Research For Proposal Defense

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Chapter I

Introduction

BACKGROUND OF THE STUDY

For millenniums, fish have always played an enormous role among the many civilizations
that have flourished on this planet. Fishes have been utilized by humans throughout history for
food, income, and other purposes. Archeological records indicate that Egyptians exploited fishes
in the Nile River from prehistoric times. Carvings record the types of fishes caught, fishing
techniques, preparation methods, and the trade of fishes (“Fishes and Humans”, 2023).

Fish particularly play a significant role in contributing a substantial portion of the world's
food supply. Fish feeds millions of people throughout the world on a daily basis. They are
considered staple food for many coastal regions and countries including the Philippines. Fish is
man’s most important single source of high-quality protein, providing ∼16% of the animal protein
consumed by the world’s population (Tidwell & Allan, 2001; Food and Agriculture Organization
(FAO) of the United Nations, 1996). It is a particularly important protein source in regions where
livestock is relatively scarce—fish supplies <10% of animal protein consumed in North America
and Europe, but 17% in Africa, 26% in Asia and 22% in China (Tidwell & Allan, 2001; FAO,
1996). The FAO estimates that about one billion people world-wide rely on fish as their primary
source of animal protein (Tidwell & Allan, 2001; FAO, 1996).
Considering the extensive global consumption of fish across regions and cultures, a
pertinent issue that arises is the concern for health safety regarding the consumption of fish. Fish
have been known to pose health risks to humans in various ways. Fish, especially raw, is a
notorious source of potential pathogenic parasites and bacteria due to the ability of bacteria to grow
and thrive without destruction through the cooking process. These pathogenic microbes can cause
foodborne illnesses, in severe cases can cause lasting damage and in rare cases, death (Moore,
2020).
Fish may also absorb contaminants such as PCBs, PBDEs, dioxins, and chlorinated
pesticides from water, sediments, and the food they eat. In contaminated areas, bottom-dwelling
fish are especially likely to have high levels of these chemicals because these substances settle to
the bottom where the fish feed (“Contaminants in Fish”, n.d.).

Moreover, Fish may take up mercury from streams and oceans as they feed. This mercury
is in the more toxic, methylmercury form. It binds to proteins in the body (such as proteins found
in muscle tissue). Food processing, preparation and cooking techniques don’t significantly reduce
the amount of mercury in fish (“Food Standards Australia New Zealand”, 2021).

Fish also frequently serve as intermediate or transport hosts for larval parasites of many
animals, including humans. Helminths with direct life cycles are most important in dense
populations, and heavy parasite burdens are sometimes found (Petty et al., 2022).

Parasitism is generally defined as a relationship between the two living species in which
one organism is benefitted at the expense of the other. The organism that is benefitted is called the
parasite, while the one that is harmed is called the host (“Parasitism Definition”, n.d.).

A host is a living organism that allows a disease-causing agent to live in them. A host may
also nourish and support the pathogen, giving them a space to survive and reproduce. Infectious
disease hosts can be humans, animals, plants, or other living beings. Hosts do not have to be
infected by the disease to spread a disease-causing agent to other hosts (Murphy & Bell, 2020).

There are different types of hosts, broadly classified as Primary hosts and Secondary hosts.
Primary Hosts The primary host, also known as the definitive host, harbors a disease-causing agent
till the agent reaches adulthood and can reproduce (sexually, when applicable). For example, the
primary host for plasmodium, the agent that causes malaria, is a female Anopheles mosquito.
Another example is chickenpox, where humans are the definitive (and only) hosts for the Varicella-
Zoster virus (Murphy & Bell, 2020).

Secondary Hosts Secondary hosts are intermediate hosts. They entertain an agent for a
specific part of the agent’s developmental cycle in a short period. Let’s continue to use malaria as
an example. Plasmodium (the agent) reproduces sexually in the female mosquito and only then
infects humans. Since humans do not host the pathogen during its reproductive cycle, we are
intermediate hosts. Birds are primary hosts for avian flu (bird flu); humans can be secondary hosts,
though human infections are rare (Murphy & Bell, 2020).

A parasite is an organism that lives on or in a host organism and gets its food from or at
the expense of its host. There are three main classes of parasites that can cause disease in humans:
protozoa, helminths, and ectoparasites (CDC, 2022).

Protozoa are microscopic, one-celled organisms that can be free-living or parasitic in


nature. They are able to multiply in humans, which contributes to their survival and also permits
serious infections to develop from just a single organism. Transmission of protozoa that live in a
human’s intestine to another human typically occurs through a fecal-oral route (for example,
contaminated food or water or person-to-person contact). Protozoa that live in the blood or tissue
of humans are transmitted to other humans by an arthropod vector (for example, through the bite
of a mosquito or sand fly) (CDC, 2022).

Helminths are large, multicellular organisms that are generally visible to the naked eye in
their adult stages. Like protozoa, helminths can be either free-living or parasitic in nature. In their
adult form, helminths cannot multiply in humans (CDC, 2022).

Although the term ectoparasites can broadly include blood-sucking arthropods such as
mosquitoes (because they are dependent on a blood meal from a human host for their survival),
this term is generally used more narrowly to refer to organisms such as ticks, fleas, lice, and mites
that attach or burrow into the skin and remain there for relatively long periods of time (e.g., weeks
to months). Arthropods are important in causing diseases in their own right, but are even more
important as vectors, or transmitters, of many different pathogens that in turn cause tremendous
morbidity and mortality from the diseases they cause (CDC, 2022).

Harm to the host can be caused by tissue damage during the parasite’s various life cycle
stages, which in themselves are detrimental to the host, but can also make the host more susceptible
to other diseases. Parasites can also harbor bacteria or viruses and transmit them to the host
organism (Lasee, 1995).

There are some parasites that are zoonotic or can be passed from animals to humans. This
can occur if animals and humans are living closely in the same environment, from human
consumption of animal products, or other means. Parasites show some level of preference for the
host they parasitize (Rosas-Valdez and Perez-Ponce de Leon, 2011).

This concept is further supported by a study done by Poulin (1997) where he examined
what composition of parasites made up species rich and species poor parasite assemblages and the
percentages of generalist parasites and specialist parasites that make up these assemblages.
Generalist parasites do not show a preference for a certain host species and can affect many
different host organisms, whereas specialist parasites will only infect a few select organisms
(Poulin, 1997).

The increased potential for infecting humans with a fish parasite is more common for
endoparasites since tapeworms and roundworms can be passed to humans who eat undercooked
or raw meat. Unlike ectoparasites, endoparasites can and do infect humans if fish or meat is not
prepared correctly (Hoffman, 1998).

Parasites, specially, occurring in freshwater fishes need serious consideration that


contaminate economically imperative fish species that, in many cases, it decreases their quality
and deliciousness (Okorie, 1972).

Infection in fishes also occurs due to overcrowding and environmental stress (Thomas,
2014). Fish parasites may be transmitted through food, introduction of exotic species in aquatic
ecosystem as well as handling and processing of the infected fish. Fish infections caused by
endoparasitic helminths tends to increase with increased level of pollution (Palm, 2011).

According to Klinger and Francis (2002), protozoa area vast assemblage of eukaryotic
organisms, and most of the commonly encountered fish parasites are protozoa, which with practice
are the easiest to identify and easiest to control. In general, protozoa are one of the major fish
parasites that have been long neglected because of the inherent difficulty in studying compared to
other larger parasites. Among protozoa, ecto and endo parasitic protozoa occupy a very important
sector as one of the hazardous threats to fish health.

Some fish parasites would develop in humans if the fish is eaten raw, but none would be
harmful if the fish is thoroughly cooked. All reports of people being infested with fish parasites
were because of ingestion of raw fish or insufficiently cooked fish (“Food Agricultural
Organization”, 1996).
Parasites of fish can either give an indication of the quality of water, since parasites
generally increase in abundance and diversity in more polluted waters (Poulin, 1992; Avenant,
2002).

There are many fish parasite that may infect human. Freshwater and brackish water fishes
are the source of human infections with foodborne trematodes. There were already estimated
numbers of people who are currently infected with Fish-borne trematodes wherein it exceeds in 18
million and most of them are at risk (Khalil et al., 2014).

Parasites also compete for food thereby depriving fish of essential nutrients and inhibiting
growth leading to death with consequent economic loss. Endoparasites are type of parasites that
are found within the flesh, cavities of the host organism. These parasites can be usually found on
the muscles, organs, membrane linings of the host organism (Peek, 2012).

As previously stated, fish may become suitable hosts for different species of parasites,
endoparasites in particular. Endoparasites in fish, which inhabit the internal organs or tissues of
the host fish, have been a subject of scientific investigation due to their potential impact on fish
health and the fishing industry. These parasites can range from microscopic protozoa to more
complex organisms like tapeworms and flukes. Research has revealed that endoparasites can
adversely affect the host fish's growth, reproduction, and overall condition, leading to economic
losses in aquaculture and fisheries (Paperna, 1991).

The presence of parasites in fish will also impact on humans, whereas nematode, cestode,
and trematode parasites can infect humans after consuming raw or imperfectly cooked fish (Abdan
et al., 2020).

Diseases are caused by many parasites including protozoans and helminths. Among the
diseases caused by the protozoans are Amyloodioniosis or Velvet Disease, Ichthryophiriasis or
White spot Disease, Trichidiniasis, Brooklynelliosis and Cryptobiosis or Trypanosomiasis.
Parasitic Helminthes include Monogenea, Trematodes, Cestodes, Nematoda and
Acanthocephalans (Cruz & Lacierda, 2012).

Life threatening or serious human health concerns identified in published literature


associated with this type of food fraud are consumption of toxins, highly allergenic species, or
contaminates which may be present in substituted fish (Williams et al., 2020).
Endoparasites have a diverse range of effects on their hosts. In fishes, they can impair host
growth, survival, reproduction, and mortality, transmit diseases, and affect the marketability of
aquaculture and fisheries products (Koepper et al., 2022).

Generally, fish from these polluted environments are infested, their consumption could
transmit the parasitosis to humans, from which fecal parasites can probably be observed from
humans to fish and from fish to humans whose reservoir is the water (Kiamfu et al., 2020).

One of the factors responsible for reduction in fish production is parasite. Parasites are vital
source of financial losses for aquaculture due to reduction in fish growth and increased mortality
(Ahmad et al., 2020)

Interactions involving hosts and parasites can provide essential ecosystem functions
and services, contributing to biomass flow, food web connectivity and population control, as well
as driving the evolution of other species (Virgilio et al., 2023).

The increasing population coupled with urbanization have resulted to problem of aquatic
pollution and a corresponding prevalence of parasites and diseases in wild fish populations.
Increasing aquatic environmental dynamics play a key role in determining where the hosts (fish or
other aquatic organisms), parasites and other microbial pathogens exist (Zarlenga et al., 2014).

Few documented evidences exist on the pathogenicity and mortality-causing ability of


parasites to the fish population, which could be due to the unnoticeable negative impacts of this
parasites (Roberts, 2001).

Fish may serve as parentenic/intermediate or definitive hosts of parasites that are harmful
to man and animals. Zoonotic diseases that result from the ingestion of raw or under cooked fish
include opisthor-chiasis, diphyllobothriasis, clonorchiasis, gnathosomiasis and anisakiasis (Okoye
et al., 2014).

There is a multitude of possible diseases (parasitic, bacterial, viral, etc.). Stressed fish can
often be identified by abnormal behaviour such as decreased appetite, nervous or waddling
swimming, upright position at the surface, or by clinical symptoms or pathologies such as
morphological abnormalities (barbels or damaged fins, large belly, blocked mouth, goiters, etc.),
eye disorders (protruding eyes, glassy eye, loss of eye, etc.) or by the presence of a large number
of other diseases. ), gill disorders (degeneration, whiteheads, etc.), internal organ disorders (dark
spots on the liver, heart, spleen, inflammation of the intestine; etc.), skin disorders (foamy lips,
blackish tumours, etc.), behavioural disorders (fish piping air on the surface, uncoordinated
swimming movements, etc.), undesirable hosts (algae, hydrous, chlorinated water, etc.).
Nevertheless, these symptoms are not specific, therefore, precise laboratory techniques are
required to diagnose the disease (Lacroix, 2004).

Globally, per capita apparent fish consumption nearly quadrupled from 9.9 kg in the 1960s
to 18.9 kg in 2010 (FAO, 2014), with fish accounting for 17 percent of animal-derived and 6.5
percent of overall protein consumption (Ottinger et al., 2016)

Parasites reduce fish survival by reducing their size, changing the behavior of affected fish,
and making them susceptible to further diseases, resulting in increased mortality. As a result of
death and tissue damage, parasites can cause significant economic losses in fish productivity (Abd-
Elrahman et al., 2023)

Parasites of fish constitute one of the major problems to fish health. Parasites of fish have
been a great concern since they often bring about a host of disease conditions in fishes. A parasite
is an organism that lives on or within a part of another species from which it obtains nutrients.
These diseases often produce a weakening of the hosts’ immune system thereby increasing their
vulnerability to other secondary infections (Osimen & Anagha, 2021).

Some symptoms of parasitic infections to human are unusual gastrointestinal problems


such as bloating, cramping, diarrhea or unusual bowel movements. What makes the diagnosis
difficult is that the symptoms may occur many hours or days after the consumption of the fish
(Badar, 2007).

Some of them are parasitic in the external surface of fish; others are parasitic in the internal
organs. They can infect fishes in different stages of their life, as well as different aquatic
environmental conditions, and are also considered to be biological indicators of environmental
pollution. Parasites interfere with the nutrition, metabolism, and secretory function of the
alimentary canal, damage nervous system, and also upset the normal reproduction of the host
(Faruk, 2018).
Factors that can influence the occurrence of parasites inside mariculture facilities are: fish
density, environmental conditions and water quality (e.g., temperature, salinity, pH), fish handling,
nutrition, feed source, feeding pattern, and also parasite-/host-species relationships (Palm et al.,
2015)

Fish are very frequently infected by either endo- or ectoparasites, or both, and can have
important role in their life cycle, often transmitting infection to other animals which feed on them,
including humans. Parasitic infection can cause a variety of pathological changes which can be
quite detrimental to the fish health, including tissue damage, organ obstruction, and nutrient
deprivation (Vuić et al., 2022).

A large number of varied parasites of both plant and animal origin invade the body surface
or internal organs of fish, many of which can be transmitted to humans and other fish, eating
animals, causing certain disease of medical and veterinary importance (Balarabe-Musa & Osawe,
2013).

The presence of parasites in fish will have an impact on reducing consumption, decreasing
quality in aquaculture, reducing the body weight of consumption fish, and rejection by consumers
due to morphology or abnormal body shape of fish. The type of parasite in marine fish is
determined by its geographical distribution, the presence of intermediate hosts, endurance of fish
(in the infected host phase), and the length of time they are infected (Uliya & Yusni, 2020).

The increased potential for infecting humans with a fish parasite is more common for
endoparasites since tapeworms and roundworms can be passed to humans who eat undercooked
or raw meat. Unlike ectoparasites, endoparasites can and do infect humans if fish or meat is not
prepared correctly (Edeh & Solomon, 2016).

According to Solomon, Olawale, and Ekprikpo, (2021) these are some fishes being studied
that have been seen with endoparasites:

Clarias gariepinus

It has an average adult length of 1–1.5 m. It reaches a maximum length of 1.7 m and can
weigh up to 60 kg. These fish have slender bodies, flat bony heads, and broad terminal mouths
with four pairs of barbells. They also have large accessory breathing organs composed of modified
gill arches.It is a nocturnal fish like many catfish. It feeds on living as well as dead animal matter.
Because of its wide mouth, it is able to swallow relatively large prey whole. It is also able to crawl
on dry ground to escape drying pools.

Chrysichthys nigrodigitatus

Chrysichthys nigrodigitatus is also known as silver cat fish, found in Africa, including
Nigeria. They belong to the family Bagridae. The fish is common in the Niger Delta where it is a
valued source of protein and constitutes the dominant commercial catch of artisanal fishermen. C.
nigrodigitatus has an omnivorous feeding habit which exposes it to a variety of parasites that
negatively impact on its health. Due to its place in the daily diet of humans in Africa, zoonotic
infections arising from ingesting raw fish, knowingly or unknowingly, could cause serious
problems.

Tilapia zilli

It has a maximum length of 40 cm and a maximum published weight of 300 grams with a
total of 13-16 dorsal spines. The non-breeding coloration of T. zilli is dark olive on top and light
olive to yellow-brown on the sides. Lips are bright green and chest is pinkish

Mormyrups deliciosus

They are widespread in Afro-tropical River systems and very abundant in West Africa.
Roberts (1975) attributed their success primarily to two adaptations, namely, their electric organs,
which are non-visual sense organs important in nocturnal movement and communication and
diversification of feeding habits

Gnathonemus cyprinoides

It is a genus of elephant fish in the family Mormyridae, they exhibit two structural, sexually
dimorphic characters; anal fin ray bone expansion and indentation of the posterior ventral body
wall.

The relevant knowledge shared in the previous paragraphs above prompted the proponents
to conduct a study regarding the incidence of endoparasites in a commercially important fish
species in the city of Ozamiz. This study will specifically utilize Chanos chanos (Bangus) which
is a commercially sold fish in the city.

Chanos chanos (milkfish) locally known as Bangus is the main aquaculture product of the
Philippines. It is one of the most popular seafood dishes in the country (Cruz, 2016). It is
considered to be one of the most important fish species farmed in the Philippines and is usually
cultivated in freshwater, brackish water and marine environments. It continued to provide
affordable source of protein for many of the people and also livelihood for most of the local
families which work in Aquaculture (Yap et al., 2007).

The selection of the said fish species does not only stem from its commercial relevance in
the city but also from the fact that it is often used as an option for raw consumption in a popular
dish called “kinilaw”.

Kinilaw is a bright and tangy dish of raw fish marinated in vinegar that’s indigenous to the
Philippines. At its most basic, kinilaw is cubed raw fish tossed with vinegar—usually coconut or
cane vinegar—and the flesh of a sour fruit like green mangoes and/or the juice of citrus fruit like
calamansi or dayap (Gilbuena, 2021). Many people, especially those who are lack knowledge with
microscopic endoparasites, would have a perception that consuming fish in its raw form or in
undercooked preparations would not pose any threat with their health. Some may say that
marinating the fish in vinegar and lime juice, due to their acidity, could eliminate the pathogens
such as bacteria and parasites thus making “kinilaw” or any other forms of raw consumption of
fish as a generally safe practice.

The results of the study by Beyhan and Yilmaz (2016) revealed that 1% acetic acid was
insufficient on the viability of Ascaris eggs. At the 30th minute, 3% acetic acid demonstrated 95%
effectiveness, and at 5% concentration, all eggs lost their viability. Treatment of acetic acid at the
ratio of 4.8% in 30 minutes, or a ratio of 4.3% in 60 minutes is required for full success of
treatment. Although acetic acid has been known to contain antimicrobial properties, CHU (2016)
states that marinating raw aquatic food products with wine, vinegar, etc. cannot effectively kill
bacteria and parasites.

Currently, there were no found studies in Ozamiz City that utilize the fish species. Thus,
the proponents of this study endeavor to furnish foundational data to bridge this existing gap.
Moreover, the focus of this study is to determine the incidence of endoparasites in the
commercially sold and “kinilaw-staple” Chanos chanos (Bangus) Fish in Ozamiz City. Ultimately,
the results of this study are committed to educating the city's residents about the health risks of
eating raw fish.

OBJECTIVES OF THE STUDY

The main objective of this study is to determine the incidence of endoparasites in commercially
significant and kinilaw-staple Chanos chanos (Bangus) Fish in Ozamiz city. It specifically aims
to achieve the following objectives:

1. To determine the prevalence of endoparasites in the examined Chanos chanos samples


2. To determine the intensity of infection in samples found to be infected with endoparasites;
and
3. To determine the density of infection of infected fish samples.

SIGNIFICANCE OF THE STUDY

The main significance of this study is to determine the incidence of endoparasites in


Chanos chanos fish that are being sold in Ozamiz City. Moreover, the study’s findings will be
used to provide health awareness among the people in Ozamiz City regarding the consumption,
most especially in raw form, of Chanos chanos (Bangus) fish.

SCOPE AND LIMITATIONS OF THE STUDY

This study will be conducted in Ozamiz city. The fish samples that will be examined will
come from various locations in the city that sell the said fish species including its very own public
market. The allotted timeframe for this study will be the entire duration of the second semester of
the academic year 2023-2024 which shall begin in the month of January, year 2024. This study is
limited only on the examination of the presence of endoparasites in Chanos chanos Fish in Ozamiz
City.
Chapter II

Materials and Methods

Collection of Fish Sample

A total of 15 fish samples will be bought in the 3 selected study sites within the City which are as
follows: Site I: Gango Community Market, Site II: Fish Vendors near Rodolfos Restaurant, & Site
III: City Public Mall. The samples will be placed in an ice-filled Styrofoam box and will be brought
at Misamis University where it will be processed and examined for endoparasites.

Figure 1. Map of the Study Area, Ozamiz City, Misamis Occidental, Philippines. Site I: Gango
Community Market, Site II: Fish Vendors near Rodolfos Restaurant, & Site III: City Public Mall.

Determination of length and weight of fish samples

The fish total weight (TW) will be measured using a digital weighing scale, and the total length
(TL) will be measured using a ruler (Abdel- Ghaffer, Abdel-Gaber, Bashtar, Mehlhorn, & Al
Quraishy, 2015). The length and weight of the fish samples will be taken inside the laboratory.
Isolation and Identification of endoparasites

The procedure on the examination of the fish samples will be based on the study of Cabuga and
Pondang (2023). Individually, the fish sample will be dissected through its abdomen by using the
scalpel and scissors. The gut of the fish will be extracted and placed directly into the Petri dishes
with a 0.6% saline solution. Each isolated organ will be sliced and cut to observe the presence of
the parasite.

Afterward, a dissecting microscope will be used for the parasite determination (Cabuga and
Pondang, 2023; Kawel et al., 2016). Using the study of Cabuga and Pondang, 2023; Moravec &
Van 2015; da Silva etal., 2018; Neves etal., 2020, the identification of helminth parasites. All the
observed endo-parasites were preserved in 70% ethyl alcohol (Cabuga and Pondang, 2023; Leela
& Rao, 2014).

Data Analysis

Data will be analyzed using the formula used in the study of Cabuga and Pondang, 2023 that was
based on the formula of Miahet al., 2013 and Margolisetal., 1982 in analyzing the degree of
parasitism in an organism.

Where:

Prevalence is equivalent to the number of individuals of a host species infected with a particular
parasite species divided by the number of hosts examined.

𝑁𝑜. 𝑜𝑓 𝐻𝑜𝑠𝑡 𝐼𝑛𝑓𝑒𝑐𝑡𝑒𝑑


𝑃𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒 𝑅𝑎𝑡𝑒 = 𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝑁𝑜. 𝑜𝑓 𝐻𝑜𝑠𝑡 𝐸𝑥𝑎𝑚𝑖𝑛𝑒𝑑

Mean Intensity is the total number of a particular parasite species in a sample of a host species
divided by the number of infected individuals of the host species in the sample.

𝑁𝑜. 𝑜𝑓 𝑃𝑎𝑟𝑎𝑠𝑖𝑡𝑒𝑠 𝑐𝑜𝑙𝑙𝑒𝑐𝑡𝑒𝑑 𝑖𝑛 𝑎 𝑆𝑎𝑚𝑝𝑙𝑒


𝑀𝑒𝑎𝑛 𝐼𝑛𝑡𝑒𝑛𝑠𝑖𝑡𝑦 =
𝑁𝑜. 𝑜𝑓 𝐼𝑛𝑓𝑒𝑐𝑡𝑒𝑑 𝐻𝑜𝑠𝑡
Relative Density or Abundance is equal to the total number of individuals of a particular parasite
species in a sample of hosts divided by the total number of individuals of the host species (both
infected and uninfected) in the sample.

𝑁𝑜. 𝑜𝑓 𝑃𝑎𝑟𝑎𝑠𝑖𝑡𝑒𝑠 𝑐𝑜𝑙𝑙𝑒𝑐𝑡𝑒𝑑 𝑖𝑛 𝑎 𝑆𝑎𝑚𝑝𝑙𝑒


𝐷𝑒𝑛𝑠𝑖𝑡𝑦 𝑜𝑓 𝐼𝑛𝑓𝑒𝑐𝑡𝑖𝑜𝑛 =
𝑇𝑜𝑡𝑎𝑙 𝐻𝑜𝑠𝑡 𝐸𝑥𝑎𝑚𝑖𝑛𝑒𝑑
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PREVALENCE OF ENDOPARASITES IN “Kinilaw Staple” Chanos chanos (Bangus) IN
OZAMIZ CITY, PHILIPPINES

A Research Proposal Presented to:

The Faculty of the College of Medical Technology

Misamis University

Main Campus, Ozamiz City

ADVISER:

MRS. MERASOL O. DUYAG

PROPONENTS:

ANTIAMPO, RHEA GEM R.

BOLINKIT, YNA EZABELLEE U.

OGABANG, FIEL M.

January 2024

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