Study area There are nine districts in the Malakand region including Shangla, Swat, Buner Dir Upper & Lower, Chitral Upper & Lower, Bajaur, and Malakand make up the Malakand Division. Malakand division, with a population of 8.7 million and a total area of 32007 km. Previously, the districts were known as the princely states of Malakand Agency (Swat), Chitral, Dir, and Malakand Protected Area. Malakand division is located in Khyber Pakhtunkhwa's north, near Chitral's crucial Wakhan strip, the Afghan border with Dir, and the Karakoram Highway at Besham. It is located at 35° 29′59.99′′N and 72° 00′0.00′′E. This area is mountainous, with high peaks in the north rising to a height of 6000 meters above sea level. Along the Swat River, the height gradually lowers from north to south. The Malakand region is located in the temperate zone, where summers can be hot and muggy because of heavy monsoon rains, and winters can be frigid with temperatures falling below freezing [15].
Data collection procedure To identify potential risk factors for intestinal parasitic infection (IPIs) the survey was created to collect data on gender, age, and locality (urban vs. rural) demographics, critical medical indications (diarrhea, dysentery, bloating stomach pain, vomiting, and nausea), abdominal pain, environmental sanitation, and living conditions (period, interaction with domestic animals, and mud). In addition to asking questions, interviewers looked at the students' footwear and fingernails during the talk. Following a review of the respondents' responses, all students' proper feces samples were collected using a labeled, clean plastic container, toilet paper, and applicator stick pieces. Samples were emulsified in a 10% formalin solution once the stool examination was finished. Laboratory technicians employed direct techniques (saline and iodine mounts) and formol-ether concentration techniques in less than 20 minutes to recognize and detect each stage of intestinal parasites. To ensure quality control, 20% of the stool samples were randomly chosen and transported to the laboratory at the University of Malakand Chakdara in Pakistan to check the quantity, timing, and collection method examined.
Stool Sample Processing The collected samples were sent to Malakand University parasitological laboratory for the investigation of the feces. Initially, stool samples were observed and everyday patient information was recorded in the registered office database. The stool was examined macroscopically (with the naked eye) for color, consistency, the presence of blood, mucus or any segments, or adult helminth worms. Following macroscopic examination, all stool samples were mounted directly with normal saline (0.85% NaCl solution) to check for the presence of trophozoites and motile intestinal parasites. Lugol's iodine staining remained then done to identify intestinal parasite cysts. The slide was then stained with Lugol's iodine to reveal intestinal parasite cysts. In the following step, to precisely detect cysts or eggs of intestinal parasites, the sediments were dyed with iodine, placed on a slide, and covered with a cover slip.
Ethical clearance The Abdul Wali Khan University Mardan Ethics Committee approved every step of this study's process. Before collecting samples, all study participants were given a written explanation of the study's procedures and their written informed consent. (AWKUM 782750)
Parasite identification Under a microscope, intestinal parasites were studied and identified using reliable and standardized criteria based on the morphological traits of adult stages, larval stages, and Eggs of parasites.
Statistical tests Where appropriate, the software (GraphPaid and Minitab) was used to analyze the data. P value when a statistical test result was less than 0.05 at 96% CI. An odd ratio has also been calculated.