001). Test of association (Chi-square) between different saline 
concentration that were used for the washing of vegeta- The study showed that parasitic contamination was 
higher for vegetables from Agartha market (67.8%) than 
from the main market (47.2%). www.ghanamedj.org  Volume 52 Number 2 June 2018 DISCUSSION The study aimed to estimate parasitic contamination of 
commonly consumed salad vegetables sold in two major 
market sites in Koforidua, New Juaben Municipal. The 
overall prevalence was 57.5%.The highest contaminated 
vegetable being 97.2% of spring onion, followed by 
70.8% of lettuce, 50.0% of tomatoes, and 43.1% of cab-
bage and the least being 26.4% of carrot. The overall parasitic recovering rate among all the vege-
table types in this study was consistent with previous 
report from Jimma Town, Southwest Ethiopia (57.8%).7 
In similar studies done in Ghana, Accra, a much lower 
recovering rate of 36.0% was observed.2 Other lower 
prevalence rates were detected in Alexandria, Egypt6, in 
Ardabil, Iran8, and Nigeria3 where the contamination 
rates were (31.7%) , (29%), and (36%) respectively. Much lower rates of contamination were detected in 
Riyadh, Saudi Arabia (16.2%) 9, and Turkey (6.3%).10 
Higher prevalence rate were detected in Kenya 
(65.5%)11, Tripoli, Libya (68%)12 and in Khorramabad, 
Iran (79%).13 Balantidium coli was the second highest parasite detect-
ed in this study. A much lower prevalence of 8.19% and 
0.8% were however detected in Ilorin, Nigeria and south 
western Nigeria respectively.16, 18 High contamination is 
possibly due to pig and human fecal matter contaminat-
ing the water supply used for irrigation. Cryptosporidium sp. oocyst (11.11%) compared to simi-
lar study in Alexandria (29.3%), was lower.6 But  much 
lower rates were detected in south Ethiopia and Norway 
with the prevalence of 4.72% and 6 % respectively.1, 19 
Presence of Cryptosporidium sp. oocyst may be due to 
use of contaminated water used for irrigation. This variation in contamination rates of the vegetables 
may in part, be due to the differences in shape and sur-
face of vegetables. Green leafy vegetables such as let-
tuce has uneven surfaces that probably facilitate sticking 
of parasitic eggs, cysts, and oocysts more readily, either 
at the farm or when washed with contaminated water. However, vegetables with smooth surface such as carrot 
had the lowest prevalence rates. The differences in the 
prevalence rate may also have been due to different 
sample size, sampling method, laboratory investigation 
methods used and cross contamination during transpor-
tation, or handling of vegetables in the market.6 Fasciola egg was identified as 7.2% in this study. Low-
er recovery rates of 5% was detected in similar studies 
in Iran8 and higher rate of 14.5% in Riyadh.9  Some 
Fasciola sp. RESULTS www.ghanamedj.org  Volume 52 Number 2 June 2018 90 Original Article There was however, a significant difference (p<0.001) 
for test of association between parasite detected and 
market type (Table 2). The most frequent occurring parasite was Strongyloides 
stercoralis larvae (36.4%) and the least occurring was 
Fasciola egg (7.2%), flagellate was (7.8%), Balantidium 
coli was 13.6%, and Cryptosporidium sp. was 11.1%. Strongyloides stercoralis was also detected as the most 
occurring parasite (43%) in Duedu’s work2 and 45.8% 
was detected in south western Nigeria while as a much 
lower prevalence rate of 1.1% was detected by Aziz and 
others and 16.5% in Jos, Nigeria.16,17 Strongyloides 
stercoralis has been noted to be widely distributed in 
areas of poor sanitation. Infection may have occurred 
due to soil and water being contaminated by human 
defecation. The differences in the rates may have been 
due to different geographical locations as well. The most frequent occurring parasite was Strongyloides 
stercoralis larvae (36.4%) and the least occurring was 
Fasciola egg (7.2%), flagellate was (7.8%), Balantidium 
coli was 13.6%, and Cryptosporidium sp. was 11.1%. Strongyloides stercoralis was also detected as the most 
occurring parasite (43%) in Duedu’s work2 and 45.8% 
was detected in south western Nigeria while as a much 
lower prevalence rate of 1.1% was detected by Aziz and 
others and 16.5% in Jos, Nigeria.16,17 Strongyloides 
stercoralis has been noted to be widely distributed in 
areas of poor sanitation. Infection may have occurred 
due to soil and water being contaminated by human 
defecation. The differences in the rates may have been 
due to different geographical locations as well. www.ghanamedj.org  Volume 52 Number 2 June 2018 REFERENCES 1. Bekele F, Tefera T, Biresaw G, Yohannes T. Para-
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town, Southern Ethiopia. Infectious Diseases of 
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38:725-30. 7. ACKNOWLEDGEMENT This research was supported by Ensign College-
Students Research Award Program of Bob and Lynette 
Gay. We appreciate the support of the medical laborato-
ry scientists of the Eastern Regional Hospital Laborato- 13. Ezatpour B, Chegeni AS, Abdollahpour F, Aazami 
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2014; 2014. DISCUSSION are known to be zoonotic.20, 21 Other parasites like flagellates which were fast moving 
were recovered from almost all the vegetable types in 
this study. Washing vegetables the second time recovered 42.2% 
parasites. This may be an indication that two wash alone 
is not enough to remove all the parasites from the vege-
tables. Duedu et al. (2014) has shown that, washing 
vegetables with just water was not enough to remove 
any contaminating parasites. He, however, recorded that 
using saline, phosphate buffered saline and tap water 
recovered 52%, 34% and 14% parasites respectively and 
use of saline was more effective in recovering of para-
sites. The most contaminated vegetable type identified was 
spring onion and the least being carrot. However, in 
similar study in Accra, lettuce was found to be the most 
contaminated (61%) while tomatoes was the least 
(18%).2 Other works done in Benha, Egypt, and Saudi 
Arabia,  identified lettuce as the most contaminated 
vegetable where prevalence were 45.5% and 27.8% 
respectively. This difference may be due to pre harvest 
factors such as contaminated water mostly used for irri-
gation and soil contaminate with human feces.14, 15 Parasitic contamination was higher in Agartha market 
(67.8%) than the main market (47.2%). This might have 
been associated with mode of display of vegetable, ex-
posure to dust and flies. Houseflies have been reported 
as a transport host for transmission of Cryptosporidium 
sp.22-24 91 www.ghanamedj.org  Volume 52 Number 2 June 2018 Original Article Several factors may have contributed to such differ-
ences the parasitic prevalence such as geographical area, 
category of samples examined, methods used for detec-
tion of the parasites, type of water used for irrigation, 
and processing of such vegetables which are different 
from country to another. 8. Daryani A, Ettehad GH, Sharif M, Ghorbani L, 
Ziaei H. Prevalence of intestinal parasites in vege-
tables consumed in Ardabil, Iran. Food control. 2008; 19:790-4. 9. Al-Megrm WI. Prevalence of intestinal parasites in 
leafy vegetables in Riyadh, Saudi Arabia. Interna-
tional Journal of Tropical Medicine 2010; 5:20-3. CONCLUSION 10. Adanir R, Tasci F. Prevalence of helminth eggs in 
raw vegetables consumed in Burdur, Turkey. Food 
Control 2013; 31:482-4. The level of parasitic contamination of vegetables in the 
two markets surveyed is high. This calls for public edu-
cation on the rigor required to wash these vegetables 
before they are consumed. The sources of contamination 
of these vegetables need to be investigated to enable 
interventions at farm level to reduce levels of contami-
nation. 11. Nyarango RM, Aloo PA, Kabiru EW, Nyanchongi 
BO. The risk of pathogenic intestinal parasite infec-
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Ghenghesh KS. Parasitological contamination in 
salad vegetables in Tripoli-Libya. Food control. 2010; 21:760-2. 24. Conn DB, Weaver J, Tamang L, Graczyk TK. 
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poridium recovered from Musca domestica, Musca 
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health 2011; 58:69-75. www.ghanamedj.org  Volume 52 Number 2 June 2018 ganic pig farms: a review. Outlook on Agriculture 
2007; 36:193-7. REFERENCES Tefera T, Biruksew A, Mekonnen Z, Eshetu T. Par-
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