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

Intestinal parasitic infections are illness and diseases caused by helminths and protozoan [1]. These infections have been occurring predominantly in developing countries and remain a major public health problem with vast socioeconomic devastation among vulnerable rural communities [2‐4]. According to the WHO report in 2014, more than 3.5 billion people were infected with intestinal helminths mainly by Taenia saginata, S.stercoralis, H.nana, A. lumbricoides, T.trichiura and hookworms [5]. From helminthic infections that are grouped under geo-helminthic; A. lumbricoides, T.trichuria and hook worm are widely distributed in sub-Saharan Africa, the Americas, China and East Asia [6, 7]. Many studies showed that more than two billion people were infected by geo-heminthic in worldwide. Two third (2/3) of African countries had high risk areas with prevalence of more than 50% [8]. On the other hand, neglected intestinal protozoans like E. histolytica/dispar, G. lamblia and other coccidian are triggering millions morbidity and mortality among children, pregnant women and immune-compromised people [9, 10].

People are infected through ingestion of infective stages (eggs, cyst,) or skin penetration by larvae stage of the parasites with contaminated soil, water and under cooked meat and/or vegetables [11‐13]. The occurrence of parasitic infections varies with the level of sanitation, water, environment, climates, host and parasitic factors [14]. Generally, they are more predominant illnesses or diseases in the tropics and sub-tropics than temperate climate [15]. Overall, the intestinal parasites could be causes of most illnesses that range from simple and asymptomatic (fever, abdominal pain, weight loss, diarrhea, anemia, malnutrition, mal-absorption, peri-anal irritation and cough) to complex and life threatening problems such as hepatomegaly, obstruction, appendicitis and pancreatic obstruction, seizures and hydrocephalus [16, 17]. The infections may lead to impaired growth, stunting, physical weakness and low educational performance of infected children. It is also imposes large health and socioeconomic burden on societies [17].

The cost-effective anti-helminthic drugs fail to achieve the desired results due to poor sanitations, inaccessibility of safe water, inadequate waste drainage system and favorable climate for transmission of the intestinal parasitic infection in Africa [17]. As a result, pregnant women and children are suffering from parasitic infections give rise to economic crunches, poverty and malnutrition. This has a negative impact on attempts to reduce the maternal and infant mortality rates in the developing countries in general and Sub-Sahara Africa in particular [18]. In line with this, many countries, including Ethiopia have been launching selected deworming programs to control intestinal geo-helminthic infections among preschool-age children to reduce their morbidity and mortality [7, 18].

Despite the presence of selective deworming drugs for under-five children and promotion of health education through health extension workers, intestinal parasitic infections are the leading cause of morbidity and mortality. This is impeding the efforts to achieve sustainable development goals [19]. Poor sanitation, untreated water, inadequate drainage system and poor healthcare system accelerated socioeconomic devastation and hinder healthcare service provision. Effective poverty reduction programmers and promotion of deworming could reduce intestinal parasite carriage [17‐19]. However, there has been need thoroughly evaluate the effectiveness and efficiency of the treatment, prevention and control methods, and risk factors and the way of mitigating of intestinal parasitic infections vulnerable rural communities. Still, there is low selective deworming coverage among under-five children for prevention of geo-helminthes in the most developing countries [20]. Therefore, determine the prevalence and associated risk factors with intestinal parasitic infection are urgently needed for vulnerable communities live in rural areas.

Intestinal parasitic infections caused by helminths and protozoans remain a major public health problem among under-five children living in and around Haro Dumal Town dwellers, thereby the infection possibly contributes to socioeconomic catastrophe and impedes community health. This study revealed that the prevalence of intestinal parasitic infection was 38.5%and such high prevalence has been consistently reported by a number of studies conducted among under-five children live in vulnerable rural communities of Ethiopia. On the other hand, the present study showed very much higher prevalence of intestinal parasitic infections compared to the study conducted in Yadot primary school children of South Eastern Ethiopia 26.2% [12] and Dera district, South Gonder 20.9% [19]. Other studies conducted in many developing countries also agree with the current study that the prevalence of soil transmitted parasites is still high compared to WHO recommending and guideline [4, 11, 14, 16].

This finding showed that the prevalence of intestinal parasite was lower than the studies conducted among children in northwestern Ethiopia; 58.3% [1], Wondo Genet, Southern Ethiopia 85.1% [3]. The significantly low prevalence of parasitic infections observed in this study might be due to geographic difference, awareness to control intestinal parasitic infection and route of transmission. Moreover, health education provided by health extension workers is an important factor influencing individual’s attitudes on the prevention of intestinal infections and child care for their family [2, 5].

This study also revealed that under-five children have been susceptible to parasitic infection by helminthic and the availability of the sources of infection. Many studies showed that selective deworming has been playing a pivotal role in reducing prevalence of geo-helminthic parasites such as T.trichuria, A.lumbricoides and hookworm provided in this age group [9, 16, 17]. In contrast to this, the prevalence of geo-helminthes such A.lumbricoides, hookworm, T tricuriaand E. vermicularis was 13.4, 14.4, 13.9 and 8.8% respectively. This shows that, there were no and/ or low coverage of the recent deworming programme in the study district or there were the possibility of having been re-infected after a period of deworming. Hence, there is the need for urgent intervention, training of health workers with a focus on prevention and control of parasitic infection, launching mass deworming and accessing health facilities [6, 12]. It is initiated us to evaluate the effectiveness and efficiency of the treatment provided for geo-helminths [8]. This agreed with the WHO strategy on eliminating soil-transmitted helminthes through protective chemotherapy in order to reduce child mortality from neglected parasitic infection to attain sustainable health developmental goals [6, 7, 13, 14].

The overall, prevalence of intestinal protozoan affection among under-five children was 25.5%. The prevalence of E.histolytica/dispar and G. lambia was 15.3 and 10.2% respectively. They had been continued to the principal intestinal human pathogenic protozoan among under-five children. This finding substantiates previous studies that E. histolytica/dispar and G. lamblia were predominant intestinal protozoan affect under-five children with gastroenteritis [8, 9]. This study argues that the prevalence of intestinal protozoan infections was ranging from 2.0–7.0% in developed countries and 20.0–30.0% in most developing countries [15]. Another study done in Nigeria and Tanzania confirmed that intestinal protozoa are a public health problem [16, 20]. Indeed, studies done in Ethiopia showed that almost all under-five children were infected with at least one of the two pathogenic intestinal protozoa [1‐3, 12, 19]. Many researchers argued that in developing counties, where there is poor sanitation, untreated water and inadequate drainage systems and poor healthcare, those parasitic infections caused socioeconomic devastation and hampered healthcare in rural vulnerable communities [5, 6, 8]. ThereforeMoreover, they recommended that effective poverty reduction programmes preventive measure for ecto-parasites, promotion of mass deworming, health education and accessing health care facilities as the major controlling and reducing transmission of intestinal parasite carriage where the prevalence is high [9, 18]. Therefore, Those children who live in vulnerable rural communities need top urgent attention for preventing and control of intestinal parasites to attain sustainable health development goals and save millions of under-five children in developing countries.