Common Gastrointestinal Symptoms and Associated Factors Among Under-5 Children in Rural Dembiya, Northwest Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Gastrointestinal (GI) symptoms such as abdominal discomfort, abdominal cramp, nausea, vomiting, gas in the GI tract, changes in bowel habits (e.g. diarrhea), or heartburn are common in the community. However, these symptoms may be misinterpreted and their impact and significance misunderstood, especially in the rural communities. This study was, therefore, conducted to assess common GI symptoms among children in rural Dembiya, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted in May 2017 among 225 randomly selected under-5 children. We primarily used mothers' report to assess GI symptoms. Health professionals also diagnosed for some symptoms. Direct stool examination technique was used to identify parasitic infections. Bacteriological analysis of drinking water was done to determine the quality of drinking water. Food safety, environmental sanitation, and hygiene condition of children were assessed using observation checklists. Multivariable binary logistic regression analysis was employed to identify factors associated with GI symptoms on the basis of adjusted odds ratio (OR) with 95% confidence interval (CI) and P < .05. RESULTS: The current study depicted that 139 of 225(61.8%) of the children had GI symptoms. Abdominal discomfort (137 of 139 [98.7%]), abdominal cramp (125 of 139 [89.9%]), and diarrhea (118 of 139 [84.9%]) were the highest GI symptoms reported. GI symptoms were significantly associated with childhood intestinal parasitic infections (OR = 13.69, 95% CI = 3.31-56.59), unclipped and unclean finger nails (OR = 2.28, 95% CI = 1.02-5.10), inadequate living environment sanitation (OR = 2.37, 95% CI = 1.08-5.18), unclean living houses (OR = 9.06, 95% CI = 2.60-31.54), and owning livestock (OR = 4.68, 95% CI = 1.82, 12.03). CONCLUSION: The prevalence of GI symptoms among under-5 children in rural Dembiya, northwest Ethiopia, was found to be high. GI symptoms were significantly associated with childhood intestinal parasitic infections, hand hygiene condition of children, and sanitation condition of the living environment. Therefore, preventing intestinal parasitic infections, improving hand hygiene condition, and promoting environmental sanitation will have overriding contributions to prevent symptoms among children in rural Dembiya.

Evidence of Households' Water, Sanitation, and Hygiene (WASH) Performance Improvement Following a WASH Education Program in Rural Dembiya, Northwest Ethiopia.

BACKGROUND: Water, Sanitation, and Hygiene (WASH) promotion is a viable solution to prevent enteric infections. It focuses on hygiene education, where a number of theoretical models have emerged which attempt to guide behavior change interventions. This study was, therefore, conducted to evaluate the effectiveness WASH education program on households' WASH performance in rural Dembiya, northwest Ethiopia. METHOD: An uncontrolled before-and-after intervention study was conducted. Baseline and endline surveys were done among 225 and 302 randomly selected households with under-5 children, respectively, using a structured questionnaire and observational checklists. Percent point change was used to see the effect of the intervention. Pearson χ2 and Fisher exact tests were used to test for statistically significant percentage point changes on the basis of P < .05. RESULT: Access to adequate sanitation was significantly improved from 43.1% at the baseline to 50.7% at the endline (P < .05). Access to protected water sources was high at the baseline (73.8%) and remained high (81.1%) at the endline (P < .05). Significant proportion of households (58.3%) practiced good drinking water handling at the endline compared with the baseline (6.7%) (P < .001). Practice of home-based water treatment was improved at the endline (47%) compared with the baseline (7.6%) (P < .001). The general hygienic condition of children was significantly improved at the end of the intervention compared with the conditions before the intervention (P < .05). At the end of the intervention, mothers' hand washing practice was improved to 68.2% from 24.4% at the baseline (P < .001). Moreover, 52.4% and 69.5% of the households at the baseline and endline, respectively, had good food safety practice (P < .05). CONCLUSION: The proportion of households who practiced water safety, basic sanitation, good personal hygiene, and basic food safety measures significantly increased at the endline. This significant increment clearly showed that our WASH interventions were effective to improve households' WASH performance in rural Dembiya. The local health office need, therefore, strengthens the WASH education program.

Effects of water, sanitation and hygiene (WASH) education on childhood intestinal parasitic infections in rural Dembiya, northwest Ethiopia: an uncontrolled before-and-after intervention study.

BACKGROUND: Soil-transmitted helminthes (STH) infections are among the most common infections worldwide and affect the most deprived communities. Adequate water, sanitation, and hygiene (WASH) prevents environmental contamination, thereby preventing transmission of STH. Cognizant of this, WASH education was implemented in rural Dembiya to reduce intestinal parasitic infections. This study was, therefore, conducted to assess the impacts of the intervention on households' WASH conditions and prevalence of intestinal parasitic infections. METHOD: An uncontrolled before-and-after intervention study was used. Cross-sectional studies were done before and after the intervention. Two hundred twenty-five and 302 under five children were recruited randomly at the baseline and endline, respectively. Data were collected using a structured questionnaire and observational checklists. Direct stool examination and Kato-Katz methods were used to identify parasites in the stool. We used percent point change and prevalence ratio (PR) to see the effects of the intervention on WASH conditions and prevalence of intestinal parasitic infections respectively. Pearson chi-squared and Fisher's exact tests were used to test for statistically significant percentage point changes of WASH conditions. The effect of the intervention on intestinal parasitic infections was statistically tested on the basis of PR with 95% confidence interval (CI). RESULTS: The baseline prevalence of intestinal parasitic infections was 25.8%, and the endline prevalence was 23.8%. The prevalence of intestinal parasitic infections was not significantly decreased at the endline compared with the baseline [PR = 0.92, 95% CI = (0.62, 1.38)]. Ascaris Lumbricoides was the most prevalent parasitic infection both at the baseline and endline. The proportion of children who had good hygienic condition increased from 1.3% at the baseline to 34.4% at the end line (p <  0.05). The percentage of mothers/care givers who washed hands at different pick times was significantly increased from 24.4% at the baseline to 68.2% at the endline (p <  0.001). The proportion of households who practiced home-based water treatment was significantly increased from 7.6% at the baseline to 47% at the endline (p <  0.001). The proportion of households who used sanitary latrine was increased from 32% at the baseline to 49% at the endline (p <  0.05). CONCLUSION: This before-and-after intervention study found that households' WASH performance was significantly improved at the endline compared with the baseline. The endline prevalence of intestinal parasitic infections was slightly lower than the baseline prevalence; however, the reduction was not statistically significant. The local health office needs to strengthen the WASH education program, mobilize the community to construct WASH facilities, and support the community to sustain households' WASH performance.

Socioeconomic Predictors of Intestinal Parasitic Infections Among Under-Five Children in Rural Dembiya, Northwest Ethiopia: A Community-Based Cross-sectional Study.

BACKGROUND: Soil-transmitted helminths and protozoan parasitic infections are endemic throughout the world. The problem of intestinal parasitic infection is higher among developing countries where children are the most vulnerable groups. Although health information related to parasitic infections is available globally, it is often limited in rural setups in least developed countries. This study was, therefore, conducted to assess socioeconomic predictors of intestinal parasitic infections among under-five children in rural Dembiya, Northwest Ethiopia. METHODS: This cross-sectional study was conducted among 224 randomly selected households with under-five children. We used questionnaire to collect data and direct stool examination to identify intestinal parasitic infections. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and P < .05 was used to identify socioeconomic predictors of parasitic infections. RESULTS: We found that 25.4% (95% CI = [20.2, 31.1]) under-five children had intestinal parasitic infection. Ascaris lumbricoides was the leading infection, which accounted 44 of 224 (19.6%). The prevalence of childhood intestinal parasitic infections was higher among households with no members whose education level is secondary and above (AOR = 3.36, 95% CI = [1.23, 9.17]). Similarly, intestinal parasitic infections were statistically associated with presence of 2 under-five children in a household (AOR = 3.56, 95% CI = [1.29, 9.82]), absence of frequent health supervision (AOR = 3.49, 95% CI = [1.72, 7.09]), larger family size (AOR = 2.30, 95% CI = [1.09, 4.85]), and poor household economic status (AOR = 2.58, 95% CI = [1.23, 5.41]). CONCLUSIONS: Significant proportion of children was infected with intestinal parasitic infection in rural Dembiya. Educational status of family members, number of under-five children in a household, health supervision, family size, and wealth index were statistically associated with parasitic infections. Provision of anthelmintic drugs, health supervision, and health education targeted with transmission and prevention of infections are recommended.

Effects of water, sanitation and hygiene (WASH) education on childhood intestinal parasitic infections in rural Dembiya, northwest Ethiopia: an uncontrolled before-and-after intervention study

BACKGROUND@#Soil-transmitted helminthes (STH) infections are among the most common infections worldwide and affect the most deprived communities. Adequate water, sanitation, and hygiene (WASH) prevents environmental contamination, thereby preventing transmission of STH. Cognizant of this, WASH education was implemented in rural Dembiya to reduce intestinal parasitic infections. This study was, therefore, conducted to assess the impacts of the intervention on households' WASH conditions and prevalence of intestinal parasitic infections.@*METHOD@#An uncontrolled before-and-after intervention study was used. Cross-sectional studies were done before and after the intervention. Two hundred twenty-five and 302 under five children were recruited randomly at the baseline and endline, respectively. Data were collected using a structured questionnaire and observational checklists. Direct stool examination and Kato-Katz methods were used to identify parasites in the stool. We used percent point change and prevalence ratio (PR) to see the effects of the intervention on WASH conditions and prevalence of intestinal parasitic infections respectively. Pearson chi-squared and Fisher's exact tests were used to test for statistically significant percentage point changes of WASH conditions. The effect of the intervention on intestinal parasitic infections was statistically tested on the basis of PR with 95% confidence interval (CI).@*RESULTS@#The baseline prevalence of intestinal parasitic infections was 25.8%, and the endline prevalence was 23.8%. The prevalence of intestinal parasitic infections was not significantly decreased at the endline compared with the baseline [PR = 0.92, 95% CI = (0.62, 1.38)]. Ascaris Lumbricoides was the most prevalent parasitic infection both at the baseline and endline. The proportion of children who had good hygienic condition increased from 1.3% at the baseline to 34.4% at the end line (p <  0.05). The percentage of mothers/care givers who washed hands at different pick times was significantly increased from 24.4% at the baseline to 68.2% at the endline (p <  0.001). The proportion of households who practiced home-based water treatment was significantly increased from 7.6% at the baseline to 47% at the endline (p <  0.001). The proportion of households who used sanitary latrine was increased from 32% at the baseline to 49% at the endline (p <  0.05).@*CONCLUSION@#This before-and-after intervention study found that households' WASH performance was significantly improved at the endline compared with the baseline. The endline prevalence of intestinal parasitic infections was slightly lower than the baseline prevalence; however, the reduction was not statistically significant. The local health office needs to strengthen the WASH education program, mobilize the community to construct WASH facilities, and support the community to sustain households' WASH performance.

Childhood intestinal parasitic infection and sanitation predictors in rural Dembiya, northwest Ethiopia.

BACKGROUND: Intestinal parasites are a common problem in the world. The greater proportion of infections is associated with poor water, sanitation, and hygiene (WASH). This study was conducted to assess intestinal parasites, WASH condition, and their association in rural Dembiya, northwest Ethiopia. METHODS: A cross-sectional study was employed. Two hundred twenty-five children aged 6-59 months were included. Mothers were interviewed using a structured questionnaire, and the living environment was observed using checklists. Kato-Katz technique was used to determine the intensity of parasitic infections. Escherichia coli (E. coli) was used as a biological indicator for drinking water quality. Multivariable binary logistic regression analysis was conducted to identify WASH predictors of parasites on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. RESULTS: The prevalence of intestinal parasites was 25.8% (95% CI = 20.3-32.0%). Ascaris lumbricoides (78%), hookworm (12%), Hymenolepis nana (7%), Enterobius vermicularis (5%), Schistosoma mansoni (3%), Giardia lamblia (3%), and Trichuris trichiuria (2%) were identified infections. Intestinal parasites were associated with poor child hand washing practice [AOR = 3.86, 95% CI = 1.53, 9.75], unprotected water sources [AOR = 7.79, 95% CI = 3.30, 18.40], access to water below 20 l/c/d [AOR = 3.05, 95% CI = 1.28, 7.23], poor food safety[AOR = 4.33, 95% CI = 1.62, 11.58], and poor sanitation [AOR = 5.01, 95% CI = 1.56, 16.16]. CONCLUSION: A. lumbricoides, hookworm, H. nana, E. vermicularis, S. mansoni, G. lamblia, and T. trichiuria were identified. Child hand washing practice, service level of water supply, water sources, food safety, and sanitation were associated with intestinal parasites. WASH promotion is needed to prevent infections.

Childhood intestinal parasitic infection and sanitation predictors in rural Dembiya, northwest Ethiopia

BACKGROUND@#Intestinal parasites are a common problem in the world. The greater proportion of infections is associated with poor water, sanitation, and hygiene (WASH). This study was conducted to assess intestinal parasites, WASH condition, and their association in rural Dembiya, northwest Ethiopia.@*METHODS@#A cross-sectional study was employed. Two hundred twenty-five children aged 6-59 months were included. Mothers were interviewed using a structured questionnaire, and the living environment was observed using checklists. Kato-Katz technique was used to determine the intensity of parasitic infections. Escherichia coli (E. coli) was used as a biological indicator for drinking water quality. Multivariable binary logistic regression analysis was conducted to identify WASH predictors of parasites on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05.@*RESULTS@#The prevalence of intestinal parasites was 25.8% (95% CI = 20.3-32.0%). Ascaris lumbricoides (78%), hookworm (12%), Hymenolepis nana (7%), Enterobius vermicularis (5%), Schistosoma mansoni (3%), Giardia lamblia (3%), and Trichuris trichiuria (2%) were identified infections. Intestinal parasites were associated with poor child hand washing practice [AOR = 3.86, 95% CI = 1.53, 9.75], unprotected water sources [AOR = 7.79, 95% CI = 3.30, 18.40], access to water below 20 l/c/d [AOR = 3.05, 95% CI = 1.28, 7.23], poor food safety[AOR = 4.33, 95% CI = 1.62, 11.58], and poor sanitation [AOR = 5.01, 95% CI = 1.56, 16.16].@*CONCLUSION@#A. lumbricoides, hookworm, H. nana, E. vermicularis, S. mansoni, G. lamblia, and T. trichiuria were identified. Child hand washing practice, service level of water supply, water sources, food safety, and sanitation were associated with intestinal parasites. WASH promotion is needed to prevent infections.