Intestinal parasitosis, anaemia and risk factors among pre-school children in Tigray Region, Northern Ethiopia
Authors: Wasihun Araya Gebreyesus , Teferi Mekonen , Negash Letemichal , Marugán Javier , Yemane Dejen , McGuigan Kevin G. , Conroy Ronan M. , Abebe Haftu Temesgen , Dejene Tsehaye Asmelash 
Published: August 2019

Background

Intestinal parasitic infections (IPIs) and anaemia are major health problems. This study assessed the prevalence of IPI, anaemia and associated factors among pre-school children in rural areas of the Tigray region, northern Ethiopia.

Methodology/Principal Finding

A community based cross-sectional study was conducted among 610 pre-school children in rural communities of Northern Ethiopia from June 2017 to August 2017. Stool specimens were examined for the presence of trophozoites, cysts, oocysts, and ova using direct, formal-ethyl acetate concentration, Kato–Katz, and Ziehl-Neelsen techniques. Haemoglobin was measured using a HemoCue spectrometer. Among the 610 pre-school children participated in the study, prevalence of IPIs and anaemia were 58% (95% CI: 54.1–61.9%) and 21·6% (95% CI: 18·5% to 25·1%), respectively. Single, double, and triple parasitic infections were seen in 249 (41%, 95% CI: 37% to 45%), 83 (14%, 95% CI: 11% to 17%), and 22 (3.6%, 95% CI: 2.4% to 5.4%) children, respectively. Of the seven intestinal parasitic organisms recorded from the participants,Entamoeba histolytica/disparwas the most prevalent 220 (36.1%) followed byGiardia lamblia128 (20.1%), andHymenolepis nana102 (16.7%). Mixed infections were common amongG. lamblia, E. histolytica/disparandCryptosporidiumspp. oocyst. Age 48-59 months prevalence ratio (PR = 1·078, P=0·009), child deworming (PR= 1.2; 95% CI=1.00-1.4, p= 0.045), and having two or more children aged under five (PR=0.76, 95% CI= 0.61-0.95, p=0.015) were independent predictors for IPIs. Anaemia was associated with proper disposal of solid waste (PR= 1.5, 95% CI=0.1.1-2.10, p=0.009). Eating raw meat (PR=0.49, 95% CI=0.45-0.54, p=0.000), any maternal education (PR=0.64 95% CI=0.52-0.79, p=0.000), and household water treatment (PR=0.75, 95% CI=0.56-1.0, p=0.044) were associated with lower prevalence of anaemia.

Conclusions

More than half of the children were infected with intestinal parasites and one in five were anaemic. This study has identified a number of potentially modifiable risk factors to address the significant prevalence of IPIs and anaemia in these children. Improvements in sanitation, clean water, hand hygiene, maternal education could address both short and long-term consequences of these conditions in this vulnerable population.

Author Summary

Intestinal parasitic infection and anaemia are public health problems in developing counties. Children due to their immature immune systems and frequent exposure to unhygienic environments are at high risk which in turn put them at an increased risk of malnutrition and growth deficits. Similarly, childhood anaemia impairs physical growth, impairs immune function and weakens motor development. The finding of this study reveals more than half of the children were infected.Entamoeba histolytica/dispar, Giardia lambliaandHymenolepis nanawere dominant parasites. Multiple infections was common amongGiardia lamblia, Entamoeba histolytica/disparandCryptosporidiumspp. Oocyst. Children aged 48-59 months were more infected with intestinal parasites. Soli transmitted helminths in this study was low. 21.5% of the children were anaemic and was associated with disposal of solid waste and presence of domestic animals. However, Eating raw meat, maternal education and household water treatment were found preventive of anaemia in the study. It seems worth understanding the prevalence and effects of parasitic infection and anaemia in this vulnerable group to design an appropriate interventions. Finally, if parasite transmission and anaemia is to be significantly prevented control programs such as improving sanitation, clean water, maternal education may be critical in this vulnerable age groups.