Prevalence of Necator americanus infection and risk factors among school-age children in Mirab Abaya District, South Ethiopia

Hemoglobin Level and Risk of Anemia in Soil-Transmitted Helminths Infections among Children: A Systematic Review and Meta-analysis

Introduction. Soil Transmitted Helminthiasis (STH) is a Neglected Tropical Disease with almost 25% world population infected. Children were vulnerable to infection with morbidities affecting growth. STH infection alters children nutritional status which potentially causing anemia. Meta-analysis relating STH infections to hemoglobin (Hb) level and risk of anemia in children is limited. Aim. To compare hemoglobin levels and risk of anemia in children infected and uninfected with STH. Methods. Meta-analysis conducted from journals obtained from Pubmed, ScienceDirect, WileyLibrary, Cochrane, EBSCO, Proquest, DOAJ, and GoogleScholar from 2011-2021. Full text cross sectional studies on children with relevant topic is included, while unclear, inaccessible, or post interventional studies were excluded. Articles were analyzed in Review Manager 5.4 in mean difference (MD) and odds ratio (OR) with Confidence Interval (CI) of 95%. Result. Out of 25,683 articles in literature search, 29 were eligible for systematic review and meta-analysis. STH infection significantly decreases hemoglobin level (MD -0.2g/dL; p=0.02) and increases risk of anemia (OR 1.83; p<0.00001). Species analysis presented parallel result on Trichuris trichiura (MD -0.31g/dL; p=0.001 and OR 1.66; p=0.009), Hookworm (MD -0.56g/dL; p=0.02 and OR 3.3; p<0.00001), and multiple infection (MD -0.25g/dL; p=0.03 and OR 4.49; p=0.005). Ascaris lumbricoides didn’t show significance on hemoglobin level but comparable for risk of anemia (MD -0.16g/dL; p=0.17 and OR 1.57; p=0.001). Discussion. All STH infections exhibits lower hemoglobin level and higher risk of anemia caused by lower nutrition absorption and occult bleeding in gastrointestinal tract. Hookworm and multiple infections has the highest risk of anemia. Proportion of anemia may vary in studies and influenced by sociodemographic characteristics, but higher proportions occur in STH infected. Conclusion. Children infected with STH has lower hemoglobin level and in risk of anemia compared to uninfected children, hence further study is still needed to be conducted. Keywords: Anemia, Children, Hemoglobin, Infection, Soil Transmitted Helminths

Determinants of Helminthic Infections and Anemia among Schoolchildren in Bahir Dar Zuria District, Northwest Ethiopia

Background

Soil-transmitted helminths and Schistosoma mansoni are the major helminthic parasites that cause major public health problems among schoolchildren in developing countries. Infection with the above parasites decreases the hemoglobin level of children. However, information regarding the current status of helminthic infections and anemia is limited. Hence, this study aimed to assess the prevalence and determinants of helminthic infections and anemia among children.

Methods

A cross-sectional study was conducted among 394 schoolchildren at Sekelet primary school in northwest Ethiopia, from February to March 2017. Study participants were selected by a systematic random sampling technique. Stool samples were collected and processed via the modified Ritchie's concentration technique to detect parasites in stool. A HemoCue Hb 201 analyzer was used to determine the hemoglobin level. Data were analyzed using SPSS version 23 statistical software. Association of helminthic infections and anemia with independent variables was determined using logistic regression analysis. Variables with P < 0.05 were considered statistically significant.

Results

From the total of 394 participants, 185 (46.9%), 164 (41.6%), and 112 (28.4%) were infected with intestinal parasites, helminths, and STHs, respectively. The prevalence of hookworm and Schistosoma mansoni were 106 (25.6%) and 54 (13.7%), respectively. The prevalence of anemia among the schoolchildren was 278 (70.6%). Anemia was prevalent among 55 (51.9%) hookworm-infected and 19 (35.2%) S. mansoni-infected children. Not wearing shoes and improper utilization of latrine were significantly associated (P < 0.05) with hookworm infection, and frequent swimming in the river was also significantly associated (P ≤ 0.001) with Schistosoma mansoni infection. Schistosoma mansoni and hookworm infections were also significantly associated (P ≤ 0.001) with low levels of hemoglobin.

Conclusion

Hookworm and Schistosoma mansoni infections and anemia are highly prevalent among schoolchildren. Hookworm and Schistosoma mansoni infections are significantly associated with anemia. Therefore, helminthic detection and hemoglobin determination should be done simultaneously among schoolchildren.

Current status of intestinal parasitic infections and associated factors among primary school children in Birbir town, Southern Ethiopia

Background

Intestinal parasites still pose major public health problems in developing countries like Ethiopia. Local epidemiological data is indispensable in order to design and monitor prevention and control strategies. Therefore the present study aimed to assess the prevalence of intestinal parasitic infections and associated factors among students at Birbir town, Southern Ethiopia.

Methods

A school-based cross-sectional study was conducted from March to May 2018. Three hundred fifty-one students, who were selected by stratified followed by systematic random sampling, participated in the study. Socio-demographic information was collected using a structured questionnaire. Anthropometric measurements of height and weight were taken at the time of interview. Stool samples were collected and processed by direct wet mount and formol-ether concentration techniques for microscopic detection of intestinal parasites. Data was analyzed using SPSS version 20.

Results

Among 351 (180 male and 171 female) children participated, 135 (38.5%) and 216 (61.5%) were within the age groups of 5–9 and 10–14 respectively. Ninety five (27.1%; 95%CI: 22.2–31.9) of them were tested positive for intestinal parasites. Helminths and protozoa account 21.1 and 7.1% prevalences respectively. Seventy eight children were infected with a single parasite species while 17 were positive for double or triple infections. A. lumbricoides (31, 8.8%) was the most frequently detected parasite followed by T. trichiura (20, 5.7%) and hookworms (19, 5.4%). Age group of 10–14 years (AOR = 2.51; 95%CI: 1.41–4.45, p = 0.002) and absence of hand washing habit after toilet (AOR = 4.49; 95%CI: 2.00–10.1, p = 0.001) were significantly associated with intestinal parasitic infection.

Conclusions

The prevalence of intestinal parasitic infection among school age children is still unacceptably high. Age group of 10–14 year old and not having habit of hand washing after toilet were significantly associated with intestinal parasitic infection. The ongoing school based deworming should be strengthened and be integrated with school health programs.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-3879-5) contains supplementary material, which is available to authorized users.

Multivariate analysis of factors associated with Schistosoma mansoni and hookworm infection among primary school children in rural Bahir Dar, Northwest Ethiopia

BACKGROUND

Soil-transmitted helminths and Schistosoma mansoni infections are the major causes of morbidity and mortality in Sub-Saharan countries. The highest burden of the disease resides in school-age children. Poor water sanitation and hygiene are believed to be the major contributing factors for the high prevalence. Therefore, the goal of this study was to determine the prevalence of intestinal parasite infections in rural Bahir Dar, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted from April 2017-June 2017 among 409 randomly selected primary school children. A structured questionnaire was used to obtain socio-demographic information and determinant factors through interviewing the students. Stool examination was done by Ritchie's concentration method. The data were entered and analyzed using SPSS version 22. Prevalence of helminthic infections was calculated using descriptive statistics. The association between helminthic infection and determinant factors was determined by Bavarian regression. The confounding effect was checked by multivariate regression at 95% confidence interval. Any association was significant when the p-value was < 0.05.

RESULT

The overall prevalence of intestinal parasite infection was 47.2%.(193/409).. The prevalence of Hookworm species and Schistosoma mansoni was 31.1 and 8.0%, respectively. Co-infection of Hookworm species with Schistosoma mansoni was 5.1% (21/409). The highest prevalence of Schistosoma mansoni was recorded for boys (21%), older children (21.4%) and rural children (17.6%) (P < 0.05). Schistosoma mansoni infection was also higher among children whose household drinking water was sourced from streams/rivers (P < 0.05). The multivariate analysis showed lower odds of Schistosoma mansoni infection for those with no history of bathing (AOR = 3.7, 95% CI: 1.1-12.2; P = 0.034), washing clothes/utensils (AOR = 3.4; 95% CI: 1.2-9.7; P = 0.022), swimming (AOR = 2.8, 95% CI: 1.2-6.9; P = 0.023), and irrigation (AOR = 2.8, 95% CI: 1.3-6.0; P = 0.01). Significantly, higher odds of Hookworm infection was recorded for older children (AOR = 2.3, 95% CI: 1.08-4.89; P = 0.029), boys (AOR = 1.9, 95% CI: 1.12-3.24; P = 0.018), and rural children (AOR = 1.8, 95% CI: 1.04-3.0; P = 0.037). Regular shoe wearing (AOR = 0.29, 95% CI: 0.16-0.50; P = 0.00) is protective for hookworm infection. Higher odds of hookworm infection was also recorded for schoolchildren who had the habit of eating raw vegetables (AOR = 1.2 95% CI: 1.1-1.7 P = 0.011).

CONCLUSION

Hookworm infection and schistosomiasis are prevalent in the school children in rural Bahir Dar in Northwest Ethiopia. Various activities and behaviors of the children were strongly associated with helminthic infection. Hence health education should be delivered regularly to minimize/avoid the risky behaviors and water-based activities. Deworming programs should also be implemented on a regular basis.

Sanitation, hookworm, anemia, stunting, and wasting in primary school children in southern Ethiopia: Baseline results from a study in 30 schools

Background

Inadequate nutrition; neglected topical diseases; and insufficient water, sanitation, and hygiene (WASH) are interrelated problems in schools in low-income countries, but are not routinely tackled together. A recent three-year longitudinal study investigated integrated school health and nutrition approaches in 30 government primary schools in southern Ethiopia. Here, we report on baseline associations between sanitation, hookworm infection, anemia, stunting, and wasting.

Methods

In each school, the Schistosoma mansoni, S. haematobium, and soil-transmitted helminth infection intensities; blood hemoglobin concentrations; heights; and weights of approximately 125 students were assessed. Of these 125 students, approximately 20 were randomly selected for student WASH surveys. Of these 20, approximately 15 were randomly selected for household sanitation observations. School WASH was also assessed through a combination of observations and questions to the headteacher. Mixed-effects logistic regression was used to compare household sanitation with hookworm infection (the other parasites being much less prevalent); and hookworm infection with anemia, stunting, and wasting.

Findings

Blood, stool, and urine samples were provided by 3,729 children, and student WASH and household WASH surveys were conducted with 596 and 448 of these students, respectively.

Hookworm, Ascaris lumbricoides, Trichuris trichiura, and S. mansoni infections had prevalences of 18%, 4.8%, 0.6%, and 0.3%, respectively, and no S. haematobium infections were found. Anemia, stunting, and wasting had prevalences of 23%, 28%, and 14%, respectively.

No statistically significant associations were found between latrine absence or evidence of open defecation at home, and hookworm infection (adjusted odds ratio, OR = 1.28, 95% confidence interval, CI: 0.476–3.44; and adjusted OR = 1.21, 95% CI: 0.468–3.12; respectively); or between hookworm infection and anemia, stunting, or wasting (adjusted OR = 1.24, 95% CI: 0.988–1.57; adjusted OR = 0.992, 95% CI: 0.789–1.25; and adjusted OR = 0.969, 95% CI: 0.722–1.30; respectively).

Conclusions

In this setting, no statistically significant associations were found between sanitation and hookworm; or between hookworm and anemia, stunting, or wasting. More evidence on best practices for integrated school health interventions will be gathered from the follow-up surveys in this study.

It is thought that inadequate sanitation may exacerbate hookworm transmission, and that hookworm infection may give rise to health problems including anemia, stunting, and wasting. Integrating monitoring of, and interventions against, these problems may yield significant cost savings. Such integrated interventions should be guided by both evidence of the relationships between the various health problems, and examples of optimally effective integration. Here, we present baseline findings from a three-year longitudinal study investigating combined school feeding; school water, sanitation, and hygiene (WASH); and deworming interventions in 30 primary schools in southern Ethiopia. In particular, we compare household sanitation, hookworm infection, and anemia, stunting, and wasting, in the schoolchildren. None of these associations were found to be statistically significant (although hookworm infection was associated with borderline statistically significantly higher odds of anemia; P = 0.06). The lack of significant associations may be due to the low intensities of the hookworm infections in this setting, poor conditions of latrines reducing their impact on hookworm transmission, and other factors such as malaria and inadequate diet causing anemia, stunting, and wasting.