Intestinal parasitic infections (IPI) are one of the most common diseases and resulted in widespread morbidity starting from early times of human history. The eggs of certain intestinal worms were recovered from mummified feces of humans dating back thousands of years(1). These days intestinal parasites, mostly of soil transmitted helminthiasis, affect nearly a third of global population and it severely affects underprivileged populations of developing countries where poverty, undernutrition, inadequate sanitation and lack of clean drinking water prevails(2,3). In 2010, an estimated 438.9 million people were infected with hookworm, 819.0 million with A. lumbricoides, 464.6 million with Trichuris Trichuria and these parasites inflicted nearly 5 million years lived with disability in the world(4).
Intestinal parasitosis refers to a group of diseases caused by one or more species of protozoa, cestodes, trematodes and nematodes. These parasites are responsible for the major share of morbidity and mortality in those communities where there is over-crowding, poor environmental sanitation and personal hygienic practices, which make them a great concern for the developing countries. The greatest burnt of the disease is shared by children aged 12–14 years.(2) Factors ranging from water, sanitation and hygiene to weak health service delivery to populations at risk of infections were major reasons for persistence of these diseases in the community(5).
The effect of this group of disease is mainly manifested as a chronic and insidious effect on health and quality of life, while intense infection can result in developmental faltering, poor growth and poor school performance(2). Studies indicate that children with heavy intestinal parasitic infection have lower body mass index, lower hemoglobin levels and are often stunted(6).Some studies also revealed that children with heavy parasitic infection to have poor anthropometric indices, growth retardation, poor cognitive development, chronic inflammatory diseases and life threatening surgical conditions. Furthermore, the chemotherapeutic treatment of the intestinal parasites resulted in improved physical, motor and language development(7–9).
The effect of intestinal parasitic infection on health of infected children is found to depend on the status of the children. Children with underlying nutritional problems and other health conditions are more likely to suffer from the brunt of the diseases and develop morbidities(10).
World Health Organization(WHO) strives to eliminate the soil transmitted helminths and schistosomiasis(STH) as public health problems by providing chemotherapeutic treatments to Pre-school age children(PSAC), school age children(SAC), women of reproductive age and adults with increased risk of developing morbidity through annual and bi annual distribution of chemotherapeutic agents. The frequency of mass drug administration(MDA) depends on the initial prevalence of the disease(2). The government of Ethiopia has also started implementing the MDA since 2013(11).
According to WHO, three quarters of children with intestinal worms requiring chemotherapy are in South East Asia and African regions. In Africa only, nearly three hundred million preschool age and school age children require preventive chemotherapy; this figure accounts for 30% of the global chemotherapy requirement(2).
In Ethiopia the prevalence of intestinal worms among school aged children ranged from 20% to 100% with the highest percentage in wet and humid central areas while the prevalence is found to be limited in arid and dry areas of the country. In Ethiopia intestinal parasites are endemic in 329 districts with about 6,545 Kebeles and 11,410 schools(11).
Street children are defined by the United Nations as “boys and girls for whom ‘the street’ (including unoccupied dwellings, wasteland, etc.) has become their home and/or source of livelihood, and who are inadequately protected or supervised by responsible adults.” Additionally, the organization categorizes “street children” as either children on the street, who worked on the street and went home to their families at night and children of the street, who lived on the street, were functionally without family support who lived completely on their own(12).
There are wide controversies concerning the reliable estimate of the number of the street children around the world. The widely contested claim of the United Nations International Children’s Fund (UNICEF) stating the figure at 100 million is now rendered baseless and currently the estimate is stated in the area of tens of millions with rapidly increasing pattern due to a rapidly urbanizing and growing global population. Together with increasing inequalities and migration, studies suggest that numbers are generally increasing, including in richer regions. Studies suggest factors like war, HIV/AIDS, economic and social disintegration, family separation and abuse for increasing pattern of the number of the street children(12,13).
The precise estimate of number of street children in Ethiopia is also controversial. In 2007 the ministry of Labor and Social Affairs conducted a study that is supported by the UNICEF and estimated the overall number of children on or off the street at around 150,000 with about 60,000 living in the capital. The recent estimates of the number of street children as 500,000–700,000 is roughly five times higher than the report in 2007 and approaches two to three times the population of Jimma town(14).
Several studies indicated that street children are disproportionately affected with range of diseases and health problems including parasitic infections, infestations, other infectious diseases, unintentional injuries, violence, abuse by older adults and police officers, substance abuse, malnutrition, sexually transmitted diseases, other reproductive and mental health problems. In all categories of infection fulltime street residents are far greatly affected than those on the street children(15–18).
Despite the wide-ranging health problems of the street children, only few studies are conducted to quantify the situation in Ethiopia on this segment of population and especially limited when it comes to the issue of intestinal parasitic infections. Most studies conducted to assess the prevalence of intestinal parasites in Ethiopia are conducted in institutions like schools. Some studies that are conducted to assess the prevalence of these diseases in Ethiopia are also carried out among the overall street residents and some on street beggars and not specifically on street children. This shows the paucity of information on the prevalence and factors associated with intestinal parasitic infections on street children, a group of children that are most likely to suffer from these conditions than adults and even than supervised children.
Accordingly, the objective of this study was to assess the prevalence and factors associated with intestinal parasitic infections among street children to bridge the knowledge gap and provide the rationale to reconsider the ongoing intervention modalities in the way that this segment of population will also be included.