Prevalence of Intestinal Parasites and its Predisposing Factors among Patients Sent for Stool Examination at Ambo General Hospital, Oromiya Region, Ethiopia

**Result**

In Ambo General Hospital, among patients visiting the hospital during the study period, 244 population were taken as sample population and the sample contain 136(55.7%) females and 108(44.3%) males. The study population were selected by convenient sample technique at 95% confidence interval. The respondent were interviewed and their stool specimen were examined microscopically. From sampled population 154(63.1%) of patient were positive for at least single infection while 90(36.9%) were negative for any parasites. Therefore, the overall prevalence rate of intestinal among patients sent for stool examination at Ambo General Hospital was 63.1%. From total study population of 244, of which 136(55.7%) females and 108(44.3%) males, 92(37.7%) of female and 62(25.4%) of male patients were found to be positive for intestinal parasitic infection. Even though female patients were affected more than male, there was no statically association between sex and intestinal parasitic infection (p>0.05).

Intestinal parasitic infection were high on young age groups and its distribution decreases as age increases. There was statistical association between intestinal parasitic infections and age p<0.05 from the study population, 74(30.4%) of them were students and 58(23.7%) of them were farmers, out of this 48(19.7%) of students and 34(13.9%) of farmers were positive for intestinal parasites infections respectively. The rest were merchants 40(16.4%), house wife 26(10.7%), government employees 24(9.8%). There was no statistical association between parasites infection and occupation. p>0.05. From total population, 64(26.2%%) of patients were illiterates and 180(73.8%) were literates, out of them 42(17.2%) of illiterates and 112(45.9%) of literates were positive for intestinal parasitic infections. There was statistical association between parasites infection and educational status. p<0.05.

| Stool examination | | | | | p-value | Total | |
| :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- |
| | Positive | | Negative | | | | No | % |
| Sex | Male | 62 | 25.40% | 46 | 18.90% | 0.25 | 108 | 44.30% |
| | Female | 92 | 37.70% | 44 | 18.00% | | 136 | 55.70% |
| | Total | 154 | 63.1 | 90 | 36.9 | | 244 | 100 |
| Age | 0-14 | 64 | 26.20% | 22 | 9% | 0.001 | 86 | 35.20% |
| | 15-29 | 40 | 16.40% | 30 | 12.30% | | 70 | 28.70% |
| | 30-44 | 26 | 10.70% | 16 | 6.60% | | 42 | 17.30% |
| | 45-59 | 18 | 7.40% | 12 | 4.90% | | 30 | 12.30% |
| | >60 | 6 | 2.4 | 10 | 4.10% | | 16 | 6.50% |
| | Total | 154 | 63.10% | 90 | 36.90% | | 244 | 100% |

The source of water for drinking, pipe 172(70.2%), well 40(46.4%), spring 18(7.3%) and river 14 (5.7 %%), from these 102(41.8%) of pipe, 30(12.3%) of well, 14(5.7%) of spring and 8(3.3%) of river water users were positive for intestinal parasitic infections respectively. There was statistical association between parasites infection and source of water. p<0.05. From total well of 40, 34(85%) of them were protected and 6(15%) of them were not protected, out of the patients who uses well as source of water for drinking, 26(65%) from protected well and 4(10%) from unprotected well who uses well as source of water for drinking were positive for intestinal parasitic infections. There was statistical association between parasites infection and source of water. p<0.05. Common form of waste disposal systems were open field 122(50.0%) and burn 54(22.1%), out of them 78(32.0%) and 34(22.1%) of patients were positive for intestinal parasitic infections respectively. There was statistical association between parasites infection and source of water p<0.05.

Total

From the study population, 8(3.3%%) of them eats raw meat always, 104(42.6%) eats sometimes and 132(54.1%%) never eats, out of them 6(2.5%), 72(29.5%), and 76(31.1%) were positive for intestinal parasitic infections respectively.

There was no statistical association between parasites infection and row meat P>0.05. From the study population, 34(13.9%) of them eats unwashed fruits and vegetables always, 98(40.1%) eats sometimes and 112(45.9%) never eats, out of them 26(10.6%), 34(27.8%) and 60(24.6%) were positive for intestinal parasitic infections respectively. There was statistical association between parasites infection and row meat. P<0.05.

respectively. There was statically association between parasites infection and row meat. p<0.05.

During the study the patients were observed for finger nail status and 166(68.0%)of the patients finger nails were trimmed and 78(32.0%) were not, out of them 102(41.8%) and 52(21.3%)of them were positive for intestinal parasitic infections respectively. There were statistical association between parasites infection and not trimming their finger nails. p<0.05.

From the study population, 134(63.1%) of them have habit of hand washing always, 86(35.2%),washes sometimes and 4(1.7%) never wash, out of them 86(35.2%), 64(26.2%) and 4(1.7%) were positive for intestinal parasitic infections respectively. There was statistical association between parasites infection and row meat. p<0.05.

Table 3: Distribution of intestinal parasites versus habit of eating raw meat, habit of eating unwashed fruit and vegetable ,habit of eating undercooked food, habit of trimming finger nail and habit of hand washing before meal among patients who sent for stool examination at Ambo General hospital, Ambo town, Ethiopia, August 22,2021- August 31,2021.

From the study population, 180(73.8%) of them have habit of wearing shoes always, 54(22.2%) eat wear sometimes and 6(2.4%) never wear, out of them 2(0.8%),

6(2.5%) and 4(1.6%) were positive for intestinal parasitic infections respectively. There was statistical association between parasites infection and row meat. p<0.05.

Total of seven intestinal parasites were identified. From the identified species G.lambilia was the mast common 132(52.9%) followed by E.histolytica 42(20.2%), A.lambricoids 16(7.7%), hook worm 12 (5.8%), Tina species 10(4.8%), T.trichuria 10(4.8%) and S.mansoni 8(3.8%).

Discussion

In the cross sectional study out of the sample population of 244, 154(63.1%) were positive for intestinal parasitic infection while 90(36.9%) were negative for any parasites. Intestinal parasite infection prevalence in the study area was higher when compared with the global prevalence, in which 2 billion people affected and 450 million are ill due to the intestinal parasites [6, 7]. The study done in Jimma health center shows prevalence of intestinal parasitic infection was 20.6% which was lower when compared with the study area (29). Also the study conducted in Sudan among Children in Al-kalakla, Khartoum and study done in Sanja Primary Hospital among patients attending at the hospital show lower prevalence of intestinal parasitic infection 30% and 52.9% respectively when compared with the study area [25, 26, 27, 28]. This difference on the prevalence of parasitic infection due to: Geographical area which affects the distribution of intestinal parasites. The period at which the study done i.e. seasonal prevalence of parasites. Different socio economic status of peoples on different area of the world. The study population for example children are more affected groups and this may increase the figure if children are taken as the study population. The laboratory methods used.

The most common parasite seen in the study area is G.lambilia trophozites 110(52.9%). This prevalence is higher when compared with other studies such as study done in jimma health center 20.6% and in Sanja Primary Hospital 52.9% [28, 29]. The prevalence of G.lamblia in the area was higher when compared with the study done by kathery H in Sudan which is 12.5% [25]. As well as the prevalence of G.lamblia in the area was higher when compared with the study done in Ethiopia among primary school children done by Assemie MA,. which is 9.98 % [26].

This difference could be due to:-the study period may increase the prevalence of parasitic infections which was during the rain period. The above researches were done years back and lack of health information on study area may increase the figures. The prevalence of E. histolytic trophozoites is the second most common 20.2%. The prevalence is lower when compared with other studies such as study done in sanja primary hospital 21.5% [28, 29, 30, 31, 32]. This lower prevalence is due to: Route of acquiring the infection is feco-oral and there is improved hygienic way on feeding. The prevalence of A. lambricoids in the study area is 7.7% which makes it the third most prevalent intestinal parasite. When compared with other studies done in other part of the world, it is lower in Ethiopian such as the study done by Bismarck NN in a population of school aged children in Cameron shows 8.8% [24]. The study done by Belete YA, Kassa TY, on patients of Jimma health center requested for stool examination in Jimma town was 5.7% which showed lower prevalence than the study area [16]. The highest prevalence of A.lanbricoids in the study area compared with the study done on jimma town is due to low socio economic status and poor sanitation in the study area.

Hook worm is the fourth most prevalent intestinal parasite accounting 5.8%. The study conducted in Thailands, Sanja primary hospital among patients attending the hospital and Ethiopia among primary school children showed highest prevalent of hook warm when compared with this study area 10.7%, 13.3% and 12.51% respectively [22, 26, 28]. Not practicing shoes wearing in the sanja population and primary school children in Ethiopia may be the cause for the highest prevalence of the worm and also they may not dispose waste properly [28]. The prevalence of hookworm in this area was slightly higher when compared with the study done in hawassa university clinic 5.4% [27]. This is because obviously, the urban population practice shoe wearing and they also properly manage waste disposal when compared with the rural population. Teania saginata was found in the population which is 4.8% prevalent. Teania species was not detected in all other studies. This indicates that, the population are eating raw meat and they were not aware towards the possibility of being infected from eating raw meat.

There is significant association between educational status and intestinal parasitic infection which is similar with the study done in assam India by Rebecca T. to assess the prevalence and risk factors for soil transmitted helminthes and identified level of education as the risk factors [27]. This may be due to:-Illiterate people have no knowledge on ways of transmission of parasites and how to prevent the transmission. Educated peoples have improved socio economic status and they have knowledge about environmental sanitation. There is also significant association between intestinal parasitic infection and latrine usage, waste disposal, hand washing habit, eating unwashed fruits and vegetables, undercooked foods, raw meat. Which is comparable with study Ethiopia among primary school childrens [27]. This could be due to:-Low socio economic status. Habit of eating unwashed fruits and vegetables, and undercooked foods. Absence of hand washing before meal, especially in children. Lack of knowledge towards the effect of eating raw meat which is more common in adults and older patients. Practicing of open field as waste disposal.

Generally in the study area the prevalence of G.lamblia and E.histolytica are higher other intestinal parasitic infection. This due to: - Even though there is no significant association between water source and intestinal parasitic infection, there is a problem on water purification system, materials by which they collect and store water. They were practicing open field on waste disposal system. Some patients have no habit of washing hands before meal and after toilet use in the study area. They use fruit and vegetables for consumption without washing and cooking appropriately.

Conclusion

As it expected in developing countries intestinal parasitic infection is very high and common. There was high prevalence of intestinal parasitic infection in the study in which 63.1% of them were found to be positive for at least single intestinal parasite. Total of seven intestinal parasites were identified. From the identified species G.lambilia was the most common 132(52.9%) followed by E.histolytica 42 (20.2%), A.lambricoids 16(7.7%), Hook worm 12 (5.8%), Tina species 10(4.8%), T.trichuria 10(4.8%) and S.mansoni 8(3.8%). Age, educational status, source of water, age, waste disposal system, habit of eating unwashed fruit and vegetables and undercooked foods, and habit of hand washing and finger nail status were the risk factors for intestinal parasitic infections. But sex and occupation were not the risk factors for intestinal parasitic infections.

Recommendation

The result found from the health center reflects the prevalence of intestinal parasites in the communities of that area, since they come from the areas around. Therefore, to solve these problems of the high prevalence and to control determinate factors:- Health education should be given for the community. Literacy campaign. Proper environmental sanitation and personal hygiene. Proper usage of latrine and waste disposal system, Safe water supply and proper usage of water with clean materials. Promotion of health services activities and provision of mass treatment and deworming should be given. This finding from the study could be used as base line data and further investigation should be done to know the problem of intestinal parasitism more in the area by the others.