Magnitude of Intestinal Parasitic Infections and Associated Factors among Food Handlers Working at Woldia University Student’s Cafeteria, Northeastern Ethiopia: An institution based cross-sectional study

doi:10.21203/rs.2.12319/v2

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Magnitude of Intestinal Parasitic Infections and Associated Factors among Food Handlers Working at Woldia University Student’s Cafeteria, Northeastern Ethiopia: An institution based cross-sectional study

https://doi.org/10.21203/rs.2.12319/v2

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Abstract Objectives: the main of this study was to assess the Magnitude of intestinal parasitic infections and associated factors among food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia. Institutional based cross-sectional study was conducted among 256 study participants in Woldia university student’s cafeteria, Northern Ethiopia. Systematic random sampling method was used to select the study participants. Data was collected using a standardized questionnaire by direct interviewing of study participants. Logistic regression was carried out to identify factors associated with intestinal parasitic infections. Results: A total of 256 food handlers were enrolled making the overall magnitude of the intestinal parasite which was stool specimens positive for different diagnostic stages of parasites was found to be 43(16.8%). Entamoeba histolytica/dispar was the most prevalent parasites 14(5.5%), followed by Giardia lamblia 10(3.9%). Lack of food safety training [AOR = 6.58; 95%CI: 2.46–17.62], no regular medical checkup [AOR=2.41; 95 %CI: 1.47-4.24], no handwashing practice after toilet by soap[AOR =3.24; 95%CI: 1.28-8.19], no handwashing practice before eating by soap [AOR =4.03; 95%CI:1.64-9.91] and haven’t food preparation license [AOR= 6.13; 95 % CI: 2.18-17.22] were significantly associated with parasitic infection among food handlers. Keywords: Intestinal parasites, Food handlers, Student cafeteria, Woldia University

Infectious Diseases

Intestinal parasites

Food handlers

Student cafeteria

Woldia University

Intestinal parasitic infections are a major public health problem worldwide and assessed to infect about one third of the total population; particularly in low and middle income countries and constituting the greatest cause of illness and disease in children’s and food handlers with up to 2 million deaths are estimated per year [1–3]. According to WHO estimates, more than half a million deaths per year in Africa are due to food and water-borne related diseases which shows the tip of the iceberg, as many more cases that are sporadic went unreported [4]. In Ethiopia, intestinal parasitic infections are the major causes of mortality and morbidity causing a series of public health problems such as malnutrition, anemia, and growth retardation as well as higher susceptibility to other infections [1–2]. Poor environmental sanitation, irrigation, overcrowding, resettlement, and low altitude were suggested to be responsible for high prevalence of intestinal parasitic infection in the country [3–5]. Proper educations, protocols, training programs on the hygienic practices and regular medical checkup among food-handlers help to control the prevalence of intestinal pathogens and parasites at certain limits [2, 6]..

Different studies conducted in Ethiopia showed that there was high magnitude of enteric pathogens among food handlers working at university student’s cafeteria, due to improper hygienic practices, improper fingernail trimming and unavailability of standard protocols [2, 7, 8]. The most prevalent intestinal protozoan parasites in Ethiopia are Giardia lamblia and Entamoeba histolytica/ dispar. Helminthic infection includes Ascaris lumbricoides, Trichuris trichuria and Taenia species [8, 9]. In spite of the public health importance of these intestinal parasites and the potential consequences, there was no enough data about the magnitude of intestinal parasites among food handlers in Woldia University. Therefore, this study was aimed to assess the magnitude and factors associated with intestinal parasitic infections among food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia.

Study setting, design and period

Institutional based cross sectional study design was conducted from March to June 2018 at Woldia University student cafeteria. Woldia University is one of higher governmental university in Ethiopia which was found in Amhara region and located 521 km far from Addis Ababa, capital city of Ethiopia. It has 2 campus namely, Woldia (main campus) and Mersa College of Agriculture campus but our study was conducted in the main campus.

Sample size determination and sampling technique

The sample size was determined by using a single population proportion formula considering the following assumptions and calculated by taking a previous study on prevalence of intestinal parasites in the stool samples of food handlers in Mekelle University student cafeteria of 52.3% [10], 5% confidence interval and 5% marginal error (d = 0.05). By considering a 10% non-response rate, the final sample size of the study was 256.

Method of data collection

Socio-demographic data and associated risk factors including institution and home related data were collected using pre tested structured questionnaire in a face to face interview. Stool specimens were collected from food handlers in a clean stool cup pre-labeled with study subject identification code at Woldia health center. A portion of the specimen (approximately 1–2mg) was processed using direct saline preparation examined under 10× and 40× objective lenses of a light microscope for detection of helminthes ova and larvae, protozoa cysts and trophozoites. After completion of direct stool examination, one gram of each sample was emulsified in 10% formalin solution and examined in formol–ether concentration technique.

Data Quality Assurance

Training was given for data collectors and supervisors about techniques of data collection and briefed on each question included in the data collection tool. The pre-test was conducted to ensure the validity of the tool, and then the correction was made before the actual data collection. Double data entry was done by two data clerks and consistency of the entered data was cross-checked by comparing the two separately entered data.

Data processing and analysis

The collected data were coded, cleaned, and entered into Epi data version 4.2 and exported to SPSS window version 24 for analysis. The binary logistic regression model was used to assess the association between independent variables and intestinal parasitic infections. All variables with P value ≤ 0.25 in the bivariable analysis were included in the final model of multivariate analysis in order to control all possible confounders. Level of statistical significance was declared at p-value <0.05.

Socio demographic characteristics and hygienic practice of food handlers

A total of 256 study participants were involved in the study with a response rate of 100%. Among them 164(64.1%) food handlers were female. The mean age of the study participants was 25.24 (± 3.26 SD) years. About 116(45.5 %) were in age groups of 20–24 years. The majority of food handlers 210(82%) had attended primary and above education. Of the total study participants, 205(80.1%) had completely trimmed their nails, 230 (89.8%) were used hair cover during work, 209(81.6%) of food handlers were used gown [Table S 1].

Working House condition and practice related factors of food handlers

Concerning working house condition, 105(41%) and 106(41.4%) had one rooms and windows respectively. One hundred thirty nine (54.3%) had fair ventilation system whereas 183(71.5%) had good illumination systems. Regarding latrine condition, 149(58.2%) had latrine with segregated water and 196(76.6%) has clean by cleanliness [Table 1].

Table 1: Working House condition and practice of food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia, 2018, (N=256).

Variables	Characteristics	Frequency (n=256)	Percentage (%)
Houseroom of food handlers	One room	105	41%
	Two rooms	69	27.%
	three rooms	82	32%
Number of windows for food handlers	One window	106	41.4%
	Two window	78	30.5%
	Three window	72	28.1%
Ventilation system of house for food handlers	Good	90	35.2%
	Fair	139	54.3%
	Bad	27	10.5%
Illumination system of house for food handlers	Good	183	71.5
Illumination system of house for food handlers	Bad	73	28.5
Type of floor of house for food handlers	Cement	137	53.5%
Type of floor of house for food handlers	Soil	119	46.5%
Type of kitchen house of food handlers	Attached to the main house	87	34.0%
Type of kitchen house of food handlers	Detached to the main house	169	66.0%
Cleanses of house of food handlers	Very good	97	37.9%
Cleanses of house of food handlers	Good	159	62.1%
Use of water of food handlers	Private pipe	110	43.0%
Use of water of food handlers	Common pipe	146	57.0%
Type of latrine for food handlers	Has water segregation	149	58.2%
Type of latrine for food handlers	No water segregation	107	41.8%
Cleanliness of latrine for food handlers	Clean	196	76.6%
Cleanliness of latrine for food handlers	Not clean	60	23.4%
Liquid disposal methods for food handlers	Open field	90	35.2%
Liquid disposal methods for food handlers	Use segregation	166	64.8%
Solid waste disposal system of food handlers	Hole	170	66.4%
	Open field	49	19.1%
	Municipal body	37	14.5%
Use of hair cover during work of food handlers	Yes	230	89.8%
Use of hair cover during work of food handlers	No	26	10.2%

Magnitude of intestinal parasite

Both direct microscopic and concentration techniques were used for identifying intestinal parasites from 256 stool specimens of food handlers. The overall prevalence of intestinal parasite positive for different intestinal parasite species was found to be 16.8% (95% CI, 12.1%-21.5%). Entamoeba histolytica/dispar was the most prevalent parasites 14(5.5%), followed by Giardia lamblia 10(3.9%), Ascaris lumbricoides 9(3.5%), Strongloid stercolaris 3(1.2%), Trichuris. trichiura 3(1.2%), Taenia species 2(0.8%), and Hook worm 2(0.8%).

Factors Associated with intestinal parasitic infection

The odds of food handlers who didn’t always wash their hand after toilet by soap were three times more likely acquired intestinal parasitic infection than those who wash their hands after toilet by soap (AOR =3.24; 95%CI:1.28-8.19). Concerning food handlers regular medical checkup and had food preparation license, food handlers who had regular medical checkup were 2.4 times (AOR=2.41; 95 % CI: 1.47-4.24)) and food handlers who had food preparation license were 6.13 times (AOR= 6.13; 95 % CI: 2.18-17.22) more likely acquired intestinal parasitic infection as compared with their counter parts. We also found that the odds of having food safety hygiene and training practices were 6.58 times higher (AOR = 6.58; 95%CI: 2.46–17.62) among food handlers than food handlers that had no training opportunity. Those food handlers who did not trim their fingernail were 3.11 times more likely (AOR=3.11; 95 % CI: 1.14-8.67) infested than those who did regularly [Table 2].

The overall prevalence of intestinal parasitic infection among food handlers working in Woldia university student cafeteria was 16.8%. This finding was similar with studies from different parts of Ethiopia such as 14.5% Aksum Town [13], 15% Wollo University student’s cafeteria[14]. However, the prevalence of IPIs was low as compared to studies conducted in Ethiopia, 41.1% in Bahrir Dar, Amhara [15], 52.4% Mekelle University student cafeteria, Tigray[10], 45.3% Addis Ababa University student’s cafeteria, Addis Ababa [11], 33%, in Jimma University Specialized Hospital, Southwest Ethiopia [16], 36% Arba Minch University, Southern Ethiopia[19], 25.2% Haramaya University cafeterias, Eastern Ethiopia [12], 61.9% among food handlers at Prison, East and West Gojjam [5] and 43.38% Saudi Arabia[18]. The possible reason might be due to good personal hygiene practices and environmental sanitation, continuous health-promotion practices, time of the study and geographical variation of the participants.

In our study, E. histolytica/dispar was the most prevalent parasites 14(5.5%), followed by Giardia lamblia 10(3.9%) among food handlers working in Woldia university student cafeteria. In contrast, the most abundant parasite of Arba Minch University students’ cafeteria, were Entamoeba histolytica/dispar 48 (14 %) followed by Ascaris lumbricoides 32 (9.27%) [17], Haramaya University cafeterias were Entamoeba histolytica/ dispar (46.7%) and A. lumbricoides (14.3%) [12], Wollo University student’s cafeteria were E. histolytica (5.5%) followed by A. lumbricoides (4%) and then G.lamblia (3%) [14]. However, the predominant organism was found to be A. lumbricoides in other studies which was conducted in Jimma University Specialized Hospital [16] and Gondar Ethiopia [9]. This might be due to food habits, cultural factors and geographical conditions

These findings indicated that lack of food safety training, no regular medical checkup, no hand washing practice after toilet and after eating by soap were significantly associated with parasitic infection among food handlers. The odds of food handlers who didn’t always wash their hand after toilet by soap were three times more likely acquired intestinal parasitic infection than those who wash their hands after toilet, which is supported with the study conducted in Arbaminch University, Ethiopia [19], Haramaya University [12] and at Prison, East and West Gojjam [5]. This might be due to the fact that those food handlers who didn’t wash their hands with soap after toilet may infest with intestinal infection during eating, drinking and cooking.

The odds of food handlers who hadn’t received regular a medical checkup were 2.4 times more likely infested with intestinal parasites as compared with those food handlers who had received medical checkup. This is in line with the study conducted in Aksum Town [13] and Wollo University student’s cafeteria [14]. This might be due to the fact that those food handlers who hadn’t received medical checkup may not know their status as a result they became carrier and infested with intestinal parasites.

Food handlers who hadn’t taken food safety training were 6.58 times more infested with intestinal parasites as compared with food handlers who took food safety training. This is in line with the study conducted in Aksum Town [13] and Dessie town [6]. This might be due to the fact that those food handlers who didn’t took food safety training may not understand the way of prevention and control mechanism as a result they became highly infested with intestinal parasites.

Food handlers who did not trim their fingernail were 3 times more likely infested with intestinal parasites than those who trimmed their fingers regularly. This is similar with the study conducted in Wollo University student’s cafeteria [14], Arbaminch University, Ethiopia [19] and at Prison of East and West Gojjam [5]. This might be due to the fact that those food handlers didn’t trim their fingernail which makes them carrier of parasites in the fingernail as a result they became more infested with intestinal parasites.

Generally, the overall magnitude of intestinal parasitic infection among food handlers at Woldia university student cafeteria was found relatively low as compared from other public university within country. However, food safety training, fingernail trimming practice, hand washing with soap after toilet, hand washing after eating and medical checkups was the potential factors for intestinal parasitic infection. Therefore, regular and contentious training on food safety and hand washing practice and regular periodic medical checkup are essential strategies for prevention of intestinal parasitic infections. In addition, further studies should be undertaken on bacterial isolates and associated risk factors among those food handlers at study area.

Limitations of the study

The cross-sectional nature of study design limits the applicability of the findings in establishing causality between the variables.

Table 2:- Bivariate and Multivariate logistic regression analysis of factors associated with intestinal parasitic infections among food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia, 2019 (n = 256).

Variables		Positive (%)	Negative (%)	COR (95% CI)	AOR (95% CI)
Sex	Male	15	77	1.00	1.00
Sex	Female	28	136	0.95(0.48-1.88)	1.79(0.62-5.18)
Age	15-19	4	9	0.41(0.11-1.47)	1.91(0.40-9.09)
	20-24	18	98	1.00	1.00
	25-29	12	59	0.89(0.40-1.99)	0.53(0.06-5.10)
	30-34	5	24	0.84(0.28-3.49)	1.31(0.27-6.41)
	≥ 35	4	23	1.04(0.32-3.38)	1.71(0.24-12.22)
Hand washing after toilet with a soap	Yes	14	169	1.00	1.00
Hand washing after toilet with a soap	No	29	44	7.96(3.87-16.32)	3.24(1.28-8.19)*
Hand washing before eating food with a soap	Yes	17	182	1.00	1.00
Hand washing before eating food with a soap	No	26	31	8.98(4.37-18.45)	4.03(1.64-9.91)**
Fingernail trimming	Yes	22	183	1.00	1.00
Fingernail trimming	No	21	30	3.76(1.88-7.51)	3.11(1.14-8.67)***
Use of apron when handling food	Yes	37	172	1.00	1.00
Use of apron when handling food	No	6	41	0.68(0.27-1.72)	0.37(0.09-1.50)
Use of hair cover during work of food handlers	Yes	38	192	1.00	1.00
Use of hair cover during work of food handlers	No	5	21	1.20(0.43-3.34)	0.70(0.17-2.81)
Year of service	< 1 year	9	39	0.90(0.40-2.03)	0.29(0.05-1.71)
	1-5 year	32	150	1.00	1.00
	6-10 years	2	24	2.54(0.57-11.31)	0.54(0.08-3.84)
Food safety training	Yes	22	186	1.00	1.00
Food safety training	No	21	27	6.57(3.20-13.52)	6.58(2.46-17.62)****
Medical checkup for IPs	Yes	25	186	1.00	1.00
Medical checkup for IPs	No	18	27	3.06(1.45-6.47)	2.41(1.47-4.24)***
Having license for food handling practice	Yes	23	184	1.00	1.00
Having license for food handling practice	No	20	29	5.52(2.70-11.20)	6.13(2.18-17.22)****
Took medication	Yes	16	42	1.00	1.00
Took medication	No	27	171	2.41(1.19-4.89)	0.51(0.18-1.39)

Significant at: *P=0.013, **P=002, ***P=0.03, ****P=0.001, 1.00 = reference.

Acronyms

AOR: Adjusted odd ratio; CDC: Center for disease control and prevention; CI: Confidence interval; IPIs: Intestinal Parasitic Infections; IRB: Institutional Review board; SPSS: Statistical Package for Social Sciences; WDU: Woldia University; WHO: World Health Organizations.

Acknowledgement

The authors would like to thank our data collectors and supervisors for their invaluable effort to make this study real. The author’s deep gratitude also goes to our study subjects who were volunteered and took their time to give us all the relevant information for the study.

Funding

The research was self-funded. The authors’ independently design the study, analyze and interpret the data, prepared the manuscript.

Availability of data and materials

All related data has been presented within the manuscript. The dataset supporting the conclusions of this article is fully available from the authors on request.

Author’s Contributions

BA, YB, and AD was the investigator who initiated the research, wrote the research proposal, conducted the field work, supervised data entry, analyzed the data and wrote the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Ethical approval was obtained from Woldia University institutional review board (WDU/IRB). All the study participants were informed about the purpose of the study, their right to refuse. The participants enrolled in the study were informed about the study objectives, expected outcomes, benefits and the risks associated with it. Written consent was taken from the participants before the interview.

Consent for publication

Not applicable.

Competing interest

The authors declared that they have no competing interests.

Authors' Information

¹Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia

² Departments of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia

³Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia

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Magnitude of Intestinal Parasitic Infections and Associated Factors among Food Handlers Working at Woldia University Student’s Cafeteria, Northeastern Ethiopia: An institution based cross-sectional study

Status:

Journal Publication

Version 2

Abstract

Introduction

Methods

Study setting, design and period

Sample size determination and sampling technique

Method of data collection

Data Quality Assurance

Data processing and analysis

Results

Discussion

Conclusions

Declarations

References

Supplementary Files

Status:

Journal Publication

Version 2