The study was carried out at Boricha district, Sidama zone, South Ethiopia. It is located 206 km from Addis Ababa, the capital city of Ethiopia, and 32 km from Hawassa main city of Southern nation nationalities and peoples of Ethiopia. According to the 2018 Ethiopian central statistical agency report, the total population of the district was estimated to be 325,636. From these, nearly all (97%) population live in rural area. Children of 6 to 59 months’ age account of 13.94% of the population. Boricha consists of 4 urban and 39 rural Kebeles. The health service coverage of the district was 85%. It has one government district hospital, ten health centers, thirty-nine health posts and eight private clinics.
Study design, period and population
Community based cross sectional study was carried out in Boricha district from January 1st to 30th, 2018. The source population were all children aged 6 to 59 months who live in Boricha district. The study population were children aged 6 to 59 months who lived in randomly selected household. Those children whose family lived less than 6 months, took preventive chemotherapy (deworming), and treated recently for intestinal parasites were excluded from this study.
Sample size determination and sampling technique
Sample size was calculated by using single population proportion formula in consideration of the following assumptions: The prevalence of intestinal parasites was taken as 24.3% , 95% confidence level, 5% margin of error. Thus, n = z2pq/d2. Then, n = 1.962*0.243(0.757)/0.05 = 283. By using a design effect of 2 and adding 10% non-response rate, a total sample sizes of 624 were included. Boricha was selected intentionally by considering its context of exposure for intestinal parasites and lack of previous research related to the problem. There are 43 Kebeles in the district. Of these, 4 were urban and 39 were rural Kebeles. A two stage sampling technique was applied to select the representative sample size of this study. Firstly, eight Kebeles were selected using simple random sampling based on their proportion of place of residence which satisfy 20–30% of the total district Kebeles. Secondly, a sampling frame was prepared through census. It consisted of lists of household in the selected Kebeles. There were a total of 8482 children in the selected Kebeles. The calculated sample interval (K=N/n) was 14. Then, systematic random sampling strategy was used to select the study participants. The first child was identified by using simple random sampling strategy by using lottery method. Then, consecutive children were selected at a regular interval of 14th household. If there was no child from the household for consecutive visits, the next nearest child was included. One child was included by using lottery method when more than one child was present selected households. Each child was given a unique identifier to be identified during the socio-demographic and stool examination.
In the current study, the outcome variable was presence of intestinal parasites. It is a binary outcome variable. Independent variables included socio-demographic, environmental and health seeking behavior variables. Socio-demographic variables included the following variables: age and sex of child, religion, ethnicity, family size, wealth index, maternal/paternal education and occupation, marital status and media availability. Environmental variables consisted of variables like, water source, availability of latrine, availability of safe excreta disposal, type of house and numbers of room. Health-seeking behavior variables included the following variables: personal hygiene practice, type of water consumption, water handling technique, hand washing practice, playing with soil, habit of eating raw vegetables and fruits and wearing shoes, health service availability, household food insecurity status and dietary diversity score.
Is present when a child is infected with at least one intestinal parasite infection.
Family size is defined as a total number of family members living in the household. Family size is classified as small when it is less than six. It is classified as medium when it is between six to eight, and it is classified as large when it is greater than eight.
Data collection method and tools
Data were collected by face to face interview using a structured and pre-tested questionnaire. Data were collected in Sidama language from children’s parents (caregivers). Interviewers have also inspected whether children wore shoe or not. Data were collected by eight diploma nurses, two laboratory technicians, and eight community health workers. Two health officers supervised data collection process.
Stool collection and examination
All parents / guardians/ were informed by health extension workers to bring their children of age 6 to 59 months to health posts. Parents or guardians were asked to provide about 2 g of fresh stool sample of their children using clean, tightly corked, leak proof containers. The sample was analyzed using wet mount technique and the remaining portion was concentrated using formal ether concentration technique . The specimens were examined microscopically for the presence of eggs, trophozoites or cysts. Stool samples were collected from 622 children whose age was between 6 to 59 months for intestinal parasites examination.
Data quality control
Questionnaire was prepared in English language, and translated into Sidama language (local language). Then, it was re-translated back to English to keep its consistency. Comparison was done between two versions to assess inconsistent and inaccurate data. It was pre-tested by 5% of sample size in Kebeles which were not included in the actual study area. Finally, any inconsistent and inaccurate data was re-adjusted accordingly. Data collectors and supervisors were given two-day training before the actual data collection time. The training was focused on the aim, procedure and data collection technique.
Data processing and analysis
Data were cleaned, coded and entered in to a computer using Epi data. Then, data were exported and analyzed by SPSS version 22. Descriptive statistics was used to show prevalence of intestinal parasites. Tables and graphs were formed to present data. Binary logistic analysis was done first and variables with p-value < 0.25 were considered as candidate for multivariable logistic regression. Model fitness was checked using Hosmer-Lemeshow test of goodness of fit before the actual logistic regression analysis. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI was reported. Variables which have P-value of less than 0.05 in the multivariable logistic regression analysis was considered as significantly associated factors of intestinal parasites. Finally, those variables whose p-value less than 0.05 were considered as statistically significant in multi-variable logistic regression.