Intestinal Parasitic Infection and Its Associated Factors Among Primary School Students in Ethiopia; a Systematic Review and Meta-Analysis
Authors: Assemie Moges Agazhe , Petrucka Pammla , Shitu Daniel , Hune Yidersail , Abebe Ayele Mamo , Telayneh Animut Takele , Ambaw Mekdes Marew , Ketema Daniel Bekele , Tesfaye Bekele , Getaneh Temesgen , Mengist Belayneh , Habtegiorgis Samuel Derbie 
Published: August 2020

Abstract
Background: Intestinal parasitic infection (IPI) remains a major public health concern affecting both children and adolescents in Ethiopia. However, little attention has been given to intestinal parasitic infection within primary school children. Therefore, this systematic review and meta-analysis was done to determine pooled prevalence and associated factors of intestinal parasitic infection in this target group.Method: We systematically retrieved available articles on the prevalence of intestinal parasitic infection in primary school children in Ethiopia. PubMed, Scopus, Cochrane Library, Google Scholar, and Science Direct between September 1 and December 27, 2019. Two authors independently extracted all relevant data using a standardized Microsoft™ Excel data extraction form. Heterogeneity among included studies was assessed with the Higgins I2 tests. The pooled estimates and associated factors of primary school children’s intestinal parasitic infection were assessed with a random-effects model using Stata/se Version 14.Result: We have retrieved 30 eligible articles with pooled sample size of 14,445 primary school children with response rate of 97.8%. Entamoeba spp (16.11%), Ascaris lumbricoides (13.98%), Hookworm (12.51%) and Giardia lamblia (9.98%) were among the top four causes of intestinal parasitic infection among primary school children. The pooled prevalence of intestinal parasitic infection was found to be 46.09 (95% CI: 38.50, 53.68). Heterogeneity was assessed by doing subgroup analysis by study province/region, with the highest prevalence of intestinal parasitic infection being 66.6 % (95% CI: 55.5, 77.7) in Tigray region, followed by Southern Nations, Nationalities, and Peoples’ Region at 50.8% (95% CI: 33.1, 68.5). Latrine availability (OR=4.39: 2.50,7.73), fingernail hygiene (OR= 2.37: 1.67, 3.35), place of defecation (OR=1.67:1.64,4.36), maternal education (OR=2.02: 1.18,3.47), residence (OR= 1.88: 1.46, 2.41), habit of wearing shoes (OR= 2.66: 1.79, 3.96), source of drinking water (OR=1.99: 1.42,2.76), hands washing practices (OR= 3.45:1.85,6.47), and habit of washing fruits and vegetables (OR=1.59:1.01,2.49) were found to be significantly associated with intestinal parasitic infection. Conclusions: The prevalence of intestinal parasitic infection was high (46%) in the study population. Therefore, this finding warrants the need to design school children hygiene and sanitation service and expand school children deworming programs to decrease intestinal parasitic infections and improve academic performance in the country. In addition, attention should be given to promoting personal hygiene, latrine utilization, wearing shoes, avoiding eating raw food, and creating awareness for those mothers who lack formal education. Moreover, the researchers try to conduct research on province/regions which have no prior research.