Study area and design
The study was a community-based descriptive cross- sectional study, and carried out on mothers of Sekota town, which is located in the Amhara regional state, Ethiopia. The town, Sekota is the capital city of Waghimra administrative zone. It far 50 km from the rock church, Lalibella, and 655 km from Addis Ababa, the capital city of Ethiopia. The data collection period was from February 15 to March 10/2019. The Sekota town is known for water shortage. The water shortage might be a factor for poor hygiene and sanitation practices. The town, Sekota has two urban kebeles, and both kebeles were included in this study (44).
Sampling and study population
Sample size determination and sampling procedure
The sample size used in this study was 384 mother-child pairs that determined using single population proportion formula. The age of children range from 2 to 5 years. Although, the population proportion formula used for calculation in considering previous study’s proportion (P, 52.3%) (45), the power of the sample size is also greater than 85%. In calculating the sample size, 10% none response rate, 95% CI, and 5% margin of error was taken in to account. Simple random sampling technique with proportional allocation was used to get all the 384 mother child pairs (Figure 1).
Data collection tools
A pretested and structured interview-based questionnaire were developed in the English and then translated to Amharic, and re-translated to English version to record and analyze the demographic data, and data related to knowledge, attitude and practice of mothers by two independent translators. The discrepancy between the two translators was corrected in discussion between the translators and authors of this paper. This back and forth translation was rechecked by research experts and senior researchers to keep the consistency of the questionnaire. All the questions were developed in considering prevention and control methods of intestinal parasitic infestations.
Assessment of maternal knowledge, attitude, and practice
In assessing the KAP of mothers, a validated questionnaires were used. The questionnaires had three sections. The first section was about mother’s knowledge. The knowledge questionnaires were 5 and have multiple alternatives to be selected by mothers. Thus, mothers were expected to select at least one correct answer to be knowledgable for that question. The second and third section of the questionnaire was about mother’s attitude, and their practice in preventing and controlling IP infection on their under five years old children. The attitude questioners were 7, and that of the practice questionnaires were 11. In all of these sections, mothers were asked about types of intestinal parasites, mode of transmissions, sign and symptoms of intestinal parasitic infections, methods of prevention and control, and complications of IP. All mothers were interviewed in their local language using closed-ended questions. The data collectors selected from the study area and collected the data under the supervision of the researchers.
Inclusion criteria: mothers with their children, whose age was between 2 and 6 years and lives in Sekota town for at least 6 months were included.
Exclusion criteria: Mother-child pairs who were not lived in Sekota town for 6 months, and mothers who had serious illness were excluded.
Data analysis
The data were entered into epi-data version 4.2.0.0 and transferred to SPSS version 23 software for analysis. Frequency and percentiles were used to summarize the descriptive statistics of the data. The level of maternal knowledge, attitude and practice were reported as percentage and presented in tables and graph. A bivariate correlation were undertaken to assess the relation of total knowledge, attitude, and practice scores. The knowledge questions’ scoring methods were performed as per Guttmann Scale. While entering and analyzing the data of knowledge, unfavorable options got 1 point if mothers don’t know the correct answers, and 0 point was assigned for correct answers according to Guttmann scale grading scheme. Those five questions have multiple options. From these multiple options, 1 is for the option “I don’t know” and 0 is for all other list of options. Participants who list one and above correct answers among the given alternatives got 0 point. Therefore, the highest and lowest score are 5 and 0 points. The data of attitude was acquired using a questionnaire containing 7 questions where the point were worth 4 if it was “Extremely disagree”, 3 points if it was “Disagree”, 2 points if it was “Extremely agree”, and 1 point if it was “Agree” (Likert Scale). Thus, the highest score would be 28 points and the lowest score would be 7 points. A group of positive and negative attitude was categorized based on the median value. The data of practice was got using 11 “yes” and “no” ordinary questionnaires where the highest and lowest scores were 11 and 0 points (Ordinal Scale) respectively. The data was recored as 0 when the respondents answer was no, and 1 if otherwise.
Data quality
For every step of data collection, analysis, and management a standard operational procedures (SOP) were followed. The questionnaire was pretested on 5% (20 mothers) of the sample in Woldia town, Amhara region, Ethiopia. The questionnaires used to generate data on the socio-demographic data, knowledge, attitude and practice were validated before the data collection period. The data was checked for its completeness every evening of the data collection day by all investigators and data collectors. The data collectors were taking one-day refreshment training.
Operational definitions
Preschool children: Children whose age was between their first day of year 2, and completed 5 years but not attending their 6 years of birthday.
Intestinal parasites: A microorganism that can infect gastrointestinal tracts of the human body.
Attitude: Mothers’ opinion or thought about intestinal parasitic infection, its sign and symptoms, prevention and control methods, complication, and other related factors
Positive attitude: Mothers who responded below the median value for attitude questions, in which the median value was 15 in this study
Negative attitude: Mothers who responded above the median value for attitude questions, in which the median value was 15 in this study
Knowledge: Assessment of what mothers described about intestinal parasitic infections, its prevention and control methods, complications, and other related factors.
Knowledgeable/good knowledge: Mothers who scored below the median value for knowledge questions, in which the median value was 2 in this study
None knowledgeable/poor knowledge: Mothers who scored above the median value for knowledge questions, in which the median valu was 2 in this study
Practice: Assessment of mother’s actual activities to prevent and control intestinal parasitic infections in their home and out of home.
Good Practice: Mothers who scored above the median value for practice questions, in which the median value was 14 in this study
Poor Practice: Mothers who scored below the median value for practice questions, in which the median value was 14 in this study
Kebelle: The smallest administrative unit of Ethiopia. A kebele is expected to consists at least five hundred families, or the equivalent of 3,500 to 4,000 persons.