Water, sanitation, and hygiene conditions and prevalence of intestinal parasitosis among primary school children in Dessie City, Ethiopia

Abstract

Background Intestinal parasitosis is a major public health problem that affects the health of primary school children in low- and middle-income countries where water, sanitation, and hygiene (WASH) conditions are deficient. Since there is a paucity of information on the prevalence and associated factors of this problem among primary school children in Dessie City in Ethiopia, this study was designed to address these gaps. Methods A school-based cross-sectional study was conducted among 407 stratified-sampled primary school children in five primary schools at Dessie City from April to June 2018. Data were collected using a pretested structured questionnaire, an observation checklist and laboratory analysis of stool samples. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. A portion of stool from each study participant collected sample was processed using saline wet mount technique and examined by microscope. The remaining specimens were preserved with 10% formalin and transported to Dessie Comprehensive Specialized Hospital laboratory to be processed by using formol-ether concentration technique. Then, slide smears were prepared from each processed stool specimen and finally, it was microscopically examined with 10x as well as 40x objectives for the presence or absence of intestinal parasites. Factors significantly associated with intestinal parasitosis were determined using binary logistic regression model at 95% CI (confidence interval). Thus, bivariate (COR [crude odds ratio]) and multivariable (AOR [adjusted odds ratio]) logistic regression analyses were carried out. From the multivariable analysis, variables having a p-value of less than 0.05 were declared as factors significantly associated with intestinal parasitosis among primary school children. Main findings The overall prevalence of intestinal parasitosis was found to be 16.0% (95% CI: 12.5–19.4%), of these, 50.8% were positive for protozoa, 32.2% for helminth infections and 16.9% for double co-infections. Entamoeba histolytica was the most prevalent parasite (29.2%), followed by Giardia lamblia (21.5%), Ascaris lumbricoides (18.5%), Hymenolepis nana (9.2%) and Enterobius vermicularis (4.6%). Prevalence rates were similar among government (16.3%) and private (15.7%) school children. Water consumption was less than 5 liters per capita per day in 4 of the 5 schools. Thirty-eight (9.3%) of primary school students reported that they practiced open defecation. About two-thirds (285, 70.0%) said they always washed their hands after defecation. Mother’s education (illiterate) (AOR = 3.3; 95% CI: 1.20–9.37), father’s education (illiterate) (AOR = 3.9; 95% CI: 1.40–10.82), fathers who could read and write (AOR = 3.3; 95% CI: 1.25–7.86), handwashing before meal (sometimes) (AOR = 2.2; 95% CI: 1.11–4.17) and poor knowledge of WASH (AOR = 9.3; 95% CI: 2.17–16.70) were statistically associated with presence of intestinal parasitic infections. Conclusion We concluded that the prevalence of intestinal parasitosis in the study area among Grades 4–8 primary school children had public health significance. Factors significantly associated with intestinal parasitosis among primary school children’s were illiterate mothers and fathers, irregular handwashing of children before meals, and poor knowledge of WASH. Health education to improve students’ WASH knowledge and mass deworming for parasites are recommended as preventive measures; and improvements to the quality of WASH facilities in primary schools are strongly recommended to support these measures.

Water, Sanitation and Hygiene in Schools in Low- and Middle-Income Countries: A Systematic Review and Implications for the COVID-19 Pandemic

“…Water shortage (intermittent or no water supply) in schools was reported in 62% of papers (n = 40) (see Supplementary Material ). Water consumption was less than 5 L per capita per day in most of the schools assessed in Dessie City (Ethiopia) [ 45 ] and equivalent to 0.6 L per capita per day in schools of Mareko district (Ethiopia) [ 94 ]. To meet their water needs during classes, schoolchildren used to bring water from their own home or from other sources (e.g., buy in the market or fetch water from nearby houses) [ 62 , 63 , 71 , 78 , 80 , 82 , 100 ].…”

“…The longest period reported of schools without water was two consecutive weeks [ 87 ]. To deal with the irregularities in the water supply, schools also resorted to an alternative water source such as a back-up reservoir [ 45 ], alternative water source without description, [ 72 ], storing water from the main source in tanks [ 62 , 87 , 96 ] or limiting the access to the water to selected times of the day [ 29 ]. Four studies stated the ratio of water tap to school population across schools, which ranged on average from 1:7 to 1:114 [ 50 , 69 , 77 , 99 ].…”

“…Water quality was assessed in schools in 18% (n = 12) of studies across nine countries (Pakistan, Ethiopia, Taiwan, Kenya, Nicaragua, Mozambique, Rwanda, Uganda and Zambia), with 33% of schools (1003 out of 3065) reporting that the water was treated before consumption or chlorine residual was identified in the water. The treatment comprised different methods such as chlorination [ 41 , 66 , 71 , 91 ], filtration [ 41 , 71 ], boiling [ 41 , 55 ], disinfection [ 45 ], ultraviolet [ 41 ], reverse osmosis [ 55 ] and solar water disinfection (SODIS) [ 71 ], and treatment without specification of methods [ 84 ]. None of the schools assessed in Eswatini [ 78 ], Cambodia [ 80 ] and Nepal [ 95 ] provided treated drinking water to students.…”

Knowledge and Practice on Prevention of Intestinal Parasitic Infection Among Mothers of Under-five Children in Bulehora Town, Bule Hora, Oromia Region, Southern Ethiopia

“…A similar study in Ethiopia, among school-age children whose mother was illiterate, were 3.3 times more likely to develop intestinal parasites (AOR = 3.3; 95% CI: 1.20-9.37) than those whose mothers had at least basic school education [16]. Further in the age group of mothers (31-35 years) had three times good practice (AOR 2.94, 95% CI 1.38-6.24) than other age group mothers on prevention of IPI.…”

Access to Water and Sanitation Infrastructures for Primary Schoolchildren in the South-Central Part of Côte d’Ivoire

“…Thirdly, by assuring access to water and sanitation facilities, schools can serve as role model to positively influence WASH at the household level. Improving the quality of WASH facilities and their use in primary schools is essential for lowering the risk and impacts of intestinal diseases among primary schoolchildren [14].…”