Prevalence of human intestinal parasitic infections and associated risk factors at Lay Armachiho District Tikildingay town health center, Northwest Ethiopia

doi:10.21203/rs.3.rs-3644263/v1

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Prevalence of human intestinal parasitic infections and associated risk factors at Lay Armachiho District Tikildingay town health center, Northwest Ethiopia

https://doi.org/10.21203/rs.3.rs-3644263/v1

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Human intestinal parasitic infections are caused by intestinal parasitic species broadly categorized in to helminthes and protozoa and prevalent worldwide, mainly, in developing countries. The purpose of this study was to assess the prevalence of human intestinal parasitic infections (HIPIs) and associated risk factors at Tikildingay town health center. The socio-demographic and risk factors data were collected using organized self-administers questionnaires, and stool sample was diagnosed to determine the prevalence. The data were entered with EPI Info version 7 and analyzed by SPSS version 20. Among 404 total participants in the study 181 (44.8%) were males and 223 (55.2%) were female. The overall prevalence of HIPIs was 36.63% (148/404). Five intestinal parasitic species were identified, among these, the most predominant parasite was E. histolytica/diaper (18.56%) followed by G. lamblia (11.39%), Hookworm (5.1%), A. lumbricoides (0.99) and S. mansoni (0.5%). Out of the total infection cases in the study area, 50.68% of the infection cases were caused by E. histolytica. Those who have no hand washing habit before meal are 22.709 times more infected than those who always wash their hand (CI = 1.771, 291.112 and at p-value 0.05). In general, to prevent the HIPIs improving health service and pure water supply; as well as creating awareness to the community about personal hygiene, environmental sanitation, proper waste disposal, transmissions and prevention ways are mandatory.

Associate risk factor

Intestinal parasite

Prevalence

Tikildingay health center

1.1 Back Ground of the Study

Human intestinal parasitic infections (HIPIs) are causing considerable disease, malnutrition and death worldwide, mostly in developing countries (Abiye et al., 2019). The HIPIs are one of the main public health problems in hot regions, especially among poor societies (Kefale et al., 2021; Nigus and Amir, 2021). The HIPIs are caused by intestinal parasitic species, mainly divided into protozoa and helminthes (Mustafa et al., 2020). Intestinal parasites of protozoa are unicellular, but helminthes are multi-cellular; and both are eukaryotic organisms, belonging to animal kingdom; inhabit the gastrointestinal tract in human (Beyene, 2018). The protozoan parasite (Entamoeba histolytica, Giardia intestinalis/lamblia and Cryptosporidium parvum) and soil transmitted helminthes (Ascaris lumbricoides, Trichiuris trichiura and Hookworm) are the most prevalent intestinal parasites causing high disease and death, and affecting nearly all populations at some point in their lives, especially in sub-Saharan Africa (Baye et al., 2019; Yoahnnes et al., 2021).

The transmission of helminthes mainly facilitated by their egg. The eggs passed with the stools then accidentally ingested with contaminated soil, food, and water (Sorobetea et al., 2018). On the other hands, these eggs hatch in the soil, develop in to larvae, then mature and actively penetrate the skin of a person walking barefoot on the contaminated soil, then the adult worm live in the intestine and produce thousands of eggs each day (Afshar et al., 2020; Hashmey et al., 2022). Typically the transmission of protozoan is via fecal-oral rout. The life cycle of protozoa consists of both cyst and trophozoites. The infectious cysts are the resistant life stage that excreted with stool and acquired through the ingestion with contamination (Getaneh et al., 2019). The cysts changed to trophozoites, which is actively feeding stage that replicate and cause disease within the intestine (Sorobetea et al., 2018). In general, involving close human-human contact, unhygienic conditions and walking with barefoot promote ingestion and transmission of cyst and egg with contaminated food or water as well as penetration of intact skin (Getaneh et al.,2019; Afshar et al., 2020).

The most common symptoms of intestinal protozoans are acute or chronic diarrhea, abdominal pain, bloating, flatulence, and weight loss resulting from mal-absorption (Osman et al., 2016). The symptoms of helminthes mainly include abdominal pain, mild anemia, excessive fatigue, weight loss, diarrhea, stunted growth and impaired cognitive development (Sorobetea et al., 2018). Furthermore, the HIPIs lead to prolonged and the most devastating disease such as iron deficiency anemia, vitamin deficiency, protein depletion, chronic blood loss, physical and mental problems (Alharazi et al., 2020; Fasil et al., 2020). Stunted growth, cognitive impairment, poor psychomotor development and malnutrition in children, and surgical problems like intestinal obstruction and increased vulnerability to other infections (Ulhaq et al., 2020).

Usually, the distribution and prevalence of HIPIs vary from country to country and even locally inside countries because of several human behavioral, environmental, social, and geographical influences; and infect both gender and all age groups (Dires et al., 2020; Sebaa et al., 2021). These distribution and prevalence of HIPIs is greatly associated with has no formal education, poverty, poor personal hygiene, number of family members, residence, overcrowding, walking with barefoot, untrimmed finger nail, occupation (Demelash et al., 2021); poor sewage disposal system, latrine unavailability, lack of safe water supply, pollution of the environment by human excreta and animal wastes, avoidance of health promotion practices and impoverished health services (Cedric et al., 2020; Zewdneh and Girma, 2021). The basic method for preventing and control of HIPIs is hand washing with soap before eating, during food handling and after toilet, using safe water for drinking, sanitary practices and proper waste disposal (Wondmagegn et al., 2019). Based on the observation in the study area, the society is vulnerable to HIPIs because of eating contaminated food, unpeeled fruits, drinking unsafe water and walking with barefoot. According to the health center report, recently HIPIs were the major problems of the people visit the health center. Therefore, this study aim to assess the prevalence of HIPIs and their associated risk factors in Lay Armachiho district Tikildingay town health center, central Gondar, Ethiopia.

2.1 Description of the Study Area

This study was conducted in Tikildingay town health center in Lay Armachiho district, Central Gondar, Ethiopia, located at 12⁰59`3``North latitude and 37⁰2`39`` East longitude. The altitude is 980–2820 above sea level. The average temperature is 10–30c⁰. It is found around 803km and 25km away from Addis Ababa and Gondar. According to the District Office of Agriculture, the district has a total area of 67,148 hectares with 31 Kebeles, 2 of them are urban and the rest of 29 are rural Kebeles. The area is mostly characterized by having dry evergreen vegetation type. The Fig. 1 shows area map of the study area.

2.2. Study Design

Health center based cross sectional study were conduct to assess the prevalence of HIPIs and risk factors at Tikildingay town health center from March to June 2022.

2.3. Sample Size Determination and sampling technique

The Sample size (n) is determined by using a single population proportion formula as it was described in Daniel (1999) and conducted by Yohannes et al. (2021). Considering the Zα/2 = critical value for normal distribution at 95% confidence level which equals 1.96 (Z value at alpha = 0.05); P = 50% because the prevalence in the study area is not known and d = margin of error of (0.05). Based on the assumption, the calculated sample size would be 384 and additional 5% to compensate non-response. Then, the final total sample size would be 404. Purposive samplings were used to select participant of the study among patients with diarrhea visiting the health center during the study period.

2.4 Data Collection Methods

All the data of the study were collected after getting all the necessary ethical permission from the concerned bodies and signed consent from the participants. The demographic and associated risk factor data were collected using organized self-administered questionnaire. The Participants’ personal hygiene and finger nail status were checked by the observation of data collectors during collection time. The questionnaire was first prepared in English then translated to local language (Amharic). After giving mandatory briefing, participants were given clean stool collection cup with applicator stick to bring about 5gms of their own fresh stool. At the time of collection, the date of sampling and the identification code of the participant were labeled on the collected sample. Each of the stool samples were prepared and observed microscopically using direct wet-mount and then formal-ether concentration techniques following the procedures according to World Health Organization (WHO) guidelines by trained laboratory technician of the health center.

2.4.1. Stool Diagnosis Method

2.4.1.1. Direct Wet Mount Method

One drop of normal saline was added on a clean slide and then a stool equivalent to a matchstick head (1gm) was mixed with it. The same procedure was implemented to prepare iodine mount. The wet mounts were examined under light microscope with 10X and 40X magnifications.

2.4.1.2. Formal-Ether Sedimentation Method

About 3gms of stool was placed in a clean conical centrifuge tube containing 7ml of10% formal water by using applicator stick. The resulting suspension was filtered through a sieve in to another conical tube. After adding 3-4ml of diethyl ether to the formalin solution, the content was centrifuged at 3200 resolution per minute for 1 min. After centrifuging, the parasite sediment to the bottom of the tube and fecal debris collected in layer between the ether and formal water. After discarding the supernatant, the sediment was transferred to a slide and covered with a cover slip. The sediment was examined microscopically with 10x and then 40x for HIPIs life stages.

2.5. Inclusion criteria

The study included all age groups visited the health center for HIPIs stool examination, did not took any anti-parasitic drugs in the past 2 months, willing to participate and signed informed consent.

3.7. Study Variable

Dependent variable of the study was the prevalence of HIPIs and the independent variables were socio-demographic and associated risk factors.

3.8. Data Quality Assurance

In the study, the questionnaire was first prepared in English and translated into the local language (Amharic) then translated back into English to check consistency of meaning. The pre-test of the questionnaire was conducted on 5% of the samples. The stool sample were prepared and examined by laboratory technologists using standard operating procedures to ensure the quality of the test result.

3.9. Method of Data Analysis

Data were entered with EPI-Info version-7 and analyzed with SPSS version-20. The chi-square (X²) test was performed to verify the possible statistically significant association between dependent and independent variables with the p < 0.05. The binary logistic regression analysis was used to determine strength of the association by using crude odds ratio (COR) and then adjusted odd ratio (AOR) computed using multivariable logistic regression. The P value less than 0.05 was considered as statistically significant in all cases.

3.10. Ethical Review

Ethical clearance was first obtained from College of Natural and Computational sciences, University of Gondar, research Ethics Review Committee. Then, formal permission letter was obtained from Tikildingay health center managing office too. After the purpose of the study was explained, written consent was obtained from each study participant. Interviews were carried out privately in a separate room.

3.1. Socio-demographic factors characteristics

Out of the total 404 participant in the study, 181(44.8%) were males and 223(55.2%) were females. From the participants, 42(10.4%) of them were belongs to age group between 0–5 years old, 207(52.24%) were dwell in rural area, 101 (25%) have > 5 family members, 132 (32.7%) get the lowest monthly income, 233 (57.7%) were farmers in occupation and 239(59.2%) were illiterate (Table 1).

Table 1

Socio-demographic Characteristics among Patient at Lay Armachiho District Tikildingay Town Health Center, Central Gondar Ethiopia
Variable	Categories	Frequency	Percent
Sex	Male Female	181 223	44.8 55.2
Age	0–5 6–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 > 74	42 29 36 29 19 33 30 28 38 20 24 12 16 17 14 17	10.4 7.2 8.9 7.2 4.7 8.2 7.4 6.9 9.4 5.0 5.9 3.0 4.0 4.2 3.5 4.2
Family members	Two Three Four Five And above	42 89 91 81 101	10.4 22.0 22.5 20.0 25.0
Level of education	Illiterate Primary level Secondary level College level University level	239 117 24 15 9	59.2 29.0 5.9 3.7 2.2
Income	< 1000 birr 1000 birr 2000 birr 3000 birr And above	132 80 86 37 69	32.7 19.8 21.3 6.2 17.1
Occupation	Farmer Governmental employee Trader Others	233 21 23 127	57.7 5.2 5.7 31.4

3.2. Associated risk factor characteristics

According to the Table 2 below, 246 (60.9%) of them use toilet, 312 (77.2%) of them their nail is clean, 202 (50%) of them always wash their hand after toilet, 385(95.3%) of them always wash their hand before meal, but 255 (63.1%) of them wash their hand without soap, and 296 (73.3%) of them has no shoe wearing habit (Table 2).

Table 2

Associated risk factors among Patient at Lay Armachiho District Tikildingay Town Health Center, Central Gondar Ethiopia
Variable	Categories	Frequency	Percent
Place of stool defecation	Toilet Open field	246 158	60.9 39.1
Finger nail cleanness	Yes No	312 92	77.2 22.8
Hand washing habit after toilet	Always Sometimes Never	202 130 72	50.0 32.2 17.8
Hand washing habit before eating	Always Sometime Never	385 13 6	95.3 3.2 1.5
Hand washing habit with soap	Yes No	149 255	36.9 63.1
Source of water for drinking and cooking	River Stream Pond Pipe	34 85 10 274	8.4 21.3 2.5 67.8
Source of water for bathing	River Stream Pond Pipe	134 49 5 216	33.2 12.1 1.2 53.5
Feeding habit	Vegetable Fruit Meat Others	160 62 4 178	39.6 15.3 1.0 44.1
Water treating habit	Yes No	266 138	65.8 34.2
Shoe wearing habit	Yes No	108 296	26.7 73.3
Ways of waste disposal	Open damp Burying Burning	204 160 40	50.5 39.6 9,9
Availability of toilet	Yes No	266 138	65.8 34.2
Swimming habit	Yes No	67 337	16.6 83.4
Habits of contact / playing with soil	Yes No	63 341	15.6 84.4

3.3. The Prevalence of HIPIs

In the present study, the overall prevalence of HIPI is 148 (36.63%) and 5 species of intestinal parasitic were identified. Out of these species, the dominant was E. histolytica/dispar with the prevalence rate of 75/404 (18.56%) and it accounts for 50.68% (75/148) of the infection case burden followed by G. lamblia, Hookworm, A. lumbricoides and S. mansoni with the prevalence rate of 46 (11.39%), 21 (5.10%), 4 (0.99%) and 2 (0.5%) respectively. In this study, females (79 (53.38%) were more infected than males (69 (46.62%). The S. mansoni infection was identified only on female participants (Table 3).

Table 3

The Prevalence of Human Intestinal Parasitic Infection among Sex in the Patient at Lay Armachiho District Tikildingay Town Health Center, Central Gondar Ethiopia
Intestinal parasite	Total No. of Positive (burden in %)	Prevalence in % (n = 404)	Male No. of infected (burden in %)	Female No. of infected (burden in %)
E. histolytica/dispar	75 (50.68)	18.56	38 (50.67)	37 (49.33)
G. lamblia	46 (31.08)	11.39	20 (43.48)	26 (56.52)
Hookworm	21 (14.19)	5.10	8 (38.10)	13 (61.9)
A. lumbricoides	4 (2.70)	0.99	3 (75.00)	1 (25.00)
S. mansoni	2 (1.35)	0.5	0 (0.00)	2 (100)
The overall prevalence	148 (100)	36.63	69 (46.62)	79 (53.38)

3.4. Association of socio-demographic Factor with the Prevalence of HIPI

In the study area, regarding to age group, high prevalence was observed in the age group of < 5 years old (18 (12.2%) and less prevalence was registered in the age group of 55–59 (2 (1.4%). Regarding to residence, the prevalence of HIPI were higher among urban dwellers (78 (52.7%) than rural (70 (47.3%). In terms of occupation, high prevalence of intestinal parasite were observed on farmer (88 (59.5%) and it was less in trader (7 (4.7%). In relation to education, higher prevalence was shown on illiterates (99 (66.9%) (Table 4).

Table 4

Socio-demographic factors with the Prevalence of HIPI among in the Patient at Lay Armachiho District Tikildingay Town Health Center, Central Gondar Ethiopia
Socio-demographic characteristics	Categories	Intestinal parasitic		X²	P-value
Socio-demographic characteristics	Categories	Positive (%) (n = 148)	Negative (%) (n = 256)	X²	P-value
Sex	Male Female	69 (46.62) 79 (53.68)	112 (43.7) 144 (56.3)	0.313	0.576
Age	0–5 6–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 > 74	18 (12.2) 7 (4.7) 12 (8.1) 13 (8.8) 5 (3.4) 8 (5.4) 11 (7.4) 10 (6.8) 13 (8.8) 11 (7.4) 10 (6.8) 2 (1.4) 6 (4.1) 8 (5.4) 5 (3.4) 9 (6.1)	24 (9.4) 22 (8.6) 24 (9.4) 16 (6.2) 14 (5.4) 25 (9.8) 19 (7.4) 18 (7.0) 25 (9.8) 8 (3.1) 14 (5.5) 10 (3.9) 10 (3.9) 9 (3.5) 9 (3.5) 8 (3.1)	16.174	0.441
Level of education	Illiterate Primary level Secondary level College level University level	99 (66.9) 36 (24.3) 8 (5.4) 3 (2.0) 3 (2.0)	140 (54.6) 82 (32.0) 16 (6.2) 12 (4.7) 6 (2.3)	6.579	0.160
Residence	Rural Urban	70 (47.3) 78 (52.7)	137 (53.4) 119 (46.4)	1.451	0.228
Family members	Two Three Four Five And above	16 (10.8) 37 (25.0) 22 (14.9) 36 (24.3) 37 (25.0)	26 (10.1) 52 (20.3) 69 (26.9) 45 (17.6) 64 (25.0)	9.187	0.057
Income	< 1000 birr 1000 birr 2000 birr 3000 birr And above	46 (31.1) 29 (19.6) 37 (25.0) 11 (7.4) 24 (16.2)	86 (33.5) 51 (19.9) 49 (19.1) 26 (10.1) 44 (17.2)	2.463	0.651
Occupation	Farmer Govern. employee Trader Others	88 (59.5) 9 (6.1) 7 (4.7) 44 (29.7)	145 (56.6) 12 (4.7) 16 (6.2) 83 (32.4)	1.077	0.783

3.5. Association of risk factors with prevalence HIPI

Among the studied risk factors, hand washing habit before eating and availability of toilet have statistically significant association with the HIPIs (p < 0.05) in the study area. According to the below table, those who use toilet for defecation, has clean finger, wash their hand before meal, wash hands without soap, use pipe water for drinking and cooking, have no swimming habit, has water treating habit, has shoe wearing habit, get toilet in their home and have a Habits of contact / playing with soil have registered relatively higher prevalence with the rate of 114 (28.23%), 99 (66.9), 140 (94.6), 98 (66.2), 106 (71.6), 127 (85.8), 103 (69.6), 113 (76.4), 107 (72.3) and 123 (83.1) respectively (table: 5).

Table 5

The Prevalence of HIPIs with the Association Risk Factors among in the Patient at Lay Armachiho District Tikildingay Town Health Center, Central Gondar Ethiopia.
Associated risk factors	Categories	Intestinal parasites		X²	p-value
Associated risk factors	Categories	Positive (%) (148)	Negative (%) (256)	X²	p-value
Availability of toilet	Yes No	107 (72.3) 41 (27.7)	159(62.1) 97(37.9)	4.328	0.037*
Place of defecation feces	Toilet Open field	99 (66.9) 49 (33.1)	147(57.4) 109(42.6)	3.532	0.060
Finger nail cleanliness	Yes No	114 (77.0) 34 (23.0)	198(77.3) 58(22.7)	0.005	0.942
Hand washing habit after toilet	Always Sometimes Never	73 (49.3) 45 (30.4) 30 (20.3)	129(50.4) 85(33.2) 42(16.4)	1.035	0.596
Hand washing habit before eating	Always Sometime Never	140 (94.6) 3 (2.0) 5 (3.4)	245(95.7) 10(3.9) 1(0.4)	6.678	0.035*
Hand washing habit with soap	Yes No	50 (33.8) 98 (66.2)	99(38.7) 157(61.3)	0.963	0.327
Source of water for drinking and cooking	River Stream Pond Pipe	11 (7.4) 26 (17.6) 3 (2.0) 106 (71.6)	23(9.0) 58(22.7) 7(2.7) 168(65.6)	1.571	0.666
Source of water for bathing	River Stream Pond Pipe	49 (33.1) 15 (10.1) 2 (1.4) 82 (55.4)	85(33.2) 34(13.3) 3(1.2) 134(52.3)	0.954	0.812
Swimming habit	Yes No	21 (14.2) 127 (85.8)	46(18.0) 210(82.0)	0.968	0.325
Water treating habit	Yes No	103 (69.6) 45 (30.4)	163(63.7) 93(36.3)	1.463	0.226
Feeding habit	Vegetable Fruit Meat Others	56 (37.8) 22 (14.9) 2 (1.4) 68 (45.9)	104(40.6) 40(15.6) 2(0.8) 110(43.0)	0.716	0.869
Shoe wearing habit	Yes No	35 (23.6) 113 (76.4)	73(28.5) 183(71.5)	1.134	0.287
Ways of waste disposal	Open damp Burying Burning	68 (45.9) 62 (41.9) 18 (12.2)	136(53.1) 98(38.3) 22(8.6)	2.472	0.291
Habits of contact / playing with soil	Yes No	25 (16.9) 123 (83.1)	38(14.8) 218(85.2)	0.299	0.585

4.3. Associated Risk Factors with the Intestinal Parasitic Infection

The univariate was first done and then the variables with p < 0.25 were analyzed by multivariate. Only hand washing habit before eating showed statistical significant association with HIPI. Those have no habit of hand washing before eating were 22.709 times infected than those always wash (Table 5)

Table 6

The Prevalence of Intestinal Parasitic Infection Was Stratified by Socio-demographic Characteristics and associated risk factors among in the Patient at Lay Armachiho District Tikildingay Town Health Center, Central Gondar Ethiopia
Socio-demographic characteristics	Categories	Intestinal parasitic		p-value	COR(95%CI)	p- value	AOR(95%CI)
Socio-demographic characteristics	Categories	Positive (%)	Negative (% )	p-value	COR(95%CI)	p- value	AOR(95%CI)
Level of education	Illiterate Primary level Secon. level College level Univ. level	99 (66.9) 36 (24.3) 8 (5.4) 3 (2.0) 3 (2.0)	140 (54.6) 82 (32.0) 16 (6.2) 12 (4.7) 6 (2.3)	0.160	0.770(0.173,2.895) 1.171(0.277,4.951) 1 (0.197,5.079) 2(0.306,13.062 1	0.067	0.512(0.122,2.148) 0.890(0.205,3.855) 0.833(0.163,4.271) 1.974(0.302,12.895) 1
Residence	Rural Urban	70 (47.3) 78 (52.7)	137 (53.4) 119 (46.4)	0.228	1.283(0.855,1.924) 1	0.357	1.234(0.789,1.932) 1
Availability of toilet	Yes No	107 (72.3) 41 (27.7)	159(62.1) 97(37.9)	0.037*	1 1.628(1.405,1.975)	0.520	1 1.734(1.286,2.184)
Place of stool defecation	Toilet Open field	99 (66.9) 49 (33.1)	147(57.4) 109(42.6)	0.060	1 1.497(1.437,1.719)	0.621	1 1.792(1.314,2.399)
Hand washing habit before eating	Always Sometime Never	140 (94.6) 3 (2.0) 5 (3.4)	245(95.7) 10(3.9) 1(0.4)	0.035*	1 8.750(1.012,75.649) 16.667(1.361,204.033	0.050*	1 1.700(1.178,97.209) 22.709(1.771,291.112)

Checking the current distribution and extent of intestinal parasitic infection in a given community is vital to implement preventive and therapeutic interventions. This study assessed the prevalence of human intestinal parasitic infections (HIPIs) and associated risk factors at Lay Armachiho District Tikildingay Town Health Center, Northwest Ethiopia. The overall prevalence of HIPIs in the study area was 36.63% (148/404) which is higher than study reports from Wonago health center, Ethiopia (16.6%) (Girum, 2015), Jimma health center, Ethiopia (20.6%) (Yohannes et al., 2021), and five years trend analysis in Debre Tabor comprehensive specialized hospital, Ethiopia (27.3%) (Lamma et al., 2022). However, it is relatively lower than studies in other areas, such as, Sanja primary hospital, Ethiopia (52.9%) (Tahir et al., 2021), teaching hospitals in Zagazig district, Egypt (56%) (Marwa and Heba, 2022), Shahura Health Center, Ethiopia (56.9%) (Abiye et al., 2019), Teda Health Center, Ethiopia (62.3%) (Abraraw et al., 2013) and the University hospital of Bobo-Dioulasso, Burkina Faso (65.3%) (Sangare et al., 2015). The difference in prevalence of HIPIs could be due to the diversity of cultural practices in the different study area, the study period, age variations, health status condition, water supply, feeding habit, and geographical differences.

In this study, the most common parasite was E. histolytica/dispar with the prevalence rate of 18.56% (75/404) and it accounts for 50.68% (75/148) infection case burden in the study area. Its prevalence is comparative with the study result from five years trend analysis in Debre Tabor comprehensive specialized hospital, Ethiopia (18.6%) (Lamma et al., 2022) but higher than reports from Jimma health center, Ethiopia (4.2%) (Yohannes et al., 2021), Teda Health Center, Ethiopia (4.6%) (Abraraw et al., 2013), Wonago health center, Ethiopia (8.94%) (Girum, 2015) and teaching hospitals in Zagazig district, Egypt (10.0%) (Marwa and Heba, 2022). Whereas, it lower than research conducted in Sanja primary hospital, Ethiopia (52.9%) (Tahir et al., 2021), University hospital of Bobo-Dioulasso, Burkina Faso (65.3%) (Sangare et al., 2015) and Shahura Health Center, Ethiopia (28.0%) (Abiye et al., 2019).

The second prevalent parasite was G. lamblia with prevalence of 11.39% (46/404) and it caused 31.08% (46/148) of the infections in the area. The prevalence was comparative with result of teaching hospitals in Zagazig district, Egypt (12.6%) (Marwa and Heba, 2022) and Teda Health Center, Ethiopia (12.4%) (Abraraw et al., 2013). On the other hand, it is higher than studies from Wonago health center, Ethiopia (3.93%) (Girum, 2015), University hospital of Bobo-Dioulasso, Burkina Faso (4.8%) (Sangare et al., 2015), Shahura Health Center, Ethiopia (5.5%) (Abiye et al., 2019), Debre Tabor comprehensive specialized hospital, Ethiopia (5.7%) (Lamma et al., 2022), Jimma health center, Ethiopia (6.5%) (Yohannes et al., 2021) and Sanja primary hospital, Ethiopia (52.9%) (Tahir et al., 2021).

These two of the most common protozoan (Giardiasis and Amoebiasis) majorly transmitted by fecal-oral rout with the ingestion of cysts which is facilitated by direct or indirect transmission by person-to-person or indirectly through the use of contaminated food or water. The possible reason for the aforementioned higher and difference in prevalence of E. histolytica and G. lamblia might be contaminated water supply, poor habit of washing hand after toilet and before meal, poor handling food, habit of consuming foods without proper washing, peeling or cooking, and poor awareness on keeping personal hygiene.

Hookworm species is the third prevalent parasite in this study with rate of 5.10% (21/404) and responsible for 14.19% (21/148) of the infection in the study area. This prevalence of Hookworm species is comparative with Teda Health Center, Ethiopia (6.6%) (Abraraw et al., 2013) and higher than Jimma health center, Ethiopia (0.80%) (Yohannes et al., 2021) and Debre Tabor comprehensive specialized hospital, Ethiopia (5.7%) (Lamma et al., 2022). But lower than the reports from Shahura Health Center, Ethiopia (10.4%) (Abiye et al., 2019), and Sanja primary hospital, Ethiopia (13.3%) (Tahir et al., 2021). As it is well known, Hookworm mainly transmitted when the matured larvae in the soil penetrate intact skin of barefoot walking person. The eggs are passed in the feces contaminate soil if an infected person defecates outside toilet (near bushes or open field) or if these feces are used as fertilizer, eggs are deposited on soil. They can then mature and hatch, releasing larvae. In this view, the possible reason for incidence of infection of hookworm would be environmental contamination with human and animal wastes due to poor habit of toilet utilization, and habit of waking barefoot.

In the finding of this study, females (53.38%; 79/148) were more infected with HIPIs than males (46.62%; 69/148). This result is supported by the result of Teda Health Center, Ethiopia (Abraraw et al., 2013) and Jimma health center, Ethiopia (Yohannes et al., 2021) but it is opposite to Shahura Health Center, Ethiopia (Abiye et al., 2019), and Sanja primary hospital, Ethiopia (Tahir et al., 2021), where male are more infected than females. The reseaon for higher infection on females in the study area might be due to the fact that females are more often involved in food processing and handling, water fetching activities, actively engaged in agricultural practices and spend more time in caring their child. In addition, the entire task of keeping the hygiene of the children and sometimes the family fall on her, all these may leads her to contamination of parasite from different primary and secondary sources.

Hand washing habit before eating, availability of toilet and family members were significantly association risk factors with the HIPIs in the study area. This finding was also supported by other studies. In regarding to age group, relatively high prevalence of HIPIs was obsereved among the lower age group patients, i.e., the age group of < 5 years old (4.45% (18/404). This finding is similar with several studies including Teda Health Center, Ethiopia (Abraraw et al., 2013), Jimma health center, Ethiopia (Yohannes et al., 2021), Shahura Health Center, Ethiopia (Abiye et al., 2019), and Sanja primary hospital, Ethiopia (Tahir et al., 2021). In all these studies the lower age group participants were relatively more infected than the others. This might be due to immature immunity, poor feeding and exploratory behavior, frequent hand to mouth contact, common contact with soil and contaminated objects and eating of unwashed vegetables and fruits.

This study showed that the overall prevalence of human intestinal parasites infection were 148(36.63%), and the more predominantly prevalent of protozoan and helminthes parasites were E. histolytica/dispar and Hookworm respective. In regarding to sex and age group, females and the age groups < 5years old were more infected.. The hand washing habit before eating, availability of toilet and family members were significantly association risk factors with the HIPIs in the study area. Therefore, this study has provides baseline information for further investigation in relation to determinant risk factors and possible intervention points for intestinal parasite infection in the study area. All stakeholders should give attention to raise awareness of IPIs, and how to keep personal and environmental hygiene, and improve the quality of drinking and bathing water sources.

Declaration guidelines

In this study all tests and examination, questionnaire administration and stool sample diagnosis, were carried out in accordance with relevant WHO intestinal parasite diagnosis guidelines and regulations.

Ethical approval

Before the commencement of this study, ethical permission was obtained from research ethics review committee of college of natural and computational sciences, University of Gondar. Then further permission was obtained from Tikildingay health center. Signed consent was obtained from the all participants after briefing of the purpose of the research and what is required from the participants. Then the participants were instructed how to handle and submit fresh stool sample. The diagnosis of stool sample were done by trained parasitological laboratory technician of the health center. Those positive to any intestinal parasitic infection were treated with appropriate drug by the physician of the health center. The cost of diagnosis and treatment was covered by the researchers.

Data Availability Statement

The entire raw and analyzed data of this study was fully available in the hands of researchers. Any can contact the corresponding authors to get the raw data and can be presented for acceptable reasons.

Declaration of interest

We, the authors, declare that we don’t have any conflict of interest.

Declaration of Funding

This study has no any funding bodies.

Contribution of the authors

Mrs. Tiruye Alemu was a student and this study was conducted to fulfill the requirement to get M.Sc. in Biology. Mrs. Tiruye has collected, analyzed, interpreted the data and prepared the report. Mr. Tilahun Yohannes was supervisor of the entire work.

Acknowledgement

We would like to thanks all the participants for their willingness and honest. We are grateful to the health center and laboratory technician of the health center too.

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No competing interests reported.

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Prevalence of human intestinal parasitic infections and associated risk factors at Lay Armachiho District Tikildingay town health center, Northwest Ethiopia

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Abstract

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1. INTRODUCTION

1.1 Back Ground of the Study

2. MATERIALS AND METHOD

2.1 Description of the Study Area

2.2. Study Design

2.3. Sample Size Determination and sampling technique

2.4 Data Collection Methods

2.4.1. Stool Diagnosis Method

2.4.1.1. Direct Wet Mount Method

2.4.1.2. Formal-Ether Sedimentation Method

2.5. Inclusion criteria

3.7. Study Variable

3.8. Data Quality Assurance

3.9. Method of Data Analysis

3.10. Ethical Review

3. Result

3.1. Socio-demographic factors characteristics

3.2. Associated risk factor characteristics

3.3. The Prevalence of HIPIs

3.4. Association of socio-demographic Factor with the Prevalence of HIPI

3.5. Association of risk factors with prevalence HIPI

4.3. Associated Risk Factors with the Intestinal Parasitic Infection

4. Discussion

5. Conclusion

Declarations

References

Additional Declarations

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