4.1. STUDY SUBJECTS
This study was based on two hundred stool samples collected from school children aged 6–16 years. The study was conducted in four primary public schools; fifty students were participated from each school. At a mean age of 11 years, 67% (134 Females) and 33% (66) Males were tested for the study. The Female-to-Male ratio of the study was about 2:1.
The Socio-demographic characteristics of the study subjects were shown according to Table 1 below.
Table 1
Socio-demographic characteristics of the study subjects of Badessa Woreda, West Haraghe, in February, 2018
Variable | Group | Investigated Students | Percentage (%) |
Gender | Female | 134 | 67 |
Male | 66 | 33 |
Total | | 200 | 100 |
Age Group | 6–9 Years 10–13 Years ≥14 Years | 76 74 50 | 38 37 25 |
School Name | School 1 | 50 | 25 |
| School 2 | 50 | 25 |
| School 3 | 50 | 25 |
| School 4 | 50 | 25 |
Total | | 200 | 100 |
Family Education level | Grade 1–4 | 199 | 99.5 |
Grade 5–8 | 1 | 0.5 |
Total | | 200 | 100 |
Finger nail Status | Trimmed | 129 | 64.5 |
Not trimmed | 71 | 35.5 |
Total | | 200 | 100 |
Drinking water Source | River | 139 | 69.5 |
Well | 61 | 30.5 |
Total | | 200 | 100 |
Shoes Wearing Habits | Occasional | 90 | 45 |
Not at all | 110 | 55 |
Total | | 200 | 100 |
The study showed that 76 (38%) of the study subjects were from the age group of 6–9 years, 74 (37%) from the age group of 10–13 years, and 50 of the study subjects (25%) were from ≥ 14 years of age group. About 99.5% (199) of the study subjects were from the family educational level of grades 1–4. All study subjects had no habits of toilet use (100%) and none of them treated with anthelminthic drug (100%) before the study was conducted (Table 1).
Other variables such as; drinking water source, finger trimming status, and bare footing habits were directly related to the prevalence of intestinal helminths in the study subjects.
The following table (Table 2) showed the result concordance with different variables and p- value of the significant variations.
Table 2
Socio-Demographic Characteristics and Personal hygienic habits in Relation to intestinal Helminth infection in the study population
Variables | Group | Positive (%) | Negative (%) | Total (%) | P value |
Gender | Female | 90 (67.2) | 44 (32.8) | 134 (67.0) | P = 0.015(0.021) OR 2.04[1.12–3.73] F = 0.781 (0.626-0.9) M = 1.19[1.08–2.35] P = 0.000 P = 0.000 OR = 0.048Neg.= .753[.679-.851]Pos.=15.79[2.21–2.616] P = 0.000 OR = 0.110(.019-.249) P = 0.000 OR = 6.9[2.588–18.79] Neg.=1.33[1.17–1.516] Pos.=.191[0.078–0.47] P = 0.385 OR = 1.4 = 0.987[.962-1] |
Male | 33 (50.0) | 33 (50.0) | 66 (33.0) |
Total | | 123 (61.8) | 77 (38.5) | 200 (100) |
Age Group | 6–9 Years | 72 (94.7) | 4 (5.3) | 76 (38.0) |
10–13 Years | 40 (54.1) | 34 (45.9) | 74 (37.0) |
≥14 Years | 11 (22.0) | 39 (78.0 | 50 (25.0) |
Total | | 123 (61.5) | 77 (38.5) | 200(100) |
Drinking Water Source | River Water | 36 (25.9) | 103 (74.1) | 139 (69.5) |
Well Water | 1 (1.6) | 60 (98.4) | 61 (30.5) |
Total | | 37 (18.5) | 163 (81.5) | 200 (100) |
Finger nail Status | Trimmed | 60 (46.5) | 69 (53.5) | 129 (64.5) |
Not Trimmed | 63 (88.7) | 8 (11.5) | 71 (35.5) |
Total | | 123 (61.5) | 77 (38.5) | 200 (100) |
Shoes Wearing habits | Occasional | 5 (5.6) | 85 (94.0) | 90 (45.0) |
Not at all | 32 (29.1) | 78 (70.9) | 110 (55.0) |
Total | | 37 (18.5) | 163 (81.5) | 200 (100) |
Family Education | Grade 1–4 | 123 (61.8) | 76 (38.2) | 199 (99.5) |
Grade 5–8 | 0 (0.0) | 1 (0.5) | 1 (0.5) |
School Names | School 1 | 31(62.0) | 19 (38.0) | 50 (25.0) |
School 2 | 9 (18.0) | 41(82.0) | 50 (25.0) |
School 3** | 62 (124) | 5 (10.0) | 67 (33.5) |
School 4* | 45 (90.0) | 5 (10.0) | 50 (25.0) |
Total | | 147 (73.5) | 70 (35.0) | 217 (108.5) |
*Multiple Infections of: Hook Worm + Enterobius vermicularis 7 (3.5%)
**Hook Worm + Schistosoma mansoni 17 (8.5%)
Total 24 (16.3%)
High parasitic prevalence was observed among the age group of 6–9 years (P = 0.000). Therefore, among all ages, this age group was the highest (accounted for about 38% followed by the age group of 10–13 Years, 37% and ≥ 14 Years was 25%) (Refer Table 2).
There were significant Variations of the parasites between the above variables (Table 2): gender (P = 0.15 (0.021), OR = 2.04 [1.12–3.73], Female (0.781[0.626-0.9)) and Male (1.19 [1.1.08–2.35]); Drinking Water source (P = 0.000) OR = 0.048 (.006-.8); Finger nail status (P = 0.000) or = 0.110 [.049-.249]; Shoe wearing Habits (P = 0.000) OR = 6.9 ([2.588–18.791] (Refer Table 2).
Toilet use, treatment status with anthelminthic drugs before the study, and residence with domestic animal(s) were excluded from the relations due to the following data: All study subjects had no habits of toilet using (Open-air defecations were practiced (100%); none of them treated with anthelminthic drugs before the study was conducted (100%); all study subjects were not live with domestic animal (s).
Prevalence of intestinal helminths detected in faecal samples of all study subjects was summarized for the four schools participated in the study in Table 3.
Table 3 Prevalence of Intestinal Helminths detected from 200 faecal samples from four Public Primary Schools in Badessa Woreda, West Hararghe Zone.
Helminthic Parasites (Ova / Eggs)
Schools | No of Students Examined | Ascaris lumbricoides | Enterobius vermicularis | Hook Worm | Schistosoma mansoni | Total |
School 1 | 50 | 10 (20%) | 7 (14%) | 12 (24%) | 2 (4%) | 31(62%) |
School 2 | 50 | 4 (8%) | 2 (4%) | 3 (6%) | 0 (0.0) | 9 (18%) |
School 3 | 50 | 0 (0.0) | 0 (0.0) | 17 (34%) | 45 (90%) | 62 (124%)* |
School 4 | 50 | 10 (20%) | 7 (14%) ** | 28 (56%) | 0 (0.0) | 45 (90%) |
Total | 200 | 24 (19.5%) | 16 (13%) | 60 (48.8%) | 47 (38.2%) | 147 (73.5%) |
* Multiple Infections of: Hook Worm and Schistosoma mansoni |
** Multiple Infections of Hook Worm and Enterobius vermicularis |
Table 4 represents a further analysis of the detected cases by the two techniques applied for the study.
COMPARISON OF FAECAL SAMPLES DETECTED BY WET MOUNT AND KATO-KATZ TECHNIQUES
A Total of 147 intestinal Helminth Parasitic cases were detected by wet mount and Kato-Katz techniques. From these cases, the Kato-Katz technique detected 147 cases of intestinal Helminths from 123 positive students [100%], whereas; the Wet mount technique detected only 45 [30.6%] which were positive cases by the Kato-Katz technique. There was a significant difference between Wet mount and the Kato-Katz technique [P = 0.000]. There was a far apart between the two methods [Kappa value = 0.241] (Refer Table 4).
Table 4 Comparison of the numbers and percentages of cases detected by Wet mount, Kato-Katz, and Both Techniques
Number of detected cases (Detection Rate, %)
Helminths [Ova /Egg] | Number of Positive Cases [n = 147] | Positive by Wet mount Only | Positive by Kato-Katz Only | Positive detection by Both Methods | Total |
Ascaris lumbricoides | 24 | 0 [0.0] | 19 [79.2%] | 5 [20.8%] | 24 |
Enterobius vermicularis | 16 | 0[0.0] | 16 [100%] | 0 [0] | 16 |
Hook Worm | 60 | 0[0.0] | 34 [56.7%] | 26 [43.3%] | 60 |
Schistosoma mansoni | 47 | 0[0.0] | 33 [70.2%] | 14 [29.78%] | 45 |
Total | 147 | 0 [0.0] | 102 [69.4%] | 45 [30.6%] | 147 [100%] |
4.2 DISCUSSION
The current study demonstrated that the prevalence of intestinal helminths were very high in the area when we compared with the previous studies. There were significant variations of all species in all schools (refer Table 3).
This study demonstrated that the variations of intestinal helminth distribution in the woreda areas/ schools required further study. School 3 primary school is the largest in Schistosoma mansoni due to highly intensified irrigations are developing whereas; School 4 primary school is the largest in Hook Worm infection. All samples were examined by Wet mount and Kato-Katz techniques, according to the standardized procedure described elsewhere (2, 9). One slide was prepared per person for each technique (Wet mount and Kato-Katz techniques), and egg findings from Kato-Katz preparation were conducted 30 minutes after its preparation.
This study has an agreement in Kato-Katz technique Sensitivity with some of the previous studies (1, 3, 5, 8, 9, 12, 14, and 15); However, the study conducted in other areas (4, 6, 7 and 17) revealed that Kato-Katz technique was less sensitive for soil transmitted Helminths including Hook Worm infection. The present study found that Kato-Katz technique is more sensitive than Wet mount technique for all intestinal helminths infections. In contrast to the previous study (4), the present study examined a single slide per person and concluded that the Kato- Katz technique, when used with the wet mount, is sensitive, appropriate and efficient for the examination of intestinal helminthiasis.
As to the relationship between prevalence sexes, the study demonstrated that the infection rate was higher in females in comparison to males. The study also demonstrated that the prevalence of intestinal Helminths was related with drinking river water, bare footing, and not trimming the finger nails. However, within the limited scope of this study, the relationships between using toilets, family education, antihelminthic treatment, and residence with domestic animals and prevalence of intestinal helminths were given less attention according to the following data. All study participants used no toilet (100%), 199 (99.5%) families had grade 1–4 educational level, all participants were not treated with any antihelminthic drug before the study was conducted (100%), and all participants were not living with any domestic animal(s).
The overall prevalence of Intestinal Helminths in the woreda was 73.5%. This may be due to poor personal and environmental hygiene like other areas of the country.
The most serious consequence of Hook Worm infection is chronic blood loss from the small intestine, which leads to iron deficiency anemia, particularly in children and women of childbearing age, whose physiological needs for iron are greater. In areas where Hook Worm anemia is present, 50% or more of the population may have hemoglobin values below the normal range and some of these may have severed degrees of anemia (10).
The overall prevalence of intestinal Helminths among the study subjects were led by Hook Worm infection with 48.8% followed by Schistosoma mansoni with 38.2%, Ascaris lumbricoides with 19.5% and 13% with Enterobius vermicularis. There were significant variations of the parasites among schools. School 3 public primary school was the highest prevalence with 214% including multiple infections of Hook Worm and Schistosoma mansoni. School 4 was 48.8% in Hook Worm infection and Hook Worm and Enterobius vermicularis double infection was observed.
This is the first report on the sensitivity of Kato-Katz technique, after the examination of Hook Worm infection on 30 minutes after preparation.
4.3. CONCLUSSION
The current study concluded that the Kato- Katz technique for Schistosoma mansoni and Soil- transmitted intestinal Helminths examination in faecal samples. It also a selective technique for field survey to investigate the prevalence and drug resistance of the parasites. It seems necessary to indicate that Kato-Katz technique is not appropriate for intestinal examination in areas where the species may exist.
4.4. RECOMMENDATIONS
High magnitude of Hook Worm in School 3 and Schistosoma mansoni in School 4 areas calls for immediate intervention. School 1 and School 2 areas also need nonspecific control measures.
The study wants to indicate that a comprehensive control strategy for helminths infection should include:
Ensuring the wide availability of anithelmintics for schistosomiasis and soil-transmitted helminth infections in all health services in endemic areas;
Ensuring good case management of symptomatic cases (example, IMCI);
Regular treatment of all children at risk, including adolescent girls; through school-and community-based initiatives;
Treating pregnant women at risk through antenatal care and other women’s health programs;
Ensuring a saved water supply and adequate sanitation facilities in all schools;
Ensuring provision of potable water and sanitation facilities at house or community level;
Promoting good hygiene and sanitation practices among school children and caregivers (Hand washing, finger nail trimming, using of latrines, and use of footwear) through community development activities and in school curricula.