Prevalence of intestinal parasitic infections and associated risk factors among pregnant women attending antenatal care center at Felege Hiwot Referral Hospital, northwest Ethiopia

Soil-transmitted helminths and associated factors among pregnant women in Doreni district, Oromia region, Ethiopia: a cross-sectional study

BACKGROUND

Soil-transmitted helminthiasis (STH) refers to a set of parasitic illnesses caused by nematode worms and spread to people through faeces-contaminated soil. It is highly prevalent in low- and middle-income countries due to a lack of environmental sanitation and personal hygiene. Pregnant women are among the risk groups for infection by soil-transmitted helminths. Former studies of the disease burden among pregnant women in Ethiopia didn't indicate the intensity of parasitic infection. The aim of this study was to assess the prevalence and associated factors of soil-transmitted helminths among pregnant women.

METHODS

An institution-based cross-sectional study was conducted among 416 randomly selected pregnant women. The data were collected using a structured interview-administered questionnaire and a laboratory test. The Kato-Katz technique was used to diagnose soil-transmitted helminthiasis and determine the intensity of the infection. The collected data were entered into Epi-Data version 4.6 and exported to SPSS version 25 for analysis. Multivariate logistic regression analysis was used to identify independent predictors of soil-transmitted helminths at a p-value < 0.05.

RESULTS

The overall prevalence of soil-transmitted helminths among pregnant women was 30%. (95%, CI: 26-34%). Living in a rural area (AOR = 3.35; 95% CI = 1.83-6.13), drinking from an unprotected water source (AOR = 2.52; 95% CI = 1.45-4.37), not washing one's hand after the toilet (AOR = 2.75; 95% CI = 1.55-4.88), lacking health information (AOR = 1.70; 95% CI = 1.01-2.85), working as a daily labourer (AOR = 2.88; 95% CI = 1.01-8.20), and walking barefoot (AOR = 4.00; 95% CI = 2.29-7.00) were significantly associated with the presence of soil-transmitted helminths among pregnant women.

CONCLUSION

The prevalence of STH was significantly moderate in the study area, where pregnant women were mostly affected by ascariasis and hookworms. Living in a rural area, being a daily labourer, walking barefoot, not washing hands after the toilet, drinking from an unprotected water source, and lacking health information were the determining factors. Interventions including health education, the expansion of pure drinking water sources, the promotion of personal hygiene, and the wearing of shoes are recommended to reduce the burden of soil-transmitted helminths in the study area.

Parasitism in viviparous vertebrates: an overview

The reproductive mode of viviparity has independently evolved in various animal taxa. It refers to the condition in which the embryos or young develop inside the female's body during gestation, providing advantages such as protection, nutrition, and improved survival chances. However, parasites and diseases can be an evolutionary force that limit the host's resources, leading to physiological, morphological, and behavioral changes that impose additional costs on both the pregnant female and her offspring. This review integrates the primary literature published between 1980 and 2021 on the parasitism of viviparous hosts. We describe aspects such as reproductive investment in females, offspring sex ratios, lactation investment in mammals, alterations in birth intervals, current reproductive investment, variations between environments, immune system activity in response to immunological challenges, and other factors that can influence the interaction between viviparous females and parasites. Maintaining pregnancy incurs costs in managing the mother's resources and regulating the immune system's responses to the offspring, while simultaneously maintaining an adequate defense against parasites and pathogens. Parasites can significantly influence this reproductive mode: parasitized females adjust their investment in survival and reproduction based on their life history, environmental factors, and the diversity of encountered parasites.

Prevalence and risk factors of intestinal parasitic infections among pregnant women in Taiz Governorate, Yemen: A hospital-based study

Background

Intestinal parasitic infections in pregnant women have been associated with severe adverse outcomes such as anemia, low birth weight, and mother and fetus morbidity and mortality. This study aimed to determine the prevalence of intestinal parasitic infection and its associated risk factors among pregnant women in Taiz, Yemen.

Methods

A cross-sectional study was conducted between July 2022 and January 2023. Sociodemographic and other explanatory variables were obtained via face-to-face interviews using a structured questionnaire. The wet-mount and formol-ether concentration techniques were applied to identify the IPIs. Data were analyzed using SPSS, version 20, and p-values < 0.05 were considered statistically significant. An analysis of descriptive statistics and multivariate logistic regression was conducted. A p-value < 0.05 was deemed statistically significant. The study included a total of 393 pregnant women.

Results

Of the 393 pregnant women screened for intestinal parasites, 144 (36.6 %) had at least one parasite. The most common intestinal parasite was Giardia lamblia (12.2 %), followed by Ascaris lumbricoides (10.9 %), Entamoeba histolytica/dispar (7.4 %), Enterobius vermicularis (14.3 %), and Hymenolepis nana (1.8 %). Being a farmer (AOR = 2.7, 95% CI: 1.69-4.26, p = 0:003) and drinking from unsafe water wells, streams, rain, and dams (AOR = 2:6, 95% CI: 1.68-4.25, p ≤ 0:001) were significantly associated with IPIs.

Conclusion

Pregnant women in the study area still face a severe health burden due to intestinal parasitic infection. Therefore, it is recommended that health education should be improved, and safe tap water should be provided to pregnant women to reduce the incidence of IPIs.

Burden of intestinal parasitic infections and associated factors among pregnant women in East Africa: a systematic review and meta-analysis

BACKGROUND

The ultimate goal of preventing intestinal parasites among pregnant women is to reduce maternal and newborn morbidity and mortality. Numerous primary studies were conducted in East Africa presented intestinal parasite infection and associated factors among pregnant women. However, the pooled finding is not known. Therefore, this review aimed to identify the pooled prevalence of intestinal parasite infection and its determinants among pregnant women in East Africa.

METHODS

Articles published from 2009 to 2021 were searched in PubMed, Web of Science, EMBASE, and HINARI databases. The search for unpublished studies such as thesis and dissertations was checked in Addis Ababa University and Africa Digital Library. PRISMA checklist was used to report the review. Articles published in the English Language were considered. The data were extracted by two authors using data extraction checklists on Microsoft excel. Heterogeneity among the included studies was checked using I² statistics on forest plots. Sensitivity and sub-group analyses were conducted to assess the presence of primary studies, and study characteristics responsible for the observed heterogeneity.

RESULTS

Of the 43 identified articles, about 23 articles were removed due to duplications. Then, by assessing the abstracts and full texts, four articles were removed because they failed to meet the eligibility criteria. Finally, 16 articles were included in the systematic and meta-analysis.The pooled prevalence of intestinal parasites among pregnant women in East Africa was 38.54 (28.77, 48.32). In this study, variables like residing in rural areas (OR: 3.75; CI: 1.15,12.16), availability of latrine(OR: 2.94; 95% CI: 2.22, 3.91), eating raw fruits/vegetables (OR: 2.44; 95% CI: 1.16, 5.11). and sources of water as unprotected sources (OR: 2.20; 95% CI: 1.11,4.35) show statistically significant association with the increased burden of intestinal parasites among pregnant women.

CONCLUSION

The burden of intestinal parasite infection among pregnant women in East Africa was high. Therefore, efforts should be made in deworming pregnant women at the community and institutional level by stakeholders to reduce the burden of intestinal parasite infections and related complications.

The epidemiology of Schistosoma mansoni in the Lake Tana Basin (Ethiopia): Review with retrospective data analyses

Schistosoma mansoni is one of the major waterborne diseases grouped underwater based Neglected Tropical Diseases in Africa. In Ethiopia, the Lake Tana Basin has favorable environment (temperature and water) for S. mansoni transmission. The prevalence of S. mansoni varies among regions based on environmental conditions and human water contact. Therefore, this review was conducted to identify hot spots districts and determine the prevailing S. mansoni prevalence in the Lake Tana Basin. Research articles published in English in the last 65 years were searched from Google scholar, PubMed, and Web of science. In addition, four-year S. mansoni data that were reported in health care facilities were extracted from health management information system in 61 districts of the Lake Tana Basin. In total, 43 research articles on S. mansoni that met the inclusion criteria and were published between 1957 and 2022. Over 98% of the articles were cross-sectional studies, while five articles addressed malacological studies. Among 61 districts, 19 (31%) were identified as hotspot districts for S. mansoni infection in the Lake Tana Basin. S. mansoni prevalence and the abundance of its host snail showed spatial and seasonal variations. On average 2000 school children/year attended health care facilities for S. mansoni infection. Swimming habits [adjusted odds ratio (AOR) = 3.2, p = 0.030], irrigation practice (AOR = 3:09, p ≤ 0.001), fishing (AOR = 2:43, p = 0.005) and being male (AOR = 1.74, p = 0.002) were risk factors for contributing to S. mansoni infection. This study showed the spatial and seasonal variations of S. mansoni prevalence and its endemicity in the hottest lowland areas of the Lake Tana Basin. The research articles on S. mansoni had poor geographical coverage. Malacological studies on water bodies, assessments on knowledge and attitude in the community towards S. mansoni transmission are areas of future studies.

Nutritional factors for anemia in pregnancy: A systematic review with meta-analysis

Background

Anemia in pregnancy is a serious threat to maternal and child health and is a major public health problem. However, the risk factors associated with its incidence are unclear and controversial.

Methods

PubMed, Ovid Embase, Web of Science, and Cochrane databases were systematically searched (inception to June 27, 2022). The screening of search results, extraction of relevant data, and evaluation of study quality were performed independently by two reviewers.

Results

A total of 51 studies of high quality (NOS score ≥ 7) were included, including 42 cross-sectional studies, six case-control studies, and three cohort studies. Meta-analysis showed that infected parasite, history of malarial attack, tea/coffee after meals, meal frequency ≤ 2 times per day, frequency of eating meat ≤ 1 time per week, frequency of eating vegetables ≤ 3 times per week, multiple pregnancies, multiparous, low household income, no antenatal care, rural residence, diet diversity score ≤ 3, have more than 3 children, history of menorrhagia, underweight, family size ≥ 5, middle upper arm circumference < 23, second trimester, third trimester, birth interval ≤ 2 year were all risk factors for anemia in pregnancy.

Conclusions

Prevention of anemia in pregnancy is essential to promote maternal and child health. Sufficient attention should be paid to the above risk factors from the social level and pregnant women's own aspects to reduce the occurrence of anemia in pregnancy.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022344937.

Prevalence and Associated Risk Factors of Human Intestinal Helminths Parasitic Infections in Ethiopia: A Systematic Review and Meta-Analysis

Background

Intestinal helminth infections are still public health problems in tropical and subtropical countries including Ethiopia. This review and meta-analysis aimed to produce the pooled prevalence and associated risk factors of human intestinal helminth parasitic infections (HIHPIs) in Ethiopia.

Methods

Articles written in English were searched from online databases. Sixty-seven studies were included. Meta-analysis was computed using STATA version 14.

Result

The pooled prevalence of HIHPIs was (33.35%, 95% CI: 28.85%, 37.86%). Ascaris lumbricoides (10.84%, 95% CI: 9.34, 12.34), hookworm spp. (8.89%, 95% CI: 7.75, 10.04), Schistosoma mansoni (4.22%, 95% CI: 3.64, 4.81), Trichuris trichiura (2.51%, 95% CI: 2.17, 2.86), Hymenolepis nana (2.29%, 95% CI: 1.96, 2.63), Taenia species (1.01%, 95% CI: 0.80, 1.22), Strongyloides stercoralis (1.17%, 95% CI: 0.92, 1.41), and Enterobius vermicularis(0.71%, 95% CI: 0.52, 0.90) were recorded. Handwashing before food (OR: 5.22,95% CI: 3.49, 6.94), handwashing after toilet (OR: 3.03, 95%; CI: 1.01, 5.05), age (OR: 1.66, 95% CL. 1.09, 2.23), open defecation (OR: 2.42, 95% CI: 1.60, 3.24), eating raw and unwashed vegetables/fruits (OR: 1.98, 95%; CI: 1.30, 2.66), maternal education (OR: 1.81, 95% CI: 0.91, 2.72), family income (OR: 2.00, 95% CI: 0.87, 3.31), source of drinking water (OR: 3.12, 95% CI: 1.96, 4.27), swimming/contact with river water (OR: 1.90, 95% CI: 1.11, 2.69), barefoot (OR: 3.28, 95% CI: 1.67, 4.88), playing with soil (OR: 2.64, 95% CI: 1.40, 3.88), and family size (OR: 3.75, 95% CI: 2.03, 5.46) were factors associated with HIHPIs in Ethiopia. High heterogeneity of the prevalence of HIHPIs was observed among the studies within and among regions (I2 > 99.6% and P ≤ 0.001).

Conclusion

HIHPIs in Ethiopia were significantly high. Therefore, special attention should be given by all stakeholders to minimize HIHPIs in Ethiopia.

Prevalence of Intestinal Parasite Infections and Associated Factors among Pregnant Women in Northwest Ethiopia

Background

Intestinal parasite infections are among the most common infections worldwide. They pose a high burden in pregnant women in developing countries causing maternal anemia, low birth weight, and prenatal mortality. This study is aimed at assessing intestinal parasite infection prevalence, species diversity, and associated factors among pregnant women.

Methods

A community-based cross-sectional study was conducted among pregnant women in Debre Elias district from March 2021 to July 2021. Three hundred sixty-three study participants meeting the inclusion criteria were enrolled for the study, and all submitted the required amount and quality of stool specimen. Immediately after collection, macroscopic (gross) and microscopic (saline wet mount) examination of stool sample was performed to detect and identify intestinal parasites. The generated data were checked for completeness, coded, entered, and analyzed using SPSS version 20.0 (SPSS Inc., Chicago, 2011) software. Binary logistic regression was applied to show significant association between dependent and independent variables. Statistically significant association was declared at a P value of < 0.05.

Result

Of the study participants screened for intestinal parasite, 43.5% (158/363) were infected with at least one intestinal parasite. From the total positives, 40.5% (147/363) were mono and 3.0% (11/363) were double infections. Five intestinal parasite species were recorded, of which hookworm was the predominant, (65.2%, 103/158) followed by E. histolytica/dispar (12.7%, 20/158) and G. lamblia (11.4%, 18/158). Ascaris lumbricoides and Taenia species comprised the least percentage (1.9%, 3/158 each). Source of drinking water and occupation were identified as significant factors associated with intestinal parasite infection. Farmer pregnant women were 6.41 times (AOR = 6.41, 95% CI: 1.05-39.16; P = 0.034) more likely to be infected by intestinal parasites than their counterparts. Pregnant women who drank tape water were 0.52 times less (AOR = 0.52, 95% CI: 0.30-0.88; P = 0.017) likely to be infected by intestinal parasites.

Conclusion

Intestinal parasite infections remained a serious health burden to pregnant women in the study area with the dominance of a hematophagous worm (hookworm). Community-based intestinal parasite screening and treatment are essential to alleviate the burden caused by intestinal parasite infections.

Prevalence of Intestinal Parasitic Infections and Their Associated Risk Factors among Pregnant Women Attending Antenatal Care Center at Woreilu Health Center, Woreilu, Northeast Ethiopia

Background

Intestinal parasitic infections (IPIs) affect millions of pregnant women worldwide and if left untreated can cause adverse effects for mothers, fetuses, and newborns. This study was aimed at determining the prevalence and associated risk factors of intestinal parasitic infections among pregnant women in Woreilu, Northeast Ethiopia.

Methods

A cross-sectional study was conducted in Woreilu Health Center from October 2018 to February 2019. A convenient sampling technique was used to select the study subjects. The data related to the sociodemographic information and associated risk factors were collected by the interview technique, and fresh stool samples were collected from each pregnant woman. The microscopic examination of the stool samples was done by using direct wet mount preparations in normal saline and formol ether concentration techniques. Descriptive statistics and binary logistic regression were used. A p value < 0.05 was taken as statistically significant.

Results

A total of 331 pregnant women were included. The mean ± standard deviation of age of the participants was 26.3 ± 5.96 years ranging between 16 and 43 years. The overall prevalence of IPIs was 144 (43.5%) with the predominance of E. histolytica/dispar (44.4%) followed by A. lumbricoides (15.7%). Being a student (AOR = 3.35, 95% CI: 1.01-11.09, p = 0.047), second trimester (AOR = 3.94, 95% CI: 1.46-10.64, p = 0.007), third trimester (AOR = 3.32, 95% CI: 1.15-9.6, p = 0.027), and using spring water for drinking (AOR = 2.91, 95% CI: 1.62-5.22, p ≤ 0.001) were significantly associated with IPIs.

Conclusion

The prevalence of IPIs was high in this study. Being a student, second and third trimester, and using spring water for drinking were associated factors with IPIs. Therefore, improving the sanitation of the students and providing clean drinking water for the women should be strengthened. Screening women and providing health education during their antenatal care (ANC) visits are also recommended.

Prevalence of Intestinal Parasitic Infections and Associated Risk Factors among Pregnant Women Attending Prenatal Care in the Northwestern Ethiopia

Intestinal parasitic infections (IPIs) are the common health problems in developing countries with low socioeconomic and poor living conditions. IPIs affect millions of pregnant women worldwide and may lead to adverse maternal and fetal effects. The present study was aimed at determining the prevalence and associated risk factors of IPIs among pregnant women in Ethiopia. A hospital-based cross-sectional study involving 384 pregnant women was conducted from November 2018 to March 2019. Relevant information on potential risk factors associated with IPIs was gathered using a semistructured questionnaire. Stool samples were collected and examined using wet mount and formol-ether concentration techniques. Logistic regression was used to evaluate the possible association between dependent and independent variables. The overall prevalence of IPIs was 36.7%. Seven species of parasites were identified. The most prevalent intestinal protozoan parasite identified was Entamoeba histolytica/dispar (9.6%) followed by Giardia intestinalis (8.9%). The predominant helminth parasite identified was Ascaris lumbricoides (8.6%), followed by hookworm (5.2%), Taenia spp. (3.6%), Strongyloides stercoralis (1.3%), and Schistosoma mansoni (1.04%). Six pregnant women (1.56%) had infection by two parasite species. The odds of IPIs were higher among illiterates (AOR = 4.63), lowest monthly income earners (AOR = 3.49), primigravida (pregnant for the first time) (AOR = 2.04), those who used unboiled well/stream/river water for drinking (AOR = 14.55), ate soil (AOR = 2.32), and consumed raw vegetables (AOR = 1.91). The prevalence of IPIs in the study subjects was substantially high. Thus, screening of the women for IPIs and providing health education during their antenatal care (ANC) visit are recommended to prevent possible adverse maternal and fetal effects resulting from these infections.

Prevalence of Soil-Transmitted Helminthes and Associated Risk Factors Among People of Ethiopia: A Systematic Review and Meta-Analysis

Background:

A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.

Objective:

This systematic review and meta-analysis aimed to determine the overall prevalence of STH infections in Ethiopia.

Methods:

Articles written in English were searched from online public databases. Searching terms taken separately and jointly were “prevalence,” “soil-transmitted helminths” “nematode,” “Geo-helminths,” “roundworm,” “Necator,” “Ancylostoma,” “Ascaris,” “Trichuris,” “hookworm,” “whipworm,” “ S. strecoralies,” “associated factors,” and “Ethiopia.” We used STATA version 14 for meta-analysis and Cochran’s Q test statistics and the I2 test for heterogeneity.

Result:

From 297 reviewed articles 41 fulfilled the inclusion criteria. The pooled prevalence of STH infections in Ethiopia was 36.78% Ascaris lumbricoides had the highest pooled prevalence 17.63%, followed by hook worm12.35%. Trichuris trichiura 7.24% when the prevalence of S. strecoralies was 2.16% (95% CI: 0.97-3.35). Age, sex, residence, family education level, lack of shoe wearing habits and open defecation were identified as risk factors for STH infection. Eating unwashed and uncooked fruit and vegetables increased the risk of STH infection by 1.88 times while untrimmed finger nail and lack of hand washing habits increase the risk of STH infection by 1.28 and 3.16 times respectively with 95% CI.

Limitation:

Lack of published studies from Afar, Gambela, Somali, and Benshangul gumuz regions may affect the true picture. The other limitation is that the search strategy will be restricted articles published only in the English language but there might be articles that published using another language.

Conclusion:

Ascaris lumbricoides, hookworms and Trichuris trichiura, are the most prevalent soil-transmitted helminthes infections in Ethiopia. Age, sex, residence, family education level, lack of shoe wearing habits Open defecation untrimmed finger nail and lack of hand washing habits significantly associated with STH infection. When eating unwashed, uncooked fruit and vegetables were not significantly associated with STH infection. Strategic use of anti-helminthic, health education, and adequate sanitation, taking into account this epidemiologic information is helpful in the control of STH infections in Ethiopia.

Magnitude of Intestinal Parasite Infection and Associated Factors Among Pregnant Women Attending Antenatal Care Service in Shewarobit Town Health Facilities, North Shoa Zone, Amhara Region, Ethiopia

Introduction

Intestinal parasites are the most common infectious gastrointestinal parasites in developing countries including Ethiopia. Globally, it remains a public health problem by affecting 3.2 billion people, of which 10% were pregnant women. In Sub-Saharan Africa, pregnant women are the risky group next to children for this infection. This study aimed to assess the magnitude and associated factors of intestinal parasite infection among pregnant women.

Methods

Facility-based cross-sectional study was conducted among 365 pregnant women attending antenatal care service in Shewarobit town health facilities, North Shoa Zone, Amhara Region, Ethiopia. Data were collected using an interview questionnaire and laboratory microscopic stool examination from February 1, 2020, to March 30, 2020. Descriptive statistics and multivariable analyses were used to characterize the data and to identify the associated factors with the outcome variable at a p-value <0.05, respectively.

Results

A total of 347 (95.1%) pregnant women participated in this study. The magnitude of intestinal parasite infection was 27.7% during the study period. Among the parasites, G. lamblia and S. mansoni were the most prevalent identified parasites. Pregnant mother, who did not have handwashing practice after using the toilet [AOR: 3.89, 95% CI (1.86–8.13)], had a habit of walking on barefoot [AOR: 5.65, 95% CI (1.72, 18.56)], had uncooked food meal habit [AOR: 5.12, 95% CI (1.24, 21.14)], use of water in unimproved water source [AOR: 3.20, 95% CI (1.11–9.24)], lack of health education [AOR: 4.08, 95% CI (2.01–8.27)], and not dewormed [AOR: 3.09, 95% CI (2.01–7.94)] were predictors for parasitic infection.

Conclusion

High prevalence of intestinal parasite infection is observed in pregnant women. Personal hygiene practice, health education, and water quality were factors identified as contributors to intestinal parasite infection in pregnant women. Public health measures on water and environmental sanitation, health education for intestinal parasite infection and personal hygiene practices, and early deworming are vital to reduce the intestinal parasites’ infection and assure safe pregnancy.

Prevalence and Associated Risk Factors of Intestinal Parasitic Infections among Pregnant Women Attending Antenatal Care in Yifag Health Center, Northwest Ethiopia

Background

A cross-sectional study was conducted from November 2019 to March 2020 to determine the prevalence and associated risk factors of intestinal parasitic infections (IPIs) among pregnant women attending antenatal care (ANC) at Yifag Health Center.

Methods

The data were collected by a questionnaire interview technique and collecting the stool samples from each pregnant woman. Wet-mount and formol-ether concentration techniques were applied to identify the IPIs. Data were analyzed using SPSS, version 25, and P-values < 0.05 were considered statistically significant.

Results

Out of the total 280 pregnant women who were selected using a simple random sampling technique, 277 participated in the questionnaire survey and gave stool samples (a response rate of 98.9%). The prevalence of IPIs among pregnant women was 53.4% (95% CI: 47.37, 59.42). Taenia species (18.1%) was the predominant parasite followed by Giardia lamblia (12.6%), Entamoeba histolytica/dispar (9.4%), hookworms (9%), Ascaris lumbricoides (4%), Schistosoma mansoni (3.2%), Hymenolepis nana (0.7%), Strongyloides stercoralis (0.4%), and Enterobius vermicularis (0.4%). Eating raw vegetables (AOR = 2.721; 95% CI: 1.266, 5.849; P=0.010) and poor personal hygiene (AOR = 4.015; 95% CI: 1.456, 11.07; P=0.007) were associated risk factors for G. lamblia, while eating raw meat (AOR = 2.477; 95% CI: 1.252, 4.902; P=0.009) for Taenia species infections. The prevalence of intestinal parasites was high and still a health burden to the pregnant women in the study area. We recommend avoiding eating raw meat, strengthening sanitation and hygiene programs, and routine deworming of pregnant mothers to reduce the burden of IPIs among pregnant women.

Intestinal parasitic infections and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Intestinal parasitic infections (IPIs) are public health problems widely distributed in the world and cause significant morbidity and mortality; many of which occur among women of reproductive age. IPIs caused by helminthes and protozoan parasites are common among pregnant women. Data on the national pooled prevalence of intestinal parasites and associated factors during pregnancy is not documented well in Ethiopia. This review aims at summarizing evidences on the burden of IPIs and associated factors among pregnant women in Ethiopia.

METHODS

Published and unpublished studies were thoroughly searched at MEDLINE/PubMed, EMBASE, Google Scholar, CINAHL, Cochrane library and Science Direct. In addition, repositories of Addis Ababa, Gondar and Jimma Universities were searched. Eligible studies were selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The pooled prevalence of intestinal parasites and summary odds ratios (ORs) were determined with 95 % confidence intervals (CI). Sub-groups analyses were done based on study region, types of parasites, methods of stool examination and study setting. The statistical analyses were performed using STATA version 14.0 software.

RESULTS

Among 168 retrieved studies, 31 studies with a total population of 12,118 pregnant women were included. The estimated pooled prevalence of IPIs among pregnant women in Ethiopia was 27.32 % (95 % CI: 20.61, 33.87 %). In the subgroup analysis, Oromia and Amhara regions had the highest prevalence with a 29.78 % (95 % CI: 15.97, 43.60) and 29.63 % (95 % CI: 15.37, 43.89); respectively. In addition, studies conducted in the community showed higher prevalence than institution based studies (49.93 % Vs 24.84 %; respectively). The most prevalent type of intestinal parasite identified were Hookworm followed by Ascaris lumbricoides with a pooled prevalence of 11.2 and 10.34 %, respectively. In our analysis; residence, being bare footed, lack of hand washing habit and eating uncooked/raw vegetables were significantly associated with IPIs among pregnant women in Ethiopia.

CONCLUSIONS

Prevalence of IPIs during pregnancy is relatively high in Ethiopia. Poor hygienic practices were identified as risk factors. Based on our finding, targeted preventive measures shall be considered so as to prevent morbidity and mortality due to IPIs.

Global prevalence of intestinal parasitic infections and associated risk factors in pregnant women: a systematic review and meta-analysis

BACKGROUND

Intestinal parasitic infections (IPIs) during pregnancy, if left untreated, can cause adverse effects for the mothers, foetuses and newborns. However, limited information is available about the global status of IPIs in pregnant women. Here we undertook a meta-analysis to estimate the global prevalence of IPIs and associated risk factors in pregnant women.

METHODS

We searched the PubMed, Science Direct, Scopus, Web of Science and Google Scholar databases for relevant studies that were published between 1 January 1987 and 30 December 2019. A random effects meta-analysis model was used to estimate the pooled prevalence, odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 114 studies comprising 98 342 pregnant women across 35 countries were included in the systematic review and meta-analysis. Among IPIs identified from pregnant women, three helminth infections (hookworm 19% [95% CI 15 to 23], Ascaris lumbricoides 17% [95% CI 13 to 21] and Trichuris trichiura 11% [95% CI 7 to 16]) and three protozoan infections (Blastocystis sp. 21% [95% CI 4 to 46], Entamoeba histolytica/dispar 9% [95% CI 3 to 19] and Giardia sp. 8% [95% CI 4 to 13]) were identified as the most prevalent intestinal parasites. Moreover, we found that there was a significant association between IPIs with increased risk of anaemia in pregnant women (OR 2.65 [95% CI 2.08 to 3.37]). The prevalence of IPIs was slightly higher in geophagic pregnant women compared with controls, but this was not significant (OR 1.22 [95% CI 0.87 to 1.71]). According to species, the pooled OR of A. lumbricoides infection had a significantly higher risk in geophagic pregnant women compared with controls (OR 2.66 [95% CI 1.37 to 5.16]). There was a positive relationship between the high prevalence of IPIs in pregnant women living in rural areas compared with urban residents (OR 3.36 [95% CI 1.57 to 7.19]).

CONCLUSIONS

The current review revealed a relatively high prevalence of IPIs in pregnant women, especially in some low- and middle-income countries. These results suggest a need for improved prevention and control efforts to reduce the health risks to pregnant women.

Burden of intestinal parasitic infections among pregnant women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Comprehensive nationwide data on prevalence and distribution of intestinal parasites (IPIs) among pregnant women are lacking. Therefore, the aim of this study was to provide pooled prevalence estimate, prevalence in different regions and species-specific IPIs among pregnant women in Ethiopia.

METHODS

The search was carried out in Medline via PubMed, Scopus, Science Direct, Web of Science and Google Scholar on published and unpublished data between 2008 and Sep 2020 for studies describing rate of IPIs among pregnant women in Ethiopian. A random-effects model and forest plots to estimate pooled effect size and effect of each study with their confidence interval (CI) were used to provide a visual summary of the data. We conducted meta-regression to understand the source of heterogeneity and pooled the prevalence using 'metaprop' command using STATA software version 14.

RESULTS

A total of 3149 of the 9803 pregnant women were infected with one or more species of IPIs resulted in an overall prevalence of 29% (95% CI 22-37%). The prevalence estimate varied among studies with considerable heterogeneity (χ² = 2069.19, p < 0.001 I² = 98.84). The prevalence of IPIs was 36% (95% CI 22-50%) in Oromia region, 29% (95% CI 10-47%) in Amhara region, 24% (95% CI 17-32%) in southern nation, nationality and people region, 24% (95% CI 22-27%) in Tigray region and 24% (95% CI 20-29%) in Addis Ababa city. Hookworms with pooled prevalence estimate of 10% (95% CI 8-13%) followed by Ascaris lumbricoides 10% (95% CI 7-13%), and Entamoeba histolytica/dispar 6% (95% CI 4-8%) were the three common species of IPIs identified in this group of population.

CONCLUSION

The prevalence of IPIs among pregnant women is relatively high in comparison to other general population. Hookworms and Ascaris lumbricoides were the most dominant species of intestinal helminths, whereas Entamoeba histolytica/dispar was the dominant intestinal protozoa among pregnant women in Ethiopia.

Effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care at Debre Markos Referral Hospital, Northwest Ethiopia: Institution based prospective cohort study

BACKGROUND

Intestinal parasitosis is a common disease that causes misery and disability in poor populations. The number of individuals affected is staggering. From two billion peoples who harbor parasites worldwide, 300 million suffer severe morbidity and more than 25% of pregnant women are infected with hookworm, which causes intestinal bleeding and blood loss, and has been most commonly associated with anemia. Intestinal parasite infection during pregnancy has been associated with iron deficiency, maternal anemia, and impaired nutritional status, as well as decreased infant birth weight.

OBJECTIVE

This study aimed to assess the effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care in Debre Markos Referral Hospital from December 2017 to February 2019.

METHOD

A prospective cohort study design was conducted among 94 intestinal parasite-infected pregnant women as an exposed group and 187 pregnant women free from intestinal parasite were used as a control group. The effect of intestinal parasites on hematological profiles of pregnant women was assessed at Debre Markos Referral Hospital antenatal care ward. Socio-demographic data and nutrition status were assessed by using structured questionnaires and mid-upper arm circumference (MUAC), respectively. Two ml of venous blood and 2 gm of stool samples were collected to analyze the hematological profiles and detect intestinal parasites, respectively. Wet mount and formol-ether concentration (FEC) techniques were used to detect intestinal parasites. Hematological profile was analyzed using Mind ray BC-3000 plus instrument. Data were double entered into EpiData version 3.1 software and exported to SPSS version 24 software for analysis. Results were presented using tables and graphs. Associations of hemoglobin levels with intestinal parasitic infections were determined using binary logistic regression models. P≤0.05 was considered statistically significant. The mean hematological profile difference between parasite-infected and parasite-free pregnant women was computed using independent t-test.

RESULTS

In the present study, the predominant parasites identified were Entamoeba histolytica, hookworm, Giardia lamblia, Schistosoma mansoni, and Ascaris lumbricoides. About 8.2% of intestinal parasite-infected pregnant women had mild anemia while 4% had moderate anemia. Only 1.2% of intestinal parasite-free pregnant women developed moderate anemia. The mean HGB, HCT, MCV, MCH, and MCHC values of intestinal parasite-infected pregnant women were 12.8g/dl, 38.2%, 94.7fl, 33.1pg and 34.7g/dl, respectively. But the mean HGB, HCT, MCV, MCH and MCHC values of pregnant women who were free from intestinal parasites were 14.4 g/dl, 39.8%, 94.9fl, 33.9pg and 35.5g/dl, respectively. Anemia was strongly associated with hookworm (AOR = 21.29, 95%CI: 8.28-54.75, P<0.001), S.mansoni (AOR = 63.73, 95% CI: 19.15-212, P<0.001) and A.lumbricoide (AOR = 14.12, 95% CI 3.28-60.65, P<0.001).

CONCLUSION

Intestinal parasitic infection in pregnant women caused adverse impact on hematological profiles and was an independent predictor of anemia. Intestinal parasitic infection significantly decreased pregnant the level of HGB, HCT, MCV, MCH, and MCHC values. To minimize maternal anemia deworming could be good before pregnancy.

Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin

Background

An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six.

Principal findings

Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2^nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1^st ANV, 9% at the 2^nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2^nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association.

Conclusions

Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries.

Soil-transmitted helminth infections impact 1.5 billion individuals, primarily in low- and middle- income countries, each year and contribute to malnutrition, anemia, and impaired neurocognitive development in children. However, these infections in pregnancy and their impact on offspring have been less studied. One previous study found associations between soil-transmitted helminth infection during pregnancy and impaired cognitive functioning in offspring one year after birth. The current study aimed to follow these children prospectively until six years in order to confirm whether these associations persisted or not. Infections during pregnancy were no longer associated with cognitive or motor functioning in children; however, infections were associated with impaired behavioral development. Animal-based models have hypothesized maternal inflammation and poor birth outcomes to be the mechanisms behind this relationship; however, our findings did not support these mechanisms. This is one of very few prospective cohort studies in Sub-Saharan Africa to investigate these associations, and more research is needed to corroborate results. Limitations include limited power and the possibility that results are due to chance from multiple statistical tests. Adequate and accessible prevention and treatment efforts in pregnancy and childhood should be provided to populations in low- and middle- income countries at high risk of infection.

Prevalence of schistosomiasis and its association with anemia among pregnant women: a systematic review and meta-analysis

BACKGROUND

Schistosomiasis is a highly prevalent parasitic disease that can lead to adverse maternal and perinatal outcomes. To our knowledge, there has been no systematic review and meta-analysis of schistosomiasis during pregnancy.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant published studies were searched in international databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar), from their inception until May 31, 2020. The retrieved studies were assessed for quality using the Modified Newcastle-Ottawa Scale. OpenMeta Analyst software was used for the statistical analysis.

RESULTS

Thirty-two studies enrolling 21024 pregnant women were included in this meta-analysis. All 32 of these studies were conducted in Africa. Of these studies, 19, 11, and 2 investigated S. mansoni, S. haematobium, and combined S. mansoni and S. haematobium infections, respectively. The pooled prevalence estimate of schistosomiasis during pregnancy was 13.2% (95 CI 11.0-15.4). A random model was used because of high heterogeneity (Q = 99.14; P < 0.001). In subgroup analyses, the pooled prevalence estimate of S. haematobium was significantly higher than the pooled prevalence estimates of S. mansoni [22.5% (95% CI 1.6-43.5) vs 8.7% (95% CI 6.0-11.3, P = 0.016), respectively]. The results of meta-regression analyses showed a non-significant difference in the prevalence of schistosomiasis during pregnancy according to the study sample sizes and year of publication. Only six studies evaluated the association between schistosomiasis during pregnancy and anemia. Schistosomiasis was associated with anemia in these six studies (OR = 3.02, 95% = 1.25‒7.28, P = 0.014).

CONCLUSION

The present meta-analysis suggests that schistosomiasis during pregnancy is an existing health problem. This meta-analysis also highlights the lack of data on the determinants and outcomes of schistosomiasis during pregnancy. Preventive measures are needed and could be part of antenatal care in areas endemic with schistosomiasis.

Prevalence of intestinal parasite infections and associated risk factors among patients of Jimma health center requested for stool examination, Jimma, Ethiopia

BACKGROUND

Intestinal parasitic infections are still a serious public health problem in poor and developing countries like Ethiopia. Local epidemiological data is crucial to design and monitor prevention and control strategies. This study aimed to determine the prevalence of intestinal parasite infections and associated risk factors among patients requested for stool examination at Jimma health center, Southwest, Ethiopia.

METHODS

A cross-sectional study was conducted among a total of 384 patients in Jimma health center, Southwest, Ethiopia. Stool samples were collected and examined using direct wet-mount and formal-ether concentration techniques. Data were analyzed using the Chi-Square (X2) test and SPPS Version 24 and P Value<0.05 was considered for statistically significance.

RESULTS

The overall prevalence of intestinal parasite infections was found to be 79(20.6%). The infection rate was slightly higher in females 261(68%) than in males 123(32%). Eight types of intestinal parasites were identified and the highest prevalence was Giardia lamblia 25(6.5%) followed by A. lumbricoides 22(5.7%). Single parasitic infection was found among 67(17.4%) of the patients and double infection was 12(3.1%). Shoe wearing habits, Status of fingernail, Handwashing before a meal and after defecation, Source of water for bathing and drinking were significant factors(p<0.05) for intestinal parasitic infection.

CONCLUSION

A relatively low prevalence of intestinal parasite infections was observed among patients of Jimma health center requested for the stool examination.

Magnitude of parasitic infections and associated factors among pregnant women at health facilities in Hawassa, Southern Ethiopia

Background: Intestinal parasitic infections (IPIs) are common problems during pregnancy, with adverse outcomes including low birth weight and prenatal mortality. The burden of parasitic infections and its impacts are high among pregnant women in developing countries like Ethiopia. Therefore, this study aimed to assess the burden and associated factors of parasitic infections. Methods: A facility-based cross-sectional study was conducted among 365 randomly selected women attending antenatal clinic at five selected health facilities. Data was collected by a pre-tested questionnaire and stool specimens were collected in clean plastic containers. A combination of direct microscopy and the formol-ether concentration technique was used as soon as the specimen collected. Data entry and analysed for descriptive and logistic regression models by SPSS v.23. The result declared as statistically significant at p < 0.05.   Results: The overall prevalence of IPI was 161 (45.9%). The most frequently identified parasites were Ascaris lumbricoides (27.9%), Schistosoma species (13.7%), Trichuris trichiura (5.1%), Hookworm (4.8%), and Taenia species. (1.4%). The IPIs were associated with women having no formal education [AOR=2.19, 95% CI: 1.05-4.57] or elementary school education [AOR=1.90, 95% CI: 1.11-3.27], as compared with high school educated and above. Monthly income of less than 1920 Ethiopian birr [AOR=2.06, 95% CI: 1.28-3.31], sharing a latrine with neighbours [AOR=1.83, 95% CI: 1.14-2.93], using lake water for washing clothes [AOR=2.24, 95% CI: 1.34-3.74], habit of eating raw vegetables [AOR=2.26, 95% CI: 1.30-3.92] were associated with IPI as compared to their counterparts. Conclusions: Nearly half of the pregnant women were infected with IPs. The health facilities and clinicians need to focus on prevention of IPIs by early diagnosis, treating lake water before use, promote proper latrine utilization and provision of pertinent health education as part of ante-natal care service. It is important to minimize the impact of IPIs on pregnant women and their child.

Strongyloides Stercoralis Infection in Ethiopia: Systematic Review and Meta-analysis on Prevalence and Diagnostic Methods

Strongyloides stercoralis is a helminthic intestinal parasite that causes the disease strongyloidiasis. Its prevalence is high in tropics and sub-tropics due to poor sanitation and hygiene. However, its true prevalence is not well known in Ethiopia as most health institutions use low sensitive diagnostic methods. This review aimed to determine the pooled prevalence of S. stercoralis at country, and regional state levels. Papers published on S. stercoralis in Ethiopia from 2010 to 2020 were collected from PubMed, Google Scholar and Science direct databases and Addis Ababa repository. Identification, screening, checking the eligibility, and inclusion of the relevant literatures were done. Articles with S. stercoralis positive results from Ethiopian populations were included. Articles which focused on Strongyloides infection in foreigners, and other than stool samples were excluded. The pooled prevalence of S. stercoralis and heterogeneity between studies and across regions were computed. From the 43 articles, the overall prevalence of S. stercoralis in Ethiopia was 1.82 %. Across regions, relatively high prevalence of S. stercoralis (8.78 %) was recorded in Addis Ababa city. High prevalence of S. stercoralis was found to be 44.02 % with a combination of formol ether concentration, Baermann concentration, and molecular methods. Low prevalence of 0.26 %, 0.31 %, and 1.20 % was evidenced respectively with Kato-Katz, direct saline microscopy, and formol ether concentration methods. Using random effect analysis, the pooled prevalence of S. stercoralis in Ethiopia, across regions and across diagnostic methods was 2.1 % (95 %CI: 1.20 – 3.60), 2.6 % (95 %CI: 0.80 – 8.20) and 3.7 % (95 %CI: 1.10 – 11.70), respectively. The heterogeneity was high (P<0.001). This review revealed that Strongyloides infection is probably underreported and its prevalence could be higher than the reported in Ethiopia. Therefore, a revision of the best combination of diagnostic methods could be advisable as it gives better diagnostic results in routine diagnosis of Strongyloides infection in Ethiopia.

The Prevalence of Intestinal Parasites and Their Associated Factors among Diabetes Mellitus Patients at the University of Gondar Referral Hospital, Northwest Ethiopia

BACKGROUND

Worldwide, more than one-sixth of the population is infected by intestinal parasites, of which the majority live in developing countries. On the other hand, the prevalence of diabetes mellitus has been increasing over recent decades in developing countries. Patients with diabetes mellitus encountered impaired immunity and suffer from the consequences of infection particularly intestinal parasitic infection.

OBJECTIVE

This study is aimed at assessing the prevalence of intestinal parasites and associated factors among diabetes mellitus patients at the University of Gondar Referral Hospital, Northwest Ethiopia.

METHODS AND MATERIALS

An institutional-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Referral Hospital from February 15 to March 30, 2018. A total of 234 diabetes mellitus patients were enrolled. A systematic random sampling technique was used to select study participants. Sociodemographic and clinical data were collected using a semistructured questionnaire. A 5-gram stool sample was collected to identify parasitic infection using a direct wet mount and formal-ether concentration technique. Data was entered and analyzed by using SPSS version 20. A p value of ≤0.05 was considered as statistically significant.

RESULT

In the current study, the overall prevalence of intestinal parasite infection among diabetics was 45 (19.2%). The parasites identified in this study were Ascaris lumbricoides 15 (6.41%), Entamoeba histolytica/dispar 9 (3.85%), Hookworm 9 (3.85%), Schistosoma mansoni 7 (3%), Enterobius vermicularis 3 (1.3%), and Giardia lamblia 2 (0.9%). Poor educational background (AOR = 3.62; 95% CI (1.038, 12.65); p = 0.043), poor hygiene and sanitation (AOR = 4.67; 95% CI (1.82, 12.07); p = 0.001), and inappropriate latrine usage (AOR = 5.41; 95% CI (1.43, 20.56); p = 0.013) were significantly associated with the prevalence of intestinal parasitic infection among diabetes mellitus patients.

CONCLUSION

The overall prevalence of intestinal parasitic infection among diabetes mellitus patients was relatively high. There should be continued prevention, control, and management of intestinal parasitic infection in such a study population.

Strongyloidiasis in Africa: Systematic Review and Meta-Analysis on Prevalence, Diagnostic Methods, and Study Settings

BACKGROUND

Strongyloidiasis is an intestinal parasitic infection mainly caused by Strongyloides stercoralis. Although it is a predominant parasite in tropics and subtropics where sanitation and hygiene are poorly practiced, the true prevalence of strongyloidiasis is not known due to low-sensitivity diagnostic methods.

OBJECTIVE

This systematic review and meta-analysis is aimed at determining the pooled prevalence of strongyloidiasis in African countries, stratified by diagnostic methods, study settings, and patients.

METHODS

Cross-sectional studies on strongyloidiasis published in African countries from the year 2008 up to 2018 in PubMed and Google Scholar databases and which reported at least one Strongyloides spp. infection were included. Identification and screening of eligible articles were also done. Articles whose focus was on strongyloidiasis in animals, soil, and foreigners infected by Strongyloides spp. in Africa were excluded. The random effects model was used to calculate the pooled prevalence of strongyloidiasis across African countries as well as by diagnostic methods and study settings. The heterogeneity between studies was also computed.

RESULT

A total of 82 studies were included. The overall pooled prevalence of strongyloidiasis was 2.7%. By individual techniques, the pooled prevalence of strongyloidiasis was 0.4%, 1.0%, 3.4%, 9.3%, 9.6%, and 19.4% by the respective direct saline microscopy, Kato-Katz, formol ether concentration, polymerase chain reaction, Baermann concentration, and culture diagnostic techniques. The prevalence rates of strongyloidiasis among rural community, school, and health institution studies were 6.8%, 6.4%, and 0.9%, respectively. The variation on the effect size comparing African countries, diagnostic methods, study settings, and patients was significant (P ≤ 0.001).

CONCLUSIONS

This review shows that strongyloidiasis is overlooked and its prevalence is estimated to be low in Africa due to the use of diagnostic methods with low sensitivity. Therefore, there is a need for using a combination of appropriate diagnostic methods to approach the actual strongyloidiasis rates in Africa.

The association between the lack of safe drinking water and sanitation facilities with intestinal Entamoeba spp infection risk: A systematic review and meta-analysis

Intestinal protozoa infections are responsible for considerable morbidity and mortality, especially where the exposed population suffers from a lack of drinking water and sanitation facilities. In this study, the association between the lack of safe drinking water and sanitation (toilet) facilities with intestinal Entamoeba spp infection in the children (5-11 years), adult (18-55 years), and all age (5-55 years) were assessed. For this purpose, some of the international databases such as Scopus, PubMed, Web of Science, and Embase were screened to up to 7 June 2019 in order to retrieve the related citations. Also, the pooled odds ratios (ORs) following 95% confidence intervals (CIs) were calculated using a random-effects model. Twenty-nine articles with 36 studies were included while the OR extracted or calculated by using 2 × 2 contingency tables. However, the ingestion of contaminated water insignificantly can increase the odds ratio (OR) of Entamoeba spp infection (OR 1.01, (95% confidence interval [CI] 0.58 to 1.43), no access to sanitation (toilet) facilities significantly can increase odds of Entamoeba spp infection (OR 1.18, 95% CI 1.05 to 1.32). The meta-regression analysis showed that over time, odds of intestinal Entamoeba spp infection increased in both lack of safe drinking water (Coefficient: 3.24, P-value < 0.01) and sanitation (toilet) facilities (Coefficient: 2.36, P-value < 0.05) subgroups. Considering the findings, lack of safe drinking water resulted in a further increase in intestinal Entamoeba spp infection among adult (OR: 2.76), children (OR = 0.57) and all age groups (OR: 1.50), and also lack of sanitation (toilet) facilities resulted in further increase intestinal Entamoeba spp infection in children (OR: 1.06), adult (OR: 1.26) and all age (OR: 1.16). In this context, the lack of safe drinking water and sanitation facilities (toilet) was associated with a high risk of intestinal Entamoeba spp infection. Further attempts to providing public health facilities can control the prevalence of intestinal Entamoeba spp.

Prevalence and Determinants of Intestinal Parasitic Infections among Pregnant Women Receiving Antenatal Care in Kasoa Polyclinic, Ghana

Background

Intestinal parasitic infections affect pregnant women worldwide. The infection has been implicated in causing life-threatening conditions in both gravid women and their developing foetus. Sub-Saharan Africa is known to harbor the greatest proportion of intestinal parasitic infections largely due to socioeconomic and environmental factors. In Kasoa, Southern Ghana, there is paucity of data on the prevalence and associated factors of intestinal parasitic infections among pregnant women.

Objective

The aim of the study was to determine the prevalence of intestinal parasitic infections and associated factors among pregnant women attending antenatal care in Kasoa Polyclinic.

Methods

A hospital based analytical cross-sectional study was carried out among three hundred (300) conveniently sampled pregnant women receiving antenatal care services at the Kasoa Polyclinic. Structured questionnaires were administered to the study participants to assess sociodemographic and other possible factors. Stool samples were collected from each pregnant woman and examined for the presence of intestinal parasites by microscopy using direct wet mount as well as formol-ether sedimentation techniques.

Results

Overall prevalence of intestinal parasites was 14.3% (95% CI 11–19%). Entamoeba histolytica (5.0%) was the most predominant parasite species identified followed by Ascaris lumbricoides (4.3%), Giardia lamblia (2.3%), Trichuris trichiura (1.3%), Schistosoma mansoni (0.3%), Hookworm (0.3%), Hymenolepis nana (0.3%), and Isospora belli (0.3%). Age > 30 years (AOR = 0.17, 95% CI = 0.06–0.48; p=0.001), multigravidity (AOR = 0.43, 95% CI = 0.19–0.97; p=0.043), and 2^nd and 3^rd trimesters (AOR = 4.73, 95% CI = 1.36–16.49; p=0.015) were independently associated with intestinal parasitic infections among pregnant women.

Conclusions

A prevalence of 14.3% pregnant women compared to previous studies in Ghana is relatively low. It however suggests that intestinal parasitic infection is still a problem. The major factors noted were age, gravidity, and gestational age. Routine stool examination and provision of public health education are recommended to prevent infection of pregnant mothers and their unborn babies.

Intestinal parasitic infections in pregnancy - A review

Intestinal parasitic infections are widespread worldwide and with increased global travel and transport of food, these are not entirely limited to traditionally endemic areas. The prevalence of parasitic infections in endemic areas among pregnant women ranges from 24 to 70 % with approximately 10 % of women having multiple parasites. Pregnancy with its increased nutritional demands and altered immunological defenses is an especially vulnerable time for acquiring parasitic infections, which may be associated with adverse outcomes such as anaemia, which in some cases may even contribute to mortality. The presence of a helminthic infections during pregnancy may also cause immunological effects that can contribute to maternal morbidity and mortality as well as affecting the maternal immune response and immune system function in the baby after birth. Mass administration of anthelminthic drug therapy has been applied in endemic areas but there is inconclusive evidence of its benefit in improving pregnancy outcomes, however, no safety concerns have been highlighted with the use of the recommended drugs for parasitic infections.

Prevalence and Factors Associated with Intestinal Parasitic Infections among Pregnant Women in West Gojjam Zone, Northwest Ethiopia

Background

Intestinal parasitic infections are the major causes of morbidity and mortality in sub-Saharan countries. The disease burden of these parasites is significantly high among pregnant women in developing countries like Ethiopia. Poor living conditions, sanitation, and hygiene are believed to be the contributing factors. The aim of this study was to determine the magnitude of intestinal parasitic infection and factors associated with pregnant women.

Methods

A cross-sectional study was conducted from February 2017 to June 2017. A structured questionnaire was used to obtain the sociodemographic and other explanatory variables via face-to-face interviews. Stool samples were collected and examined using formol ether concentration technique. The magnitude of parasitic infection was calculated using descriptive statistics. The association between intestinal parasitic infection and determinant factors was assessed by logistic regression. The differences were considered to be statistically significant if the p value was less than 0.05.

Results

From a total of 743 pregnant women, the overall prevalence of intestinal parasitosis was 277 (37.3%). The prevalence of hookworm 138 (18.6%) was the leading cause of intestinal parasitosis followed by E. histolytica/dispar 113 (15.2%). Dwelling in rural area (AOR: 2.9 (95% CI: 1.85-4.85)), being a farmer (AOR: 1.91 (95% CI: 1.20-3.03)), eating raw vegetables (AOR: 1.45, 95% CI:0.09-0.24), lack of proper use of latrine (AOR: 2.89 (95%1.18-7.08)), poor environmental sanitation (AOR: 0.19 (95%: CI:0.08-0.47)), habit of soil eating (AOR: 0.42 (95% CI: 0.25-0.72)), having irrigation practice (AOR: 0.47 (95% CI: 0.29-0.77)), and lack of health education (AOR: 0.32 (95% CI: 0.13-0.77)) were significantly associated with intestinal parasitic infections.

Conclusions

Intestinal parasitic infection is a major problem among pregnant women in the study area. High parasitic infection is associated with poor hygienic and sanitation practices. Therefore, awareness creation through health education should be given to pregnancy on intestinal parasitic infection and associated factors.

Prevalence of hookworm infection and associated factors among pregnant women attending antenatal care at governmental health centers in DEMBECHA district, north West Ethiopia, 2017

BACKGROUND

Hookworm infection is a major public health problem in developing countries. The main way people become infected with hookworm's larva is through direct skin contact with contaminated soil when walking on barefoot. It is one of a major cause of anemia in pregnant women. The objective was to assess the prevalence and associated factors of hookworm infection among pregnant women who attended antenatal care at governmental health centers in Dembecha district, Ethiopia, 2017.

METHODS

Institutional based cross sectional study was conducted on 306 pregnant women. Study participants were selected by systematic random sampling technique from February 1 to March 30, 2017. Data collectors and supervisors were trained. Semi-structured Amharic version questionnaire was used to collect data using face to face interview technique and stool sample was examined. Collected data were entered by using Epi data version 3.1 and exported to SPSS. The exported data was analyzed and presented by using descriptive summary statistics and tables. After bivariate logistic regression analysis, all variables with a p-value < 0.25 were entered into multivariate logistic regression and p value < 0.05 considered as significantly associated with the outcome variable.

RESULTS

Prevalence of hookworm infection was 32.0%. There was a positive association of hookworm infection with living in single room [AOR =2.8; 95% CI; 1.32-5.81], living with domestic animals [AOR = 3.4; 95% CI; 1.35-8.76], monthly income ≤1500 Ethiopian birr [AOR = 3.7; 95% CI; 1.76-7.64], unavailability of latrine [AOR = 2.2; 95% CI; 1.03-4.55], habit of walking on barefoot [AOR = 4.3; 95% CI; 2.17-8.48] and not habit of hand washing before meal [AOR = 3.4; 95 CI; 1.14-10.12].

CONCLUSION

This study showed high prevalence of hookworm infection among pregnant women in the study area. Living in single room, living with domestic animals, monthly income ≤1500 Ethiopian birr, unavailability of latrine, habit of walking on barefoot and not habit of hand washing before meal had positive association with hookworm infection. Public health measure should focus on availability latrine and separation of humans and domestic animals room to decrease prevalence of hookworm infection among pregnant women.

Identification of risk areas and practices for Taenia saginata taeniosis/cysticercosis in Ethiopia: a systematic review and meta-analysis

Background

Bovine cysticercosis (BCC) is an infection of cattle with the metacestode stage of Taenia saginata, the beef tapeworm, which causes taeniosis in humans. BCC is responsible for considerable economic losses in the meat sector worldwide. This systematic review and meta-analysis summarizes the prevalence, risk factors and treatment efforts made so far on T. saginata infections in Ethiopia, providing a detailed analysis of different factors influencing the varying prevalence estimates in Ethiopia to gain more insight into the occurrence and risk factors of T. saginata taeniosis and cysticercosis to date.

Methods

A systematic review and meta-analysis was conducted on data collected from published and grey literature accessed through an electronic database and manual search.

Results

The literature search resulted in 776 outputs of which 132 conformed to the predefined criteria. The average zonal prevalence of meat inspection-based BCC ranged from 2% in Buno-Bedele to 24.6% in Sidama zone. The pooled prevalence of BCC was influenced by the number of muscle/organs inspected, ranging from 3.4% (95% CI: 1.7–5.1%) using fewer predilection sites to 19.4% (95% CI: 13.3–25.4%) using inspection of a maximum number of predilection sites. None of the tested variables were significantly associated with BCC. Questionnaire-based taeniosis ranged between 19.0% in Halaba special woreda to 70.0% in Gedeo zone and stool test-based taeniosis varied from 0.6% in central Tigray to 10.7% in Gurage zone. Questionnaire-based prevalence of taeniosis was higher in people with a frequent raw beef consumption habit (pooled OR, pOR: 10.5, 95% CI: 6.0–17.9), adults (pOR: 2.5, 95% CI: 1.7–3.6), men (pOR: 2.8, 95% CI: 2.1–3.6), and Christians (pOR: 2.0, 95% CI: 1.4–2.8) compared to less frequent raw beef consumers, younger people, women and Muslims, respectively.

Conclusions

This review revealed a widespread but variable occurrence of BCC and taeniosis in Ethiopian regions and zones, urging for harmonized and enhanced detection for improved control of the parasite. Accurate prevalence estimates using more sensitive tests, detailed risk factor analysis, as well as data on financial losses are needed to develop effective control strategies for the Ethiopian epidemiologic condition.

Parasitic infections among pregnant women at first antenatal care visit in northern Ghana: A study of prevalence and associated factors

Background

Parasitic infections remain widespread in developing countries and constitute a major public health problem in many parts of sub-Saharan Africa. It is prevalent among children under 5 years and pregnant women; however, studies among the later high risk group is limited in the northern part of Ghana. Here, we evaluated the prevalence and associated factors of parasitic infections among pregnant women at first antenatal care visit in northern Ghana.

Methods

This was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, Bolgatanga Regional Hospital, Upper East Region-Ghana. A total of 334 consecutive consenting pregnant women were included. Questionnaires were administered to obtain socio-demographic data. Venous blood, stool and urine samples were collected for parasite identification using microscopy. Factors associated with parasitic infections were evaluated using regression models. Statistical analysis was performed using R.

Results

Parasitic infections identified were giardiasis (30.5%), P. falciparum malaria (21.6%) and schistosomiasis (0.6%). Polyparasitic infection was identified in 6.6% of the population. Increasing age [Age of 20–29 years: AOR = 0.16, 95% CI (0.06–0.38); Age of 30–39 years: AOR = 0.21, 95% CI (0.08–0.50); Age >39 years: AOR = 0.30, 95% CI (0.11–0.83)] was associated with lower odds whiles presence of domestic animals [AOR = 1.85, 95% CI (1.01–3.39)], being in the second trimester of pregnancy [AOR = 2.21, 95% CI (1.17–4.19)], having no formal education [AOR = 3.29, 95% CI (1.47–7.35)] and basic education as the highest educational level [AOR = 6.03, 95% CI (2.46–10.81)] were independent predictors of increased odds of giardiasis. Similarly, having no formal education [AOR = 2.88, 95% CI (1.21–8.79)] was independently associated with higher odds of P. falciparum malaria. The use of insecticide treated net (ITN) [AOR = 0.43, 95% CI (0.21–0.89)] and mosquito repellent [AOR = 0.09, 95% CI (0.04–0.21)] were independent predictors of lower odds of P. falciparum malaria.

Conclusion

Giardiasis and P. falciparum malaria are common among pregnant women in northern Ghana. The major associated factors of giardiasis are lack of or low level of formal education, the presence of domestic animals and being in the second trimester of pregnancy. Increasing age confers protection against giardiasis. Likewise, lack of formal education is an associated factor for P. falciparum malaria among pregnant women in northern Ghana. The use of ITN and mosquito repellents reduce the risk of P. falciparum malaria. Given the possible role of parasitic infections in adverse pregnancy outcomes, our findings highlight the need for regular screening and treatment of infected women in the northern parts of Ghana. Public health education and improving socio-economic status could help reduce the risk of parasitic infections among pregnant women in the region.

Prevalence of intestinal parasitic infection and associated factors among pregnant women attending antenatal care at public health facilities in Lalo Kile district, Oromia, Western Ethiopia

OBJECTIVE

This study aimed to assess the prevalence of intestinal parasitic infection and associated factors among pregnant women attending antenatal care at public health facilities in Lalo Kile district, Oromia, Western Ethiopia.

RESULTS

Out of the 315 respondents, the mean age was 24.7 ± 2.54 years ranging between 15 and 44 years. The majority of the respondents were Oromo in ethnicity (90.2%) and protestant in religion (83.2%) and almost all (99%) of the study participants were married. Two hundred twenty-six (72%) of pregnant women were attended at least primary school and two hundred forty-six (78.1%) of the respondents were from farmer households. About half of the households (51.7%) had a monthly income of greater than 35 USD. The overall prevalence of intestinal parasitic infection was 138 (43.8%) with the predominance of hookworm (33.7%) followed by Ascaris lumbricoides (7.3%). Being a farmer [AOR, 95% CI 7.3 (1.46, 37.00), P = 0.03], walking barefooted [AOR, 95% CI 6.13 (1.98, 19.00), P = 0.002] and absence of proper handwashing after latrine [AOR, 95% CI 5.36 (1.78, 16.00), P = 0.003] were significantly associated with occurrence of the intestinal parasitic infection.

Prevalence and factors associated with intestinal parasitic infection among under-five children in and around Haro Dumal Town, Bale Zone, Ethiopia

BACKGROUND

Intestinal parasitic infection is diversified illness and diseases caused millions morbidity among under-five children lives in developing countries particularly vulnerable rural communities. Deworming coverage in such community is low. The aim of this study was to determine the prevalence and associated risk factors of intestinal parasitic infections (IPIs) among under-five children live in and around Haro Dumal Town.

METHODS

Community-based cross-sectional study was conducted in 561 randomly selected under-five children from June to August, 2018. The stool samples were collected and examined by basic parasitological techniques. Data related to socio-demographic and risk factors were collected using a self administered questionnaire. Statistical data analysis was done using SPSS version 21 and the bivariate and multivariate logistic regression used to compute the association between variables. P-value of < 0.05 was statistical significance.

THE RESULTS

Of the 561 total under-five children, 216 (38.5%) were found to be infected with intestinal parasites. E.histolytica/dispar (15.3%) was the most prevalent parasite, followed by hook worm (14.4%) and T.trichuria (13.9%). Regarding risk factors, geo-phage [(AOR = 4.7; 95%CI: 2.0-10.4), P < 0.001], tungiasis [(AOR = 3.1; 95%CI: 1.1-6.6), P < 0.001], eating raw vegetable [(AOR = 1.3; 95%CI: 1.4-3.3), P < 0.001] were significantly associated with intestinal parasitic infections.

CONCLUSION

Intestinal parasitic infections (IPIs) were found to be highly prevalent in the study area. Hence, improving sanitation, controlling ecto-parasite such as tungiasis, provision of safe water and successful mass-deworming are important.

Soil-Transmitted Helminths And Other Intestinal Parasites Among Schoolchildren In Southern Ethiopia

Background

Intestinal parasitic infections are the neglected tropical diseases that have a devastating effect and leads to malnutrition, morbidity and mortality in schoolchildren. The aim of this study was to determine the presence of soil-transmitted and other intestinal parasites among schoolchildren in southern Ethiopia.

Methods

A cross-sectional study was conducted in Gara Riketa primary school children at Hawassa Tula Sub-City, Southern Ethiopia from March 1 to April 20, 2017. The parent of participating children was interviewed with a structured questionnaire to collect the sociodemographic and risk factors data. Well-trained laboratory technicians were involved in the stool examination through direct and concentration methods. The data were entered and analyzed using SPSS version 20. ORs at 95% CI were considered as a statistically significant association with a p-value < 0.05.

Results

Out of 384 schoolchildren enrolled for the study, 260 (67.7%) were infected with one or more intestinal parasites. The predominantly identified parasite was Ascaris lumbricoides 146 (38.0%) followed by hookworms 12 (3.1%). The study showed that intestinal parasitic infections have a statistically significant association with being in 4th grade, the mother´s educational status (grade 9-12), having cut nails and washing hands before eating.

Conclusion

The rates of soil-transmitted helminths and other intestinal parasitic infections were very high in Gara Riketa primary school children. Based on the statistical analysis, hygiene and nail clipping are important habits to prevent infection with intestinal parasites.

Prevalence and associated factors of soil transmitted helminthes among pregnant women attending antenatal care in Maytsebri primary hospital, North Ethiopia

OBJECTIVES

Soil-transmitted helminthes are among the most common infections worldwide and affect the poorest and most deprived communities. A health facility based cross-sectional study was conducted among pregnant women attending at Maytsebri primary hospital. Data was entered and analysed using SPSS version 20 software. Multivariate analyses were used to identify determinant factors associated with soil transmitted helminthiasis. A total of 448 pregnant women were examined microscopically with a Katokatz technique for parasitological study to each women.

RESULTS

Out of the total 448 pregnant women examined in the primary hospital, 229 (51.5%) women were infected by at least one of the soil transmitted helminthiasis. Hookworm was the most prevalent 179 (78.16%) soil transmitted helminthes infection. Women who had a habit of eating soil were 2.6 times more likely to be infected by soil transmitted helminthes compared to who do not eat soil. Participants who wear shoe always were 95% less likely to be infected by soil transmitted helminthes. Efforts should be done to advance the awareness of women how to prevent soil transmitted helminthes.

Strongyloidiasis in Ethiopia: systematic review on risk factors, diagnosis, prevalence and clinical outcomes

BACKGROUND

Strongyloidiasis is a gastrointestinal infection caused by the parasitic nematode Strongyloides stercoralis. It is estimated to infect up to 370 million people globally and is predominately found in tropical and subtropical areas of socioeconomic disadvantage.

MAIN BODY

This systematic literature review identified studies published in the last ten years on the risk factors, diagnosis, prevalence and/or clinical outcomes of strongyloidiasis in Ethiopia. The prevalence of S. stercoralis ranged from 0.2 to 11.1% in adults, 0.3% to 20.7% in children, 1.5% to 17.3% in HIV positive adults and 5% in HIV positive children. The identified studies primarily used microscopy based techniques that potentially underestimated the prevalence four fold compared with serology and PCR. Strongyloidiasis in children presents a particularly significant issue in Ethiopia as children often presented with anemia, which is associated with impaired mental and cognitive development. The most significant risk factor for strongyloidiasis was HIV status and although other risk factors were identified for helminth infections, none were statistically significant for S. stercoralis specifically. Several studies detected S. stercoralis in dogs and non-biting cyclorrhaphan flies. However, future research is needed to explore the role of these reservoirs in disease transmission.

CONCLUSIONS

This review demonstrated that strongyloidiasis is an overlooked and neglected disease in Ethiopia. There is a need for a systematic approach using a combination of molecular and serology based diagnostic methods to ascertain the true incidence and burden of strongyloidiasis in Ethiopia. Further research is also needed to break the cycle of transmission by identifying environmental reservoirs, risk factors and exploring the potential for zoonotic transfer.

Prevalence of intestinal parasitic infection and its association with anemia among pregnant women in Wondo Genet district, Southern Ethiopia: a cross-sectional study

BACKGROUND

Previous studies reported contradicting findings about the association between intestinal parasitosis and maternal anemia. In this study we aimed to determine the prevalence of intestinal parasitic infection and its association with anemia among pregnant women in Wondo Genet district, Southern Ethiopia.

METHODS

This facility-based cross-sectional study was conducted in June and July 2018. Pregnant women (n = 352) were randomly drawn from five health centers using antenatal care follow-up lists. Trained data collectors administered the questionnaire. Capillary blood was collected and analyzed for hemoglobin using the HemoCue method. Stool sample was collected following standard procedure and analyzed for the presence and types of intestinal parasites using direct microscopy with Formalin-ether concentration technique. Association between intestinal parasitosis and anemia was measured using multivariable binary logistic regression analysis. The outputs are presented using adjusted odds ratio (AOR) with 95% confidence intervals (CI).

RESULTS

The overall prevalence of intestinal parasitic infection was 38.7% (95% CI: 33.6-43.8%). One-tenth (9.7%) of the pregnant women were infected with polyparasites. Ascaris lumbricoides was the predominant infection encountered in 24.9% of the women. The other infections identified were: hookworms (11.2%), Giardia lamblia (5.4%), Entamoeba histolytica (3.4%), Trichuris trichiura (2.9%) and Schistosoma mansoni (2.3%). The mean (± standard deviation) hemoglobin concentration was 12.3 (±1.9) g/dl and 31.5% (95% CI: 26.6-36.4%) women were anemic (hemoglobin < 11 g/dl). The prevalence of anemia among women infected with intestinal parasite (55.6%) was substantially higher than the prevalence in their counterparts (16.4%) (p <  0.001). In a multivariable model adjusted for multiple potential confounders including socio-economic status indicators, the odds of anemia were six times increased (AOR = 6.14, 95% CI: 2.04-18.45) among those affected by at least one intestinal parasite.

CONCLUSION

Strengthening the existing water, sanitation and hygiene programs and routine deworming of pregnant mothers may help to reduce the burden of both intestinal parasitic infection and anemia in pregnant women.

Prevalence of intestinal parasites and associated risk factors among inmates of Mekelle prison, Tigrai Region, Northern Ethiopia, 2017

BACKGROUND

In Ethiopia, like other developing countries, intestinal parasitic infections are the major public health problems affecting millions annually. Overcrowding and poor living conditions are the major risk factors. Prison inmates are among the most vulnerable groups to intestinal parasitic infections. However, there is scarcity of epidemiological data regarding intestinal parasites among prison inmates in Ethiopia, notably in Tigrai. Thus, we aimed to determine the prevalence of intestinal parasites and identify the associated factors among inmates of Mekelle prison, Tigrai, Northern Ethiopia.

METHODS

A cross sectional study involving 291 inmates was conducted from February to June 2017 among inmates of Mekelle prison. After systematically selecting subjects, stool specimens were examined using direct wet mount and formol-ether concentration techniques. We used SPSS version 21 for data analysis. We considered p-value less than 0.05 significant at 95% confidence level.

RESULTS

Of the 291 inmates enrolled in the study, 124 (42.6%) harbored one or more intestinal parasites. The protozoan Entamoeba histolytica/dispar/moshkovskii was the predominant parasite accounted for 68 (23.3%) of the infections followed by Giardia lamblia (10.3%) and Entamoeba coli (8.2%). Fourteen (4.8%) participants were co-infected with different parasite species. The co-infections of Entamoeba histolytica/dispar/moshkovskii and Giardia lamblia were detected among 3.1% of the participants. In bivariate analysis, hand fingernail status (COR 1.86, 95% CI, 1.08-3.20) and duration of stay in prison (COR 2.23, 95% CI 1.31-3.79) were statistically associated with intestinal parasite infections. In multivariable regression, inmates who stayed in the prison for one year or less were more likely to harbor intestinal parasitic infections (p = 0.013) than those who stayed longer. No other single predictor variable was found to be significantly associated with intestinal parasitic infections.

CONCLUSIONS

The result of this study showed that intestinal parasites are significant health problems among inmates of Mekelle prison.

Hymenolepiasis in a Pregnant Woman: A Case Report of Hymenolepis nana Infection

Hymenolepiasis is an infection caused by Hymenolepis nana (H. nana) and H. diminuta (H. diminuta). Hymenolepiasis is prevalent throughout the world with human infections with H. nana being frequently reported in the literature as compared to H. diminuta. Hymenolepiasis is more frequent among children, and most human infections remain asymptomatic and self-limited. Symptoms including abdominal pain, diarrhea, and vomiting are frequently noted in the cases of heavy infections. We report a case of hymenolepiasis caused by H. nana in a pregnant woman.

Prevalence and risk factors for intestinal parasitic infections in pregnant women residing in three districts of Bogotá, Colombia

BACKGROUND

Intestinal parasitic infections (IPI) lead to significant morbidity and mortality in pediatric and adult populations worldwide. Intestinal parasitism during pregnancy is of interest as it may affect the health of pregnant women and their offspring. This study determined the prevalence of IPI in pregnant women living in substandard conditions in three urban districts of Bogotá, Colombia. Associations between prevalence and sociodemographic factors, housing, and living conditions were also evaluated.

METHODS

In a cross-sectional and community-based study, pregnant women were recruited from three districts of Bogotá. A total of 550 participants answered a questionnaire; 331 of these also provided stool samples, with 233 providing one and 98 providing two stool samples. Questionnaire responses were associated with the presence of intestinal parasites, which was determined using a standard combined microscopy technique including direct wet mount and formol-ether concentration. Results were verified by supplementary examination of 48 stool samples by quantitative polymerase chain reaction (qPCR).

RESULTS

Among pregnant women who lived in selected poor residential areas in Bogotá, the overall prevalence of intestinal parasitism was 41% with 9% polyparasitism. Pathogenic parasites were present in 1.2% of the 331 participants including Giardia lamblia and Ascaris lumbricoides. Higher prevalence was found for parasites with debated pathogenicity, including Blastocystis hominis (25%), Endolimax nana (15%), Entamoeba coli (8%), and Iodamoeba butschlii (2%). Entamoeba histolytica/dispar complex was also detected (1.5%). When comparing a subset of stool samples using the combined microscopy technique and qPCR, the latter detected a higher 58.3% overall IPI prevalence. Higher prevalence of infections by any intestinal parasite was found in participants who had never been dewormed (p = 0.01). Higher but not statistically significant associations were found between any parasite and women living with a partner, and intestinal polyparasitism and being from a minority group and not having a water sink.

CONCLUSIONS

This first study of the prevalence of intestinal parasitism in Bogotá focused on pregnant women living in poverty, found a high prevalence of intestinal parasites of debated pathogenicity, and confirmed a low prevalence of pathogenic intestinal parasites. These results highlight the need for educational interventions to disrupt transmission routes for prevalent parasites.

Prevalence and molecular characterization of Strongyloides stercoralis, Giardia duodenalis, Cryptosporidium spp., and Blastocystis spp. isolates in school children in Cubal, Western Angola

BACKGROUND

Human infections by the gastrointestinal helminth Strongyloides stercoralis and the enteric protozoans Giardia duodenalis, Cryptosporidium spp. and Blastocystis spp. are not formally included in the list of 20 neglected tropical diseases prioritised by the World Health Organization. Although largely underdiagnosed and considered of lower public health relevance, these infections have been increasingly demonstrated to cause significant morbidity and even mortality globally, particularly among children living in resource-poor settings.

METHODS

In this cross-sectional survey the prevalence, frequency and molecular diversity of S. stercoralis, G. duodenalis, Cryptosporidium spp. and Blastocystis spp. were investigated in a school children population in the province of Benguela (Angola). A total of 351 stool samples were collected during January to June 2015. The presence of S. stercoralis and G. duodenalis was confirmed by qPCR methods. Giardia duodenalis assemblages and sub-assemblages were determined by multilocus sequence-based genotyping of the glutamate dehydrogenase and β-giardin genes of the parasite. Detection and identification of Cryptosporidium and Blastocystis species and subtypes was carried out by amplification and sequencing of a partial fragment of the small-subunit ribosomal RNA gene of both protozoan. Analyses of risk factors potentially associated with the transmission of these pathogens were also conducted.

RESULTS

Prevalences of S. stercoralis, G. duodenalis, Cryptosporidium spp., and Blastocystis spp. were estimated at 21.4% (95% CI: 17.1-25.7%), 37.9% (95% CI: 32.8-43.0%), 2.9% (95% CI: 1.1-4.5%) and 25.6% (95% CI: 21.18-30.2%), respectively. Overall, 64.1% (225/351) of the children were infected by at least one of the pathogens investigated. Sequence analyses of the 28 G. duodenalis isolates that were successfully genotyped allowed the identification of sub-assemblages AI (14.3%), AII (14.3%), BIII (7.1%) and BIV (25.0%). Discordant typing results AII/AIII and BIII/BIV were identified in 7.1% and 14.3% of the isolates, respectively. A total of five additional isolates (17.9%) were identified as assemblage B. Three Cryptosporidium species including C. hominis (70%), C. parvum (20%) and C. canis (10%) were found circulating in the children population under study. A total of 75 Blastocystis isolates were assigned to the subtypes ST1 (30.7%), ST2 (30.7%), ST3 (36.0%), ST5 (1.3%) and ST7 (1.3%), respectively. Children younger than seven years of age had significantly higher risk of infections by protozoan enteropathogens (PRR: 1.35, P < 0.01), whereas being underweight seemed to have a protective effect against these infections (PRR: 0.74, P = 0.005).

CONCLUSIONS

The burden of disease attributable to human strongyloidiasis, giardiosis, cryptosporidiosis and blastocystosis in Angola is considerably higher than initially estimated in previous surveys. Surveillance and control of these infections should be jointly tackled with formally considered neglected tropical diseases in order to maximize effort and available resources. Our data also demonstrate the added value of using molecular diagnostic methods in high transmission areas.

Distribution of Parasites Detected in Stool Samples of Patients in Le Dantec University Hospital of Dakar, Senegal, from 2011 to 2015

To identify the parasites responsible for intestinal parasitic infections diagnosed at Le Dantec University Hospital of Dakar, distribution of parasites detected in stool samples of patients was studied. From 2011 to 2015, 2578 patients were included in the study. A direct examination and Ritchie technique were performed as parasite search techniques. In total, 408 samples were positive showing 440 intestinal parasites; this corresponds to prevalence of 15.8%. Parasites were detected in monoparasitism (85.7%) and multiparasitism (14.3%). The most common species found in monoparasitism were Entamoeba coli (38.9%), E. histolytica/dispar (12.7%), Giardia intestinalis (8%), and Ascaris lumbricoides (7.3%). The most common associations were A. lumbricoides-Trichuris trichiura (3.6%) and E. coli-G. intestinalis (2.7%). Nonhospitalized patients were significantly more affected with 65.4% compared to hospitalized counterparts; and also there were more men (50.7%) than women. With 67.4%, adults were the most affected age group, while the elderly were less affected with only 7% (p = 0.5). This study shows increasing prevalence of intestinal parasitic infections over the years. So health education should be promoted in addition to the already begun mass treatment program. This would help to limit or even halt the spread of these diseases.