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Knowledge and practices of parents of school age children towards Helminthiasis and malaria in northwestern Ethiopia

樱花视频 volume听24, Article听number:听3345 (2024) Cite this article

Abstract

Background

Helminthiasis and malaria prevail in developing countries including Ethiopia, where they claim lives, retard physical and mental growth, reduce productivity and contain economic growth. Implementing helminthiasis and malaria control strategies require adequate knowledge and practices of the affected communities. Knowledge and practices of parents of school age children was assessed in relation to risk of child infection with Helminthiasis and malaria.

Methods

A total of 398 parents of school age children attending Maksegnit Number Two Elementary School from September 2020 to June 2021 were interviewed regarding their sociodemography, knowledge and practice towards Helminthiasis and malaria. The risk of child infection with Helminthiasis and malaria in relation to sociodemography and household practices was tested using multivariable logistic regression model.

Results

Risk of child infection with Helminthiasis was lower when the responding parent was female (OR鈥�=鈥�0.54; CI鈥�=鈥�0.32鈥�0.92) and monthly household income was 鈮モ��2001 birr (OR鈥�=鈥�0.39; CI鈥�=鈥�0.22鈥�0.70). A monthly income of 鈮モ��2001 birr was associated with a low risk of child infection with malaria (OR鈥�=鈥�0.37; CI鈥�=鈥�0.21鈥�0.65). Children living with married parents were at higher risk of Helminthiasis (OR鈥�=鈥�2.25, CI鈥�=鈥�1.33鈥�3.81) and malaria (OR鈥�=鈥�2.71, CI鈥�=鈥�1.60鈥�4.58) infection. Latrine with wooden floor was correlated with a high risk of child infection with Helminthiasis (OR鈥�=鈥�7.2; CI鈥�=鈥�2.16鈥�23.95). While washing with soap after toilet (OR鈥�=鈥�0.09; CI鈥�=鈥�0.03鈥�0.34) and eating washed cabbage/fruit (OR鈥�=鈥�0.26; 0.15鈥�0.44) were associated with a lower risk of infection. Parents who participated in environmental management based vector control were less likely to report child infection with malaria (OR鈥�=鈥�0.44; 0.20鈥�0.97). A child living in residual insecticide sprayed house was at risk of malaria infection (OR鈥�=鈥�3.16; CI鈥�=鈥�1.45鈥�6.92).

Conclusions

In general female responding parent, higher household income, and washing with soap after toilet or eating washed cabbage/fruit were associated with decreased risk of intestinal helminthiasis infection in children. In addition, higher income and participation in enviroinmental management based vector contol were associated with decreased malaria infection risk in children.

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Introduction

Helminthiasis and malaria are major parasitic diseases in economically developing countries including Ethiopia. They claim lives, retard physical and mental growth, reduce productivity, cause malnutrition, and contain economic growth [1,2,3,4,5]. Helminths consume iron, protein, blood, vitamin A, and nutrition that are essential for the physical and cognitive well being of human kind [2, 3]. Soil-transmitted Helminthiasis affects over 1.5听billion people among which over 260听million are pre-school and 654听million school-age children [6]. Schistosomiasis alone affected 229听million people, of which over 90% were in Africa, and greater than 54% of them were school children in 2015 [7]. In highly malarious areas, up to 70% of school-aged children harbor Plasmodium parasites that cause malaria and are thus vulnerable to its adverse effects [8].

In developing tropical countries, school age children have the highest risk of asymptomatic and clinical malaria [4, 8, 9]. Children could potentially be exposed to unrecognized deaths and serve as an infection reservoir for the wider population [9]. Their exposure to malaria could partly result from the low coverage of the group with malaria control tools such as long-lasting insecticide treated nets [4, 10] and the low level of attention given to them by parents and public health personnel. In addition, the active playing behavior of the children along streams and with soil exposes them to schistosomiasis and soil-transmitted helminthes, respectively [6, 7].

Improved sanitation, use of core vector mosquito control tools and treatment of cases are essential to prevent Helminthiasis and malaria [11]. The effectiveness of these strategies primarily depends on the active involvement of the affected communities, which in turn depends on their knowledge, attitudes and practices [12]. Adequate community knowledge about Helminthiasis contributes to the reduction of transmission and re-infection through improving hygienic practices, timely treatment of cases and sustained child deworming. Similarly, knowledge of malaria enhances the implementation of adequate control practices, such as use of insecticide treated nets and managing vector breeding habitats [11]. However, knowledge on the cause, transmission and preventive measures of diseases vary from community to community, among households and individuals [12]. Thus, implementing effective helminthiasis and malaria control strategies requires understanding the knowledge and practices of communities living in endemic areas [11]. In view of the priority given to helminthiasis and malaria control in Ethiopia, this study assessed the knowledge and practices of parents of school age children towards the diseases.

Methods

Study area and population

The study was conducted in Maksegnit town and its surrounding rural villages in Central Gondar Zone, Amhara Regional State, Ethiopia [5]. Parents of school age children attending Maksegnit Number Two Elementary School and who lived in Maksegnit Town and nearby rural villages from September 2020 to June 2022 participated in the study.

Study design and procedure

As part of a longitudinal follow-up study aimed to evaluate the impact of repeated anthelmintic treatment of school age children on the epidemiology and clinical outcomes of malaria, a baseline cross-sectional survey was carried out on the knowledge and practice of parents鈥� of study participants about malaria and Helminthiasis.The school vice director and investigators of the study requested school children who have been in the follow-up, to bring their parents or guardians after explaining the purpose of the study [5]. First, the research team explained the purpose of the study to the parents or guardians of the children and requested their consent to participate.Then school teachers interviewed parents/guardians about their knowledge and practice towards malaria and Helminthiasis.

Data collection

Data was collected using a questionnaire that constituted about 123 questions/items to measure the parent鈥檚 sociodemography, knowledge and practices towards Helminthiasis and malaria. The questionnaire was first developed in English and later translated to the local language Amharic. The data acquired using the questionnaire in Amharic language was latter transcribed back to English for analysis and write up. Data about sociodemography included gender, education, marital status, monthly household income in Ethiopian currency (Birr), religion, occupation, and residence (i.e., Maksegnit town or surrounding rural village). Data in relation to the knowledge of parents towards Helminthiasis were ever heard of helminthic parasites, source of information, names of perceived helminthic parasites, source of helminth infection, treatments and controls to helminthic parasites among others. Data about the practices of parents included deworming program, defecation sites and hygiene practices. While data in relation to the knowledge and practices of parents towards malaria included ever heard of malaria, source of information, was child infected with malaria within the previous year, treatment made, how is malaria transmitted and controlled and use of nets. Each question had categorical responses and one response was recorded for each question.

Ethical considerations

The study protocol was approved by the Institutional Review Boards of the University of Nebraska Medical Center (IRB# 0618-20-FB) and Aklilu Lemma Institute of Pathobiology, Addis Ababa University (ALIPB IRB/25/2012/20). Prior to conducting the study, permission was obtained from Amhara Regional Health Office, Central Gondar Zonal Health Office, Gondar Zuria District Health Office, Central Gondar Educational Office and Maksegnit Number Two Primary School Director Office. Written informed consent was obtained from parents/guardians who were willing to participate in the study.

Data analysis

Data was entered and analyzed using SPSS Statistics Version 20.0 software. Frequencies of perceived responses of the parents in relation to the variables on sociodemography, knowledge, and practices towards Helminthiasis and malaria were analyzed. Multivariable logistic regression analysis was used to test the relationship of knowledge and practice of parents related to malaria and Helminthiasis infection with the odds of infections with these parasites in their children. The values of odds ratios with confidence intervals excluding 1 were considered significant.

Results

Parents鈥� socio-demographic characteristics and child infection risk with Helminthiasis and malaria

A total of 398 parents of school children participated during the interview of which 51.8% (n鈥�=鈥�206) were males (Table听1). Considerable proportion (44.1%; 171/388) of the respondents were illiterate. Over half of the respondents were married (66.2%; 249/376), and reported a monthly income of 鈮も��2000 ET Birr (66.8%, 249/373). Majority of the participants were Orthodox Christians (86.3%, 340/394). Farming was practiced by 68.7% (259/377), daily labor by 15.9% (60/377) and government/NGO employement by 15.4% (58/377). Majority of the participants (81.1%, 309/381) were residents of Maksegnit town. Only 18.9% (72/381) were from rural areas.

A school age child was at a significantly lower risk of helminth infection when the responding parent was female (OR鈥�=鈥�0.54; CI鈥�=鈥�0.32鈥�0.92) and the monthly household income was 鈮モ��2001 birr (OR鈥�=鈥�0.39; CI鈥�=鈥�0.23鈥�0.70). A monthly household income of 鈮モ��2001 birr was associated with low risk of child infection with malaria (OR鈥�=鈥�0.37; CI鈥�=鈥�0.21鈥�0.65). On the other hand, a child living with married parent was associated with higher risk of both Helminthiasis (OR鈥�=鈥�2.25, CI鈥�=鈥�1.33鈥�3.81) and malaria infections (OR鈥�=鈥�2.71, CI鈥�=鈥�1.60鈥�4.58).

Table 1 Socio-demographic characteristics of parents of school age children and risk of child infection with helminthiasis/malaria, Maksegnit, northwestern Ethiopia, June 2022
Full size table

Knowledge of parents about Helminthiasis

Close to 82% (323/394) of the parents heard about helminth parasites (Table听2). Their primary source of information was public media (58.8%;200/340) followed by health personnel (37.6%;128/340) and local community (3.5%; 12/340). About 70.8% (262/370) perceived helminthiasis, but a relatively low proportion (32.1%; 84/262) cited the correct names of the parasites. Ascaris was the most frequently cited parasite (54.8%; 46/84) followed by tapeworm (39.3%; 33/84). The majority (74.3%;284/382) reported contaminated food, water, or hand as source of helminthic parasite infection. Close to 68% (264/388) reported that their children were infected with at least one helminthic parasite and 85.9% (269/313) sought modern healthcare for their infected children. The great majority (91.5% ;356/389) perceived that helminthic parasites are preventable. Health education and hygiene were the preferred prevention strategies by the parents (74.4%; 267/359) compared to the treatments (25.6%;92/359). Over 59% (n鈥�=鈥�212) heard about deworming program.

Table 2 Knowledge of parents of school age children towards Helminthiasis, Maksegnit, northwestern Ethiopia, June 2022
Full size table

Household practices and risk of child infection with Helminthiasis

Only 31.9% (106/332) of parents reported that their children participated in deworming program (Table听3). About 81% (317/392) of households used latrine and 19% (75/392) open-field. About 45.7% (148/324) used cement floor latrine, 33.3% (108/324) wooden floor and 21% (68/324) mud floor. A child who used latrine with wooden floor was at greater risk of infection with Helminthiasis (OR鈥�=鈥�7.2; CI鈥�=鈥�2.16鈥�23.95). About 98% of respondents cited that their children wear shoes daily. The majority (91.7%;321/350) had metal-roofed houses. Close to 71% (278/393) reported that their children practiced hand washing using soap after toilet, 85.3% (336/394) after touching dirt and 93.4% (367/393) before eating. About 45.6% (180/395) ate washed cabbage and fruit, 16.8% (65/388) ever ate uncooked meat and 52.4% (199/380) reported that their children bathed/washed in streams and rivers. Close to 74% (286/387) had child/children who contacted cats most frequently, 21.2% (82/387) cattle and 4.9% (19/387) chicken. Washing with soap after toilet (OR鈥�=鈥�0.09; CI鈥�=鈥�0.03鈥�0.34) and eating washed cabbage and fruit (OR鈥�=鈥�0.26; 0.15鈥�0.44) were associated with significantly low odds of child infection with helminths.

Table 3 Household practices and risk of child infection with helminthic parasites, Maksegnit, northwestern Ethiopia, June 2022
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Knowledge of parents about malaria

Over 94% (372/394) of the parents had information about malaria (Table听4). Health workers informed 46.3% (174/376) of the parents, public media 46.5% (175/376), and community 7.2% (27/376). About 68.7% (259/377) reported that their children were infected with malaria and 88.8% (269/303) sought modern healthcare for their sick children. About 89.6% (337/376) perceived that malaria is treatable with drugs of which 61.5% (118/192) cited Coartem as the drug of choice and 15.6% (30/192) chloroquine. According to 66.8% (257/385), malaria is transmissible and 77.9% (272/349) perceived that malaria is transmitted by mosquito bites, 11.5% (40/349) by respiratory tract and10.6% (37/349) by physical contact with a sick person. A very high proportion (86.6%;220/254) responded that mosquitoes breed in water habitats. The choice of control method depended on effectiveness (39.7%; 151/380), low cost (23.4%; 89/380), availability (22.9%; 87/380) and safety (13.9%; 53/380). 鈥淒o not have鈥� was the most frequently cited (94.1%;206/219) reason for not using mosquito nets.

Table 4 Knowledge of parents of school age children towards malaria, Maksegnit, northwestern Ethiopia, June 2022
Full size table

Parental practices and risk of child infection with malaria

Close to 56.2% (204/363) of the parents involved in environmental management based vector control, 35.5% (129/363) used tablets and 8.3% (30/363) used IRS/LLINs to control malaria (Table听5). Parents who participated in environmental management for vector control were less likely (OR鈥�=鈥�0.44; 0.20鈥�0.97) to report child infection with malaria. Only 15.2% (60/394) of the parents had their houses sprayed with residual insecticide within the previous 12 months, but associated with higher risk (OR鈥�=鈥�3.16; CI鈥�=鈥�1.45鈥�6.92) of child infection with malaria. About 76.3% (300/393) reported at least one household member used net and 53% (150/283) reported that children slept under LLINs, 29% (82/283) pregnant women and 18%(51/283) parents.

Table 5 Parents鈥� percieved malaria control practices and risk of school age children infection with the diseases, Maksegnit, northwestern Ethiopia, June 2022
Full size table

Discussion

Knowledge and practices of parents of Maksegnit Number two primary school children were assessed towards helminthiasis and malaria infection risk. Close to 82% of the parents had information about helminthic parasites, primarily through public media and health personnel. This could arise from the fact that most of the respondents lived in Maksegnit town where the urban setting makes media and public health services easily accessible. The high level of parents鈥� knowledge strengthens helminthiasis control by improving hygienic practices, modern healthcare seeking behaviours, and participation in deworming programs. A female parent and a parent with a monthly household income of 鈮モ��2001 birr were less likely to report a helminth infected school child. This could result from better maternal hygiene practices and urban living conditions [13]. Helminthiasis has been associated with poverty all over the world including the United States of America, Latin America, Africa and mainland China [14,15,16,17].

A child living with married parent was associated with a higher odds of Helminthiasis. Married parent could increase the number of household members relative to the unmarried, thereby increasing the possibility of overcrowding and hence increased feco-oral transmission of Helminthiasis. Large family size was reported to be a predisposing factor for soil-transmitted helminths (STH) infection in Ambo town of western Ethiopia [18], in Ecuadorian birth cohort study [19], in the Amazonian southern border region of Ecuador [20] and in Daman district of Kandahar, Afghanistan [21].

Contaminated food, water, or hand was perceived to be the primary source of helminthic parasite infection. In a similar study in Sekota Town of Ethiopia, 75 (19.9%) mothers perceived soil contact as a source of helminthaisis, 29 (7.7%) contaminated water, and 65 (17.2%) contaminated food [22]. Similarly, a school child playing with soil/dirt was 7.53 times at risk of STH infections in North Sumatera, Indonesia [23]. Furthermore, the parents鈥� knowledge was in line with previous reports that revealed ingestion of helminth eggs contaminated food and water cause helminth infections [24,25,26].

Washing using soap after toilet and eating washed cabbage and fruit were associated with significantly low risk of child infection with helminthic parasite. In a similar study in North Sumatra in Indonesia, hand washing habits decreased the risk of soil-transmitted helminth infections significantly [23]. Access to sanitation, and hand washing both before and after defecating were associated with lower risk of helminth infection [25]. A meta-analyses indicated a significant reduction of soil-transmitted helminth infections related to washing practices, access to water and hygiene [25]. Continued sanitation and hygiene practices are essential for the sustainable control of helminthic parasite infections [26]. However, hygiene practices such as frequency of hand washing using soap with rubbing, drying mechanism, and conditions of fingernails may vary from individual to individual depending on the education level, health education provision, and availability of water [27] which further entail variations in infections [28].

Almost all of the parents had information about malaria. This is in agreement with the awareness (91.3%) reported in Maygaba town of northwest Ethiopia [29] and in a hospital based cross-sectional study in South Gondar ( 92.5%) [30]. Their main source of awareness was health personnel (47.4%) followed by public media (45.2%), and community (7.4%). Health personnel was also among the leading sources of awareness, in which case hospitals created awareness for 63.8% of inhabitants and health extension workers for 62.1%, but public media (only for 7.9%) was the least important source in the south Gondar [30].

Although the awareness of parents regarding malaria was high, over 68% of them reported that their child/children had malaria infection during the previous year. In connection with this, previous studies revealed an unacceptably high prevalence of malaria in the area [31,32,33]. The high level of malaria prevalence around Meksegnit in the context of the high level of community awareness entails poor coverage of interventions or a possibility of emerging antimalaria drug resistant Plasmodium parasites and a widespread occurrence of insecticide resistant malaria transmitting Anopheles species in the area.

Close to 77.9% of the parents perceived that malaria is transmissible through the bites of mosquitoes. This is similar to the perception by 68.5% in Woreta area [34] and 75.6% in Maygaba town [29], located in northwestern Ethiopia. But, our observation is higher than the perception of 59.6% reported from southwest Ethiopia [35]. A similar hospital-based cross-sectional study, in South Gondar a few years back reported a much higher proportion (86.2%) that mentioned mosquito bites as cause of malaria [30]. This high level of awareness of communities in different parts of the country helps to effectively implement core malaria vector control tools, namely long lasting insecticide treated mosquito nets, indoor residual insecticide spraying and mosquito breeding habitat management.

A parent who participated in environmental management based vector control activity was less likely to report a malaria infected school age child. Environmental management at community level is considered safe and cost effective in areas where breeding habitats are limited and can play a significant role in integrated vector management strategy [36, 37]. A parent whose house sprayed with residual insecticide in the previous 12 months experienced a significantly high risk of school age child infection with malaria. In Ethiopia, indoor spraying with residual insecticides is mainly performed in a highly malarious village during or just before the main transmission season. Several reports indicate that the major malaria vector, Anopheles arabiensis, has developed resistance to the existing insecticides in different parts of Ethiopia [38, 39]. Thus, occurrence of insecticide resistant vectors in highly malarious foci expose children to repeated mosquito bites and hence malaria transmission among the school children.

Strengths and limitations

The study involved parents of school age children as children are most vulnerable to helminthic parasite infections due to their active interaction with friends, helminth egg and ova contaminated soil, food stuff and water bodies that serve as source of schistosomiasis infection. They are also vulnerable to malaria infection. The study could enhance prevention of helminthiasis and malaria transmission among school age children. However, the data was limited to responses of the parents that missed actual environmental and occupational predisposing factors of infections.

Conclusions

Female responding parent, higher household income, washing with soap after toilet or eating washed cabbage/fruit were associated with decreased risk of Helminthiasis infection in school age children. In addition, higher household income and parent participation in environmental management for vector contol were associated with decreased risk of malaria infection in children. Thus, strengthened personal/environmental sanitation and management of vector breeding habitat may contribute to reduce Helminthiasis and malaria infections in school age children, respectively.

Data availability

Data sets generated and/or analyzed during the study and supporting the results reported in the article are available and can be found from the corresponding author upon request.

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Acknowledgements

Authors are greatefule for the Colledge of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA for sponsoring the study. We would like to thank the parents of Maksegnit Number Two Primary School Children for their participation during the study. The management and tearchers of Maksegnit School are duely acknowledged for their active support and intervieweing the parents. We are also indepted to Aklilu Lemma Institute of Pathobiology for providing us field vechile for the data collection.

Funding

All the activities of the study including design, data collection, data entry, analysis and manuscript preparation were perfomed using the University of Nebraska Medical Center Faculty Diversity Fund.

Author information

Authors and Affiliations

  1. Aklilu Lemma Institute of Pathobiology, Addis Ababa Unversity, P. O. Box 1176, Addis Ababa, Ethiopia

    Abebe Animut,听Berhanu Erko听&听Yohannes Negash

  2. Department of Epidemiology, Colledge of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4395, USA

    Abraham Degarege

Authors
  1. Abebe Animut

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  2. Berhanu Erko

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  3. Yohannes Negash

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  4. Abraham Degarege

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Contributions

Authors contributionsAA and AD designed the study and wrote the main manuscript text. AA and YN collected the data.AA, BE and AD designed the study. AD initiated the study. AA and AD analyzed the data. All authors reviewed the manuscript for publication.

Corresponding author

Correspondence to Abebe Animut.

Ethics declarations

Ethical approval and consent to participate

The study protocol was approved by the Institutional Review Boards of the University of Nebraska Medical Center (IRB# 0618-20-FB) and Aklilu Lemma Institute of Pathobiology, Addis Ababa University (ALIPB IRB/25/2012/20). Prior to conducting the study, permission was obtained from Amhara Regional Health Office, Central Gondar Zonal Health Office, Gondar Zuria District Health Office, Central Gondar Educational Office and Maksegnit Number Two Primary School Director Office. Written informed consent was obtained from parents/guardians who were willing to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Animut, A., Erko, B., Negash, Y. et al. Knowledge and practices of parents of school age children towards Helminthiasis and malaria in northwestern Ethiopia. 樱花视频 24, 3345 (2024). https://doi.org/10.1186/s12889-024-20848-4

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  • DOI: https://doi.org/10.1186/s12889-024-20848-4

Keywords

樱花视频

ISSN: 1471-2458

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