COLLEGE OF SCIENCE
DEPARTMENT OF BIOLOGY
PREVALENCE
OF
INTESTINAL
PARASITIC
INFECTIONS
ASSOCIATED RISK FACTORS AMONG YIFAG AND
AND
AGIDKIRIGNA
COMPLETE CYCLE PRIMARY SCHOOL CHILDREN IN LIBOKEMKEM
DISTRICT, NORTHWEST ETHIOPIA.
BY
ALAMIREW WOSSEN
A
THESIS
SUBMITTED
TO
THE
DEPARTMENT
OF
BIOLOGY
PRESENTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE DEGREE OF MASTER OF SCIENCE IN BIOLOGY.
SEPTEMBER, 2018
1
BAHIR DAR UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF BIOLOGY
PREVALENCE OF INTESTINAL PARASITIC INFECTIONS AND ASSOCIATED RISK
FACTORS AMONG YIFAG AND
AGIDKIRIGNA COMPLETE CYCLE PRIMARY
SCHOOL CHILDREN IN LIBOKEMKEM DISTRICT, NORTHWEST ETHIOPIA.
A THESIS SUBMITTED TO THE DEPARTMENT OF BIOLOGY PRESENTED IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE
IN BIOLOGY.
MSc. THESIS
BY
ALAMIREW WOSSEN
ADVISOR:AYALEW WONDIE(Ph.D)
SEPTEMBER, 2018
BAHIR DAR, ETHIOPIA
2
APPROVAL SHEET
As a thesis research advisor I hereby certify that I have read and evaluated this thesis prepared
under my guidance, by Alamirew Wossen Kassa entitled ”Prevalence of Intestinal Parasitic
Infections and Associated Risk Factors among Yifag and Agidkirigna complete cycle
Primary Schools Children in Libokemkem District, Northwest Ethiopia”. I am recommended
the paper to be submitted as fulfilling the requirements for the Degree of Master of Science in
Biology.
Ayalew Wondie (Ph.D)
Advisor
________________
Signature
____________
Date
As members of the board of examiners for the MSc. Thesis open defense examination, we certify
that we have read and evaluated the thesis paper prepared by Alamirew Wossen Kassa and
examined the candidate. We recommended the thesis to be accepted as fulfillment for the
requirements of the Degree of Master of Science in Biology.
____________________________
Chairperson
___________________________
Internal Examiner
___________________________
External Examiner
________________
Signature
_______________
Signature
________________
Signature
3
_____________
Date
_______________
Date
_______________
Date
DECLARATION
I the under signed, declare that this thesis is my original work and has not been presented for
degree in any other university and that all sources of materials used for the thesis have been duly
acknowledged.
Name Alamirew Wossen.
Signature __________________
Department: Biology.
Date _________________
4
ACKNOWLEDGEMENTS
First and for most, I would like to thank God for his endless blessings in all my life. For most, I
would like to express my sincere gratitude to my advisor Dr. Ayalew Wondie for his invaluable
support, in guidance and patience; and whose expertise, understanding, and advice, added to my
knowledge who gave me constructive comments, critical reviews and other materials that make
this study a success.
I am also indebted to Ministry of Education and Bahir Dar University; College of Science,
Department of Biology for facilitated every facilities and financial support for the success of this
study.
I wish to give my sincere thanks to Libokemkem (Addiszemen) District Education office for gave
me permission to did this study and Libokemkem (Addis zemen) District Health Office and Yifag
Health Centre Administrator workers and laboratory technicians especially, for Ato Melashu
Yassin and W/ro Gebeyanesh Asmare for their assistance in data collection particularly in the
intestinal parasitological microscopy examination.
I also give my sincere thanks to Yifag and Agidkirigna complete cycle primary school
administrators, teachers, students and parents for their cooperation and support during the various
aspects of the study.
My sincere thanks go to my colleagues Yibabie Zemene and Solomon Gedefaw, helped me from
data collection to technical assistance in data analysis period and other my friends that helped me
during my work.
Finally, I would like to thank to my families and friend ships that helped me during my work.
Last but not the least I am greatly indebted to my beloved wife W/ro Tiringo Birhanu for her
invaluable and unreserved help and appreciation for the entire of my work.
i
TABLE OF CONTENT
Page
ACKNOWLEDGEMENTS............................................................................................................................. i
TABLE OF CONTENT.................................................................................................................................. ii
LIST OF TABLES ........................................................................................................................................ iv
LIST OF FIGURES ........................................................................................................................................ v
LIST OF ABBREVIATIONS ....................................................................................................................... vi
ABSTRACT ................................................................................................................................................. vii
1. INTRODUCTION ...................................................................................................................................... 1
1.1 Back Ground of the Study .................................................................................................................... 1
1.2 Statement of the problem ...................................................................................................................... 3
1.3 Research Questions............................................................................................................................... 4
1.4 Objectives of the study ......................................................................................................................... 4
1.4.1 General objective ........................................................................................................................... 4
1.4.2 Specific objectives ......................................................................................................................... 4
1.5 Significance of the study ...................................................................................................................... 5
1.6 Limitations of the study ........................................................................................................................ 5
2. LITERATURE REVIEW ........................................................................................................................... 6
2.1 General Description of Intestinal Parasitic Infections (IPIs) ................................................................ 6
2.2 Global prevalence of intestinal parasitic infections .............................................................................. 6
2.3. Prevalence of intestinal parasitic infections in Africa ......................................................................... 8
2.4 Epidemiological distribution of intestinal parasitic infection in Ethiopia ............................................ 9
2.5 Prevalence of protozoan parasitic infections. ..................................................................................... 10
2.5.1 Prevalence of Giardia lamblia infection ...................................................................................... 11
2.5.2 Prevalence of Entamoeba histolytica ........................................................................................... 13
2.6 Prevalence of Intestinal Helminthic Infections................................................................................... 14
2.6.1 Prevalence of Ascaris lumbricoides............................................................................................. 15
2.6.2 Prevalence of Hookworm infection ............................................................................................. 16
2.6.3 Prevalence of Trichuris trichiura ............................................................................................... 17
2.6.4 Prevalence of Strongyloides stercoralis ....................................................................................... 18
2.6.5 Prevalence of Schistosoma mansoni ............................................................................................ 19
2.6.6 Taenia Species ............................................................................................................................. 21
2.6.7 Prevalence of Hymenolepis nana................................................................................................. 22
ii
2.6.8 Prevalence of Enterobius vermicularis infection ......................................................................... 23
2.7. General transmission and risk factors for intestinal parasitic infection ............................................. 24
2.8 General prevention and control of intestinal parasitic infections (IPIs). ............................................ 25
3. MATERIALS AND METHODS ............................................................................................................. 26
3.1. Description of the Study Area ........................................................................................................... 26
3.2 Study Design and period..................................................................................................................... 27
3.3 Study population ................................................................................................................................. 27
3.4 Sample size determination and sampling techniques ........................................................................ 27
3.4.1 Sample SizeDetermination .......................................................................................................... 27
3.4.2 Sampling Technique .................................................................................................................... 28
3.5 Data Collection ................................................................................................................................... 28
3.5.1 Questionnaire ............................................................................................................................... 29
3.6 Parasitological examination................................................................................................................ 30
3.6.1 Direct Wet Saline Mount ............................................................................................................. 30
3.6.2 Formal Ether Concentration ........................................................................................................ 30
3.7 Data Analysis...................................................................................................................................... 30
3.8 Ethical Clearance ................................................................................................................................ 31
4. RESULTS ................................................................................................................................................. 32
4.1 Socio demographic characteristics of the school children .................................................................. 32
4.2 Associated risk factors of intestinal parasitic infections ..................................................................... 32
4.3 Prevalence of Intestinal Parasitic Infections ....................................................................................... 35
4.4 Binary logistic regression analysis of socio demographic and socio economic factors associated with
intestinal parasitic infections (IPIs) .......................................................................................................... 39
5. DISCUSION ............................................................................................................................................. 49
6. CONCLUSION AND RECOMMENDATIONS ................................................................................. 56
6.1 Conclusion .......................................................................................................................................... 56
6.2 Recommendations .............................................................................................................................. 56
REFERENCES ............................................................................................................................................. 58
APPENDIX .................................................................................................................................................. 71
Appendix 1: Laboratory Test Procedures for Parasitological Examination ............................................ 71
A.Test procedure for direct saline wet mount examination of stool ......................................................... 71
Appendix 2: Table of Laboratory data collecting format ......................................................................... 72
APPENDIX 3: Information to participants consent form and questionnaire format ................................ 73
Appendix 4: English questionnaire form ................................................................................................. 74
APPENDIX 5: Amharic version of concent form .................................................................................... 75
Appendix 6 : Amharic vershion questionnaire form ............................................................................... 76
iii
LIST OF TABLES
Page
Table 1: Demographic characteristics of Yifag and Agidkirigna complete cycle primary school children in
2017/2018 (n=403). ...................................................................................................................................... 32
Table 2: Frequency of respondents based on associated risk factors among Yifag and Agidkirigna junior
primary school children in Libokemkem district, 2017/2018 (n=403). ........................................................ 33
Table 3: The Association of Intestinal Parasitic Infections(IPIs) with risk factors in Yifag and Agidkirigna
complete cycle primary school children, in Libokemkem district 2017/2018 (n=403)................................ 36
Table 4: Prevalence of IPIs based on sex in Yifag and Agidkirigna complete cycle primary schools
children in Libokemkem district, 2017/2018 (n=403), where males(n=202); Females(n=201). ................. 38
Table 5: Binary logistic regression analysis of intestinal parasitic infections in relation to socio
demographic and socioeconomic factors amongYifag and Agidkirigna complete cycle primary school
2017/2018 (n=403). ...................................................................................................................................... 40
Table 6: Prevalence of intestinal parasitic infections in different age groups among Yifag and Agidkirigna
primary school children in Libokemkem district 2017/2018 (n=403). ......................................................... 42
Table 7: Binary logistic analysis between eating raw, undercooked, and unwashed vegetables and fruits
with E.histolytica and A.lumbricoides in both schools 2017/2018 (n=403). ............................................. 43
Table 8: Risk factors associated with hookworm in Yifag and Agidkirigna complete cycle primary school
children in Libokemkem district 2017/2018 (n=403). .................................................................................. 44
Table 9: The risk factors associated with S.mansoni in Yifag and Agidkirigna complete cycle primary
school children in Libokemkem district 2017/2018 (n=403). ...................................................................... 45
Table 10: Prevalence of intestinal parasitic infections (IPIs) with school type (Yifag and Agidkirigna) in
Libokemkem district 2017/2018 (n=403), where Yifag (n=223);(Agidkirigna n=180). .............................. 47
iv
LIST OF FIGURES
Page
Figure 1፡ Students during questionnaire period .......................................................................................... 29
Figure 3: Prevalence of intestinal parasitic infections in Yifag and Agidkirigna complete primary schools
children, in Libokemkem district 2017/2018(n=403). .................................................................................. 35
Figure 4: Prevalence of protozoan and helminthic infections in Yifag and agidkirigna complete cycle
primary school children, 2017/2018 (n=403), where Protozoan infections (n=33) Helminthes infections
(n=75). .......................................................................................................................................................... 38
Figure 5: Prevalence of intestinal parasitic infections based on sex in Yifag and Agidkirigna complete
cycle primary schools children in Libokemkem District, 2017/2018.(n=403), where Males (n=202);
Females (n=201) ........................................................................................................................................... 39
Figure 6: Prevalence of Intestinal parasites in Rural and Urban dwellers among primary schools children in
Yifag and Agidkirigna in Libokemkem district, 2017/2018(n=403)............................................................ 46
Figure 7: Prevalence of intestinal parasitic infections (IPIs) with school type (Yifag and Agidkirigna) in
Libokemkem district 2017/2018 (n=403), where Yifag (n=223);(Agidkirigna n=180). .............................. 47
Figure 8: Prevalence of intestinal parasites based on grade level among in Yifag and Agidkirigna complete
cycle primary school children in Libokemkem district 2017/2018 (n=403), Where Grade1-4 (n=202);
grade5-8(n=201). .......................................................................................................................................... 48
v
LIST OF ABBREVIATIONS
ANRS……………………. Amhara National Regional State
AZHC…………………….Addis Zemen Health Centre
CDC………………………Center for Disease Control
COR………………………Crude Odd Ratio
CI…………………………Confidence Interval
g…………………………..gram
IPIs……………………….Intestinal Parasitic Infections
mg…………………………milligram
ml………………………….milliliter
mm…………………………millimeter
rpm…………………………revolution per minute
SPSS………………………Statistical Packages for Social Science
STHs……………………….Soil Transmitted Diseases
WHO……………………….World Health Organization
YHC………………………..Yifag Health Centre
vi
ABSTRACT
Primary school children are one of the highly susceptible groups to intestinal parasitic infections.
Intestinal parasitic infections (IPIs) are prevalent through the tropics and sub tropics, especially
among poor countries including Ethiopia. The effective prevention and control of intestinal
protozoa and helminthic infections require identification of local risk factors. The aim of this
study was to assess the prevalence of intestinal parasitic infections and associated risk factors
among primary school children in Yifag and Agidkirigna inLibokemkem district, Northwest
Ethiopia. The study was conducted from November 2017 to June 2018, involving 403 students
those selected by using systematic random sampling technique from two primary schools,Yifag
and Agidkirigna in Libokemkem district. The stool samples were examined microscopically using
direct wet mount and formal-ether concentration technique. Structured questionnaire was used to
obtained relevant information on socio-demographic data. Data was analyzed by SPSS version 20
software using Chi-square test, binary logistic regression. Out of 403 stool samples examined,
108(26.8%) infected with intestinal parasitic protozoan and helminthic parasites.The overall
protozoan infection was 33(8.2%) while helmithic infection was 75(18.6%). A total of eight
species were identified; A.lumbricoides (7%), E.histolytica (6.2%), H.nana (5.5%), S.mansoni
(2.2%), G.lamblia (2%), Taenia species (1.7%), Hookworm (1.5%) and E.vermicularis
(0.7%).Types of infection in the study subjects were single infection. Prevalence rate of intestinal
parasitic infections had significantly associated with eating raw, under cooked, unwashed
vegetables and fruits; the habit of using toilet, latrine availability of the area; shoe wearing habit
of the students, residential area, educational status of the mothers (p<0.05). On the other hand sex,
grade level, age, trimming fingernails, and hand washing habit before meal, bathing or swimming
in the water bodies were not significantly associated with IPIs (P>0.05). The high prevalence of
intestinal parasitic infections in the school children implies the need of health education in
relation to encouraging shoe wearing habit, hand washing habit before meal and after toilet,
deworming the school children, encouraging the habit of using toilet, building enough toilets in
the school and at their home, improvement of safe water supply, health facilities, that may restrict
children from defecating in the open field and near river/streams and it contributes to reduce and
prevent (control) the rate of transmission of intestinal parasitic infections.
Key words: Yifag, Agidkirigna, Intestinal parasitic infections, Prevalence, School children
vii
1. INTRODUCTION
1.1 Back Ground of the Study
Parasitic diseases are incriminated in causing more than 33% of global deaths of which
intestinal parasitic infections are believed to take the major share (WHO, 1991; WHO, 1998).
It is estimated that about 3.5 billion people are affected and 450 million are ill due to these
infection, the majority is being children (WHO, 2004; Tadesse Hailu, 2014; Mulusew
Andualem, 2014).
Intestinal parasitic infections (IPIs), caused by intestinal helminthes and protozoan parasites,
are among the most prevalent infections in humans in developing countries, protozoan
parasites more commonly caused gastrointestinal infections compared to helminthes.
Intestinal parasites cause a significant morbidity and mortality in endemic countries. It has
been estimated that A. lumbricoides, hookworm and T.trichiura infect 1,450 million, 1,300
million and 1,050 million people worldwide, respectively (Desta Haftu et al., 2014). While
Schistosomiasis affects over 200 million people (Committee, 2002). On the other hand, in
2013 schistosomiasis is endemic in 78 countries, with an estimate of more than 261 million
people requiring treatment (WHO, 2015). Of this total estimate, 46.4% are school age
children and 92.0% are residents in Africa. E.histolytica and G.lamblia are also estimated to
infect about 60 million and 200 million people worldwide, respectively (WHO, 2015).
Intestinal protozoa and helminthic infection rate are highest in children living in sub Saharan
Africa. It is estimated that approximately a quarter of the total population is infected with one
or more, typically the nematode worms, which are the most prevalent of intestinal parasites.
Intestinal parasitic infections (IPIs) are the main health problems which can cause mortality
and morbidity among infected people. Young children are reported to be disproportionately
affected by intestinal parasitic infection compared to adults due to their increased nutritional
requirements and less developed immune systems (Scrimshaw,1994).Intestinal parasitic
infections in this age group have been linked with significantly reduced growth, physical
fitness and appetite (Stephenson et al.,1993) and an increased risk for protein-energy
malnutrition (Stephenson et al., 2000), iron-deficiency, anemia, mental problems (Amare
1
Menggistu et al., 2007), reduced cognitive/psychomotor development (Nokes et al., 1992)
and low educational achievement in children (Mengistu Legesse and Berhanu Erko, 2004).
Intestinal helminthic infections cause recurrent gastrointestinal and upper respiratory tract
infection contributing to high morbidity and mortality in children. The problem is also still
present in developed countries like United States being a public health problem (Kappus et
al., 1994).The reason for being global health problem is that helminthic infections have
largely been over looked by clinician, because although worms can cause severe clinical
problem, patients rarely report at health center due to its slow progress of sign and symptoms
(Shally et al., 2003). In Ethiopia, intestinal parasitic infections are the major causes of
mortality and morbidity causing aserious of public health problems such as malnutrition,
anemia, and growth retardation as well as higher susceptibility to other infections(Abraraw
Abate et al., 2013).WHO also indicated that the prevalence of helminthes infections in
Ethiopia ranges from 31-57.8% (WHO, 2004).
The role of intestinal parasites in causing morbidity and mortality as well as in the
pathogenesis of other infectious diseases differs from species to species. Similarly, the
prevalence of various species of intestinal parasites also differs from region to region because
of several environmental, social and geographical factors (Mengistu Legesse and Berhanu
Erko, 2004).
Intestinal parasites cause serious problem in Ethiopia (Amare Mengistu et al., 2007) because
of its lowest quality of drinking water supply and latrine coverage in the world. As
comparison by 2000, Ethiopia had only 12% latrine coverage while Kenya had 87% (Abera
Kumie and Ahmed Ali, 2005).
As the study of Asrat Ayalew and his collegues (2011), in Delgi school children Northwest
Ethiopia ten species of intestinal parasites (A.lumbricoides 48%, G.lamblia 41.9%,
E.histolytica/dispar 27.3%, S.mansoni 15.9%, Hookworm 11.5%, T.trichiuria 7%, H.nana
6.8%, Taenia species 5.3%, E.vermicularis 2.6%, and S.stercolaries 2.4%) were identified
with an overall prevalence of 79.8%. The effective prevention and control of intestinal
helminthic infections require the identifications of local risk factors (Girum Tadesse, 2005).
Epidemiological study on the prevalence of infection of intestinal parasites in different
regions/localities is a primary objective to identify high risk communities and formulate
2
appropriate intervention (Mengistu Legesse and Berhanu Erko, 2004; Abraraw Abate et al.,
2013).
According to Addis Zemen and Yifag Health Center report from 2015-2017 intestinal
helmintheiasis is one of the top ten identified diseases and approximately 1000 people were
clinically treated in each year (AZHC report 2015-2017). In Yifag town and Agidkirigna,
there are various favorable conditions for the transmission and prevalence of intestinal
parasites, poor habit of using latrine, washing clothes and bathing in the infected river, poor
personal and environmental hygiene, low supply of tap water and using river water for drink,
irrigation practices are some of observable conditions that can favor for transmission of
intestinal parasites is expected to high. Studies in many parts of the country have shown a
high prevalence of intestinal parasitic infections amongst school children (Leykun Jemaneh,
2001; Mengistu Legesse and Berhanu Erko, 2004). Likewise, there is intestinal parasitic
infections in and around Libokemkem (Addis zemen), particularly Yifag town and
Agidkirigna kebele.
1.2 Statement of the problem
Intestinal parasitic infections (IPIs) are major public health problems in several tropical and
sub tropical developing countries like Ethiopia with poor socio economic status.These are
more common in school age children and are associated with high morbidity and mortality
and there is an economic loss in the country (WHO, 2002; De Silva et al., 2003; Mengistu
Legesse and Berhanu Erko, 2004; Grum Tadesse, 2005; Asrat Ayalew et al., 2011).
Information on the prevalence and extent of intestinal parasitic infection in agiven community
is required.Although several studies have been conducted on the prevalence of intestinal
parasites in Ethiopia. There are still several places for which epidemiological information is
not available one of such places in Ethiopia is Libokemkem district particularly in Yifag town
and Agidkirigna keble.
3
1.3 Research Questions
Thus, this study will resolve the following proposed questions:
 Which types of intestinal parasites are found in the school children?
 Which parasite is the most prevalent in the school children?
 Which environmental risk factors are associated with the prevalenceof intestinal
parasites?
 Which group of residents (rural/urban) dweller students are highly affected?
1.4 Objectives of the study
1.4.1 Gene vral objective
 To assess the prevalence of intestinal parasitic infections and associated risk factors
among Yifag and Agidkirigna complete cycle primary school children in
Libokemkem district, Nnorthwest Ethiopia.
1.4.2 Specific objectives
 To determine the prevalence of major intestinal parasites based on sex, age, and
residence of students in the study area.
 To identify the type of intestinal parasites which are more prevalent in the study
area.
 To evaluate the prevalence and associated risk factors of intestinal parasitic
infections among school children in the study area.
4
1.5 Significance of the study
It was necessary to conduct school based cross sectional studies to estimate the status of
intestinal parasitic infections among Yifag and Agidkirigna complete cycle primary school
children. Thus, the result that was obtained from this study may serve as a source of data for
further studies and evaluate the current status of intestinal parasites and to identify associated
risk factors in the study area. Furthermore, this study could provide a base line data to create
awareness program for the general prevention and control strategy of intestinal parasitic
diseases.
1.6 Limitations of the study
In the present study, the IPIs parasitological surveys did not include other techniques such as
Kato-Katz technique to provide information on the intensity of intestinal parasitic infections.
Intensity of intestinal parasitic infections (IPIs) usually expressed quantitatively as the
number of eggs excreted per gram of stool, is an essential measure for the evaluation of
control programs (Kloos et al., 1993).
5
2. LITERATURE REVIEW
2.1 General Description of Intestinal Parasitic Infections (IPIs)
Intestinal parasitic infection is one of the six top major public health problems in developing
countries including Ethiopia (Markou and Chatzopoulos, 2009). Children are being major
victim (Steketee, 2003; Tilahun Workneh et al., 2014). Intestinal parasitic infections are
linked to lack of sanitation, lack of access to safe water and improper hygiene; thus occurring
wherever there is poverty. People of all ages are affected by the cycle of prevalent parasitic
infections; however, children are the highly parasites are responsible for one of the major
health problems with socio-economic effects in the world, especially in tropical and
subtropical areas (WHO, 2006). The intestinal parasites live in their host intestine and take up
the nutrition from the host, and cause abdominal discomfort, dysentery, mechanical irritation
of intestinal mucosa, mal-absorption syndromes and obstruction. Faeco-oral route is their
mode of transmission (Ichpujanin and Bathia, 1998).Intestinal protozoan parasites can also
affect children in a variety of ways; they cause mal absorption, reduced growth, increased risk
for protein energy malnutrition, reduced psychomotor development and anemia(Abdullah et
al., 2016).
Parasites which are found in the intestine can be categorized into two groups; as protozoan
and helminthes. The major intestinal parasites of global public health concern are the
protozoan species such as E. histolytica and G. intestinalis, soil transmitted helminthes A.
lumbricoides, T. trichiura, hookworm and S.mansoni (WHO, 2000). Helminthic infections are
enhanced by poor socio-economic conditions, lack of sanitary facilities, improper disposal of
human feces, insufficient supply of potable water, poor personal hygiene, poor housing
conditions and lack of education (WHO, 1996).
2.2 Global prevalence of intestinal parasitic infections
Globally due to intestinal parasitic infection, 3.5 billion people are affected, and of this 800
million are children who are ill as a result of these infections (WHO, 2014; Mulusew
Andualem, 2014). And yearly more than 200,000 deaths are reported (WHO, 2006).
Moreover, the incidence of intestinal parasitic infections is 50% in developed countries,
whereas it reaches up to 95% in developing countries. These infections are caused by parasitic
6
protozoan and helminthes and the main clinical manifestation of the disease is diarrhea (Sah
et al., 2013). Infection rates are higher in children living in sub-Sahara Africa, followed by
Asia and then Latin America and the Caribbean (Harhay et al., 2010).
Parasitic infections are prevalent worldwide but more so in the tropical regions (Okyay et al.,
2004). A study done in 48 states of the United States of America indicated that one third of
the 2896 patients examined were infected with intestinal parasites. The highest number of
individuals was from California with 859 patients and the lowest were from Mississippi with
2 patients (Amin, 2002). Nineteen species of intestinal parasites were identified with 10 % of
the patients having multiple infections of 2-4 parasitic species. Several epidemiological
studies carried out in different countries have shown that the socio-economic situation of
individuals is an important factor in the prevalence of intestinal parasites. It has been shown
(Ahmed and Chaudhuri) that the socio-ecological risk factors of intestinal parasitic infections
in an urban squatter camp in Egypt, were lack of provision of both tap water and sewerage
systems inside dwelling places (Ahimed and Chaudhuri, 1999).
Another study conducted in Brazil, indicated that the estimated prevalence of diarrhea
decreased by 45 and 44 % respectively due to the improved water supply and sanitation,
although there was no significant impact on parasitosis (Gross et al., 1989). It has been shown
that some Mexican children from lower income families with unemployed and less educated
mothers had a higher risk of intestinal parasitism including those who defecated in open areas
(Quihui et al., 2006). The results of this study agree with another research done in Turkey,
particularly in relation to the educational status of the mother (Okyay et al., 2004).
Other study reported from Prevalence of intestinal parasites among the population of the
Gaza Strip, Palestine the overall prevalence of intestinal infection of 600 subjects examined,
245 (40.8%) were infected with one or more intestinal parasites. The most common parasites
found in the stool samples were E.histolytica/dispar 28.5%, G.lamblia 9.5%, E.coli 4.5%,
E.hartmanni 4.0%, H.nana 1.5%, S.stercoralis larva was found in 1.2%, A. lumbricoides and
Endolimax nana were isolated in less than 1% of the examined sample (Mezeid et al., 2014).
Besides the other studies, a study was conducted to determine the prevalence of intestinal
parasites in children from eight schools located in Thailand (phuttamounthon District).
Nakhon prathom province,during 2004. The overall prevalence of these subjects (12.6%)
7
were infected with one or more of ten intestinal parasitic species from these (11.15%) were
single infections (1.5%) were mixed infections (Warunee et al., 2007). Similar study was
conducted in Turkey by Okyay among school children the overall prevalence that (31.8%)
were infected with one or more intestinal parasites. Out of these (6.45) students were infected
more than one parasites, 5.7% with two parasites and (0.7%) with three parasites. The most
common intestinal parasites were E.vermicularis, Giardia intestinalis and Entamoeba coli.
The most important factors identified in this study were being in rural residence, their mother
education less than elementary school, Sometimes or never utilization of paper and washing
anal area by hands after defecation were responsible for the occurrence of intestinal parasites
in this area (Okyay, 2004).
2.3. Prevalence of intestinal parasitic infections in Africa
In developing countries, particularly those with tropical climates and at low altitudes,
intestinal infections remain a serious medical and public health problem among the poor,
who are negatively affected by low socio-economic conditions, poor personal and
environmental hygiene, overcrowding, and limited access to clean water (Amare Mengistu et
al., 2007).
Gastrointestinal protozoa and helminthic infection rate are highest in children living in sub
Saharan Africa. It is estimated that approximately a quarter of the total population is infected
with one or more, typically the nematode worms, which are the most prevalent of intestinal
parasites. The 2006 estimated proposed that of 181 million school aged children in sub
Saharan Africa, almost half (89 million) were affected by one or more of these parasitic
worms, while the whole populations will be geographically at risk. Children are observed to
disproportionately carry the greatest burden of infection (Brooker et al., 2006). Regarding the
at-risk population by Schistosomes, an estimated 660 million were concentrated in Africa,
accounting for 85% of the global at risk estimate. The prevalence of the disease is higher in
sub-Saharan countries including Ethiopia. Children whose age ranged 10-14 are the most
affected groups (WHO, 2002).
A number of different researches were conducted in different parts of Africa about intestinal
parasitic infections. A retrospective study was carried out by (Mazigo et al., 2010) to
determine the prevalence of intestinal parasitic infections among patients attending Bugando
8
Medical Centre in Mwanza, Northwestern Tanzania, from January, 2008 to March, 2010,
intestinal parasitic infections were recorded in 57.1% of the stool samples examined.
Helminthes eggs were observed in 36.6% of the samples with hookworm eggs recorded in
25.2% and S. mansoni in 5.6% of the samples. Protozoan parasites were recovered in 20.5%
of the samples in which 13.6% had E.histolytica, 6.9% G.lamblia. T.trichiura, A.lumbricoides
and S.mansoni were detected in single infection in 16.4%, 5.8% and 1.5% of the infected
study subjects respectively. H.nana and S.mansoni predominantly affected males. Giardia
trophozoites and H. nana were significantly higher in pre-school children than other age
groups while higher proportion of teenagers were infected by A. lumbricoides and S. mansoni,
Taeniasis was also dominant in teenagers. (Adebote et al., 2004) carried out studies on
helminthes infections in 80 pre-school children in three villages in Zaria, Nigeria and
recorded a prevalence of 67.5%. The specific parasite prevalence for A.lumbricoides was
55%, S.stercoralis was 25%, hookworm was 15%, S.haematobium was 10%, E.vermicularis
was 2.5% and S.mansoni was 1.25%. Similar study was conducted in School Children in
Oshodi Lagos Nigeria (2017) three species of intestinal parasitic infections were identified
with overall prevalence of 58.3%. The predominant parasites were E.histolytica (35.8%),
E.coli (22.0%) and A.lumbricoides (5.1%). The prevalence among sex is 25.1% in males and
33.2 % in females (Ajayi et al., 2017).
A study to determine the prevalence of intestinal parasites associated with food vendors in
Accra to assess the risk of consumers of street food recorded an overall prevalence of 21.6%
helminthes infection was 15.2% and protozoan infection 6.4% (Ayeh-kumi et al., 2009).
Seven different parasites were identified-A.lumbricoides (5.0%), S.stercoralis (4.4%),
E.vermicularis (4.1%), Cryptosporidium parvum (2.5%), G.lamblia (2.0%), Ancyclostoma
duodenale (2.0%), and E.histolytica/dispar (2.0%).
2.4 Epidemiological distribution of intestinal parasitic infection in Ethiopia
In Ethiopia a number of epidemiological studies showed that intestinal parasitic infections
were widely distributed in different areas of the country with different magnitudes of
prevalence. According to Shiberu Tedila (1986), every person in Ethiopia would have
infection by one or more helminthic parasites in his life time.However, amoebiasis and
giardiasis are common causes of intestinal protozoan infections throughout the nation. The
9
prevalence of amoebiasis ranges from 0 - 4% and that of giardiasis is 3- 23% (TesfaYohanes
et al., 1988).
According to Tilahun Workineh et al., 2014 the overall intestinal parasite infection in
Northwest Ethiopia in Debre Elias primary school children was (84.3%). Multiple intestinal
infections were identified; among these the dual infections were (14.2%). The most prevalent
intestinal parasite were Hookworm (71.2%), E.histolytica/dispar (6.7%) and S.stercoralis
(2.4%), similar study was conducted by involving 399 school children among school children
in Dagi primary school, ANRS, Ethiopia. Eight species of intestinal parasites were identified
with an overall prevalence of 77.9%. Students were infected with one or more intestinal
parasites and the predominant parasite was hookworm (23.6%) followed by G.lamblia
(22.8%), E.histolytica (21.6%) and Strongyloides (1.5%). The presence of mixed parasitic
infection was (34.1%), double and triple infections were (91.5%) and (8.5%) respectively.
Intestinal parasitic infection was higher in children whose fathers’ occupational status were
farmers, who had unclean finger nails and who did not have the habit of wearing shoes (Mulat
Alamir et al., 2013).
2.5 Prevalence of protozoan parasitic infections.
Protozoan parasites are the more common cause of intestinal disorders compared to
helminthes especially in developing countries. A number of intestinal protozoan parasites are
reported in different parts of the world like G.lamblia, Dientamoeba fragilis, E.histolytica,
Blastocystis homini, Isospora belli, Cyclospora cayetanensis and Microsporidia. Among them
Entamoeba, Giardia and Cryptosporidium are the major protozoan parasites of global public
health concern. Protozoan parasites being single celled can rapidly multiply inside the body
leading to the development of the serious infection (Abdullah et al., 2016). Nearly 2.2 million
people die every year due to diarrheal diseases caused by intestinal protozoan parasites. Out
of these, 1.8 million deaths occur alone in low-income countries (WHO, 2004).
Numerous protozoa inhabit the gastrointestinal tract of humans. The majority of protozoa are
non-pathogenic commensals or their presence only result in mild disease and also the
pathogenic forms are G.lamblia, E.histolytica and Blastocystis hominis. Some of these
organisms can cause severe disease under certain circumstances such as severe acute diarrhea
which may lead to chronic diarrhea, nutritional disorders, dysentery and potentially lethal
10
systemic disease (Azian et al., 2007).Infection with E. histolytica and G. lamblia is acquired
rapidly by children less than 10 years of age (Shetty et al., 1992). Protozoan infections are in
general higher in children especially in those under 5 years of age while there was reduction
as age increased. The reason could be due to slow development of immunity in adults to the
protozoan parasites and better awareness in washing hands and other personal hygiene
measures (Amare mengistu et al, 2007).
Reports from different parts of Ethiopia showed that there is a difference in the prevalence
rate of amoebiasis, giardiasis and cryptosporidiosis. In Ethiopia high prevalence of intestinal
protozoan parasite infection is attributable to factors associated with low socio-economic
status such as poor personal hygiene, environmental sanitation, low household income,
overcrowding living condition and lack of clean water supplies. For instance, Ethiopia has
one of the lowest quality drinking water supply and latrine coverage (WHO, 2010).
2.5.1 Prevalence of Giardia lamblia infection
Epidemiology: Giardia lamblia is a cosmopolitan parasite with worldwide distribution and
most common protozoan isolated from gastro intestinal tract (Shiberu Tedla, 1986; Sah et al.,
2013).According to World Health Organization (WHO) estimation, globally there are 200
million cases of Giardiasis (Showkat et al., 2010). The organism has a worldwide distribution
and is a major cause of epidemic childhood diarrhea in developing countries. Prevalence rates
vary from 4 to 42%. It is the most commonly isolated intestinal parasite throughout the world.
Rates 20- 40% are reported in developing countries, especially in children. (Chacon-Cruz,
2003; Sah et al., 2013).
Pathogenesis: Giardia lamblia is the most protozoan intestinal parasite isolated worldwide as
a causative agent of diarrhea. The incidence of diarrhea associated with Giardia is generally
higher in developing countries in Africa, Asia, South and Central America where access to
clean water and basic sanitation is lacking. The prevalence for Giardia lamblia in developed
countries is around 2-5% but in developing countries may be up to 20-30% Thielman and
Guerrant, 1998). In Ethiopia, the prevalence of Giardiasis ranges from 3-23%. (Dawit Ayalew
2006; Desta Haftu et al., 2014).
Transmission: It has been considered as food and water borne disease in many parts of the
world. Contaminated water and raw vegetables by cysts and cysts are resistant forms and are
11
responsible for transmission of giardiasis. Person to person transmission of giardiasis is the
prevalent mode of transmission and the risk factors are closed human contact combined with
unhygienic conditions, where access to clean water and basic sanitation is lacking. Giardiasis
is spread by fecal-oral contamination the prevalence is higher in populations with close
contact and poor sanitation. The disease is commonly water-borne because Giardia is resistant
to the chlorine levels in normal tap water and survives well in cold mountain streams.
Because giardiasis frequently infects persons who spend a lot of time camping, backpacking,
or hunting, it has gained the nicknames of "backpacker's diarrhea" and beaver fever (CDC,
2013).
From randomly selected (10%) of food handlers who were working in hotels and bar, 63%
were infected with intestinal parasites. The most dominant were G.lamblia 33% and followed
Entamoeba histolytica 21.5%(Shiferaw Teklemariam et al.,2000).Person to person
transmission is associated with groups that exercise poor fecal-oral hygiene, such as children
in child care centers (Stofer, 2014).
Symptoms: Epidemiological studies suggest that the parasite is responsible for about acute
diarrhea and chronic diarrheal illness in the world. Giardiasis is one of several causes of
intestinal infection and diarrhea (acute diarrhea, gastro intestinal distress including nausea,
vomiting, malaise, abdominal cramping, steatorrhea (light colored stools with a high fat
content), fat soluble vitamins deficiency, folic acid deficiency and weight loss (10-20% loss
in weight), fatigue, depression)(WHO, 2010 , Stofer, 2014).
Diagnosis: the infection has been diagnosed by using microscopic identification of cysts or
trophozoites in either single or multiple stool specimens. The method used to detect Giardia
includes iodine stained wet smears and trichrome stained cyst concentrates prepared by
formalin ethyl acetate centrifugation. Cysts can be found by examination of the deposit of a
formal-ether concentrate of a stool preparation (WHO, 2000, 2010).
Prevention and control: Prevention of Giardiasis requires interruption of the fecal-oral
spread of the infectious cyst stage of the parasite, cysts are resistant to chlorine or iodine,
therefore, in developing countries properly toilet use, water must be boiled before it is to
drink, wash raw vegetables and soaked in vinegar for at least 15 minutes before they can be
eaten, health education, avoid eating raw, under cooked, unwashed vegetables and fruits,
12
adequate and safe water supply, good personal and environmental hygiene.(Tadesse Anteneh
et al., 2008; WHO, 2010).
2.5.2 Prevalence of Entamoeba histolytica
Epidemiology: Several members of the genus Entamoeba infect humans. Among these only
E. histolytica is considered pathogenic and the disease it causes is called amoebiasis or
amoebic dysentery. E. dispar is morphologically identical to E. histolytica, but is not
pathogenic. The two species are found throughout the world, but like many other intestinal
protozoa, they are more common in tropical countries or other areas with poor sanitary
conditions. It is one of the health issues in many developing countries and it results in the
death of thousands people per day. (WHO, 1997; Hotez et al., 2014).
Pathogenesis: Among genus Entamoeba histolytica is considered pathogenic and the disease
it causes amoebiasis or amoebic dysentery. Amoebic dysentery from E.histolytica is the
second most common cause of death from parasitic diseases worldwide after malaria. Nearly
10% of the world’s population is infected with E. histolytica, the majority being in developing
countries. E. histolytica is known to result in 50-100 million cases of colitis (inflammation of
the colon) or liver abscesses per year and up to 100,000 deaths annually (Alam et al., 2014).
Transmission: Epidemiological studies have shown that, low socio economic status, low
standards of hygiene and sanitation, in particular those related to living in overcrowding
conditions, contamination of food and water and inadequate disposal of feces are all factors
for infection with E.histolytica (Hotez et al., 2014).
Symptoms: Most of the infected individuals tend to be asymptomatic while the minority of
cases develops clinically apparent disease. Most patients complained of diarrhoea rather than
chronic diarrhoea which are the characteristic of amoebiasis, colitis or inflammation of the
colon,(Alam et al., 2014).
Diagnosis: Laboratory diagnosis is made by finding cysts in iodine stained, formal-ether
concentration method or by detecting the trophozoites in a wet preparation or a permanent
stain preparation. A common way to distinguish E.histolytica and E.dispar microscopically is
erythro phagocytosis. Classical microscopy doesn’t allow of the invasive protozoan
13
(E.histolytica) to be distinguished from the no invasive one (E.dispar) unless erythro
phagocytosis is seen during microscopic examination. (Amha Kebede et al., 2003).
Prevention and controlling mechanisms: prevention of amoebiasis at present requires
interruption of the fecal oral spread of the infectious cyst stages of the parasite, because cysts
are resistant to chlorine or iodine, in developing countries water must be boiled before it is to
drink and raw vegetables and fruits must be washed and then soaked in vinegar for 15 minutes
before they can be eaten, avoid open field defection (using of toilet)(Sackey et al., 2003;
WHO, 2010). Patients treated with an amoebicidal drug. (Amha Kebede et al., 2003).
2.6 Prevalence of Intestinal Helminthic Infections
According to World Health Organization (WHO), globally there are 1221–1472 million cases
of Ascariasis750–1050 million cases of Trichuriasis and 740–1300 million cases of
hookworm infestation (Showkat et al., 2010; WHO, 2012, 2014). These STHs are also
considered Neglected Tropical Diseases (NTD) as they inflict considerable morbidity and
mortality, though entirely preventable. It is most prevalent especially in poor communities
(WHO, 2002; Desta Haftu et al., 2014). The symptoms of soil-transmitted helminthes
infections are nonspecific and become evident only when the infection is particularly severe
(WHO, 2010).
According to Leykun Jemaneh (2001) study in Chilga District, Northwest Ethiopia of the
sample school children had 42.9%, 37.7%, and 19.4% were A.lumbricoides, hookworm, and
T. trichiura respectively. The overall prevalence rate for one or multiple parasitic infections in
the children was 64%. Children in grades one to three had higher prevalence of overall
helminthic infection than grades four to seven (GirumTadesse, 2005). A country-wide survey
conducted by Shibru Tedla (1986) reported that over 70% of the population harbored at least
one parasitic helminth,2 to 6% harbored 3 or 4 parasitic helminthes and about 0.1% harbored
six parasitic helminthes, the overall prevalence of ascariasis, trichuriasis, and hookworm
infection being 57.1%, 36.1% and 9.8%, respectively. Another study conducted in twelve
elementary schools in the Dembia plains, Northwest Ethiopia, infection due to A.
lumbricoides was registered in all school among children and was the most prevalent (41.3%)
followed by S. mansoni (35.8%), the hookworm (22.8%) and T. trichiura infection (16.5%).
14
Infection was found in all age and appears to increase with age in schistosomiasis and
ascariasis. The intensity of infection was generally higher for A. lumbricoides and S. mansoni
(Leykun Jemaneh, 1998).
2.6.1 Prevalence of Ascaris lumbricoides
Epidemiology: The worldwide prevalence of ascariasis is estimated to be more than 1.3
billion People are infected with Ascaris lumbricoides and it is more prevalent in the
developing world (De Silvia et al., 2003; WHO, 2004; 2010). Fecal contamination is a serious
environmental health problem. The prevalence of human ascaris is high in tampered and
tropical environments (Worku Legese and Solomon Gebresilasie, 2007). A high percentage of
primary school children from rural area peshawara, Pakistan have intestinal worm infections
and majority of them have Ascaris lumbricoides (Ullah et al., 2009).
Pathogenesis: Helminthes suchas, A.lumbricoides has been observed to cause interferences in
digestion and absorption of foods and lessen micronutrients and vitamin A absorption,
possibly via causing a structural abnormality of the mucosa in the small intestine (Stephenson
et al., 2000). A. lumbricoides may live in the human jejunum for 1-2 years without causing
any symptoms.In rural population, the prevalence of ascariasis ranged from 68.9% in children
to 48.9% in adults (Santra et al., 2001; Yimam Ali, 2016).
Transmission: The high prevalence of infections among the children was probably due to
their greater contact with contaminated soil. Moreover, poverty, overcrowding living
conditions, unhygienic or poor sanitation, low-educational status and unsafe water
consumption contribute to the spread of this helminthic infection. These environmental,
cultural and socioeconomic reasons make ascariasis highly endemic in developing countries
(Santra et al., 2001).
Symptoms: After they migrate to different parts of the digestive system such as the
duodenum or pancreas, significant symptoms occur. Some of these complications include
acute intestinal obstruction by clumps of large numbers of worms or perforation by worms
through the intestinal wall, Vomiting and abdominal pain developed when the worm migrated
to the duodenum, an uncommon living site for this parasite or migration of the worms to
15
ectopic sites can result in life threatening complications (Santra et al., 2001; Sawanyawisuth
et al., 2010).
Diagnosis: Sexually mature female worm produce eggs and infection can be diagnosed by
direct microscopy of feces. Sometimes the diagnosis of ascaris depends on the microscopic
demonstrations of eggs in the stool or recovery of adult worm in the stool or after passing
through the mouth (Tadesse Anteneh et al., 2008).
Prevention and control: Disposal of feces in latrines, and avoid use of, improve personal and
environmental hygiene, Food hygiene, improve standard of living conditions, properly
disinfections of human excreta, investigation of contact and source of infection and treatment
of the infected cases , health education, sanitation.(WHO, 1987; Tadesse Anteneh et
al.,2008).
2.6.2 Prevalence of Hookworm infection
Epidemiology: Hookworm infects over 1.25 billion people throughout the world. The
hookworms (Necater americanus, Ancylostoma duodenale) are medically important human
parasites and cause serious morbidity in many parts of the world. Hookworm infection affects
an estimated 576 million people throughout developing nations of the tropics, with highest
prevalence in the East Asia /Pacific Islands and sub Saharan Africa.(WHO, 2004).
Pathogenesis: Infections with A.duodenale causes greater blood loss than infection with N.
americanus (Necater 0.03ml/day, Ancylostoma 0.15ml/day).Therefore, hookworm species
distribution pattern which is basically important in control of anemia as the consequence of
infection with a species with greater blood shade (Fekadu Demssie et al., 2008).
Transmission: The adult worms are small and live in the small intestine. They measure about
1.0 to 1.5 cm in length. Although the adult worms of two species are easily identified on the
basis of presence of cutting plates (N. americanus) or A. duodenale) around the mouth, the
eggs they produce are nearly identical. The typical hookworm egg measures about 60-75 m
(WHO, 2004). The infection is acquired by skin penetration of filariform larva during contact
with contaminated soil or water or by ingestion of contaminated water. The infection occurs
in areas where the standard of living of the population is low sanitary and environmental
16
conditions favor the development of filariform larvae and infection of hosts (Leykun Jemaneh
and Shibru Tedla, 1985)
Symptoms: Most Hookworm infections are asymptomatic. Hookworm disease infection is
the leading cause of iron deficiency anemia that the degree of iron deficiency anemia induced
by hookworms depends on the species, children who suffer from chronic hookworm infection
can suffer from growth retardation as well as intellectual and cognitive impairments (Hotez et
al.,2005;Mulusew Andualem, 2014).
Diagnosis: Microscopic recovery of the typical eggs by concentration techniques required to
detect infections. Clinical history hygiene status and recent travel to endemic area can give
important clues, microscopic visualization of eggs in the stool (Hotez et al, 2003; 2005;
2014).
Prevention and control: Good disposal of feces (using of toilet) and concurrent disinfection
of human feces, improve personal and environmental hygiene, keep food hygiene, wearing of
shoes regularly, investigations of contact and source of infection and treatment of the infected
cases (Tadesse Anteneh et al., 2008; https://www.cdc.gov/parasites/hookworm/biology.html)
2.6.3 Prevalence of Trichuris trichiura
Epidemiology: Trichuris trichiura is the third most common nematodes (roundworm) of
humans.It is most frequent in areas with tropical weather and poor sanitation practices.
Trichuriasis occurs frequently in areas in which human feces are used as fertilizer or where
defecation onto soil takes place. Trichuriasis infection prevalence is 50 to 80 percent in some
regions of Asia (noted especially in china and Korea) and also occurs in areas of south eastern
United States (Nokes et al., 1992; CDC, 2013).
Pathogenesis: T.trichiura infection affected cognitive abilities in children 9-10 years of age,
whilst sever was associated with growth retardation and iron deficiency, anemia (Nokes et al.,
1992). Infection is most prevalent among children and in North America; infection occurs in
migrants from tropical or subtropical regions. It is estimated that 600-800 million people are
infected worldwide with 3.2 billion individuals at risk (Satoskar et al., 2009).
17
Transmission: Humans can become infected with the parasite due to ingestion of infective
eggs by mouth contact with hands or food contaminated with egg carrying soil. However,
there are also been rare reported cases of transmission of T. trichiura by sexual contact. Some
major outbreaks have been traced to contaminate vegetables (Satoskar et al., 2009).
Sign and symptoms: Infected patients may have abdominal pain, diarrhea; confused with
those of hookworms, amoebiasis or acute appendicitis (Satoskar et al., 2009).
Diagnosis and treatment: Specific diagnosis depends on demonstrating worm or eggs in the
stool. Worm can be demonstrated by colonoscopy (Roberts and Schmidt, 2009). Because of
their frequent location in cecum, appendix or lower illeum whipworms are difficult to reach
with oral drugs or medicated enemas. Mebendazole, Albendazole & Nitazoxanid are drugs
used for the treatment of trichiuriasis (Muller, 2002).
2.6.4 Prevalence of Strongyloides stercoralis
Epidemiology: Among the Strongyloides species (S. stercoralis and S. fuelleborin), S.
stercoralis infects human, which is a cosmopolitan distribution in tropical and subtropical
regions. Sometimes, the larvae become infecting before they are passed out causing out
infection that is why people have remained infected with S. stercoralis for more than 30 years
after leaving an endemic area (WHO, 1987; Keiser and Nutman, 2004).
Pathogenesis: This is an important nematode parasite of humans because of its ability to auto
infect and disseminate throughout the organ systems of immune compromised or immune
suppressed individuals. This organism has worldwide distribution, but is especially common
in tropical and subtropical regions. The number of individuals infected with this nematode is
unknown, but estimates range from 30 million to 100 million (Alemnesh Tesema, 2011).
Transmission: Hosts are infected when free living infective larvae of Strongyloides penetrate
the skin or by ingestion of the egg (Tindal and Wilson, 1988).Strongyloides stercoralis has a
complex dual life cycle that includes parasitic and free living cycle. Infection in man arises
when soil larvae penetrate the skin, pass in the blood in to lungs,and ascend to the trachea
bronchial tree.(Keiser and Nutman, 2004 ).
18
Symptoms: Skin penetration by larvae may cause local irritation. Migrating larvae can cause
pneumonitis, and ectopic larvae can sometimes be found in the brain and other viscera. A
characteristic serpiginous urticartial rash is seen on the trunk and buttocks (Chiodini, 2003).
In very light infections there may be no demonstrable symptoms. In moderate and chronic
cases there are usually intermittent diarrhea and epigastric pain; in severe cases there may be
uncontrollable diarrhea with blood and undigested food in liquid stool. The loss of food &
continued drain of liquid causes severe emaciation (Keiser and Nutman, 2004).
Diagnosis: Diagnosis made by identifying larvae in feces (no eggs). The enterotest, where
along nylon string is swallowed and latter pulled back out of the mouth may demonstrate
larvae of strongyloides. Sputum exam may also demonstrate larvae (Keiser and Nutman,
2004).
Treatment: The goal of treatment of strongyloidiasis is eradication of the organism. Unlike
hookworms, simply reducing worm burden is efficacious. The process of autoinfection will
result in prolonged infection, potentially increasing worm burden overtime and risk of
hyperinfection in any one with residual organism (Muller, 2002). Ivermection and
Thiabendazole are effective drugs (Satoskar et al., 2009).
2.6.5 Prevalence of Schistosoma mansoni
Epidemiology: The Schistosomes cause the most important trematode infections. Globally
500-600 million people are at risk of infection; and 85% of the cases are found in 41 countries
of Africa including Ethiopia (WHO, 1991).
Pathogenesis: There are an estimated 38.3 million people living in schistosomiasis endemic
areas, comprising34.4 million preschool children 12.3million school aged children and 21.6
million adults (FMoH, 2016; Belete Mengistu et al.,2016) .These worms live in the small
blood vessels associated with the live, intestine and bladder (depending on the species) and
cause extreme pathology, morbidity and even death in individuals with heavy, chronic
infections (WHO, 2004). Study conducted in Coating Domoura village, a Northeastern state
of Brazil, the prevalence of S. mansoni was 40% (Jesus et al, 2010). A similar study
conducted among individuals living in an endemic area of Brazil has identified 30.9%
prevalence of S. mansoni by the Kato-Katz techniques (Pontes et al, 2003). Another study
19
conducted by Tadesse and Beyene in 20 school children in Ethiopia showed that 55% school
children were positive for S. mansoni. It was prevalent in urban and rural communities. Urban
centers with water body nearby had a much higher prevalence than urban centers with no
water body nearby (Tadesse Dejenie and Beyene Petros, 2009).In Ethiopia S. mansoni is
endemic and recorded from 50% of the communities studied with prevalence rates ranged
from less than 1% up to more than 90%. The region where the disease is prevalent lies
between the altitude 1500-2200m and only about 5% and 12% are found below and above this
altitude respectively (Shibru Tedla and Leyikun Jemaneh, 1998). The rate of S. mansoni
infection increased linearly with age from 1.8% for age 5 to 9 years, 4.3% for age 10 to 14
years, and 11.6% for age 15 to 19 years old (GirumTadesse, 2005).
Transmission: They have a snail intermediate host and transmission is water related. All of
the schistosome’s species produce non operculated eggs which are discharged in feces or
urine (depending on the species), and each egg has a spine on some part of the shell most
intermediate hosts of human schistsoma parasites belong to three genera, Biomphalaria,
Bulinus and oncomelania (WHO, 2004 ).
Signs and symptoms: Due to the strong host immune response to large amounts of antigenic
materials released from schistosoma worms and eggs. Eggs of S.mansoni breaks the intestinal
wall and cause bloody diarrhea, intestinal and hepatosplenic disease, portal hypertension
(Tadesse Anteneh et al., 2008; Jonathan Stofer, 2014).
Diagnosis: The diagnosis of S.mansoni infection is by detection of ova using direct
microscopic examination of stool or rectal biopsy. The egg of S.mansoni is characterized by
lateral spine.
Prevention and control: Environmental sanitation, health education, properly waste disposal,
prevention of human contact with infected water, provision of safe and adequate water
supply, intermediate host (snail) control methods, diseases in the human reservoir by
chemotherapy (case finding and treatment), drainage of stagnant water sources, chemical
control, biological control (growing fish type or other snails that feed on vector snails,….are
important to elimination of schistosomisis. (Tadesse Anteneh, 2008; Abebe Alemu et al.,
2011; Fikresilasie Samuel, 2015).
https://www.cdc.gov/parasites/schistosomiasis/biology.html accessed on 15/12/2017
20
2.6.6 Taenia Species
Epidemiology: Cestodiasis is a common name for intestinal infections caused by cestodes;
such cestodes include Taenia saginata, Taenia solium and Diphyllobothrium latum which
affect 16 million people worldwide. Taenia solium which affects 5 million people and Taenia
saginata, affecting people in beef eating countries, specifically caused a disease called
taeniasis (Abate Worku, 2014), while infection with Diphyllobothrium latum is known as
diphyllobothriasis. The cestodes live in the human intestine and those of interest here produce
eggs which are feces. The adult live in the intestine and are very large worm, i.e., several
meters in length. Proglottids as well as eggs appear in feces. The eggs of the two species are
identical; they are round to oval shape, measuring35-43
in diameter and have a thick,
radially striated shell. The egg contain a six hooked embryo called an oncosphere. These eggs
must be handled with extreme care because the egg of Taenia solium is infective to humans
and produces cysticercosis (WHO, 2004; 2010).
Pathogenesis: Symptoms appear within a few weeks and are digestive disorders. If an organ
is infected by the larvae, especially a vital organ, the consequence can be severe.
Transmission: Taeniasis is a tapeworm disease caused by Taenia solium from pork and
Taenia saginata from beef. The illness result from the ingestion of raw meat or improperly
cooked meat contaminated with larvae of tape worms (Ray and Bhnia, 2008).
Symptoms: Abdominal pain, nausea, weight loss diarrhea/constipation, change of appetite, in
addition the person may notice motile proglotides in the perianal area or observe them during
the passage of stool ( WHO,2004; Ray and Bhnia, 2008 ; Tadesse Anteneh et al.,2008).
Diagnosis: Detection of eggs in feces using direct microscopic examination of the stool,
concentration techniques, proglotides segment passed in feces (WHO, 2004; Tadesse Anteneh
et al., 2008; Stofer, 2014).
Prevention and control: The use of latrine house reduces spread of T.saginata eggs,
abstinence from eating raw or under cooked beef (cooking meat at a temperature of 56-600 c
or freezing at 8-150c), inspecting meats and discarding those containing Cysticerci, controlled
grazing of cattle and prevent them from infection, and early case detection and treatment
(Tadesse Anteneh et al., 2008; Stofer, 2014).
21
2.6.7 Prevalence of Hymenolepis nana
Epidemiology: Hymenolepis nana, the dwarf tapeworm, is the smallest tapeworm to infect
humans. This cestode belongs to a large family known as hymenolepidae (WHO, 2004). H.
nana infection has cosmopolitan distribution and most commonly infects humans living under
conditions of poor hygiene and poverty (Berhanu Erko and Shibiru Tedla, 1993). In humans,
infections with H.nana are much more common than infections with Hymenolepis diminuta.
H. nana is the most common cause of all cestode infections and is encountered worldwide.
Pathogenesis: Prevalence rate of H. nana infection among preschool children of
displacement camps in Khartoum state, Sudan was 32.6% (Abdel et al., 2015). However, it
has not received much attention, despite being the most common cestode infection.
Internationally, report frequencies vary from country to country: 9.9% in India, (Mirdha et al.,
2002), 0.1% in Libya (Sadaga et al., 2007) 11.3% in Ecuador (Jacobsen et al. 2007) and
13.1% in Thailand (Sirivichayakul et al., 2007). The parasite has been little studied in
Mexico, as the few epidemiological reports demonstrate. Recently, frequencies from 10%to23
%(Diaz et al., 2003).
Transmission: Humans become infected with H. nana by ingestion of water and food
contaminated with mouse feces, and can also transmitted from one child to another by
passing infective eggs on dirty hands (Alemnesh Tesema, 2011).
Symptoms: Abdominal pain and diarrhea, allergic reactions due to toxins released from the
worms.
Diagnosis: Direct microscopic examination to detect the eggs of the parasite in feces.
Prevention and controlling mechanisms: Educate the community and keep personal and
environmental hygiene, prevent the contaminations of the food, avoid contact with animals,
early case detection and treatment (such as taking of prazequintel), properly disposal of feces,
and avoid using of untreated human feces for fertilization.
(https://web.stanford.edu/group/parasites/ParaSites2002/hymenolepsis/epidemiology.htm).
22
2.6.8 Prevalence of Enterobius vermicularis infection
Epidemiology: The nematode (round worm) Enterobius vermicularis (previously Oxyuris
vermicularis) also called human pinworm. Adult females measure 8 to 13 mm, adult male 2 to
5 mm. Humans are considered to be the only hosts of E. vermicularis. A second species,
Enterobius gregorii, has been described and reported from Europe, Africa, and Asia. For all
practical purposes, the morphology, life cycle, clinical presentation, and treatment of E.
gregorii is identical to E. vermicularis (CDC, 2013).
Pathogenesis: Entrobius vermicularis is a cosmopolitan parasite of humans residing in the
lumen of the cecum and appendix, and the most common parasitic helminthes of humans in
temperate and developed countries. It infects 1000 million cases worldwide in particular in
temperate and cool climates (WHO, 1994).
Transmission: Self-infection occurs by transferring infective eggs to the mouth with hands
that have scratched the perianal area. Person-to-person transmission can also occur through
handling of contaminated clothes or bed linens. Enterobiasis may also be acquired through
surfaces in the environment that are contaminated with pinworm eggs (e.g. curtains,
carpeting).Some small number of eggs may become airborne and inhaled. These would be
swallowed and follow the same development as ingested eggs. Following ingestion of
infective eggs, the larvae hatch in the small intestine and the adults establish themselves in the
colon (CDC, 2013).
Symptoms: Entrobius vermicularis is an extremely well adapted parasite that usually
produces no specific symptoms in most colonized persons. Most symptoms are minor at night
when the host is in bed, female Entrobius comes outside of anus and crawls on the perianal of
skin and deposits the eggs. Crawling of the gravid female worm leads to intense pruritus and
the patient scratches the affected part or anus and restless sleeping (Efraimidou et al., 2008;
Arora and Arora, 2009).
Diagnosis: Direct microscopic examination to detect the eggs of the parasite in feces.
Prevention: Keeping of personal and environmental hygiene, early case detection and
treatment, such as taking of Albendazole and becomes cure from the parasite. (WHO, 1994).
23
2.7. General transmission and risk factors for intestinal parasitic infection
The prevalence of intestinal parasitic infections of human was related to several human
factors such as age, sex, occupation, methods of defecation, and habitats (Ibrahim Ali et al.,
1999). The role of intestinal parasites in causing morbidity and mortality as well as in the
pathogenesis of other infectious diseases differs from species to species (Stephenson et al.,
1993). The Ethiopian population still suffers with high morbidity and mortality due to risky
behavior that are observed at the community and individual level. The need for simple, but
basic personal hygiene measures like washing hands with detergents before eating is one good
example among others.
Most intestinal parasites are transmitted through fecal-oral contact transmission. Human
behavior such as open field defecation and cultural practices such as rearing of vegetables in
fecally polluted gardens were all found to be conducive for transmission of geo-helminthes
(Ascaris and the like), faeco-orally transmitted parasites (amoebae and the like) and for
Schistosomes the transmission of which is water-related (Berhanu Erko et al., 1995). Because,
People infected with soil-transmitted helminthes pass parasite eggs in their feces. In areas
where there is no latrine system, the soil and water around the village or community becomes
contaminated with feces containing these eggs. The persistence of soil transmitted helminthes
is closely linked to contamination of the environment with the feces of infected people
(WHO, 2010).
The role of intestinal parasites in causing morbidity and as well as in the pathogenesis of
other infectious diseases differ from species to species. Similarly, the distribution and
prevalence of various species of intestinal parasites also differs from region to region because
of several environmental social and geographical factors. The organism itself or cyst, ova or
its trophozoite are expelled through the rectum of their host and find their way in some
fashion to the mouth of their next host. These parasites are transmitted by ingestion of the
infective eggs, larvae or cysts depending on the species of the parasite from contaminated raw
vegetable, food, water and hand. Helminthes are transmitted by the ingestion of the infective
eggs from contaminated food, hands and water (Mengistu Legesse and Berhanu Erko, 2004).
Infection occurs by filarial form of hookworm, schistosomiasis and strongloidiasis are
transmitted through penetration when the infective larvae in the contaminated moist soil or
24
water body. It is more prevalent in the areas of poor sanitation coupled with the habit of
walking bare foot as seen in the rural farming community (WHO, 2002).
2.8 General prevention and control of intestinal parasitic infections (IPIs).
For human hosts, there are three major strategies for the control of soil transmitted
helminthes; reducing parasite intensity (and consequent morbidity) by means of improvement
in sanitation, health education and ant-helminthic treatment (Dolda and Holand, 2010). Lack
of community awareness about parasites and socio-economic condition of the community
could contribute to the spread of disease.
Health education and promotion of healthy behaviors can play a key role in reducing the
incidence of human intestinal parasitic infections. However, the effectiveness of those
activities in reducing transmission of infection varies according to different reports. In some
cases, health education can decrease costs, increase levels of knowledge, and decrease reinfection rates. Health education efforts can build trust and engage communities in aspects
that are crucial to the success of public health initiatives (Lansdown et al., 2002).
The principal measures that should be included in a control program consist of massive and
periodic treatment of the human population to prevent environmental contamination, sanitary,
excreta disposal, provision of potable water and health education for the purpose of instilling
personal hygiene habit in the population (Sackey et al., 2003).
Use of anti-helminthes/protozoan drugs is another method of controlling intestinal parasitic
infection. As World Health Organization recommended against soil transmitted helminthes
include albendazole, mebendazole, livamisol and pyrantel while for schistosomiasis
paraziquantel. Metrondazole, quinacrine and chloroquinine are drugs of choice against
protozoan parasites (WHO, 2002).
25
3. MATERIALS AND METHODS
3.1. Description of the Study Area
The study was conducted in Yifag town inYifag complete cycle primary school and in
Agidkirigna kebele Agidkirigna complete primary school, both schools found in Libokemkem
district Northwest Ethiopia. Libokemkem district is found in South Gondar zone, Amhara
Regional state.Libokemkem district located along the main road of Gondar to Addis Ababa,
between Gondar and Bahir Dar town which is 645 km from Addis Ababa, 82km from Bahir
Dar 85 km from Gondar. It is bordered by Fogera district in the South, by Belesa district in
the North by Ebinat district in the east, and by Lake Tana in the west direction. It consists of
35 kebeles, 6 of them are urban and 29 are rural. The geographical location of the district is at
11057’-12020’N latitude and 37025’-37058’E longitude. Libokemkem district landform
(altitude) is complex composed of highlands (in the range of 1800 up to 2850 meters above
sea level. Topographically, the district is characterized by plain/flat (42%) rugged features
(30%), mountainous (21%), water body (6%) and Vallies (1%). (Libokemkem district
agriculture office, 2017).
Libokemkem district covers an area of 9,514 square km. According to the 2007 district census
in Libokemkem district, 113509(50.7%) Males, 110236(49.3%) Females and total 223745
people reside in 35 kebeles. There are 32 primary schools (grades1-8), 4 high schools, 1
preparatory high school, 1Technical and Vocational collage, 11 Health centers and 1 new
hospital found in the district. Libokemkem district has diversified agro-ecological zones and
niches each with distinct soil, geology, vegetation cover and other natural resources. The
climate is generally tipped moist mid highland and tipped sub moist mid highland, with the
average annual rainfall amount of 900-1200 mm. Most of this rain is received during midJune to September. The rainfall pattern is predominantly uni-modal. Agro-ecologically the
climate is in the Woynadega with the largest coverage 81%, Kola covers 0.9% and Dega
covers 18.1%. Its average temperature is 11.1 - 27.9°C (Libokemkem district agriculture
office, 2017; and Libokemkem district government and communication affairs office, 2017).
26
3.2 Study Design and period
Across sectional study was conducted fromNovember, 2017 to June, 2018 in order to
determine the prevalence of intestinal parasite infection and associated risk factors among
complete primary school children who attend in Yifag and Agidkirigna complete primary
schools in Libokemkem district, Northwest Ethiopia.
3.3 Study population
The study population was the school children found in Yifag and Agidkirigna complete cycle
primary schools attending from grades 1-8. In 2017/2018 accademic year the total number of
enrolled students in Yifag 1645(831 were males and 814 were females) and in Agidkirigna
1324 students (686 were males and 638 were females) Total 2969 studnts (1517 were males
and1452 were females) attended their education in the academic year in both schools.
3.4 Sample size determination and sampling techniques
3.4.1 Sample SizeDetermination
A total of 403 ( 202 male and 201 female ) students were taken from Yifag complete
primary school in Yifag town(223 students ),and in Agidkirigna complete primary school(180
students) in Libokemkem district, students to examine the prevalence of intestinal parasites in
the study area.The minimum sample size ‘n’ required was determined using statistical
formula (Daniel, 1995).
n =Z2 p (1-p) / d2
Where n= the required sample size
Z=standard normal value 1.96 at 95%CI
P = expected prevalence rate that was taken 50%=0.5
d= margin of error assumed to be 5%=0.05
27
To minimize errors arising from non-respondents 5% of the sample was added to initially
estimated sample size. Hence, the estimated sample size was n= (1.962)*0.5*(1-0.5)/ (0.05)2
=3.8416
*0.25/0.0025=384. To compensate for the likelihood of non- respondent samples 5%
of the sample size was added to the initially estimated sample size (384). Hence, this addition
of contingency (5% of 384), is given 19.Then, 384+19=403.As a result, 403 primary school
children were chosen and participated in the study.
3.4.2 Sampling Technique
Students stratified according to their grade level, grades 1-4 and grades 5-8 to select the target
groups in the two complete primary schools. The quota was allocated for each school, grade
levels and sections based on their number of students. Finally, a systematic random sampling
technique was used in each complete primary schools and classroom attendance as a sample
frame.
3.5 Data Collection
Structured questionnaire was developed in English and then translated to the Amharic
language. The children or students for all ages attending in the schools were interviewed to
fill or respond the structured questionnaire during sample collection to gather information
about the study subject to complete socio demographic, socio economic and personal
character such as sex, age, grade level, residence, hand washing habit, shoe wearing, source of
drinking water, presence of latrine and its usage, and other factors in the study area. During
the conversations interviewer was observed students whether they are trimmed their finger
nail or not, their general hygiene conditions dry dirty materials on their hands and the foot
wears.
Students were provided with labeled clean plastic cup and instruct to bring his/her own
around 10 g or the smallest accepted amount is the size of pigeon’s egg stool sample by using
applicator stick (WHO, 1991).The stool was examined by direct wet saline mount method and
formal ether sedimentation technique.
28
3.5.1 Questionnaire
A well-structured questionnaire and interview were used to gather information about the study
subjects, socio demographic data and on risk factors of parasitic infections. Questionnaire was
developed in English and then translated into Amharic to get reliable information. For each
student, structured questionnaire was completed for demographic and associated risk factor
for helminthic and protozoan infection, which was administered by trained primary and
secondary school teachers. During questionnaire data collection trained interviewers were
used for grade one and grade two students. Besides this, direct observation was made on the
surrounding sanitation, human practices and interviewers also inspected whether the
fingernails of the students were trimmed or not, their foot wear; defecation patterns to identify
factors that may be risky for transmission of intestinal parasitic infections (IPIs).
Figure 1፡ Students during questionnaire period
29
3.6 Parasitological examination
3.6.1 Direct Wet Saline Mount
Laboratory experiments were conducted in Yifag health centercentre direct wet mount was
used to observe ova of intestinal parasites. One or two drops of normal saline solution was
placed at the center of a clean slide and mixed with about 2 mg stool samples with applicator
stick. The suspensions was covered with cover slip and examined under light microscope at
10X and 40Xpower of objective lenses for the presence of intestinal parasites. To confirm
negative stool samples the remaining sample, around 5 g, was preserved with 10 ml 10%
formalin solution for formal- ether concentration (WHO, 1991).
3.6.2 Formal Ether Concentration
The preserved or fresh stool specimen was processed by formal ether concentration technique.
About 1.0-1.5 g of stool specimen was mixed in centrifuge tube containing 10 ml formalin
and mixture was stirred until suspension was formed (WHO, 1991). Then 3 ml of ether was
added to the suspension and mixed well by putting a rubber stopper in the tube and then shake
for 10 seconds. After removing the stopper, the tube was placed in a centrifuge for 2-3
minutes at 2000 revolution per minute (rpm).Then the tube was removed from the centrifuge
and four layers was observed from top to bottom (the top layer ether, two fat debris, layer
three formalin, and the bottom layer was sediment). All the top three layers or supernatant
was discarded by inverting the tubes. A small amount of residual fluids was flown back to the
sediment, properly mix with the sediment, and drop of the suspension was transferred to a
clean slide and covered with cover slip. Finally the slide was examined at 10X and40X
objectives for the presence of intestinal parasites (WHO, 1991).
3.7 Data Analysis
Data were collected from school children and coded and entered in to a micro soft excel sheet
and the required statistical analysis was done using SPSS software version 20,Chi- square test
was used to analyze the association between each intestinal parasite with their risk factors and
demographic structure and binary logistic regression analysis was performed to determine the
risk of the variables by calculating the strength of the association between infection and risk
30
factors using odd ratios (OR) at 95% confidence interval (CI) and P-value <0.05(5%) was
considered as statistically significant.
3.8 Ethical Clearance
Ethical clearance was obtained from the ethical review committee of Bahir Dar university and
before data collection period, a letter was also written by Bahir Dar university biology
department about the objective of the study to the Libokemkem health center and Education
office, then the Educational office wrote permission letter to both complete cycle primary
Schools (Yifag, and Agidkirigna) And then the objective of the study was explained to the
school directors, teachers and students before the time of specimen collection. Participation
was fully voluntary and informal verbal consent as well as written consent was obtained from
each study subject. And the office of Libokemkem district, Addis Zemen Town Health Center
(AZHC) also wrote permission letter to Yifag health center (YHC). During the study, those
children who had parasites were sent to the nurses and given prescription order/paper. Finally
appropriate anti parasitic drug/treatment was given to those students who were positive for
intestinal parasitic infections (IPIs) by local nurses
31
4. RESULTS
4.1 Socio demographic characteristics of the school children
From the entire examined population (403), 202(50.1%) were Males and 201(49.9%) were
Females. From those, 269(66.7%) were rural, while the rest 134(33.3%) were urban dwellers.
Based on grade level from grades 1-4, 202(50.1%) and grades 5-8, 201(49.9%).The age
categories were 5-9years 88(21.8%), 10-14years 231(57.3%), and >14years 84 (20.8%), and
223(55.3%), 180(44.7%) participant students were selected from Yifag and Agidkirigna
complete cycle primary schools respectively.
Table 1: Demographic characteristics of Yifag and Agidkirigna complete cycle primary school
children in 2017/2018 (n=403).
demographic characterstics
Sex
Age
Grade level
Residence
School
Male
Female
5-9
10-14
≥ 15
1-4
5-8
Rural
Urban
Yifag
Agidkirigna
Frequency
Percentage
202
201
88
231
84
202
201
269
134
223
180
50.1
49.9
21.9
57.3
20.8
50.1
49.9
66.7
33.3
55.3
44.7
4.2 Associated risk factors of intestinal parasitic infections
Most of the students 302 (74.9%) used tap water, the rest 46(11.4 %) and 55(13.6%) of the
school children obtained water from unprotected stream/river and well water respectively for
drinking and cooking. 188 (46.7%) of the students included in the study had latrine in their
home; but majority of the students, 215 (53.3%) who had not latrine house in their home.
However, only one latrine was available in the school for both teachers and students. More
than half of the study participants 242 (60%) had no habit of using toilet and defecate in the
open fields while 161 (40.0%) students were used toilet. Majority of the study subjects
32
262(65.0%) did not trim their finger nails however, 383(95%) students had good habit of
washing hand before meal. Most of the students 327(81.1%) had contact with water bodies
(Rivers, Streams, Lakes,….) during bathing ,swimming, washing clothes. More than half of
the students 272(67.5%) wore shoes all the time, while the rest 131(32.5%) wore shoes
sometimes or not at all and most of the study subjects were live in crowded family
members,71(17.6%) , 182(45.2%) ,150(37.2%) have 1-3, 4-6, >6 family members in their
home respectively. With regard to family education (especially their mother’s educational
status) most students, 298(73.9%) came from illiterate family, while 105(26.1%) only came
from their family able to read/write or literal family and their mother’s occupation,
347(86.1%) were house wife, 40(9.9%) traders, 12(3%) daily laborer, 4(1%) government
employers.
Table 2: Frequency of respondents based on associated risk factors among Yifag and Agidkirigna
junior primary school children in Libokemkem district, 2017/2018 (n=403).
Risk factors
Drink water
Hand wash
Fecal defication
Latrine availability
Eating raw meat
Raw ,uncooked,unwashed
vegetables and fruits
Bath or swim in
water bodies
Dirty matters on/In finger
nails /trming
Shoe wearing
Response
Spring/River water
Tap water
Wel water
Yes
No
Open field
Latrine house
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Always
Sometimes
Not at all
33
Frequency Percentage
46
11.4
302
74.9
55
13.6
383
95
20
5
242
60
161
40
188
46.7
215
53.3
101
25.1
302
74.9
199
49.4
204
50.6
328
81.4
75
18.6
262
65
141
35
272
67.5
121
30
10
2.5
Mother educational status
Illiterate
Literal
Mothers occupation
House wife
Trader
Daily laborer
Government employee
Family members
1-3
4-6
>6
Parental economic status Poor
Middle income
Rich
House waste disposition Bury underground/Burn
mechanism
Left open field
Total prevalence of IPIs
Positive
Negative
Protozoal parasites
Positive
Negatie
Giardia lamblia
Positive
Negative
Entamoeba histolytica
Positive
Negative
Helminthic parasites
Positive
Negative
Hook worm
positive
Negative
Ascaris lumbricoides
Positive
Negative
Hymenolepis nana
Positive
Negative
Enterobius vermicularis
Positive
Negative
Schistosoma mansoni
Positive
Negative
Taenia species
Positive
Negative
34
298
105
347
40
12
4
71
182
150
64
296
43
163
240
108
295
33
370
8
395
25
378
75
328
6
397
28
375
22
381
3
400
9
394
7
396
73.9
26.1
86.1
9.9
3
1
17.6
45.2
37.2
15.9
73.4
10.7
40.4
59.6
26.8
73.2
8.2
91.8
2
98
6.2
93.8
18.6
81.4
1.5
98.5
7
93
5.5
94.5
0.7
99.3
2.2
97.8
1.7
98.3
4.3 Prevalence of Intestinal Parasitic Infections
From a total of 403 selected study subjects, 202(50.1%) were males and 201(49.9%) were
females participated in the study from two complete cycle primary schools (Yifag and
Agidkirigna), from those, among the stool samples examined, 108 (26.8%) were infected with
intestinal parasites. From the overall prevalence rate, sex specific prevalence of intestinal
infection, females were relatively highly infected than males, 61/201(30.3%), 47/202(23.3%)
respectively. Prevalence of intestinal parasitic infections (IPIs) among the study schools, the
highest prevalence of infections were in Agidkirigna complete cycle primary school, 57/180
(31.7%) and followed by Yifag complete cycle primary school, 51/223 (22.9%). There was a
statistically significant difference in prevalence of intestinal parasitic infections between
schools included in this study.
All of the study subjects were infected with a single infection while no one didn’t have double
or triple infections. The most frequent intestinal infections were A.lumbricoides 28(7%)
followed by E.hitolytica 25(6.2%), H.nana 22(5.5%), S.mansoni 9(2.2%), G.lamblia 8(2%),
Taenia species 7(1.7%) Hookworm 6(1.5), E.vermicularis 3(0.7%) respectively.
Prevalence rate(%)
30
26.8
Positive
25
20
15
10
5
7
6.2
5.5
2.2
2
1.7
1.5
0.7
0
Intestinal Parasites
Figure 2: Prevalence of intestinal parasitic infections in Yifag and Agidkirigna complete
primary schools children, in Libokemkem district 2017/2018(n=403).
35
Table 3: The Association of Intestinal Parasitic Infections(IPIs) with risk factors in Yifag and
Agidkirigna complete cycle primary school children, in Libokemkem district 2017/2018
(n=403).
Risk Factors
Sex
Male
Female
Residence
Urban
Rural
Age groups in yrs 5-9
10-14
≥15
Sourse of water Spring/river
Tap water
Well water
Hand wash before meal Yes
No
Intestinal parasitic infections
Positive
Negative
Total
47(23.3%) 155(76.7%)
202
61(30.3%) 140(69.7%)
201
28(20.9%) 106(79.1%)
134
80(29.7%) 189(70.3%)
269
24(27.3%) 64(72.7%)
88
68(29.4%) 163(70.6%)
231
16(19.3%) 68(80.9%)
84
16(34.8%) 30(65.2%)
46
75(24.8%) 227(75.2%)
302
17(30.9%) 38(69.1%)
55
105(27.4%) 280(72.6%)
385
3(15.0%)
15(85.0%)
18
χ2
p-value
2.575
0.109
3.566
3.59
0.050*
0.309
2.562
0.278
0.986
0.321
Feces defecation Open field
77(31.8%)
place
Laterine house 31(19.3%)
165(68.2%)
130(80.7%)
242
161
7.779 0.005*
Latrine availability Yes
No
Eating raw meat
Yes
No
39(20.7%)
69(32.1%)
34(33.7%)
74(24.5%)
149(79.3%)
146(67.9%)
67(66.3%)
228(75.5%)
188
215
101
302
6.584 0.01*
eating raw ,undercooked, Yes
unwashed, vegetables
No
and fruits.
Bath/swim in water
Yes
bodies.
No
Finger nails filled by Yes
dirty matter/Trimming No
63(31.7%)
45(22.1%)
136(68.3%)
159(77.9%)
199
204
4.732 0.03*
90(27.5%)
18(23.7%)
86(32.8%)
22(16.5%)
237(72.5%)
58(76.3%)
184(67.2%)
111(83.5%)
327
76
270
133
0.463
0.496
3.372
0.066
Shoe wearinghabit
Always
Some times
Not at all
63(23.2%)
44(36.4%)
1(10.0%)
209(76.8%)
77(63.6%)
9(90.0%)
272
121
10
8.916 0.012*
Mother EducIlliterate
ational status
Literal
Mother occupation-House wife
Trader
88(29.5%)
20(19.0%)
96(27.7%)
8(20.0%)
210(70.5%)
85(81.0%)
251(72.3%)
32(80.0%)
298
105
347
40
4.349 0.037*
36
3.237
2.801
0.072
0.423
Daily labor
Gov't employer
Family members
1-3
4-6
>6
Parents economic Poor
status
Midle income
Rich
Disposable of house-Bury /burn
hold wastes.
Left open field
*=Significant p-value<0.05
4(33.3%)
0(0.0%)
18(25.4%)
46(25.3%)
44(29.3%)
13(20.3%)
86(29.1%)
9(20.9%)
37(22.7%)
71(29.6%)
8(66.7%
4(100%)
53(74.6%)
136(74.7%)
106(70.7%)
51(79.7%)
210(70.9%)
34(79.1%)
126(77.3%)
169(70.4%)
12
4
71
182
150
64
296
43
163
240
0.782
0.676
2.895
0.235
2.345
0.126
According to Pearsons chi-square test analysis(χ2) fecal defecation habit had significant
association with intestinal parasitic infections(χ2=7.779 and P-value 0.005 ) and latrine
availability in their homes also significantly associated with intestinal infection,( χ2 =6.584
and P-value 0.01) and eating raw, undercooked ,unwashed ,vegetables, and fruits also
significantly associated with intestinal infections (χ2= 4.732 and P-value 0.03 ) and mother’s
educational status also significant association with intestinal parasitic infections (χ2=4.349
and P-value 0.037) and the study participants shoe wearing habit also significantly associated
with intestinal parasitic infections (χ2=8.916 and P-value 0.012).There was no significant
difference of infection rate of intestinal parasites between school children who did and did not
trim their fingernails. The study participants eating raw or uncooked meat, the students age
group in years ,source of drinking water, hand washing habit before meal, bath or swim in
water bodies, number of family members, parental economic status, disposable of house hold
wastes, had no statistical significant association with intestinal parasitic infections(P>0.05).
Among the total examined participants (18.6%) were infected by intestinal helminthic
parasites, while (8.2%) participants were infected by intestinal protozoan parasites the
remaining (73.2%) were not infected by intestinal parasites in the study area.
37
Figure 3: Prevalence of protozoan and helminthic infections in Yifag and agidkirigna complete
cycle primary school children, 2017/2018 (n=403), where Protozoan infections (n=33)
Helminthes infections (n=75).
In the present study the overall prevalence rate of intestinal parasite infections (IPIs) in males
and females were 23.3% and 30.3% respectively. From the examined subjects females were
more infected than males by A .lumbricoides, S.mansoni, G.lamblia, Hookworm and
E.vermicularis with the prevalence rate of 9.5%, 3.5%, 2.5% , 2% and 1.5% respectively,
whereas males were relatively more infected than females by H.nana, E.histolytica, and
Taenia species with the prevalence rate of 6.9%, 6.4%, and 2% respectively.(Figure 4).
Table 4: Prevalence of IPIs based on sex in Yifag and Agidkirigna complete cycle primary
schools children in Libokemkem district, 2017/2018 (n=403), where males(n=202);
Females(n=201).
Intestinal parasitic
No_ofMales
No_ of Females
TotalInfected
infections (IPIs)
infected(%)
n=202
9(4.5%)
13(6.4%)
14(6.9%)
2(1.0%)
3(1.5%)
4(2.0%)
2(1.0%)
0(0.0%)
47(23.3%)
Infected(%)
n=201
19(9.5%)
12(6%)
8(4.0%)
7(3.5%)
5(2.5%)
3(1.5%)
4(2.0%)
3(1.5%)
61(30.3%)
(%)
n=403
28(7.0%)
25(6.2%)
22(5.5%)
9(2.2%)
8(2.0%)
7(1.7%)
6(1.5%)
3(0.7%)
108(26.8%)
A.lumbricoides
E.histolytica
H.nana
S.mansoni
G.lamblia
Taenia species
Hookworm
E.vermicularis
Total
38
X2
3.892
0.038
1.7
2.867
0.52
0.14
0.687
3.038
2.575
P-value
0.04
0.471
0.192
0.09
0.471
0.708
0.407
0.081
0.109
Figure 4: Prevalence of intestinal parasitic infections based on sex in Yifag and Agidkirigna
complete cycle primary schools children in Libokemkem District, 2017/2018.(n=403), where
Males (n=202); Females (n=201)
4.4 Binary logistic regression analysis of socio demographic and socio economic
factors associated with intestinal parasitic infections (IPIs)
Bivariate analysis was carried out to examine factors associated with IPIs. Among the socio
demographic factors sex, grade level, family size, mother’s occupation were not statistically
significant association with the occurrence of IPIs (P>0.05). However schools, residence,
parent’s (mother’s) educational status showed significant association with IPIs (P<0.05).
As bivariate analysis from the study subjects in crude odd ratio females were 1.437 (95% CI
0.922 to 2.240) more likely infected than male children by intestinal infection but not
statistically significant (P>0.05). Students from grade level 1-4 were 0.865 times (95%CI:
0.556 to 1.345, p=0.519) more likely to be infected with IPIs than those from grade levels 58.Agidkirigna complete cycle primary school students were 1.563 times (95%CI: 1.004
39
to2.434, p=0.048) more infected with IPIs than Yifag complete cycle primary school and
there was slightly statistical difference between schools. Rural dweller students were 0.624
(95% CI 0.382-1.020) times more infected than urban dwellers by intestinal infection and
there was statistically significant (P<0.05), and the highest prevalence of IPIs students whose
mothers illiterate were 0.561 (95% CI 0.325-0.970) more likely infected than whose mothers
were educated and there was statistically significant difference between them. Students who
came from poor family were 1.038 times (95%CI: 0.400 to 2.697, p=0.239) more infected
with IPIs than those students who had middle and higher income families but not statistically
significant. Students who had not latrine house in their home and no habit of using toilet were
highly infected with intestinal parasites infections (IPIs) than who had latrine house in their
home and habit of using toilet and there was statistical significant P<0.05. And students who
lived in overcrowded living conditions (large family size) were more likely to acquire IPIs
than those lived in small size family members, but not statistical significance difference
Table 5: Binary logistic regression analysis of intestinal parasitic infections in relation to
socio demographic and socioeconomic factors amongYifag and Agidkirigna complete cycle
primary school 2017/2018 (n=403).
Risk factors
Response
Sex
Male
Female
Intestinal parasitic infections (IPIs) with their risk factors
Positive
Negative
Total
COR(Crude Odd
P-value
NO_(%)
NO_(%)
No_ (%)
Ratio)at 95%CI
47(43.5%) 155(52.5%) 202(50.1%) Reference
61(56.5%) 140(47.5%) 201(49.9%) 1.437(0.922,2.240)
0.109
Grade level
School
Grade1-4
Grade5-8
Yifag
57(52.8%)
51(47.2%)
51(47.2%)
145(49.2%) 202(50.1%) 0.865(0.556,1.345)
150(50.8%) 201(49.9%) Reference
172(58.3%) 223(55.3%) Reference
Residence
Agidkirigna
Urban
57(52.8%)
80(74.1%)
123(41.7%) 180(44.7%) 1.563(1.004,2.434) 0.048*
189(64.1%) 269(66.7%) reference
Mother's education
Rural
Literate
28(25.9%)
20(18.5%)
106(35.9%) 134(33.3%) 0.624(0.382,1.020) 0.05*
85(27.8%) 105(26.1%) reference
status
Illiterate
88(81.5%)
210(71.2%) 298(73.9%) 0.561(0.325,0.970) 0.039*
Water source
River
wel
Tap
Yes
No
16(14.8%)
17(15.7%)
75(69.4%)
104(96.3%)
4(3.7%)
30(10.2%)
38(12.9%)
227(76.9%)
279(94.6%)
16(5.4%)
Hand wash before
meal
40
46(11.4%)
55(13.6%)
30274.9%)
383(95%)
20(5%)
0.839(0.364,1.931)
(0.722-2.539)
reference
reference
0.533(0.151-1.880)
0.519
0.281
0.328
Feces defection
habit
Latrine availability
Open field
Latrinhouse
Yes
77(71.3%)
31(28.7%)
39(36.1%)
165(55.9%) 242(60%)
0.511(0.317,0.823) 0.006*
130(44.1%) 161(40%)
reference
149(50.5%) 188(46.7%) reference
in their home
Raw meat eating
habit
No
Yes
No
69(63.9%)
34(31.5%)
74(68.5%)
146(49.5%) 215(53.3%) 1.806(1.147,2.844) 0.011*
67(22.7%) 101(25.1%) 0.640(0.3921.043) 0.073
228(77.3%) 302(74.9%) reference
Habit of eating raw,
under cooked,un
washed vegetables
and fruits
Yes
No
63(58.3%)
45(41.7%)
136(46.1%) 199(49.4%) 0.611(0.391,0.954) 0.030*
159(53.9%) 204(50.6%) reference
Bath/swim in the
near by water
bodies
Yes
No
90(83.3%)
18(16.7%)
238(80.7%) 328(81.4%) 0.817(0.457,1.462)
57(19.3%) 75(18.6%)
reference
Dirty material on/in
side finger nails or
finger nails trimmed
Yes
No
86(79.6%)
22(20.4%)
209(70.8%) 295(73.2%) 0.638(0.394,1.033)
86(29.2%) 108(26.8%) reference
Always
sometimes
not at all
1-3
4-6
>6
Poor
Midleincome
Rich
63(58.3%0
44(40.7%)
1(0.9%)
18(16.7%)
46(42.6%)
44(40.7%)
13(12%)
86(79.6%)
9(8.3%)
209(70.8%)
77(26.1%)
9(3.1%)
53(18%)
136(46.1%)
106(35.9%)
51(17.3%)
210(71.2%)
34(11.5%)
Left open
Burry/burn
71(65.7%)
37(34.3%)
169(57.3%) 240(59.6%) 1.431(0.904,2.265)
126(42.7%) 163(40.4%) reference
Shoe wearing
habit
Family members
Parent's economy
House waste
disposable
mechanisms
*=Statistically significant P<0.05,
272(67.5%)
121(30%)
10(2.5%)
71(17.6%)
182(45.2%)
150(37.2%)
64(15.9%)
296(73.4%)
43(10.7%)
No_= Number, CI=Confidence Interval
E.histolytica, H.nana, S.mansoni,
G.lamblia,
Taenia species,
and
E.vermicularis) were more common in age groups 10-14 years of age, where (n= in this age
group 231) and their prevalence rates were 19(8.2%), 18(7.8%), 10(4.3%), 6(2.6%), 6(2.6%),
4(1.7%), and 3(1.3%) respectively; whereas hookworm infection was equally distributed in all
age groups, 5-9, 10-14, and ≥15years. Its prevalence rate was 2(2.3%), 2(0.9%), and 2(2.4%)
41
0.067
reference
0.014*
0.369(0.460-2.966)
0.194(0.024-1.586)
reference
0.677
1.222(0.645-2.318)
1.227(0.756-1.993)
1.038(0.400-2.697)
0.235
0.646(0.297-1.405)
reference
Based on age groups the prevalence of overall intestinal parasitic infections, most
A.lumbricoides,
0.497
0.127
between in each age category respectively. On the other hand intestinal parasitic infections
associated between age groups from the total sample study subjects were summarized in table
6. Statistically there were no significance difference between age groups and intestinal
parasitic infections.
Table 6: Prevalence of intestinal parasitic infections in different age groups among Yifag and
Agidkirigna primary school children in Libokemkem district 2017/2018 (n=403).
Detected parasitic
Infections
A.lumbricoides
E.histolytica
H.nana
S.mansoni
G.lamblia
Taenia species
Hookworm
E.vermicularis
Total infections
Age groups
5-9yrs
10-14yrs
≥15 yrs
n=24
n=68
n=16
6(1.5%) 19(4.7%) 3(0.7%)
4(1.0%) 18(4.5%) 3(0.7%)
5(1.2%) 10(2.5%) 7(1.7%)
3(0.7%) 6(1.5%)
0(0.0%)
1(0.2%) 6(1.5%)
1(0.2%)
3(0.7%) 4(1.0%)
0(0.0%)
2(0.5%) 2(0.5%)
2(0.5%)
0(0.0%) 3(0.7%)
0(0.0%)
24(6.0%) 68(16.9%) 16(4.0%)
Total
n=108
28(7.0%)
25(6.2%)
22(5.4%)
9(2.2%)
8(2.0%)
7(1.7%)
6(1.5%)
3(0.7%)
108(26.8%)
χ2
P-value
2.066
0.356
2.418
0.299
1.925
0.382
2.616
0.27
1.044
0.593
2.926
0.231
1.436
0.488
2.251
0.325
3.402
0.182
From the following (Table 7) below majority of the school children who ate raw, under
cooked, and un washed vegetables and fruits would 0.437 times with 95% CI 0.184 to 1.037
more likely infected than not ate raw, undercooked, and unwashed vegetables and fruits by
E.histolytica/dispar and which was statistically significant (p=0.030) and based on sex
females were 0.923 times with 95% CI 0.411 to 2.075 more likely infected by
E.histolytica/dispar than the males and concerning about the water source those study
subjects who used unprotected spring/river water and wel water 2.114 times 95% CI 0.477
to9.367 more likely harboured E.histolytica/dispar than who drunks tap water but not
statistically significant p- value>0.05.
The prevalence of A.lumbricoides was the school children those ate raw, undercooked, and
unwashed vegetables and fruits likely to be 0.835 times (95% CI 0.387-1.803) more infected
than not ate raw, under cooked, and un washed vegetables and fruits by A.lumbricoides but
not statistically significant (P value=0.646) and females were two times more infected than
males by A.lumbricoides and there were statistically significant difference between sex.
42
Table 7: Binary logistic analysis between eating raw, undercooked, and unwashed vegetables
and fruits with E.histolytica and A.lumbricoides in both schools 2017/2018 (n=403).
Risk factors
Sex
Male
Female
Residence
Urban
Rural
Sourse ofTap water
water for
Wel water
drinking
Spring/river
Availablity of
Yes
latrine in their
No
home
Fecal defecation- Open field
habit
Latrinehouse
Eating of raw,
Yes
under cooked,
No
unwashed,
vegetables and fruites
Risk Factors
Sex
Male
Female
Residence
Urban
Rural
Source of
Tap water
water for
Wel water
drinking
Spring/river
Latrine availability Yes
in their home
No
Fecal defe- Latrine house
cation habit Open field
Eating of raw,
Yes
undercooked,
No
unwashed
vegetables and fruits
CI= Confidence interval,
Positive
No_ (%)
13(6.4%)
12(6%)
5(3.7%)
20(7.4%)
17(5.6%)
3(5.5%)
5(10.9%)
10(5.3%)
15(7%)
Negative
No_ (%)
189(93.6%)
189(94%)
129(96.3%)
249(92.6%)
285(94.4%)
52(94.5%)
41(89.1%)
178(94.7%)
200(93%)
Total
No_ (%)
202(50.1%)
201(49.9%)
134(33.3%)
269(66.7%)
302(74.9%)
55(13.6%)
46(11.4%)
188(46.7%)
215(53.3%)
Entamoebahistolytica
Crude Odd Ratio at
95% CI
Reference
0.923(0.411-2.075)
Reference
0.483(0.177-1.315)
Reference
2.044(0.716-5.839)
2.114(0.477-9.367)
Reference
1.335(0.585-3.047)
18(7.4%)
7(4.3%)
17(8.5%)
8(3.9%)
224(92.6%)
154(95.7%)
182(91.5%)
196(96.1%)
242(60%)
161(40%)
199(49.4%)
204(50.6%)
0.556(0.231-1.387)
Reference
0.437(0.184-1.037)
Reference
Total
No_ (%)
202(50.1%)
201(49.9%)
134(33.3%)
269(66.7%)
302(74.9%)
55(13.6%)
46(11.4%)
188(46.7%)
215(53.3%)
161(40%)
242(60%)
199(49.4%)
204(50.6%)
Ascaris lumbricoides
Crude Odd Ratio at
95% CI
Reference
2.239(0.987-5.076)
Reference
1.125(0.504-2.509)
Reference
1.124(0.238-5.302)
0.890(0.189-4.195)
Reference
1.626(0.731-3.617)
Reference
0.580(0.249-1.352)
0.835(0.387-1.803)
Reference
Positive
No_ (%)
9(4.5%)
19(9.5%)
10(7.5%)
18(6.7%)
21(7%)
4(7.3%)
3(6.5%)
10(5.3%)
18(8.4%)
8(5%)
20(8.3%)
15(7.5%)
13(6.4%)
Negative
No_ (%)
193(95.5%)
182(90.5%)
124(92.5%)
251(93.3%)
281(93%)
51(92.7%)
43(93.5%)
178(94.7%)
197(91.6%)
153(95%)
222(91.7%)
184(92.5%)
191(93.6%)
*= statistically significant and p<0.05
43
P-value
0.846
0.154
0.392
0.493
0.213
0.03*
P-value
0.05
0.774
0.989
0.233
0.203
0.646
From the next (Table 8) majority of the study subjects shoe wearing habit and latrine
availability of the area and its usage had positive association with hookworm infection and
which were statistically significant.
Table 8: Risk factors associated with hookworm in Yifag and Agidkirigna complete cycle primary
school children in Libokemkem district 2017/2018 (n=403).
Risk factors
Sex
Residence
Male
Female
Urban
Rural
Yes
No
Availability of
Latrine in their
home
Feces defe- Latrine house
cation habit
Open field
Shoe wearing Always
habit
Sometimes
Not at all
Positive
No_ (%)
2(1%)
4(2%)
1(0.7%)
5(1.9%)
0(0.0%)
6(2.8%)
Hookworm
Negative
Total
No_ (%)
No_ (%)
200(99%)
202(50.1%)
197(98%)
201(49.9%)
133(99.3%) 134(33,3%)
264(98.1%) 269(66.7%)
188(100%) 188(46.7%)
209(97.2%) 215(53.3%)
1(0.6%)
5(2.1%)
1(0.4%)
5(4.1%)
0(0.0%)
160(99.4%)
237(97.9%)
271(99.6%)
116(95.9%)
10(100%)
161(40%)
242(60%)
272(67.5%)
121(30%)
10(2.5%)
χ2
P-value
0.687
0.407
0.755
0.385
5.326
0.021*
1.376
0.241
8.247
0.016*
In the following (Table 9) showed that the risk of source of water for drinking, bathing/
swimming, washing clothes in water bodies (river, stream, lakes,…..), residence of the
students, latrine availability of the area had positive association for S.mansoni infection but
source of water for drinking, sex of the participants, feces defecation habit of the study
subjects was not statistically significant (p>0.05) while, water contact habit during
bathing/swimming, washing clothes, residence, latrine house availability of the area, had
statistically significant diference in Schistosoma mansoni infection.
44
Table 9: The risk factors associated with S.mansoni in Yifag and Agidkirigna complete cycle
primary school children in Libokemkem district 2017/2018 (n=403).
S.mansoni
Total
Risk factors
Positive
Negative
Sex
No_ (%)
2(1%)
7(3.5%)
No_ (%)
No_ (%)
200(99%)
202(50.1%)
194(96.5%) 201(49.9%)
χ2
pvalue
2.867
0.09
Urban
Rural
Source of
Spring/river
water for
Tap water
drinking
Wel water
Do you bath/
Yes
swim the
No
nearby water bodies
9(3.3%)
0(0.0%)
3(6.5%)
5(1.7%)
1(1.8%)
9(2.8%)
0(0.0%)
260(96.7%)
134(100%)
43(93.5%)
297(98.3%)
54(98.2%)
318(97.2%)
76(100%)
269(66.7%)
134(33.3%)
46(11.4%)
302(74.9%)
55(13.6%)
327(81.1%)
76(18.9%)
4.586 0.032*
Availability of
Yes
Latrine in their
No
home
Feces defe- Latrine house
cation habit Open field
*=significant value
1(0.5%)
8(3.7%)
187(99.5%) 188(46.7%)
207(96.3%) 215(53.3%)
4.672 0.031*
1(0.6%)
8(3.3%)
160(99.4%) 161(40%)
234(96.7%) 242(60%)
3.191
Male
Female
Residence
4.38
3.809
0.112
0.05*
0.074
The overall prevalence of intestinal parasitic infections in rural and urban setting was 29.9%
and 20.8% respectively. From (Figure 5) intestinal infection of rural dwellers were 7.4%,
6.7%, 4.8%, 3.3%, 2.6%,2 %, 2% and 1.1%
infected by E. histolytica, A. lumbricoides,
H.nana, S. mansoni, G. lamblia, Taenia species, hookworm and E.vermicularis respectively.
In urban dwellers the prevalence rate was 7.5%, 6.7%, 3.7%, 1.5%, 0.7%, and 0.7%, by A.
lumbricoides, H. nana, E. histolytica/dispar, Taenia species, G. lamblia, and hookworm
respectively . Among the intestinal parasitic infections in this study S. mansoni and E.
vermicularis were only found in rural area but not found in urban dwellers, whereas
A.lumbricoides, H.nana E.histolytica, G.lamblia, Hookworm and Taenia species were
common in both residential areas.
45
Figure 5: Prevalence of Intestinal parasites in Rural and Urban dwellers among primary
schools children in Yifag and Agidkirigna in Libokemkem district, 2017/2018(n=403).
The prevalence rate of intestinal parasitic infection among Yifag and Agidkirigna complete
cycle primary school was 22.8% and 31.8% respectively. Of these infections A.lumbricoides
was6.7% and 7.2% respectively; E.histolytica was 4.1% and 8.9%; H.nana was 5.4% and
5.6%; G.lamblia was 2.2% and 1.7%; Taenia species was 2.7% and 0.6%; Hookworm was
1.8% and 1.1% respectively whereas S.mansoni and E.vermicularis infections were not
found (0%) in Yifag complete cycle primary school and 5% and 1.7% were found in
Agidkirigna complete cycle primary school respectively.Figure- 6.
46
Figure 6: Prevalence of intestinal parasitic infections (IPIs) with school type (Yifag and Agidkirigna)
in Libokemkem district 2017/2018 (n=403), where Yifag (n=223);(Agidkirigna n=180).
Table 10: Prevalence of intestinal parasitic infections (IPIs) with school type (Yifag and Agidkirigna)
in Libokemkem district 2017/2018 (n=403), where Yifag (n=223);(Agidkirigna n=180).
Schools
Yifag
(%)
Agidkrgna
(%)
Total
(%)
No_of
Infected Intestinal parasiticInfections(IPIs)
examined No_(%) A.l
E.h
H.n
S.m
G.l
T.s
223
55.3
51
22.9
15
6.7
9
4
12
5.4
0
0
5
2.2
6
2.7
180
44.7
57
31.8
13
7.2
16
8.9
10
5.6
9
5
3
1.7
1
0.6
403
108
26.8
28
7
25
6.2
22
5.5
9
2.2
8
2
7
1.7
H.w
E.v
4
1.8
0
0
2
1.1
6
1.5
3
1.7
3
0.7
In the present study (Figure 7) showed that the prevalence of overall intestinal parasitic
infections based on grade level, grade1-4 and 5-8 among Yifag and Agidkirigna complete
47
cycle primary school children were 28.3% and 25.5% respectively. From the overall
intestinal parasitic infections (28.3%), A.lumbricoides was (9.4%); S.mansoni was(2.5%);
and E.vermicularis was(1%) in grades level 1-4 which was higher than in grades 5-8 with the
overall intestinal parasitic infection (25.5%) A.lumbricoides was (4.5%); S.mansoni was (2%)
and E.vermicularis was (0.5%) respectively. Whereas E.histolytica (6.5%); G.lamblia (3%)
and Taenia species (2%) were higher from grades 5-8 level than grades 1-4.Figure 7.
Figure 7: Prevalence of intestinal parasites based on grade level among in Yifag and Agidkirigna
complete cycle primary school children in Libokemkem district 2017/2018 (n=403), Where Grade14 (n=202); grade5-8(n=201).
48
5. DISCUSION
Intestinal parasites are great public health problem in several tropical and subtropical
developing countries like Ethiopia, with poor sanitation, low socio-economic status, poor
personal and environmental hygiene; they are common to school age children (Girum
Tadesse, 2005) in line with this view the present study attempted to assess the prevalence of
intestinal parasitic infections and associated risk factors in school children of Yifag and
Agidkirigna in Libokemkem district, Northwest Ethiopia. Epidemiological studies carried out
in different places or countries have shown that the situation of an individual is an important
cause in the prevalence of intestinal parasitic infections having a greater rate in children
(Asrat Ayalew et al., 2011).
The present study did not revealed significant difference between intestinal parasitic
infections (IPIs) and hand washing habit before meal (p>0.05). This was inconsistent with
other studies conducted in eastern Ethiopia, Babile town by Girum Tadesse (2005) who had
shown a significant association in the prevalence of intestinal helminthic infections and hand
washing practice among individuals who rarely washed their hand compared to those who
washed their hand regularly before meal. This variation might be in awareness regarding
transmission and prevention of intestinal parasites between the study participants in this study
and other studies and differences might be due to the usage of contaminated water by the
study participants for different purposes.Children in Aborigine population Malaysia, tend to
have peculiar habits such as not washing hands before and after eating meal; that contributed
higher prevalence of intestinal protozoa (Azian et al., 2007). This finding was also in
agreement with the study of (Asrat Ayalew et al., 2011) in which hand washing practice
before meal had statistically significant association to any parasitic infection. Furthermore, in
this study, children who did and did not trim their fingernails short had no significant
association with the prevalence of intestinal parasitic infection, which is a potential source of
infection and timely trimming and keeping of personal hygiene is very important to reduce the
risk of intestinal parasitic infections.
In the current study children who did and did not eat raw, undercooked, unwashed vegetables
and fruits showed statistically significant association with the prevalence of intestinal
parasitic infections (IPIs) such as E.histolytica/dispar. The findings of this study was
49
supported by (Berhanu Erko et al. 1995; and Asrat Ayalew et al., 2011) who stated that
higher prevalence of intestinal parasites may be due to contamination of vegetables with fecal
matter in the farming area. The previous study also found that the growing of vegetables in
fecal polluted gardens are all found to be conducive for transmission of soil transmitted
helminthes and intestinal protozoa (Berhanu Erko et al., 1995).
In this study from the total prevalence rate of different age categories had different intestinal
parasitic infection prevalence rate was 24/88 (27.3%) infected school children 5-9 years old;
68/231(29.4%) infected school children 10-14 years old; and 16/84(19.0%) infected school
children in the age of ≥15years old, but not statistically significant.(p-value>0.05).This idea
was supported by the study of Abebe Alemu et al., 2011, and Gebremichael Gebretseadik,
2016, who stated that the higher infection rate among 5-9 and 10-14 age groups were due to
age of students have less knowledge about sanitation and more active for swimming in
contaminated water bodies and playing on contaminated soil and that contributed to high
infection rates for intestinal parasites and the prevalence of IPIs were higher in lower age and
reduced as children grow older ;as age increases, infection rate decreases due to awareness
about transmission of IPIs also increase and enhance their personal hygiene(Raza and Sami,
2009; Alemshet Yami et al., 2011; Eleni Kidanie et al., 2014).
In this cross sectional study the most frequent intestinal infections were A.lumbricoides (7%)
followed by E.histolytica (6.2%), H.nana
(5.5%), S.mansoni (2.2%), G.lamblia (2.0%),
Taenia species (1.7%), Hookworm (1.5%), E.vermicularis (0.7%) respectively. The result of
the study showed that, the occurrence of several intestinal helminthes were 18.6% and some
of the protozoan parasites were 8.2% with the overall prevalence of intestinal parasitic
infections (IPIs) 26.8%.This finding is almost similar to the prevalence of intestinal parasitic
infections reported in Babile town, Eastern Ethiopia (Grum Tadesse, 2005)(27.2%);in Addis
Ababa Haileyessus Adamu et al., 2005 (27.5%); in western Tajikistan(Matthys B.et
al.,2011)(26.7%). But lower than studies reported in different parts of the world in Chiang
mai, North Thiland (Somask et al.,2003)(48.9%); in South east of Lake Langano (Mengistu
Legesse and Berhanu Erko, 2004)(83.8%); South east Nigeria (Olufemi et al.,2007)(42.2%);
in Egypt(El-Masry et al.,2007)(38.5%); in Jimma (Amare Mengistu, 2007) (83%); Southern
Ethiopia, around Lake Ziway(Gezahagn Solomon,2008)(43.7%);in Jimma zone (Alemshet
Yami et al., 2011) (47.1%); North Gondar, in Delgi primary school (Asrat Ayalew et
50
al.,2011)(79.8%); and Bahir Dar (Bayeh Abera et al.,2013)(51.5%); in EnemorenaEner
district, Gurage zone, Ethiopia (Melesse Birmeka et al.,2017)(40.2%). On the other hand, the
overall prevalence of intestinal parasitic infections found in this study is slightly higher than
findings from the prevalence of intestinal parasitic infection reported in Kenya (Mutuku et
al., 2008)(12.9%); in Nepal, (Sah et al., 2013)(13%).
Out of the 403 diagnosed in study subjects 75(18.6%) were infected by helminthic parasites,
whereas 33(8.2%) were infected by protozoan parasites. From this the most prevalent
intestinal parasite in the study area was A.lumbricoides (7%).This result is almost similar to
study
conducted in around Lake Langano, Ethiopia (Mengistu Legesse and Berhanu Erko,
2004) (6.2%); but higher than the study conducted in Bablie town, Eastern Ethiopia
(3.9%)Grum Tadesse, 2005); in Metema Hospital, Northwest Ethiopia (3.7%)(Yesuf Adem
and Abebe Muche, 2010); in Debre Elias, Ethiopia(0.6%)(Tilahun Workneh et al., 2014);in
Enemorena-Ener district, Gurage zone (5.28%)(Melesse Birmeka et al.,2017). However, the
study result is lower than in Alato Caparao, Brazil(12.2%)(Ferreira et al.,2002); from Delgi
primary school (48%)(Asrat Ayalew et al.,2011); in Nigeria(30.7%)(Auta T. et al.,2013);from
Teda Health Center(23.2%)(Abraraw Abate et al., 2013);from North Gondar, Gorgora and
Chuahit towns (39.8%)(Biniam Mathewos et al, 2014); from Chencha primary school(60.5%)
(Ashenafi Abossie and Mohammed Seid, 2014); from Bahir Dar, in Donaberber primary
school (13.6%) (Tamirat Hailegebriel, 2017). Relatively high prevalence of A.lumbricoides in
the study area due to lack of availability and habit of using latrine in the school and home,
habit of hand washing before meal and after latrine, open field defecation habit, play with
contaminated soil. This study is supported by the study conducted in environmental hygiene,
in Jimma, Ethiopia (Worku Legesse and Solomon Gebresilassie,2007) and school children in
Motta town, Northwest Ethiopia (Mulusew Andualem,2014).During observation most
participant students had dirty matter on/in their finger nails, this may contributed hand to
mouth transmission of infection.
The second parasite infection in this study was, the E.histolytica /dispar its prevalence rate
was 6.2%, which was almost in line with the study done in school children in Debre Elias,
Ethiopia (6.7%)(Tilahun Workneh et al., 2014); Chandigarh, Northern India (5.3%)(Sehgal et
al.,
2010)
while
lower
than
the
study
51
reported
from
Southeast
Lake
Langano(12.7%)(Mengistu Legesse and Berhanu Erko, 2004); in Metema district
(24.3%)(Yesuf
Adem
and
Abebe
Muche,
2010);
primary
school
children
of
Delgi(27.3%)(Asrat Ayalew et al, 2011) School children aged 7-14 in EnemorenaEner
District, Gurage zone(12%)(Melesse Birmeka et al., 2017); from Bahir Dar in Donaberber
primary school(24.5%)(Tamirat Hailegebriel, 2017). In contrast to this study lower
prevalence was observed among school children of Adwa (1.8%) (Lemlem Legesse et al.,
2010); from Teda Health Center(4.6%)(Abraraw Abate et al.,2013); and the variation in the
results may be due to absence of protected water, poor hand washing practices before meals
and after the toilet, open field defecation, poor personal and environmental hygiene and there
may be socio-economic variations.
In the present study the prevalence of H.nana was 5.5%. This finding was comparable with
the study reported by Berhanu Erko et al., 1995(5.1%) and Amare Mengistu et al., 2007 (5%).
In contrast this study was higher than in Sulaimani district Iraq, Raza and Sami, 2008
(2.15%);in Metema district, Yesuf Adem and Abebe Muche, 2010 (2.3%); in Iran ,Tappe et
al., 2011(0.2%); in Tigray region, Northern Ethiopia (Tadesse Dejenie and Tsehaye
Asmelash,2010(0.32%); southwest Nigeria, Olusegun et al., 2011(0.7%) and this study was
lower than the study reported by Grum Tadesse, 2005(10.1%);Ullah et al., 2009(8%); and
Lemlem Legesse et al., 2010(8.1%).The difference in the study may be due to personal
hygiene, frequency of contact with animals, Socio-economic, environmental conditions, and
geographical differences.
In the present study the prevalence of S.mansoni was 2.2%. This finding was in line with the
study reported in Northwestern Tanzania, Mwanza 1.5% (Mazigo et al., 2010) and in
Northwestern Ethiopia, Axum 1% (Tadesse Dejenae et al., 2015).This study showed lower
S.mansoni infection rate than compared to other studies reported in different part of Ethiopia;
North Gondar Zarima 37.9%(Abebe Alemu et al., 2011); Gorgora and Chuahit 33.7%(Biniam
Mathewos et al., 2014); Sanja 89.9%(Ligabaw Worku et al., 2014); Mizan town
44.8%(Ayalew Jejaw et al., 2015); Northwestern Tanzania, Ukara 63.9%(Moshi et al.,
2014).This variation could be difference in socio-economic conditions, season of the study
area, the difference in altitude and temperature, which is favorable for the development of
snails, local endemicity of the parasite.
52
In the present study the prevalence of G.lamblia was 2%. It was in agreement with the study
done in Ghana Accra, 2% (Ayeh Kume et al., 2009). And this study is lower than the study
reported by Southeast of Lake Langano (Mengistu Legesse and Berhanu Erko,2004) (6.2%);
(Yesuf Adem and Abebe Muche, 2010) (12%); (Melessse Birmeka et al ., 2017(7.66%);
Tamrat Hailegebriel, 2017(11.4%) and this study also extremely lower than the prevalence
rate reported in other countries, such as rural region of Urmia, Iran (20.5%)(Tappe et al.,
2011); Chandigarh, India(21.4%)(Sehgal et al.,2010). The difference in the findings may be
lack of safe water supply, Socio-economic, personal and environmental conditions, seasonal
and geographical differences.
The prevalence of Taenia species was 1.7%. This finding was almost similar with the findings
from Dagi primary school, Northwest Ethiopia 1.5% (Mulat Alamir et al., 2013); from
Lumame town Northwest Ethiopia 2% (Mengistu Walle et al., 2014) and this finding is lower
than from Nigeria, 3.4% (Dada E.O, 2016) and this finding is relatively higher than from
Chencha 0.8%(Ashenafi Abossie and Mohammed Seid, 2014); from Debre Elias, Northwest
Ethiopia 0.2% (Tilahun Workneh et al., 2014). The difference may be the feeding habit of the
population, socioeconomic, personal and environmental conditons.
In the present study the prevalence of Hookworm was 1.5%.this result is extremely lower than
compared to the report of other studies, Berhanu Erko et al., 1995(40%); Leykun Jemaneh,
2001(37%); Grum Tadesse, 2005(6.7%);Tilahun Workneh, 2014(71.2%);Tadesse Hailu,
2014(21.1%); Tamrat Hailegebriel, 2017(22.8%) this difference could be due to activities of
the participants and children shoe wearing habit, environmental sanitation, personal hygiene
differences of the communities, climatic conditions and the nature of soil type. According to
Leykun Jemaneh (1985) the low prevalence of Hookworm infection could be a combination
of high temperature and long dry season that causes high mortality in the soil stage of
Hookworm.
In this study, the prevalence rate of E.vermicularis was 0.7%which is comparable to the
previous study reported by Berhanu Erko et al., 1995(0.4%); in Bahir Dar, Dona berber
primary school Tamrat Hailegebriel, 2017 (0.3%) but this study was lower than the study
reported in Eastern Ethiopia (1.4%)(Grum Tadesse,2005); and in west Azerbaijan
(10.6%)(Tappe et al., 2011).
53
In the present study the overall prevalence rate of intestinal parasite infections (IPIs) in males
and females were 23.3% and 30.3% respectively. From the examined subjects females were
more infected than males by intestinal parasitic infections. However, the difference was not
statistically significant (p>0.05). This study was in line with a study reported in Arbaminch
(Desta Haftu et al., 2014) and in Nepal (Sah et al., 2013) females were more infected by IPIs
than males. this may be females particularly in rural area highly participate indoor and out
door activities such as fetching of water, searching of fuel woods, doing of farming activities,
washing of clothes and house hold utensils.
Moreover those study subjects who were rural dwellers (29.9%) had high intestinal parasitic
infection rate than urban dwellers (20.8%) and statistically significant difference was
identified with intestinal parasitic infections (p-value<0.05). Those students who came from
rural area had higher intestinal parasitic infections than urban dwellers. This study was
supported by study conducted in rural Peshawara, Pakistan by Ullah et al.,2010; school
children in Palestine (Hussien, 2011)who described intestinal parasites (helminthiasis) is
common among children in developing countries particularly the rural area. The reason might
be due to poor personal and environmental hygiene, inadequate clean water supply, open field
defecation habit (shortage of latrine houses), less knowledge about intestinal parasitic
infection and the living standards of the study subjects may play an important role for the
higher prevalence rate of intestinal parasites from rural dwellers than urban dwellers.
The result of this study indicated children who lived in houses without latrine were more
infected than those having latrine in their home. This is in line with the previous study
reported by Bayeh Abera et al., (2013), who stated children who defecated in open fields and
poor hygiene practices were more infected with intestinal parasites.
The prevalence rate of intestinal parasitic infections among both schools (Yifag and
Agidkirigna) complete cycle primary school was 22.9% and 31.8% respectively. Of these
infections A.lumbricoides was6.7% and 7.2% respectively; E.histolytica was 4.1% and 8.9%;
H.nana was 5.4% and 5.6%; G.lamblia was 2.2% and 1.7%; Taenia species was 2.7% and
0.6%; Hookworm was 1.8% and 1.1% respectively whereas S.mansoni and E.vermicularis
infections were not found (0%) in Yifag complete cycle primary school children and 5% and
1.7% were found in Agidkirigna complete cycle primary school children respectively. The
54
reasons of variation could be differences of personal and environmental hygiene, difference in
socio-economic conditions, the difference in altitude and temperature, favorable conditions
for the development of snails and this may be some Agidkirigna’s complete cycle primary
school students were came from the population’s livelihood is agricultural farming around
Lake Tana shore in comparing than Yifag complete cycle primary school students and there
were statistical significance difference in schools and intestinal parasitic infections. This idea
was supported by other studies conducted in Jawe by Tadesse Hailu (2014) stated that in
Ethiopia most S.mansoni infections and transmission sites are in agricultural communities
along streams between1300 and 2000 meter altitude.
55
6. CONCLUSION AND RECOMMENDATIONS
6.1 Conclusion
Intestinal parasitic infections are among the most common infections in the world responsible
for morbidity and mortality (WHO, 1991).According to the World Health Organizations
(1998), more than 33% of global deaths are due to intestinal parasitic diseases.
Epidemiological distribution of intestinal parasites varies in different regions due to
environmental, social, and geographical factors the present study compared to other studies
revealed high prevalence of intestinal parasitic infection rates, among school children in Yifag
and Agidkirigna complete cycle primary school, in Libokemkem district. In this study
A.lumbricoides, E.histolytica/ dispar, H.nana were relatively the most predominant intestinal
parasites and association of latrine availability in their home ; eating raw, undercooked, and
unwashed vegetables and fruits; shoe wearing habit of the school children were statistically
significant for A.lumbricoides, E.histolytica/dispar, and Hookworm infections respectively.
The highest prevalence of intestinal parasitic infections (IPIs) was detected on students whose
families (especially mothers) were can not able to read/write (illiterate) than intestinal
parasitism was lower on children whose mothers were educated. Education greatly contributes
for the general reduction of the prevalence of IPIs in the society and there was statistically
significant difference between them.
6.2 Recommendations
There is a need for integrated control program to have a lasting impact to transmission of
intestinal parasitic infections and the following ideas are recommended:
 Health sector, education office and parents together with the District administrator
should collaborate and support the school to build enough toilets in the school that
may restrict children from open field and near river defecation.
 Health extension workers should collaborate with school community to aware
awareness about personal and environmental hygiene and latrine usage habit.
 Teachers should inspect their students’ personal hygiene and their class room
neatness.
56
 School children as well as the community should be educated by health extension
workers and other concerned person to avoid contact with infected river water,
because it is risk for S.mansoni.
 Regular school children deworming program with health education should be given
in the school compound.
 Furthermore, other studies should be made for investigation of the prevalence of
intestinal parasitic infections (IPIs) including the method using Kato-Katz technique
to provide information on the intensity (burden) of infections.
57
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70
APPENDIX
Appendix 1: Laboratory Test Procedures for Parasitological Examination
A.Test procedure for direct saline wet mount examination of stool
1.
2.
A drop of saline is placed on the slide .
Using applicator stick, a small portion of stool specimen will be taken and mix with a drop of
saline.
3. Cover it with cover slide /slip.
4. Examine microscopically with low and high power magnification (10X and 40X).
B. Test procedure for formal-ether concentration method of stool examination
1.
Emulsify 1g to 1.5g of feces in about 4ml of 10% normal saline /formalin in a screw cup
bottle.
2. Add further 3-4 ml of 10% normal saline /formalin in the bottle and mix by shaking for about
20 seconds.
3. Sieve the emulsified specimen; collect the sieved suspension in a beaker.
4. Transfer the suspension to a conical tube and add 3-4ml of ether.
5. Cover the tube with its lid and mix for one minut.
6. Centrifuge it at 2000rpm for one minute.
7. Using a stick, free the layer of debris by rotating the tip of the stick between debris and side
of the tube. Tilt the tube and pour off all the supernatant fluids .Use a cotton swab to remove
any debris adhering to the side of the tube.
8. Return the tube to its upright position.
9. Using pastor pipette, mix the sediment and transfer all the sediment to the slide
10. Examine microscopically using 10X and 40X magnification.
71
Appendix 2: Table of Laboratory data collecting format
Cod
e
Se
x
Ag
e
+v
e
v
e
Intestinal parasites in stool Examination
E. G. A. H. S. H. T. E.
h
l
l
n
m w
s
v
72
Single
infectio
n
Doubl
e
infn-
Tripl
e
infn-
APPENDIX 3: Information to participants consent form and questionnaire
format
Bahir Dar University, College of science Department of Biology
I am Alamirew Wossen Kassa a graduate student from Bahir Dar University, College of
Science Department of Biology. For the Assessment of the Prevalence of Intestinal
Parasitic Infections (IPIs) and associated risk factors among Yifag and Agidkirigna
complete cycle primary school children in Libokemkem District in South Gondar Zone,
Northwest Ethiopia. This study will use questionnaires on Socio-demographic data from
parents and school child and collect fresh stool sample. There will be clear explanation
for every question and sample collection method. You can ask any question. The
information you provide will be used to improve prevention, control and treatment for
intestinal parasites. Your participation is voluntary. Answers or your child laboratory
result will not be released to anyone and will remain secret. Your name will not be
written on the questionnaire. After the laboratory result child with any intestinal parasite
will be announced for concerned body to get treatment and care.
Consent form for parents
I.______________________ here by giving my consent for my child to participate in
the mentioned study. I understand that this study will be used to improve prevention,
control and treatment of intestinal parasites. I also trust that at the end of study, the
results will be shared with the concerned body or the local health bureau and Ministry
of Health.
Signature ________________ date ______________.
Consent form for students.
I am agreed with the objectives of the research. And I can make sure by signing the
agreement.
Name of students _______________________ signature _________ date __________.
Name of data collector_____________________
____________.
73
signature ________
date
Appendix 4: English questionnaire form
Research questionnaire prepared for gathering data about socio-demographic and socio
economic characteristics of study subjects. Please be conscious and fill your personal
data and put your correct answer. Put “”on your choice for each of questions.
1. Identification No_ ______
Date_________________
2. Age in year _______
3. Sex
1.Male
4. Grade level
1. 1-4
5. Residence
1. Urban
2.Female
2. 5-8
2. Rural
6. Where do get drinking water?
1.Tap water
2.Well water
3.Spring/river
7. Do you wash your hands before eating your meal? 1. Yes
2. No
8. Where do you defecate your feces? 1. Latrine house
2. Open field
9. Do your parents have latrine house? 1. Yes
10. Do you eat raw meat?
1. Yes
2. No
2. No
11. Do you eat raw, undercooked, and unwashed vegetables and fruits?
1. Yes
No
12. Do you bath or swim the nearby water bodies?
1. Yes
2.No
13. Is there any dirty mater on/inside the student’s hand nails and their nails trimmed
(cutting) habits? (Fill by teachers).
14. Do you wear shoes?
1. Yes
1.Always
2. No
2.Sometimes
3.Not at all
15. Which one is your mother’s educational status?
1. Can read and write (Literal)
2. Cannot read and write (Illiterate)
16. what is your mother’s occupation? 1.
Government employee
3.
House wife
2. Trader
4.
Daily laborer
17. How many family members do you have?
1.
1-3
2. 4-6
3.
18. What is your parent’s economic status? 1. Rich
>6
2. Middle income
Poor
19. How do you dispose house hold wastes?
1. Burry underground/Burn
2. Left open field
74
3.
APPENDIX 5: Amharic version of concent form
፡፡፡፡፡፡፡ ፡፡፡ ፡፡፡ ፡፡ ፡፡፡፡፡ ፡፡
አአአአአ ፡፡ ፡፡፡፡፡ ፡፡፡ ፡፡፡፡፡፡ ፡፡፡፡፡፡ ፡፡፡፡፡ ፡/፡ ፡፡፡ ፡፡፡፡ ፡፡፡ ፡፡፡ ፡፡፡
፡፡፡፡ ፡፡ ፡፡፡፡፡፡፡ ፡፡/፡/፡/፡ ፡/፡፡ ፡፡፡፡፡ ፡፡፡ ፡፡፡፡፡፡፡ ፡፡፡፡፡፡ ፡፡፡፡
፡፡፡፡፡፡
፡፡፡፡፡
፡፡፡፡
፡፡፡፡፡፡
፡፡፡፡፡
፡፡፡
፡፡፡፡፡
፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
አአአአአ፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡10፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
አአአአአአአአአአአ፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
አአአአአአአ:−፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
አአአአአአአአአአአአአአ:፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡ ፡፡፡፡፡፡፡፡፡፡፡
አአአአአአአአአአአአአአአአአአአ:−፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡ ፡፡፡፡ ፡፡፡፡፡፡ ፡፡፡፡ ፡፡፡፡፡ ፡፡፡፡
አአአአአ አአአአአአ አአ
፡፡፡፡፡፡፡፡፡፡(፡፡፡፡፡፡፡፡፡፡፡፡፡)፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡ ፡፡፡ ፡፡፡___________________፡፡ _____________
፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡ ---------------------------- ፡፡፡፡ ፡፡/፡/፡/፡/፡/፡፡ / ፡፡፡፡፡፡፡ ፡፡/፡/፡/፡/ ፡/፡፡ ፡፡፡ ፡፡፡
፡፡፡፡፡፡ ፡፡፡፡ ፡፡፡ ፡፡፡፡፡ ፡፡፡፡፡ ፡፡፡፡ ፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
75
፡፡፡፡፡፡፡
፡፡፡
-----------------------------
፡፡
---------------------
--------------------
፡፡፡፡፡፡ ፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡
፡፡፡
-----------------------------
፡፡
--------------------
--------------------
Appendix 6 : Amharic vershion questionnaire form
አአአአአአአአአ፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡/፡፡፡፡፡፡፡፡፡፡፡፡፡/፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡፡

፡፡፡፡፡ ፡፡፡ ፡፡፡፡፡፡፡፡፡

፡፡፡፡፡ ፡፡፡፡ ፡፡፡፡ ፡፡፡፡
፡፡፡፡፡ ፡፡፡፡፡፡ ፡፡፡ ፡፡፡ “ ፡፡፡፡ ፡፡፡፡፡፡፡፡
1.
2.
፡፡፡፡፡፡………………
፡፡፡
1. ፡፡፡
2. ፡፡
፡፡ ……………………….
3.
፡፡፡………
4.
፡፡፡፡ ፡፡፡ 1. 1-4
5.
፡፡፡፡፡፡፡፡፡፡ 1.፡፡፡
6.
፡፡፡፡ ፡፡ ፡፡ ፡፡፡፡፡፡ 1. ፡፡፡፡
7.
፡፡፡ ፡፡፡፡፡፡፡ ፡፡፡ ፡፡፡፡፡ ፡፡፡፡፡፡፡ ፡፡
8.
፡፡፡ ፡፡ ፡፡፡፡፡፡፡፡ ፡፡ ፡፡
1.፡፡፡ ፡፡
9.
፡፡፡፡፡/፡ ፡፡፡ ፡፡ ፡፡፡፡ ፡፡
1. ፡፡
2. 5-8
10. ፡፡ ፡፡ ፡፡፡፡፡፡፡ ፡፡
2.፡፡፡
1. ፡፡
፡፡፡፡፡
፡፡፡፡/፡፡፡
1.፡፡
2..፡፡፡
2 ፡፡ ፡፡
2. ፡፡፡
2. ፡፡፡
11. ፡፡፡ ፡፡፡፡፡ ፡፡ ፡፡፡፡፡ ፡፡፡፡፡ ፡፡ ፡፡፡፡ ፡፡፡፡፡፡፡ ፡፡
1. ፡፡
2. ፡፡፡
12. ፡፡፡፡፡፡፡፡ ፡፡ ፡፡፡ ፡፡ ፡፡፡ ፡፡፡ ፡፡፡ ፡፡፡ ፡፡፡ ፡፡፡፡፡፡፡(፡፡፡፡፡፡) ፡፡
1. ፡፡
2. ፡፡፡
13. ፡፡፡፡፡ ፡፡፡ ፡፡ ፡፡፡፡ ፡፡፡፡ ፡፡፡ ፡፡፡ ፡፡፡፡ ፡፡፡፡ ፡፡/፡፡፡ ፡፡፡፡ ፡፡፡፡፡፡
፡፡፡፡፡፡፡፡፡፡ ፡፡፡ ፡፡፡/(፡፡፡፡፡ ፡፡፡፡)
1. ፡፡
2.፡፡፡
14. ፡፡፡ ፡፡፡፡፡፡/፡፡፡፡፡፡ ፡፡፡ ፡፡፡፡ ፡፡
1.
፡፡፡፡ ፡፡፡፡፡፡
2. ፡፡፡፡፡፡ ፡፡፡፡፡፡
3. ፡፡፡ ፡፡፡፡፡
15. ፡፡፡፡፡/፡፡፡፡፡ ፡፡፡፡፡፡ ፡፡፡ 1.፡፡፡፡፡ ፡፡፡ ፡፡፡፡፡(፡፡፡፡፡)
2.፡፡፡፡፡ ፡፡፡ ፡፡፡፡፡(፡፡፡፡፡፡)
16. ፡፡፡፡፡/፡፡፡፡፡ ፡፡፡ ፡፡፡ ፡፡፡፡ ፡፡? 1. ፡፡፡፡፡፡ ፡፡፡፡
76
2. ፡፡፡
3. ፡፡፡፡፡፡፡
17. ፡፡፡፡፡፡፡/፡ ፡፡፡ ፡፡፡ ፡፡ ? 1. 1-3
2. 4-6
18. ፡፡፡፡፡፡፡/፡ ፡፡፡፡ ፡፡፡ ፡፡፡፡ ፡፡? 1. ፡፡፡፡
4. ፡፡፡፡፡፡፡
3. ፡6 ፡፡፡
2. ፡፡፡፡፡ ፡፡
3. ፡፡
19. ፡፡፡፡፡፡ ፡፡፡፡ ፡፡፡ ፡፡፡፡ ፡፡፡፡፡፡፡፡ ?1. ፡፡፡፡ ፡፡፡ ፡፡፡፡/፡፡፡፡
2. ፡፡ ፡፡ ፡፡፡
Appendix 7:Table 6: Prevalence of intestinal parasitic infections in different age
groups among Yifag and Agidkirigna primary school children in Libokemkem
district 2017/2018 (n=403).
Detected parasitic
Infections
A.lumbricoides
E.histolytica
H.nana
S.mansoni
G.lamblia
Taenia species
Hookworm
E.vermicularis
Total infections
Age groups
5-9yrs
10-14yrs
≥15 yrs
n=24
n=68
n=16
6(1.5%) 19(4.7%) 3(0.7%)
4(1.0%) 18(4.5%) 3(0.7%)
5(1.2%) 10(2.5%) 7(1.7%)
3(0.7%) 6(1.5%)
0(0.0%)
1(0.2%) 6(1.5%)
1(0.2%)
3(0.7%) 4(1.0%)
0(0.0%)
2(0.5%) 2(0.5%)
2(0.5%)
0(0.0%) 3(0.7%)
0(0.0%)
24(6.0%) 68(16.9%) 16(4.0%)
77
Total
n=108
28(7.0%)
25(6.2%)
22(5.4%)
9(2.2%)
8(2.0%)
7(1.7%)
6(1.5%)
3(0.7%)
108(26.8%)
χ2
P-value
2.066
0.356
2.418
0.299
1.925
0.382
2.616
0.27
1.044
0.593
2.926
0.231
1.436
0.488
2.251
0.325
3.402
0.182
APPENDIX 7:Table 10: Prevalence of intestinal parasitic infections (IPIs) with
school type (Yifag and Agidkirigna) in Libokemkem district 2017/2018 (n=403),
where Yifag (n=223);(Agidkirigna n=180).
Schools
Yifag
(%)
Agidkrgna
(%)
Total
(%)
No_of
Infected Intestinal parasiticInfections(IPIs)
examined No_(%) A.l
E.h
H.n
S.m
G.l
T.s
223
55.3
51
22.9
15
6.7
9
4
12
5.4
0
0
5
2.2
6
2.7
180
44.7
57
31.8
13
7.2
16
8.9
10
5.6
9
5
3
1.7
1
0.6
403
108
26.8
28
7
25
6.2
22
5.5
9
2.2
8
2
7
1.7
78
H.w
E.v
4
1.8
0
0
2
1.1
6
1.5
3
1.7
3
0.7