Prevalence of Intestinal Parasitic Infections and Associated Risk Factors Among Patients Attending Dejen Primary Hospital, Amhara National Regional State, Ethiopia

doi:10.21203/rs.3.rs-4947583/v1

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Prevalence of Intestinal Parasitic Infections and Associated Risk Factors Among Patients Attending Dejen Primary Hospital, Amhara National Regional State, Ethiopia

https://doi.org/10.21203/rs.3.rs-4947583/v1

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Intestinal parasitic infections (IPIs) are the greatest worldwide cause of illness and disease. About 1.5 billion individuals have been infected by IPIs in 2023, of these the lion shares of the burden is found in Sub-Saharan African regions. This study aimed to assess the prevalence of IPIs and associated risk factors among patients attending Dejen primary Hospital. The study was conducted in the Amhara National Regional State of Ethiopia, East Gojjam Zone, Dejen town, Dejen primary hospital. Patients in all age groups attending the hospital during the study period were included in the study. A total of 414 study participants were determined by standard formula. The socio-demographics characteristics were collected by face-to-face interview using well-structured questionnaires. Stool samples were examined microscopically using a direct wet mount method. In this study, five known parasites identified including Entamoeba histolytica, Giardia lamblia, Hookworm, Taenia spp. and Strongyloides stercoralis. Among them, E. histolytica and G. lamblia belonged to the leading protozoan parasites with 26.1 and 9.2% prevalence, respectively. The rest, Hookworm, Taenia spp. and Strongyloides stercoralis, categorized as soil helminthic parasites and accounts 3.1, 0.7 and 0.2% prevalence, respectively. The prevalence of IPIs in the study area is highly associated with the occupation of the patients, consumption of raw vegetables, swimming practice in rivers and source of drinking water.

E. histolytica

G. lamblia

Hookworm

S. stercoralis

Taenia spp

Intestinal parasitic infections (IPIs) are the common cause of illness and disease worldwide. It is estimated that 1.5 billion people or 24% of the world’s population have been infected with IPs, of these the highest prevalence reported from sub-Saharan Africa (WHO, 2023). The prevalence of IPIs is more in poor and most disadvantaged societies that lack good access to clean water, sanitation and hygiene in the developing countries, particularly in Sub-Saharan Africa (Hotez et al., 2009; WHO, 2023).

The parasitic infections are associated with lack of education, low-income families, poor personal hygiene, inadequate environmental sanitation, and overcrowding, insufficient clean water supply, tropical climate and low altitude (Ahmed M, 2023). Among IPIs, soil-transmitted helminths (STHs) including Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), and hookworms and protozoan parasites including Giardia lamblia (G. lamblia) and Entamoeba histolytica (E. histolytica) were the most prevalent IPs identified that cause significant morbidity in the world (WHO, 2023).

Infections with intestinal helminths and protozoan parasites cause health problems including deficiency of micronutrients, growth retardation, poor cognitive development and predisposition to other infections in humans (Evans and Stephenson, 1995: Tedla Shibru, 1986;). IPIs are isolated as causes of morbidity and mortality throughout the world particularly in developing countries like Ethiopia. Studies showed that parasitic protozoa and helminth infections occur in developing countries, especially among the poor communities (de Silva et al., 2003). A high prevalence of IPIs individuals is associated with poverty and poor personal hygiene, unsafe water supply and contamination of the environment by human excreta and animal wastes. IPIs increase the hosts’ susceptibility to other infections and decrease learning ability and growth in humans (Karaman et al., 2006).

Ethiopia is one of the countries with majority of the population, particularly the rural communities living with poor pure water supply and latrine coverage (Amare Mengistu et al., 2007). Thus, IPIs were the most prevalent and reported from different parts of country (Damtie D et al, 2021; Adam Y and Muche A, 2005–2008; Sitotaw B et al; Kumma WP et al, 2019; Menjetta et al, 2019; Gelaw et al, 2013; Muhamed J et al, 2022). Although several studies have been conducted on the prevalence of IPIS in Ethiopia, there are still several localities in the country including Dejen town where information about the prevalence of IPIs and their risk factors are not available. The current study aimed to assess the prevalence of IPIs and associated risk factors at DPH at Dejen town, East Gojjam zone, Northern Ethiopia.

2.1. Study Design and Period

The study was conducted in Amhara Region, East Gojjam zone, Dejen town. An institutional based cross-sectional study was carried out in Dejen Primary Hospital (DPH) from December 2022 to June, 2023, to determine the prevalence and associated risk factors of intestinal parasite infections among patients attending at DPH during the specified period.

2.2. Study population

Patients in all age groups attending DPH during the study time were the study populations and among the patients attending DPH, those who have related symptoms with IPIs considered as study population.

2.3. Sample size and sampling technique

The sample size was determined by single population proportion formula N= \(\:\frac{{z}^{2}}{{d}^{2}}*p(1-p)\) using overall prevalence of 42.9% (Destaw Damtie et al., 2021). Where N, sample size; Z is marginal error at 95% confidence interval [Z (ά/2) = 1.96]; P is prevalence of IPs; \(\:d\) is margin of sampling error assumed to be 0.05. Therefore, N = (1.96)²/(0.05)² (1-0.429) = 376

From the normal calculation the sample size obtained was 376, 10% was added by considering non-response rate, to minimize errors so the total samples were 414. The samples were selected using random sampling technique.

2.4. Inclusion and exclusion criteria

Patients who have symptoms related to parasitic infections such as vomiting, diarrhea, abdominal pain, nausea, habitat loss, weight loss and bloody feces were included under the study. Patients who were admitted as non-parasitic patients and who took antiparasitic drugs before a couple of weeks and during the study time were excluded in the study.

2.5. Study variables

The sociodemographic characteristics: sex, age, occupation, educational status, marital status; and behavioral characteristics such as contact to river when crossing, cloth washing using river water, swimming in river and time of swim, irrigation activity, shoes wearing habit, hand washing practice before meal and after toilet, finger nail status, consumption of raw vegetables, raw meat, and source of drinking water were taken as independent variables. While the prevalence IPIs were taken as dependent variables to this study.

2.6. Data collection

The socio-demographics characteristics including the information about IPIs of the respondents were collected by face-to-face interview using well-structured questionnaires. While stool sample were taken from the patients by laboratory expert who is working in the hospital. Prior to taking stool sample collection, verbal consent was obtained from patients. After explanation consent was obtained from each patient, the subjects were instructed on how to provide sizable stool samples (5g) and provided labeled clean cartons, toilet tissue papers and pieces of applicator sticks. The stool samples were labeled and then processed and examined under microscopically using direct wet mount method for IPIs diagnosis including protozoan and helminths parasites. Direct wet mount was conducted by a drop of normal saline (0.85% NaCl solution). About 1–2 mg of stool samples was emulsified with 1–2 drops of normal saline solution using an applicator stick. After homogeneous thin film preparation on each slide, cover slips were placed on each preparation and examined for the presence of parasites under light microscope of 10x and 40x objectives.

2.7. Data quality control

To collect quality data, the questionnaires was first developed in English and translated to Amharic language. Clear explanation was given for the laboratory professionals about the questionnaires. Clear introduction was also given for the respondents how to handle stool. Pre-tested questionnaires also given for the professionals.

2.8. Data Analysis

After the row data was collected through face-to-face interview, and parasitological examination, the results were initially fed in to Microsoft Excel 2007 software and then copy to Statistical Package for Social Sciences (SPSS) software version 25. Descriptive statistics was used to quantify the degree of association of IPIs with socioeconomic and potential risk factors. Bivariate and multivariate regressions were performed to determine the association between the dependent and independent variables as well as for risk factors.

3.1. Socio demographic characteristics

Most of the study participants (53.9%) were females and the age category of 15 to 29 years old. Over half (54.3%) of them were living in the urban setting and a significant share of them also living in the rural setting. Based on the occupational categories of the respondents, most of them (29%) had farming as a livelihood and the rest were students, government workers, house wives, merchants, and daily laborers. Considerable number of participants (12.4), either have no work or are dependent on their family. Above 90% of the participants were Orthodox Chrisian followers. Relatively, the equal number of participants were illiterate, read and write and secondary schools completed, while diploma and above graduates and primary school education accounts 17.4 and 13.8%, respectively. Nearly, 60 and 40% of the study participants were married and unmarried, respectively, only an insignificant number of them were either divorced or widowed (Table 1).

Table 1

The socio-demographic characteristics of the respondents
Variable	Categories	Frequency	Percent
Sex	Male	191	46.1
Sex	Female	223	53.9
Age	≤ 14	78	18.8
	15–29	168	40.6
	30–45	103	24.9
	> 45	65	15.7
Residence	Urban	225	54.3
Residence	Rural	189	45.7
Occupational status	Student	73	17.6
	Unemployed	35	8.5
	Daily labor	9	2.2
	House wife	52	12.6
	Farmer	120	29.0
	Merchant	39	9.4
	Government employee	70	16.9
	Family dependent	16	3.9
Religion	Orthodox	382	92.3
Religion	Muslim	32	7.7
Educational status	Illiterate	96	23.2
	Only read and write	94	22.7
	Primary	57	13.8
	Secondary	95	22.9
	Diploma and above	72	17.4
Marital status	Single	167	40.3
	Married	240	58.0
	Divorced	6	1.4
	Widowed	1	0.2

3.2. Prevalence of IPIs

Five well known IPs were identified among the patients attending at DPH during the study period of December 2022 to June, 2023. Namely Entamoeba histolytica, Giardia lamblia, Hookworm, Taenia spp. and Strongyloides stercoralis (Table 2). Among the IPIs identified in this study, E. histolytica and G. lamblia, recognized as a well-known and leading protozoan parasite with prevalence rate of 26.1 and 9.2%, respectively. The rest of the parasites were soil helminthic parasites including Hookworm, Taenias spp. and Strongyloides stercoralis. Furthermore, these IPs were found in either single infection or coinfection with each other. A single observation on coinfection occurred between E. histolytica and Hookworm and G. lamblia and Hookworm. While seventeen (4.1%) co-infections were observed between E. histolytica and G. lamblia. Altogether, the overall presence of the Ips in the study area is found to be 43.3%.

Table 2

Prevalence of IPs among patients attending DPH during the study period
Intestinal parasites	Frequency	Percent
Single infection
Entamoeba histolytica	108	26.1
Giardia lamblia	38	9.2
Hookworm	13	3.1
Taenia spp.	3	0.7
Strongyloides stercoralis	1	0.2
Double infection
E. histolytica and Hookworm	1	0.2
E. histolytica and G. lamblia	17	4.1
G. lamblia and Hookworm	1	0.2
Total	179	43.3

3.3. IPIs and associated risk factors

According to Table 3, many risk factors are associated with IPs in the study area. From the bivariate analysis sex, age, residence, and occupation among the socio demographic characteristics of the respondents and contact to river when crossing, swimming in rivers, hand washing habit before a meal, latrine utilization, finger nail status, habit of eating raw vegetables and source of drink water among the behavioral characteristics are moderately associated with IPIs with p value < 0.05. However, from the multivariate logistic regression analysis among the socio-demographic characteristics; occupation of the respondents was significantly associated with prevalence of IPs with p < 0.05 and behavioral characteristics: swimming in rivers, habit of eating raw vegetable and source of drink water were significantly associated with IPs with p < 0.05.

Unemployed patients and those who were daily labors were highly infected than the others (AOR: 2.94; CI: 1.17–7.42, at p = 0.022); AOR: 4.25; CI: 1.02–17.69, at p = 0.046), respectively. The chance of unemployed respondents to be infected with IPs was 2.94 times greater than who were government employees, on the other hand daily labors also infected by IPs 2.25 time than government employees. Among the behavioral characteristics of the respondents swimming in rivers with AOR: 0.51, CI: 0.20–1.25, p = 0.031; and consumption of raw vegetable, those who eat always and sometimes with AOR: 2.64, CI: 1.02–6.79, p = 0.046 and AOR: 1.89, CI: 1.03–3.47, p = 0.040, respectively were significantly associated with IPIs. Those respondents who used river water as sources of drinking water had highly infected by IPs with AOR: 2.35, CI: 1.06–5.24, p = 0.036 than who used pipe or tap water sources. The chance of infection of individuals who drink river water is 2.35 more likely than those who drank tap water. All other risk factors are not statistically significant at p < 0.05.

Table 3

Bivariate and multivariate analysis of risk factors in association with IPs among patients attending DPH
Risk factor	Category	IPs^− ve	IPs^+ ve	COD (95% CI)	AOR (95% CI)	P-value
Sex	Male	116(60.7)	75(39.3)	0.70 (0.44–1.12)	0.72 (0.46–1.12)	0.141
Sex	Female	116(52)	107(48.8)	1	1
Age	≤ 14	48(60)	32(40)	0.61(0.31–1.18)	0.54 (0.22–1.31)	0.171
	15–29	96(57.1)	72(42.2)	0.68 (0.39–1.22)	0.77 (0.39–1.52)	0.448
	30–45	57(56.4)	44(43.6)	0.70 (0.38–1.32)	0.82 (0.41–1.66)	0.588
	> 45	31(47.7)	4(52.3)	1	1	-
Residence	Urban	134(59.6)	91(40.4)	1	1
Residence	Rural	98(51.9)	91(49.1)	1.37 (0.93–2.02)	0.60 (0.28–1.30)	0.196
Occupation	Student	47(54.7)	39(45.3)	1.59 (0.81–3.09)	2.22 (0.96–5.13)	0.063
	Unemployed	21(50)	21(50)	1.91 (0.86–4.23)	2.94 (1.17–7.42)	0.022
	Daily labor	4(33.3)	8(66.7)	3.82 (1.03–14.10)	4.25 (1.02–17.69)	0.046
	House wife	23(54.8)	29(45.2)	1.58 (0.71–3.50)	1.44 (0.58–3.62)	0.434
	Farmer	63(50.4)	57(49.6)	1.88 (1.01–3.51)	1.64 (0.69–3.87)	0.261
	Merchant	32(74.4)	7(25.6)	0.66 (0.28–1.55)	0.60 (0.25–2.99)	0.251
	Gov’t employee	42(65.6)	28(34.4)	1	1	-
Educational status	Illiterate	53(55.2)	43(44.8)	1.14 (0.61–2.11)	-	-
	Read and write	53(56.4)	41(43.6)	1.08 (0.58–2.02)	-	-
	Primary	31(54.4)	26(45.6)	1.17 (0.58–2.37)	-	-
	Secondary	53(55.8)	42(44.2)	1.11 (0.60–2.06)
	Diploma & above	42(58.3)	30(41.7)	1
Religion	Orthodox	211(55.2)	171(44.8)	0.97 (0.92–1.02)
Religion	Muslim	21(65.6)	11(34.4)	1.49 (0.74–3.03)
Marital status	Married	136(56.7)	76(43.3)	1
	Single	91(54.5)	104(45.5)	1.09 (0.73–1.63)
	Divorced/widowed	5(71.4)	2(28.6)	0.52 (0.01–2.75)
Direct contact in river when crossing	Yes	57(49.1)	59(50.9)	1.47 (0.96–2.27)	1.67 (0.94–2.988)	0.083
Direct contact in river when crossing	No	175(58.7)	123(41.3)	1	1	-
Cloth wash on river	Yes	49(53.3)	43(46.7)	1.16 (0.73–1.84)
Cloth wash on river	No	183(56.8)	139(43.2)	1		-
Irrigation activity	Yes	36(60.0)	24(40.0)	0.83 (0.47–1.44)
Irrigation activity	No	196(55.4)	158(44.6)	1
Swimming in river	Yes	17 (70.8)	7 (29.2)	0.51 (0.20–1.25)	0.315 (0.11–0.895)	0.031
Swimming in river	No	215(55.1)	175(49.9)	1
Swimming/month	None	221(55.5)	177(44.5)	1
Swimming/month	1-2time/month	11(68.8)	5(31.3)	0.57 (0.19–1.66)
Hand wash after toilet	Always	190(56.4)	147(43.6)	1
	Sometimes	36(55.4)	29(44.6)	1.04 (0.61–1.78)
	Not at all	6(50.0)	6(50.0)	1.29 (0.41–4.09)
Hand wash before meal	Always	184(59.4)	126(40.6)	1	1
	Sometimes	45(46.4)	52(53.6)	1.69 (1.07–2.67)	1.380 (0.75–2.53)	0.297
	Not at all	3(42.9)	4(57.1)	1.95 (0.43–8.85)	2.54 (0.43–14.96)	0.302
Shoes wearing habit	Always	147(57.0)	111(43.0)	1
	Sometimes	79(53.7)	68(46.3)	1.14 (0.76–1.71)
	Not at all	6(66.7)	3(33.3)	0.66 (0.16–2.71)
Latrine utilization	Always	156(56.1)	122(43.9)	1	1
	Sometimes	52(51.5)	49(48.5)	1.21 (0.76–1.90)	0.784 (0.43–1.44)	0.434
	Not at all	24(68.6)	11(31.4)	0.59 (0.28–1.24)	0.418 (0.173-1.0)	0.053
Finger nail status	Trimmed	204(58)	148(42)	1	1	-
Finger nail status	Not trimmed	28(45.2)	34(54.8)	1.67 (0.97–2.88)	1.211 (0.59–2.47)	0.599
Eating raw vegetable	Always	17(54.8)	14(45.2)	1.40 (0.61–3.24)	2.64 (1.02–6.79)	0.046
	Sometimes	164(54.3)	138(45.7)	1.43 (0.86–2.88)	1.89 (1.03–3.47)	0.040
	Not at all	51(63.0)	30(37.0)	1	1	-
Eating raw meat	Yes	80(55.2)	65(44.8)	1.06 (0.70–1.59)
Eating raw meat	No	152(56.5)	117(43.5)	1		-
Source of drinking water	Pipe	152(61.0)	97(39.0)	1	1	-
	River	36(46.8)	41(53.2)	1.79 (1.06–2.99)	2.350 (1.06–5.24)	0.036
	Stream	3(30.0)	7(70.0)	3.66 (0.92–14.48)	4.01 (0.80-20.01)	0.091
	Well	41(52.6)	37(47.4)	1.41 (0.85–2.36)	1.42 (0.64–3.12)	0.385
* P-value < 0.05 was taken as statistically significant, indicated in bold

The study showed that the overall prevalence of IPs in the study area was 43.3%. The protozoan parasites E. histolytica and G. lamblia were the predominant parasites which is supported by other studies (Damtie D et al, 2021; Adam Y and Muche A, 2005–2008; Sitotaw B et al; Kumma WP et al, 2019; Menjetta et al, 2019; Gelaw et al, 2013; Muhamed J et al, 2022) about 35.5% of the total prevalence followed by soil helminths, such as Hookworm 13 (3.1%), Taenia spp. 3 (0.7%) and Strongyloides stercoralis 1 (0.2%) prevalence. This finding was related to the study conducted in in Merawi town, on school children with 42.9% prevalence (Damte D et al., 2021); in Hara Health center, at Tehuludere district 42.3% prevalence (Endris N and Mamo H, 2020); the study conducted in Metema district hospital 44.5% prevalence, northern Ethiopia (Adam Y and Muche A, 2005–2008); in Maksegnit, northern Ethiopia among school age children 40.5% ( Shiferaw K et al., 2021); in Bahir Dar and Han health centers among under five children 42% prevalence (Mohamed J et al., 2022) with protozoan parasites, E. histolytica/dispar 10.86% and G. lamblia 4.53% rate of prevalence were the most prevalent parasites in the study.

The study conducted on the prevalence and associated risk factors of intestinal parasitic infections among primary school children at Bure town, north west Ethiopia identified the above protozoan parasites, E. histolytica/dispar 22.1%, G, lamblia 8.6% and soil helminths, Hookworm 6.7%, A. lumbricoides 3.7% and Taenia spp. 0.2% prevalence (Sitotaw B et al, 2020), almost a little difference is due to the methods, sample size and materials used during the study. The parasite in the study area also exists as a single infection and as co-infection, supported by other studies (Damte D et al, 2021; Shiferaw K et al, 2021). Single infections cover 35.3% and the rest 5.0% appear as double infections. In most research conducted in Ethiopia and other countries infections show single infections and double infections such as the study conducted in Metema district hospital, northern Ethiopia (Adam Y and Muche A, 2005–2008); Debre Ealias school children (Workneh T et al, 2014) and Debarq primary hospital, northern Ethiopia (Alelign A et al, 2024).

The prevalence of IPs in this study is also differ from many other studies in different part of Ethiopia such as research among under five children in Haro Dumal town, Bale zone 38.5% (E. Gadisa and K. Jote, 2019), research conducted in Teda health centers in northern Ethiopia 62.3% high prevalence (Abate A et al, 2013); the study conducted in Debre Ealias on primary school children in East Gojjam zone 84.3% (Workneh T et al ,2014); the study conducted in Shashamane town, southern Ethiopia 19.7% (Sahiledengle et al., 2020), the possible reasons may be due to variations in geographical area, weather conditions, study period, health facilities and way of life.

The protozoan parasites including Entamoeba histolytica and Giardia lamblia were the leading parasites with 26.1% and 9.2% prevalence, respectively (Table 2). This is also like the study conducted in Hara health center, Tehuledere District, northeast Ethiopia (E. histolytica 30% and G. lamblia 6.1%) (Nuru Endris Nand Mamo H, 2020) and merawi town northern Ethiopia (E. histolytica 19.1% and G. lamblia 17%) prevalence (Damtie D et al., 2021). The soil helminths parasites including Hookworm, Taenia spp., and Strongyloides stercoralis also seen in the study area which is like the study conducted in Maksegnit (Shiferaw K. et al, 2021), northern Ethiopia but the prevalence was different, the difference might be the material used during the study and the works done to reduce the environmental sanitation.

Similarly, the socio-demographic characteristics of the respondents and behavioral factors associated with the prevalence of IPs. The occupation of the respondents among the sociodemographic characteristics shows a close relationship with the IPs, meaning statistically significant. Unemployed respondents and daily labors were highly infected by the parasites as compared to students, merchants, government employees, house wife and farmers; among unemployed respondents 21 (50%), p = 0.022 and daily labors 8 (66.7%), p = 0.046 were positive for the parasites (Table 3). The prevalence of IPIs in this study was highly linked with swimming in rivers, eating raw vegetables and source of drinking water which were statistically significant at p-value < 0.05. Multivariate analysis shows that among the patients infected with IPs who have a habit of swimming in rivers were highly infected, 7 (29.2%), p = 0.031 compared to respondents who didn’t. Again, as compared to those who didn’t ate raw vegetables respondents, who ate raw vegetables were greatly infected [respondents who ate raw vegetables always 14 (45.2%), p = 0.046 and respondents who ate raw vegetables sometimes 138 (45.7%), p = 0.040] i.e. the parasites were closely associated with eating unwashed or uncooked vegetable, this is in line with other studies (Alelign et al, 2024; E. Gadisa and K. Jote, 2019; Stotaw et al, 2019).

The parasites also significantly associated with the source of drink water, this is also supported by other studies (Shiferaw et al, 2020); Workneh T et al ,2014) patients who got their drink water from rivers were highly infected as compared to those who got their drink water from pipe [respondents who got drink water from river 41(53.2%), p = 0.036; were positive (Table 3). The reasons may be related to the poor personal and environmental sanitation and lack of clean water and consumption of uncooked or raw vegetables, as these are the main mode of transmission of IPs. The similar study results also reported in Sanja primary hospital that raw vegetable consumption and sources of drink water are among the behavioral factors significantly associated with IPs (Eyayu T et al, 2021).

The overall prevalence of IPIs among patients who attended for health care at DPH showed 43.3%. The protozoan parasites mainly E. histolytica and G. lamblia were the leading parasites identified in the study area. The prevalence of IPIs in the study area is highly linked with the occupation, swimming in rivers, the consumption of raw vegetables, and source of water they drink. Among the patients attending in the hospital, daily laborers and unemployed individuals were highly infected with IPs. Similarly, individuals who had consumed raw vegetables and swam in rivers were more vulnerable to IPs. The same is true for individuals who used river waters for drinking were highly infected by IPs than those who used tap water as well as well waters.

Acknowledgement

Authors gratefully acknowledge Addis Ababa University, School of Graduate Program for the provision of technical and financial support to this project. Authors are also thankful to the study participants and DPH staffs for their valuable information and support.

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by SD. Statistical analysis and interpretations were performed by SD, EA and FT. The first draft of the manuscript was written by SD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics declarations

Ethical approval

This study was approved by the College of Natural and Computational Sciences, Institutional Review Borad, Addis Ababa University. All methods are carried out following the relevant guidelines and regulations.

Consent to participate

Before data collection, all study patients were informed about the purpose of the study and the rights to participate or decline to participate in the study. The respondents were also informed about the confidentiality of their information and assured that all the data will only be used for research purposes. Prior to face-to-face interview, all participants signed the consent form. For participants under the age of 16, consent was obtained from their parents/guardians.

Consent for publication

All authors agreed to the publication of their data.

Competing interest

The authors declare that they have no conflict of interest

Funding

The author (s) received no specific funding for this work

Data availability

All the data and materials which are used in this study were included in the manuscript

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No competing interests reported.

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Prevalence of Intestinal Parasitic Infections and Associated Risk Factors Among Patients Attending Dejen Primary Hospital, Amhara National Regional State, Ethiopia

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Abstract

1. Introduction

2. Methods

2.1. Study Design and Period

2.2. Study population

2.3. Sample size and sampling technique

2.4. Inclusion and exclusion criteria

2.5. Study variables

2.6. Data collection

2.7. Data quality control

2.8. Data Analysis

3. Results

3.1. Socio demographic characteristics

3.2. Prevalence of IPIs

3.3. IPIs and associated risk factors

4. Discussion

5. Conclusion

Declarations

References

Additional Declarations

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