Prevalence of Gastrointestinal Parasitic Infections and Associated Risk Factors Among Secondary School Students in Wonji Shoa, Adama District, East Shoa Zone, Oromia Region, Ethiopia

Intestinal parasitic infections (IPIs) remain a significant contributor to morbidity and mortality globally, particularly in developing countries such as Ethiopia. Periodic assessments of IPI prevalence are essential prerequisite for effective control measures. Therefore, this cross-sectional study is aimed at determining the prevalence of gastrointestinal parasitic infections and associated risk factors among schoolchildren at Wonji Shoa Secondary School, East Shoa Zone, Adama district, Oromia region, Ethiopia, between January and June 2022. A simple random stratified sampling technique was employed to select participants. Sociodemographic and risk factor data were collected using a structured questionnaire. Stool samples were examined to identify parasites. Data were analyzed using SPSS version 20. Descriptive statistics, chi-square tests, and logistic regression were conducted to assess associations between variables and then the strength of the association. A p value < 0.05 was considered statistically significant. Of the 403 selected students, 330 completed the study that makes 81.89% response success. The overall IPI prevalence was 16.66% (55/330), with a higher prevalence among males (60%, 33/55) than females (40%, 22/55). Five parasite species were identified: two protozoa (Entamoeba histolytica and Giardia lamblia) with a combined prevalence of 9.70% (32/330) and three helminths (Ascaris lumbricoides, Hymenolepis nana, and Taenia spp.) with a combined prevalence of 6.97% (23/330). Cysts were detected in 62.5% of E. histolytica cases (15/24), and eggs were detected in 76.92% of A. lumbricoides cases (10/13). The study revealed a substantial IPI prevalence (16.66%) among the students. This finding underscores the need for effective prevention and control strategies. The predominance of parasitic infections among males is notable requiring further investigation of the factors. The identification of multiple parasite species indicates a complex epidemiological scenario. The presence of protozoan cysts and helminthic eggs highlights the potential for fecal-oral transmission and the importance of improved sanitation and hygiene practices.


Background of the Study
Human intestinal parasites remain a significant global health burden, particularly in developing countries such as Ethiopia, contributing substantially to morbidity and mortality [1].Gastrointestinal parasitic infections (GIPIs) are prevalent worldwide, with a particularly high endemic rate in regions including Africa, Southeast Asia, South America, and Eastern Europe [2].Intestinal parasites are categorized as either helminths (worms) or protozoa, both of which inhabit the human intestine [3].Protozoa exist in two forms: trophozoites and cysts.Trophozoites are the active, repro-ductive stage capable of causing infection, while cysts are the dormant, resistant form transmitted through fecal-oral contamination [1].Helminths are another primary causative agent of GIPIs and are classified as nematodes (roundworms), cestodes (tapeworms), and trematodes (flukes) [4].Adult worms reside in the intestine and shed eggs or larvae through feces.Transmission primarily occurs via the fecaloral route or through skin penetration [5].
The most prevalent protozoan intestinal parasites include Entamoeba histolytica, Giardia lamblia, Balantidium coli, and Cryptosporidium parvum, while common helminths comprise Ascaris lumbricoides, hookworm, Hymenolepis nana, Taenia spp., and Schistosoma mansoni [5].A strong correlation exists between high GIPI prevalence and factors such as poverty, low income, inadequate sanitation, overcrowding, improper waste management, limited access to clean water, tropical climate, and low latitude [3,6].Globally, approximately 3.5 billion individuals are affected by GIPIs, resulting in over 200,000 annual deaths.Ethiopia alone accounts for 50,000 of these fatalities [7].Rural populations and schoolaged children are disproportionately impacted by high infection rates and intensities [8].The latter group is particularly vulnerable due to behaviors such as playing in contaminated soil, poor hygiene practices, and consuming contaminated food and water [9].
Intestinal parasitic infections (IPIs) constitute a significant burden of disease, particularly among children in developing nations [10].More than 267 million preschool-aged and over 568 million school-aged children reside in regions with intensive IPI transmission, necessitating effective treatment and prevention strategies [11].Sub-Saharan Africa, including Ethiopia, exhibits a high prevalence of IPIs among schoolchildren [12], with substantial negative impacts on nutritional and cognitive development, school attendance, and dropout rates [8].The consequences of IPIs extend beyond these immediate effects, encompassing cognitive impairment, malnutrition, anemia, increased susceptibility to other infections [13], malabsorption, vitamin and mineral deficiencies, chronic blood loss, diarrhea, organ damage, impaired mental development, and stunted growth, with children experiencing more severe effects than adults [14,15].
Effective prevention and control of IPIs necessitate a comprehensive assessment of prevalence and the identification of associated risk factors, particularly within vulnerable populations [16].The endemicity of IPIs in many regions is closely linked to behavioral, geographical, economic, and social conditions [17].The study area exhibited several factors conducive to IPI transmission, including prevalent open defecation, low educational attainment, large family size, inadequate living conditions, scarcity of potable water, and a warm, humid climate.Notably, a high proportion of male students engaged in irrigation-related agricultural activities, often without proper footwear.This study is aimed at determining the prevalence of IPIs and identify associated risk factors within this context.

Description of the Study Area.
The study was conducted at Wonji Shoa Senior secondary school, located in East Shoa Zone, Oromia Region, Ethiopia.Its geographic coordinates are 8 °30′ N latitude and 39 °20′ E longitude, with an elevation of 1540 masl (Figure 1).The area experiences an average annual rainfall of 831 mm and mean maximum and minimum temperatures of 27 °C and 15 °C, respectively.Notably, the region's historical significance includes the establishment of Ethiopia's first modern sugar industry in 1954.

Research Design.
A school-based cross-sectional study was conducted among secondary school students at Wonji Shoa School from January to June 2022 to determine the prevalence of and associated risk factors for IPIs.

Inclusion and Exclusion
Criteria.Study participants consisted of students whose parents/guardians provided voluntary written consent and who had not taken any antiparasitic medication within the preceding 2 months.Students who had received antiparasitic treatment within the past 2 months or whose parents/guardians declined to provide written consent were excluded from the study.was emulsified in separate drops of saline and iodine on clean glass slides.Coverslips were applied, and the prepared slides were examined under a light microscope at 10× and 40× magnifications to detect the ova, larvae, cysts, and trophozoites of intestinal parasites.
2.4.2.2.Formal-Ether Concentration Method.Approximately 3 g of each stool sample was homogenized in 7 mL of 10% formalin and filtered through gauze.Subsequently, 3 mL of diethyl ether was added to the formalin solution, and the mixture was vigorously agitated for 30 sec by inverting the stoppered tube.The sample was then centrifuged at 2000 rpm for 3 min, resulting in four distinct layers.The upper three layers were discarded.The remaining sediment, containing the parasitic elements, was resuspended in normal saline and transferred to a microscope slide.The slide was examined under a microscope using a 10× objective lens followed by a 40× objective lens to identify cysts and ova.
2.5.Sample Size Determination Techniques.Sample size was calculated using the single population proportion formula as outlined by Charan and Biswas [18].This method has been previously employed in similar studies conducted in Merawi elementary schools [17].Given the absence of prior research on IPIs among Wonji Shoa secondary school children, a prevalence of 50% was assumed to maximize sample size.BioMed Research International With a desired 95% confidence interval, a 5% margin of error, and an anticipated 5% nonresponse rate, the calculated minimum sample size was 403.

Sampling Technique.
To select the study population, classes were initially chosen through a lottery method.A quota, proportional to the class size, was assigned to each selected class.Subsequently, participants were stratified based on sociodemographic characteristics, and then, participants were selected using simple random sampling.

Data Analysis. Data were analyzed using Statistical
Package for Social Sciences (SPSS) version 20.0.Descriptive statistics, including frequencies and percentages, were computed for categorical variables.The association between the prevalence of IPIs and sociodemographic and associated risk factors was assessed using the chi-square test.Binary logistic regression was employed to determine the strength of association between variables, expressed as crude odds ratios.A p value less than 0.05 was considered statistically significant for all analyses.
2.8.Ethical Considerations.Prior to commencement, ethical approval for the study was secured from the Ethical Review Committee of the College of Natural and Computational Science, University of Gondar.Subsequent permissions were obtained from school principals and relevant authorities in the study area.Written informed consent was acquired from the students' parents/guardians prior to participation.Students were referred to a local health center for stool examination, and those diagnosed with parasitic infections received appropriate antiparasitic treatment as prescribed by physician.All costs associated with diagnosis and treatment were covered by the research team.
2.9.Quality Assurance.Research questionnaires were initially developed in English and subsequently translated into Afan Oromo and Amharic, the local languages.To ensure conceptual equivalence, back translation into English was performed.All diagnostic procedures and treatment were conducted by laboratory technicians and physicians at Wonji Shoa Clinic in accordance with standard operating procedures outlined by the World Health Organization.Data were meticulously cleaned, coded, and entered.

Chi-Square Analysis of Risk Factors Associated With the
IPIs.Chi-square analysis revealed no significant associations between the studied risk factors and the prevalence of IPIs.However, a notable trend emerged: individuals who regularly consumed boiled water exhibited a significantly lower  4).

Logistic Regression Analysis (LRA) of the Risk Factors
With IPIs Among School Children in Wonji Shoa Secondary School Children From January to June 2022.Univariate logistic regression analysis was conducted to assess the association between sociodemographic factors and other potential risk factors with IPIs (Table 5).Age was identified as a statistically significant predictor of IPIs (p < 0 25).Compared to other grade levels, students in Grade 12 were approximately two times more likely to be infected with IPIs (OR = 1 889 -4 501, p ≤ 0 388).Additionally, individuals experiencing additional symptoms alongside diarrhea were found to be 2.9 times more likely to be infected compared to those without (p ≤ 0 392) (Table 5).

Discussion
Regular monitoring of GIPI trends within specific communities is essential for evaluating the effectiveness of existing prevention and control programs and informing the development of future therapeutic interventions.School-based deworming programs are a key component of communitywide GIPI control efforts and require ongoing assessment.
A previous systematic review and meta-analysis by Legese et al. [9] reported a significant decline in GIPI prevalence among Ethiopian children over the past two decades, although the burden of infection remains substantial among school-aged populations.This study is aimed at assessing the prevalence and associated risk factors of GIPIs among students at Wonji Shoa secondary school, Ethiopia.The overall GIPI prevalence in this study was 16.66% (55/330), which is higher than the 12% reported among schoolchildren in Taif, Saudi Arabia [19].The prevalence of GIPIs observed in this study is lower than that reported in several previous studies.For instance, Ayalew, Debebe, and Worku [20] found a prevalence of 79% among schoolchildren in Delgi, Ethiopia, while Alamir, Awoke, and Feleke [21] reported a rate of 77.9% in Dagi Primary School, Ethiopia.Other studies conducted in Ethiopia,  [10,17,[22][23][24][25][26][27].These discrepancies in prevalence may be attributed to a multitude of factors, including variations in sanitation and hygiene practices, public health infrastructure, food and water safety, nutritional status, host immunity, access to safe water, socioeconomic conditions, and environmental determinants.Previous research has consistently emphasized the complex interplay of these elements in shaping GIPI prevalence [28].
The present study revealed a higher prevalence of IPIs among male participants compared to females.This finding aligns with the previous research conducted among schoolchildren in Chilga [38] and Delgi [20], both located in Ethiopia.Conversely, a study in Adigrat, Ethiopia, reported a higher prevalence among females [39].Potential explanations for the observed gender disparity in IPI prevalence include differences in gender roles and behaviors.Male participants may be more exposed to contaminated soil and water through agricultural activities, a common source of IPI transmission.In contrast, females may exhibit greater attention to hygiene and environmental sanitation.Additionally, the higher physical activity levels and outdoor play among male students may increase their risk of exposure to infectious agents.These factors could contribute to the elevated IPI prevalence observed in the male population of the study area.
A statistically significant difference in overall IPI prevalence was observed across age groups.Higher infection rates were found in younger age brackets, specifically among students aged 1-16 years.This finding suggests that older children may have improved knowledge of hygiene practices, such as hand washing, compared to their younger peers.IPI prevalence was significantly higher among participants from rural compared to urban areas.This observation aligns with the previous research conducted in Merawi elementary schools [17], Motta town [5], Sasiga district [24], and Adigrat town [39].Potential contributing factors to the elevated IPI prevalence in rural settings include suboptimal personal and environmental hygiene, inadequate hand washing practices, open defecation, and increased exposure to contaminated soil, water, and domestic animals.

Conclusion
The prevalence of IPIs among the study population was determined to be 16.66% (n = 55).Males exhibited a higher

Figure 1 :
Figure 1: Map of the study area.

Table 1 :
Sociodemographic characteristics of study participants at Wonji Shoa senior secondary school children from January to June 2022.

Table 2 :
Different developmental stages of IPIs identified during the diagnosis of school children at Wonji Shoa secondary school from January to June 2022.

Table 3 :
Sociodemographic characteristics of the study subjects in Wonji Shoa secondary school children from January to June 2022.

Table 4 :
Associated risk factors with IPIs among school children at Wonji Shoa secondary school from January to June 2022.

Table 5 :
Associated risk factors with the prevalence of IPIs among Wonji Shoa secondary school, East Shoa, Ethiopia, from January to June 2022.

Table 5 :
Continued.BioMed Research International infection rate compared to females.Among the parasites, E. histolytica and A. lumbricoides were the most prevalent protozoan and helminth, respectively.Other parasites detected included G. lamblia, H. nana, and Taenia spp.Despite evaluation, no significant associations were found between IPI infection and the assessed risk factors.The majority of infections (36.36%) were diagnosed through cyst detection, while 23.64% were identified by egg examination.Notably, participants in the youngest age group, those from rural areas, and those with lower monthly family income demonstrated a higher prevalence of IPIs.It is recommended that community-based health education, mass drug administration, and school-based deworming programs be implemented consistently to address the burden of IPIs in the study area.