Study setting and period
The study was conducted in Sebeya primary school from January to February 2017. It is located in Glomekeda district, northern Ethiopia, which 915 km far from Addis Ababa, the capital city of Ethiopia. The school is located in altitude of 2528 m above sea level and geographically it is located 14° 28′ 14.15′′ N latitude and 39° 29′ 40.5′′ E longitude.
Institution based cross-sectional study was employed.
School-age children from grade 1 to 8 who were available during the period of data collection, whose parents/guardians have given assent and who agreed to participate were included.
Sample size determination and sampling technique
The sample size was determined using a single population proportion formula, considering the proportion of intestinal parasitic infection 47.1% , a margin of error 5%, confidence interval of 95%, as assumptions. The final sample size was 422 including a 10% non-response rate students. Samples were selected by simple random sampling technique. Proportional allocation was made to select the study subjects from each grade level based on the number of students at each grade level.
Intestinal parasitic infection (IPs): The participant was recorded positive for IPs if the stool sample examined by microscopy becomes positive to cyst or trophozoite of any parasite.
Washing hands at critical times: Washing hands after visiting the toilet, before a meal, after touching the bottom of the child, after touching animal pets, before food preparation.
Knowledge: Participants were asked to answer 10 knowledge questions about transmission and prevention methods of intestinal parasitic infection. Graded as having “Good knowledge” if they had answered correctly (≥ 80%) 8–10 questions, medium if they had answered (50–70%) 5–7 questions, and < 5 questions as “Poor knowledge”.
Data collection tools and procedure
To collect appropriate data from each student, a structured questionnaire was prepared. Parents and guardians of the chosen learners were traced and interviewed for socio-demographic variables, environmental factors, and hygienic behavior. Meanwhile, data collectors verified the accessibility of the bathroom and the fingernail cleanliness of each student.
Stool sample collection and processing
Two gram of new fecal samples were gathered from children and put in separately labeled containers of smooth plastic stools. The nature of the stool sample was observed and the date of sampling was also noted. The specimens were preserved with 10% formalin and transported to the Mekelle University Medical Parasitology Laboratory. To identify parasitic organisms, a method of formol-ether concentration was employed as described by the standard method .
Data collectors and supervisors have been trained on the methods of data collection. On the spot checking of the completeness of the data was done. The stool specimen examination was done following standard laboratory procedures and few randomly selected samples were re-checked for verification.
Data processing and analysis
Data were entered into EPI Info 7 and exported to SPSS 20 for analysis. Mean, frequency and percentage were used for description. A binary logistic regression model was used to identify significantly associated variables at a p value < 0.05. During bivariate analysis, variables with a p-value < 0.2 were candidates for multivariable logistic regression for the final model. Hosmer and Lemeshow goodness-of-fit test were performed.
This research involved a total of 422 school children, which yields 100% response rate. About 227 (53.79%) were females. The mean (± SD) age of study participants was 11.5 (± 2.31) years. Half of the parents (50.24%) receive less than 500 ETB of monthly income (Additional file 1: Table S1).
Environmental and behavioral characteristics
Two-thirds of children’s parents (63.6%) collected water from well water and 258 (61.1%) washing their hands at critical moments. Two hundred and forty-three (57.6%) of children frequently brushed their teeth and 183 (43.8%) clean their fingernail. More than two-thirds of children (65.4%) always had to wear shoes. Two hundred and thirty-nine (56.6%) children had little knowledge on prevention and control of intestinal parasite infection (Table 1).
Prevalence of the intestinal parasite infection
The prevalence of intestinal parasite infection was 29.9% (95% CI 27.7–32.1%). About 31.3% (61/195) of males were infected with at least one parasite and 28.6% (65/227) of females had the infection. The rate of single, double, and triple parasite infections was 73.02% (92/126), 20.63% (26/126), and 6.35% (8/126), respectively. A total of six parasites were detected and E. histolytica/dispar 19.43% (82/422) and G. lamblia 8.29% (35/422) were the predominant ones (Table 2).
Factors associated with intestinal parasitic infection
In multivariable analysis; grade level, father occupation, clean fingernail, open field defecation, hand washing at critical times, and shoe wearing habit were discovered to be statistically associated with parasitic intestinal diseases (p-value < 0.05) (Table 3).
According to this study, children in grade 1–4 and 5–6 were 8.21 and 2.5 times more likely than their counterparts to have intestinal parasitic diseases [AOR = 8.21, 95% CI 3.88, 17.47, and AOR = 2.50, 95% CI 1.14, 5.54]. Children whose father’s work was a daily worker were 2.96 times more likely than children whose father’s job was a civil servant to develop intestinal parasitic diseases [AOR = 2.96, 95% CI 1.07, 8.18].
Children with unclean fingernails were 1.72 times more probable than children with clean fingernails to develop parasitic intestinal infections [AOR = 1.72, 95% CI 1.04, 2.85]. On the other side, children who were washing hands at critical moments were 68% less probable than their counterparts to develop intestinal parasite infection [AOR = 0.32, 95% CI 0.16, 0.65]. Children who defecate in the open field were 2.82 times higher odds of developing intestinal parasite infections compared to children who did not practice open field defecation [AOR = 2.82, 95% CI 1.21, 7.45]. Besides, the prevalence of intestinal parasite diseases was 72% greater in children with uneven shoe habit [AOR = 1.72, 95% CI 1.02, 2.91].