Prevalence of soil-transmitted helminthic infections and factors associated with persistent transmission among pre-school aged children in west b district, Unguja zanzibar

Abstract

ABSTRACT Background: The risk of contracting Soil-transmitted Helminthic infections (STHs) is recognized to be shared by pre-school aged children (PSAC) and school aged children (SAC) due to sanitation and hygiene practices. The national efforts in Zanzibar for the control of STHs infections have predominantly focused on SAC, excluding PSAC. Even though preventive chemotherapy (PC) using mebendazole has been used in reproductive and child health (RCH) clinics during deworming and vitamin A supplementation campaigns since 2004; the results have not been optimal because attendance starts to decline after the age of 12 months. This means that some PSAC patients do not receive PC at a time when they are most vulnerable for STHs infections. This study examined the prevalence of STHs infections, the association between water, sanitation, and hygiene (WASH)-related factors and STHs infections, as well as the uptake of PC among 348 PSAC from 1 to 5 years of age in West B, Unguja – Zanzibar. Objective: This study aimed to determine the current prevalence of STHs and risk factors associated with continued transmission among PSAC in West B district, Unguja – Zanzibar. Methodology: A household-based cross-sectional study was carried out among PSAC in West B district. Multistage random sampling was used to recruit 348 PSAC. Interviews using structured questionnaires were conducted with mothers and caregivers of PSAC. The information sought was related to socio-demographic characteristics, level of knowledge of the disease, household water availability, personal hygiene and sanitation, as well as uptake of PC and associated factors. The prevalence of STHs and estimation of its intensity was assessed by analyzing stool samples through formalin-ether concentration technique (FECT) and the Kato-Katz technique (KKT), for STHs egg detection. Egg counts were represented as egg per gram (EPG). Data were analyzed by the statistical computer package (SPSS version 22) and summarized by descriptive and analytical statistics; proportions were compared by the Fisher’s Exact Test. In addition, logistic regression analyses were performed to determine association between dependent and independent variables. The 95% Confidence interval and significance level of 0.05 were used. Results: Out of 348 stool samples, 5 were infected with at least one type of STHs, giving an overall prevalence of 1.4%, and overall light intensity. The prevalence of STHs was significantly associated with occupation of mothers and caretakers (p= 0.007), place of residency (p=0.02), knowledge of mothers and caretakers on STHs infections (p=0.000), cleansing agent at hand vi washing place (p=0.013), hand washing practices with water and soap after defecation (p=0.026). The overall attendance at RCH clinic was high (94.5%) and those who attended RCH clinics received and benefitted from periodic uptake of preventive chemotherapy (PC). Main water source for domestic use was improved piped water, but very few (12.1%) treated water before drinking. Majority of households (82.5%) had hand washing facility, about half (48.3%) had water and soap at the hand washing place. High number of respondents (94.3%) had their fingernails trimmed at the time of survey together with their correspondent children. Latrine coverage was 100%, and majority (95.9%) use flush toilets, though disposal of child fecal matter was unhygienic in about 35.9%. Logistic regression analysis identified a family size as a significant factor contributing to continued STHs transmission, family size of more than five household members have an AOR of 0.117 (95% CI= 0.016-0.854, p=0.034). Conclusion and recommendations: PSAC are a potential source of continued transmission of STHs; mothers and caretakers’ occupation, poor water treatment habit, unhygienic disposal of feces of child as well as poor hand washing habit among households bring further risks of STHs transmission in the general population. Health education should be given to mothers and caretakers on the importance of treating water for domestic use, personal hygiene and sanitation, especially the proper and hygienic way of disposing fecal matter of the child.