Background
Food-borne infections are common public health problems, which become a significant public health issue all over the world [
1]. The related problems are high in the low and middle-income countries, due to the difficulties in adopting optimal hygienic practices during food handling [
2].
Intestinal parasites in Ethiopia are widespread and the loss of human life and suffering is enormous just like other low and middle-income countries. Several food-borne disease outbreaks are associated with the poor personal hygiene of people handling foodstuffs [
3]. Lack of clean and safe water, high population density, lack of proper disposal of waste, noncompliance with health standards (social and individual), lack of adequate washing of vegetables, and lack of well-cooked meat lead to a high prevalence of intestinal parasites [
4‐
6].
A lot of communicable diseases and microorganisms can enter the body through foods and cause infection. Intestinal parasites are one of the common agents to cause intestinal infection among food handlers [
7]. The dominant intestinal protozoa and helminths parasites in Ethiopia are
Giardia lamblia (G.lamblia), Entamoebahistolytica/dispar (E.histolytica/dispar), Ascarislumbricoides (A.lumbricoides) and Trichuristrichuria (T.trichuria) [
8].
Studies in Ethiopia showed that the prevalence of intestinal parasitic infection among food handlers working at University student cafeteria’s and public food establishment area such as Haramaya University cafeterias (14.3%) [
9], East and West Gojjam prison (61.9%) [
10], Wollo University student’s cafeteria (15%) [
11], Aksum Town (14.5%) [
12], Jimma University Specialized Hospital (33%) [
13], Addis Ababa University Students’ Cafeteria (45.3%) [
7], Hawassa University (20.6%) [
14], and Mekelle University student’s cafeteria (52.4%) [
2]. However, the prevalence reflected in these small and fragmented studies varied widely and remained inconclusive. Besides prevalence, identifying modifiable risk factors is a critical step in identifying potential interventions. The lack of a nationwide study that determines the prevalence and factors associated with intestinal parasitic infections among food handlers working in higher public university student’s cafeterias and public food establishments is a significant gap.
Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of intestinal parasite and associated factors among food handlers working in higher public university student cafeterias and public food establishments’ using available studies in Ethiopia. The findings from this systematic review will highlight the prevalence and factors associated with intestinal parasitic infections among food handlers working in higher public university student’s cafeterias and public food establishments’ in Ethiopia.
Discussion
Intestinal parasitic infection is one of the most common causes of morbidity and mortality among food handlers in Ethiopia [
33]. Ballpark figuring of the pooled prevalence of intestinal parasitic infection and its associated factors in Ethiopia may give attention to policymakers to take a corrective action based on the evidence. Hence, this systematic review and meta-analysis were conducted to estimate the overall pooled prevalence of IPIs and its associated factors among food handlers in Ethiopia. The overall pooled prevalence of IPIs obtained from this meta-analysis showed that (28.5%; 95% CI: 27.4, 29.7) among food handlers in Ethiopia were suffered from IPIs
. The finding of this meta-analysis was higher than the study conducted in Iran 8.8% Southwest [
34], 15.5% in Sari, Northern [
35], and 10.4% Shiraz [
36]. On the other hand, this study finding showed that the result is in line with the study done Northwest Ethiopia (27.7%) IPIs from clinically suspected patients [
37]. The possible justification for the above disparity could be credited to methodological variation in the assessment of prevalence. The discrepancy in the prevalence of IPIs this review and meta-analysis study and other African countries could be rationalized by the dissimilarity in socio-demographics, personal and environmental hygiene practice.
The subgroup analysis of this study showed that the highest prevalence of Intestinal parasitic infection was observed in SNNP, 30.39% (95% CI: 28.13, 32.64), Oromia, 29.14% (95% Cl: 25.63, 32.65) and Amhara region, 27.55% (95% CI: 25.73, 29.37), whereas the lowest prevalence was observed in Tigray and Addis Ababa with the prevalence of 27.72% (95% CI: 24.99, 30.45) respectively. The possible explanation for this variations across the region might be due to sociodemographic, environmental, behavioural characteristics of food handlers and quality of food establishments.
In this meta-analysis, the pooled prevalence of intestinal protozoa infection was
E.histolytica 6.38% (5.73, 7.04), and
G. Lamblia 3.12% (2.65, 3.60). The finding of this meta-analysis in line with the study done in Iran
G. lamblia (4.52%), and
E. hystolitica /E. dispar complex (1.39%) [
34]. However, our study finding was lower than the study done in Libya and sari Northern Iran,
E. hystolitica /E. dispar complex 19.9%
G. lamblia 4.6% [
38], and in
Giardia lamblia (1.6%) respectively [
35].
In this meta-analysis
Taenia species 1.07% (0.75, 1.40),
Hookworm 1.70% (1.31, 2.09),
T. trichuria 0.84% (0.42, 1.26),
H.nana 1.09% (0.66, 1.41),
E. vermicularis 2.69% (1.43, 3.96), and
S. mansoni 0.70% (0.34, 1.07) were the commonest protozoan infections. The finding of this study was relatively consistency with studies in Southwest Iran
, H.nana (1.29%),
A.lumbricoides (0.57%), and
E.vermicularis, T. trichiura, S. stercoralis was each less than 0.5% [
34]. However, a study conducted in Sari, Northern Iran showed that
H. nana (1.9%) was the only helminthic infection [
35]. Furthermore, a study from clinically suspected patients in northwest Ethiopia was
hookworm 21.1%, and
A.lumbricoids 3.9% [
37]. Besides, a survey study in Ethiopia reported that
A .lumbricoides 9.9%,
hookworm 9.7%, and
T.trichiura 2.6% were the commonest intestinal helminths [
39].
Under subgroup analysis, the result of this study showed that the highest prevalence of IPIs was observed in SNNP, 30.73% (95% CI: 28.34, 33.11), followed by Oromia 28.81% (95% CI: 25.69, 31.94), then Tigray and Addis Ababa 27.72%(95% CI: 24.99, 30.45) whereas Amhara region was the lowest prevalent region with the prevalence of 27.55% (95% CI: 25.73, 29.37). The potential justification for this difference might be due to the distinction in socio-demographic, environmental, geographical and behavioural characteristics.
This systematic review and meta-analysis study is aimed to identify factors associated with intestinal parasitic infection among food handlers in Ethiopia. In this study, fingernail trimming, hand washing after defecation, hand washing after touching any body parts, regular medical checkup, and food safety training were significantly associated with intestinal parasitic infections.
The odds of not having handwashing after defecation were 2.71 times more likely to develop intestinal parasitic infections than their counterparts. This finding is supported by the studies conducted in Kenya [
40], Gambia [
41], Pakistan [
42] and Ethiopia [
30,
43,
44]. This might be due to feco-oral microorganism transmissions. The odds of untrimmed fingernail were 3.04 times more likely to acquire intestinal parasitic infections than their counterparts. This finding is supported by the studies conducted in Ethiopia [
30,
43,
44]. This might be due to the fact that untrimmed fingernail may contain dust particles and microorganisms which facilitates in easily transmissions of microorganisms feco-orally.
The odds of didn’t take food safety training were 1.79 times more likely to be infected with intestinal parasites than those food handlers who took food safety training. This finding supported by the studies conducted in Bangladesh [
45] and Saud Arabia [
46]. This might be due to the fact those food handlers who didn’t take food safety training may lack the necessary knowledge and practice towards transmission and prevention of microorganisms.
Conclusion
In this study, intestinal parasitic infection among food handlers in Ethiopia was significantly high. Untrimmed fingernail, do not washing hands after defecation, do not washing hands after touching any body parts, do not made regular medical checkup and do not receive food safety training were factors that increase the prevalence of intestinal parasitic infections. Therefore, based on the study findings, the authors recommend particular emphasis shall be given to the periodic and regular medical care, health educations about personal hygiene, hand washing practice, and food safety are recommended for food handlers.
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