Adamu Tesfa MPH - Mattu

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COLLEGE OFHEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

SOIL-TRANSMITTED HELMINTHES AND ASSOCIATED FACTORS


AMONG PREGNANT WOMEN IN DORENNI WOREDA, ILUBABOR ZONE,
OROMIA, SOUTH WEST ETHIOPIA, 2023

BY: ADAMU TESFA (BSc)

A THESIS SUBMITTED TO MATTU UNIVERSITY, COLLEGE OF


HEALTH SCIENCES, DEPARTMENT OF PUBLIC HEALTH, IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR MASTERS DEGREE IN
PUBLIC HEALTH

OCTOBER, 2023

MATTU, ETHOPIA
MATTU UNIVERSITY

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

SOIL-TRANSMITTED HELMINTHES AND ASSOCIATED FACTORS AMONG


PREGNANT WOMEN IN DORENNI WOREDA, ILUBABOR ZONE, OROMIA,
SOUTH WEST ETHIOPIA, 2023

PRINCIPAL INVESTIGATOR: ADAMU TESFA (BSc)

ADVISORS:

1. TESHOME BEKANA (PhD)

2. ASRAT ZEWDIE (MPH)

OCTOBER, 2023

MATTU, ETHOPIA

II
APPROVAL SHEET
MATTU UNIVERSITY
POST GRADUATE PROGRAM
SOIL-TRANSMITTED HELMINTHES AND ASSOCIATED FACTORS AMONG
PREGNANT WOMEN IN DORENNI WOREDA , ILUBABOR ZONE, OROMIA ,SOUTH
WEST ETHIOPIA, 2023

Name of student Signature Date

AdamuTesfa _____________ ____________

Advisors:

Name of Advisors Signature Date

1. Teshome Bekana (PhD) ______________ __________

2. Asrat Zewdie (MPH) ________________ ___________

Approved by Examinning Coommitee Members :


__________________________ __________ ________________
DCG Chair Person Signature Date

Examiner Signature Date


___________________ _______________ _______________
Chairman Person :
____________________ _________________ ________________
Department Head Signature Date

_______________ _____________ ___________

College/Inistitute/Dean Signature Date

SGS Director Approval Signature Date

________________________ ________________ _______________

III
ACKNOWLEDGEMENTS

I would like to thank Mattu University College of Health Sciences, Department of Public
health for their help in adjusting and scheduling programs and giving me the chance to
conduct this research thesis.

I favor to extend my earnest gratitude to my advisors TeshomeBekana (BSc, MPH, PhD)


andAsratZewdie (BSc, MPH) for their encouragement and constructive Comments for the
success of this research thesis.

The last but not the least, my thanks shall go to my honorable and beloved families for
supporting and inspiring me throughout my work.

IV
Table of Contents Page No
APPROVAL SHEET............................................................................................................................III
ACKNOWLEDGEMENTS..................................................................................................................IV
LIST OF FIGURES.............................................................................................................................VII
LIST OF TABLES.............................................................................................................................VIII
ABSTRACT..........................................................................................................................................IX
ABBREVIATIONS AND ACRONYMS............................................................................................viii
CHAPTER ONE: INTRODUCTION.....................................................................................................1
1.1. Background of the Study..................................................................................................................1
1.2. Statement of the problem.................................................................................................................2
1.3. Significance of the study..................................................................................................................4
CHAPTER TWO: LITERATURE REVIEW.........................................................................................5
2.1. Magnitude of soil-transmitted helminthes among pregnant women................................................5
2.2. Factors associated with Soil-transmitted helminthes.......................................................................7
2.2. 1.Socio-demographic factors............................................................................................................7
2.2.2. Environmental Factors..................................................................................................................8
2.2.3 .The life style factors......................................................................................................................9
2.2.4. Health service related factors........................................................................................................9
2.2.5. Obstetric factors..........................................................................................................................10
2.3. Conceptual frame work..................................................................................................................10
CHAPTER THREE: OBJECTIVE.......................................................................................................11
3.1. General objective............................................................................................................................11
3.2. Specific objectives..........................................................................................................................11
CHAPTER FOUR: METHODS AND MATERIALS..........................................................................12
4.1 Study area and period......................................................................................................................12
4.2. Study Design..................................................................................................................................13
4.4. Population.......................................................................................................................................13
4.4.1 .Source population........................................................................................................................13
4. 4 .2. Study population........................................................................................................................13
4.5. Eligibility criteria...........................................................................................................................13
4.5. 1. Inclusion criteria.........................................................................................................................13
4.5.2. Exclusion criteria.........................................................................................................................13
4.5. Sample size determination and sampling technique.......................................................................13
4.5.1. Sample size determination...........................................................................................................13

V
4.5. 2.Sampling technique.....................................................................................................................15
4.6. Study variables...............................................................................................................................15
4.6.1. Dependent variable......................................................................................................................15
4.6.2. Independent variables..................................................................................................................16
4.7. Operational definitions...................................................................................................................16
4.9. Data Quality Assurance..................................................................................................................17
4.10. Data processing and analysis........................................................................................................18
4.11. Ethical consideration....................................................................................................................18
4. 12.Dissemination of the results.........................................................................................................18
CHAPTER FIVE: RESULTS...............................................................................................................19
5.1 Socio-demographic characteristics of pregnant women..................................................................19
5.2. Healthcare related characteristics...................................................................................................20
5.3 Environmental and life style factors related characteristics of pregnant woman............................22
5.4. Knowledge of the pregnant women about the soil transmitted helminthes...................................23
5.5. Magnitude of soil transmitted helminthes among pregnant women (N=416)...............................24
5.6. Stool examination and Kato Katz techniques.................................................................................24
5.7. Factors associated with soil transmitted helminthes......................................................................25
CHAPTER SIX: DISCUSSION...........................................................................................................28
6.1 STRENGETH AND LIMITATION OF THE STUDY..................................................................30
6.1.1. Strength of the study....................................................................................................................30
6.1.2. Limitation of the study................................................................................................................30
CHAPTER SEVEN: CONCLUSION AND RECOMMENDATION.................................................30
7.1. CONCLUSION..............................................................................................................................30
7.2. RECOMMENDATION..................................................................................................................31
REFERENCES......................................................................................................................................32
ANNEX I...............................................................................................................................................37
ANNEX II.............................................................................................................................................38
ANNEX III............................................................................................................................................40

LIST OF FIGURES

VI
Figure 1:Conceptual frame work of soil-transmitted helmenthes among pregnant women in
Doreni, Ilu Aba,Bor Zone,Oromia, August,2023……………………..……….……….10
Figure 2: Map of Doreni district of the study area, 2023……………………..………….….12
Figure3:Schematic presentation of sampling techniques on STH among pregnant
women,Doreni,Ilu Aba Bor, Oromia August,2023 (N=416)………………..………….15
Figure 4: Evidences for thesis Manuscript Submission…………………………………….18
Figure 5: Magnitude of soil-transmitted helminthes among pregnant women attending ANC
in Dorenni , Ilu Aba Bor Zone,Oromia, 2023 (N=416)…………………………...…...24

LIST OF TABLES
Table 1: Sample size calculation for factors associated with soil-transmitted among pregnant
women Dorenni, Ilu Aba Bor, August,2023(N=416)…………………….………….14

VII
Table 2: Socio-demographic characteristics of pregnant women in Doreni ,Ilu Aba Bor,
Oromia, August , 2023(N=416)……………………………………………………19
Table 3: Health service related characteristics of pregnant women attending ANC in Doreni,
Ilu Aba Bor , Oromia August , 2023(N=416)………………………….……………21
Table 4: Environment and life style related factors STH among pregnant women attending
ANC in Doreni, Ilu Aba Bor zone,Oromia,2023(N=416)…………….…………….22
Table 5: Knowledge of pregnant women about soil-transmitted helminthes among attending
ANC in Doreni, Ilu Aba Bor zone, Oromia, 2023(N=416)…………………………23
Table 6:Kato Katz techniques of STH diagnosis ,egg counts and intensity of STH among
pregnant women Attending ANC in Doreni, Ilu Aba Bor Zone ,Oromia ,
Ethiopia ,2023(N=416)……………………………………………………………….
……..25
Table 7:Biviariate and Multivariate analysis of factors associated with soil-transmitted
helminthes among pregnant women attending ANC in Dorenni district, Ilu Aba Bor
Zone,Oromia ,August 2023(N=416)…………………………………………………27

ABSTRACT
Background: Soil-transmitted helminthiasis (STH) refers to a set of parasitic illnesses
brought on by nematode worms and spread to people by faeces-contaminated soil. It is highly
prevalent in low- and middle-income countries due to a lack of environmental sanitation and
personal hygiene. Pregnant women are among the risk groups for the infection of soil-
transmitted helminths. The aim of this study was to determine the prevalence and associated
factors of soil-transmitted helminthes among pregnant women, help decrease the burden of
VIII
the problems, and take rapid measures to reduce their impacts on pregnancy in Doreni
district, southwestern Ethiopia.
Method: An institution-based cross-sectional study was conducted among 416 randomly
selected pregnant women. Data were collected using a structured interview-administered
questionnaire and a laboratory test. The Kato-Katz technique was used to diagnose soil-
transmitted helminthiasis and identify the intensity of infection. The collected data were
entered into Epi-Data version 4.6 and exported to SPSS version 25 for analysis.
Multivariable logistic regression analysis was used to identify independent predictors of soil-
transmitted helminthes at p-values < 0.05.

Results: The overall prevalence of soil-transmitted helminthes among pregnant women was
30%. (95%,CI:26-34%).Living in a rural area (AOR=3.36;95%CI =1.84–6.20), drinking
from an unprotected water source (AOR=2.56;95% CI=1.47–4.46), not hand washing after
toilet (AOR=2.66;95%CI =1.49–4.73), lack of health information (AOR=1.7; 95% CI =1.02–
2.86), being a daily labourer (AOR = 2.88; 95% CI=1.01–8.22) and walking barefoot (AOR
=3.83; 95%CI=2.18–6.73) were significantly associated with the presence of soil-transmitted
helminthes among pregnant women.

Conclusion: The prevalence of STH was significantly moderate in the study area, where
pregnant mothers were mostly affected by ascariasis and hookworm. Living in a rural area,
being a daily labourer, walking barefoot, not washing hands after the toilet, drinking from an
unprotected water source, and lacking health information were the determining factors.
Interventions including health education, the expansion of pure drinking water sources, the
promotion of personal hygiene, and the importance of wearing shoes are recommended to
reduce the burden of soil-transmitted helminthes in the study area.

Key Words: Soil Transmitted Helminthes, Pregnant Women, Ethiopia

IX
ABBREVIATIONS AND ACRONYMS

ANC Ante Natal Care


AOR Adjustment Odd Ratio
CSA Central statistics Agency
CI Confidence Interval
CLTSH Community-Led Total Sanitation and Hygiene

DHS Demographic Health Survey

DC Data collectors,

ETB Ethiopian birr

EpgEgg per gram

HgbHemoglobin
IRC Institutional review committee
LBW Low Birth weight
RT Reverse transcription
PCR Polymerase chain reaction
LBW Low Birth Weight
MDG Millennium Development Goal
MPH Masters of Public Health
SOP Standard Operational definition
STH Soil transmitted Helminthes
SPSS Statistical package and Social science
SS Sample Size
TSS Total sample Size
USA united States of America
WHOWorld Health Organization

viii
CHAPTER ONE: INTRODUCTION

1.1. Background of the Study


Soil-transmitted helminthes are refers to the intestinal worms that infect humans and spread by
contaminated soil: Intestinal whipworm, hookworm, and Ascaris lumbricoides(1) .A large part of the
world’s population is infected with one or more of these soil-transmitted helminthes.(1)

Young women, pregnant women, and their unborn children regularly contract helminthic infections repeatedly
in the poor countries, which can cause anemia, intrauterine development retardation, and low birth
weight(2). The knowledge on the prevalence of intestinal helminthiasis and its related risk factors
among people is important since it may help determine whether a country has a particular helminthic
infection(2).

The high rates of infection among pregnant women are primarily indicative of fecal pollution of soil and
domestic water supply around homes due to poor sanitation and improper sewage disposal. Pregnant
women are particularly vulnerable to STH infection(3).In many agricultural areas, women frequently
contract helminthes infections while tending to their families' food gardens(4). Onekey riskfactor for
anemia in women of reproductive age is hookworm infection, whose frequency and severity vary by
geographic region(4).

Sub-Saharan Africa has a highly overlapping geographic distribution of geo helminthiasis, the
concurrent presence of hookworm infection during pregnancy may significantly increase soil
transmitted helminthes (STH)(4).The change in immunity during pregnancy induces tolerance to fetal
implantation and also associated with decreased immunity to various infections such as IPI, making IPI
a double burden for pregnant women in that it affects the health of both pregnant women and their
offspring(5).

Ethiopia has a high prevalence of intestinal parasitic infection, which is caused by unsafe and
insufficient water provision, unhygienic living conditions, improper latrine use, and the habit of
walking barefoot(6).

1
1.2. Statement of the problem
Soil-transmitted helminthiasis (STH) is a term referring to a group of parasitic diseases caused by
nematode worms that are transmitted to humans by faecally contaminated soil and packages three
intestinal parasites hook worm, Ascariasis and trichuriasis(7).Globally,700-900 million individuals
have hook worms,500 million people have trichuriasis, and 300 million experience severe morbidity or
even death as a result of having ascaris (7).

In developing world's poorest places, helminthes are reported to be responsible for over 150,000 deaths
annually(7).WHO study from 1998, there are 250 million Ascaris lumbricoidesinfections worldwide,
with 60,000 people dying each year(8).Forty six million people are infected with Trichuris trichiura,
which has a 10,000 yearly fatality rate, and 151 million people are infected with hookworms, which has
a 65,000 annual mortality rate(8).Globally,44 million pregnancies are thought to be affected by soil
transmitted helminthes (STH) annually(9).A quarter of the world's population is contaminated with
helminthes that are spread through the soil. The world's endemic areas for soil-transmitted
helminthiasis are home to some 250 million women and girls(10).

Additionally, there is mounting proof that anemia and hookworm infection disproportionately affect
girls and women, since infection with these helminthes has the potential to have a severe influence on
maternal health and may have an effect on the developing fetus, pregnancy is a particularly vulnerable
time for women to become infected(11).Pregnant women are one of the populations at high risk for
IPIs, which are public health issues that are widespread throughout the world and cause significant
morbidity, many of which affect women who are of reproductive age(12).

Soil- transmitted helminthes(STH) are a serious problem, mostly in underdeveloped nations, especially
in sub-Saharan Africa(13). Ethiopia is one of the country has the lowest toilet coverage and, drinking
water quality in the whole globe.(13).It was projected that out of 68 million pregnant women in the 49
nations reviewed by DHS who were at risk of STH, more than 16 million of them took deworming
medicine during their most recent pregnancy(14).Ethiopia reported 51.5% of pregnant women were
infected with at least one of the STH on RT–PCR, and hookworm was the most prevalent this infection
leads to hemoglobin less than 8.75 gm/dl anemia, stunting and reduced cognitive development(15).

Ethiopia has one of the highest prevalence ofintestinal parasite (IPIs) and recognized as a significant
public health issue and common cause of outpatient morbidity in nation(16).Helminthic infections
account for about 85% of the burden of neglected tropical diseases in sub-Saharan Africa, and the seven
2
most prevalent NTDs are also common there(17).Due to chronic blood loss from the mucosal and sub
mucosal membranes, micronutrient deficiencies from inadequate diets, and reduced absorption from a
high worm burden in the intestines, soil transmitted helminthes are a major cause of maternal morbidity
and mortality in pregnant women with severe anemia(18) .

The health effects of the infections affect pregnant women in Ethiopia, one of the nations with a high
prevalence of soil transmitted helminthes ( STHs)(19).Despite years of effort to increase the availability
of latrine facilities, it is still difficult to find a village that is completely free from open
defecation(20).So, far Study done in Jima town on health institution recommends that as Health
information is given during ANC for pregnant women on possible risks of STH infections (21).

Ethiopia has implemented the strategy of deworming programmes (only after the first trimester in
pregnant women) and vitamin supplementation for the targeted demographics to lessen the burden of
STH-associated micronutrient malnutrition, and this framework was useful for planning public health
administrations in rural communities in endemic populations(22).Despite the fact that various studies
have been conducted and intervention approaches are used to control and prevent IPI in Ethiopia
information on the frequency and distribution of intestinal parasites among pregnant women is
insufficient and not updated often(23)

Understanding the magnitude and risk factors helps to design locally feasible interventions to reduce

the burden of soil transmitted infections in pregnant women. Therefore, this study was designed to

determine the prevalence and associated factors of soil-transmitted helminths among pregnant women.

3
1.3. Significance of the study
Soil-transmitted helminthes were ranked the third from the top ten diseases in study area according to
the recent district health office report which needs researchfocused on identifying the magnitude and
the risk factors particularly in pregnant women to alleviate the burdens of the problems.

Identifying the magnitude and factors of soil transmitted helminthes in pregnancy is an important
measure to provide quality of ANC services because the data will help service providers, decision
makers, local planners, and other stakeholders to understand what extent the severity of problem, the
service is utilizing according to maternal infection and what changes may be required to meet
prevention of STH and increase wellbeing by the target population.

The information from this study will help Dorenni district health office to plan appropriate intervention
towards of soil transmitted helminthes and to critically look at problem associated with soil transmitted
helminthes during the planning process,
Furthermore, the result will provide important information for health care providers and health facility
managers to design appropriate intervention suitable for their clients that will play credible role in
prevention of soil transmitted helminthes.
Finally, it also expected to provide base line information for further robust follow up study.

4
CHAPTER TWO: LITERATURE REVIEW

2.1. Magnitude of soil-transmitted helminthes among pregnant women


Across-sectional and community based study recruited from three districts of Bogotá, Colombia in
2018 showed thatpregnant women who lived in selected poor residential areas in Bogotá, the overall
prevalence of intestinal parasitism was 41% with 9% polyparasitism(24).The third national study, 2015
on the current status of major human parasitic diseases in China, revealed that the country's soil-
transmitted helminthes infection rate was 4.49%, with an estimated 29.12 million individuals
afflicted(25).

A study from north India reported40% prevalence of STH infections diagnosed by RT–PCR and a
hospital-based study from south India reveals a prevalence of 12.4% by routine stool microscopy.An
estimated 44 million pregnant women are infected with hookworm globally, and countries have
reported STH prevalence ranging from 10% to 79%(15).Another survey was conducted in Maharashtra
and Rajasthan state of India, 2017 reported that prevalence of soil transmitted helminthes were
8.34%(15). The prevalence was ranged from 10.01% and 5.76% respectively, in rural and urban areas.
(15).

Hospital-based cross-sectional study was carried out on pregnant women admitted to the Hospital
Ayres de Menezesin Portugal, 2022 Ascaris lumbricoides (90.9%) and tricuris trichiura (13.8%) were
the two most common parasite species found(26).The total prevalence of intestinal parasite infection
was 58.2% primarily attributable to helminthiasis, with a rate of 55.9%(26).A study conducted in
Columbia 2022 reported that prevalence of soil transmitted helminthes (STH) was 41%(15). Research
from several parts of south America showed that geo helminthes are extremely common, for example in
Peru 47.2% and Venezuela (73.9%)(15).Prospective cross sectional study conducted at Vanivilas
hospital Bangalore medical college Helminthiasis was found 12.4%(27). All infected pregnant women
had single type helminthes infection. Ascariasis was highly prevalent than hookworm 10% Vs 2.4%
(27).The illness ascariasis is the most prevalent and pervasive, affecting an estimated 21 million people
in Central SSA alone, or 21.4% of the region's population. Hookworm infection comes in second with
19.3 million affected people, or 19.7% of the region's population(28).

In study done in Nairobi Kenya 2014 on intestinal helminthes infection ascariasis was the most
common infection, with a prevalence of (6.5%), followed by hookworm infection at (3.9%), and

5
trichuriasis1.3% (4).Hospital based cross sectional study done in, Bauchi, Nigeria 2021 shows that the
overall STH infections, among pregnant women was 4.2%(18).Hookworm was the most common
helminthic, accounting for 60% of the four different helminthes that were found(18).

Studies conducted in Nigeria, in 2017 reported that prevalence of helminthic infection among pregnant
woman were21.8%(3).The most common helminthic was ascaris lumbricoides9.2%, followed by
hookworm infection 7.5% and tricuris trichuria infestation 3.4% (3).A Hospital based cross-sectional
study done in Ghana showed that the overall prevalence of helminthes infection was 14.3%(29).

Systematic review and meta-analysis conducted in 2021 reported that the estimated pooled prevalence
of soiltransmitted helminthes among pregnant women in Ethiopia was 27.32%. In the subgroup
analysis, Oromia and Amhara regions had the highest prevalence with a 29.78% and 29.63 %
respectively(12).

Institutional based cross sectional study done at Maytsebri hospital, in Tigray region 2019 showed that
51.5% of pregnant women had at least one of the helminthiasis that spread via the soil(7).The most
common type of 78.16% soil-transmitted helminthes infection was hookworm(7).A cross-sectional
study conducted at Yirgalem General hospital,Sidama 2022 showed that the prevalence of intestinal
parasite infection (IPI) was 35.8%(16).

According to study done in Mecha northwest Ethiopia the prevalence of intestinal parasite among
pregnant women was 70.6% (6). The most common intestinal parasite species was
ascarislumbricoides32.7%(6).A study done in west Dembia,Ethiopia revealed that the prevalence
ofsoil-transmitted helminthes among pregnant women was 27.5%(10).Ascaris39%,and
hookworm,38%species of the total cases(10).According to study done at Gilgibe in dam area in Jimma,
2013 the prevalence of soil transmitted helminthes (STH) was 7.7% hookworm was the most prevalent
29.4% soil transmitted helminthiasis infection followed by ascaris lumbricoides 15% and tricuris
trichiura 3.4%(30).

A cross sectional study done in Jimma town health institution,Oromia in 2021, showed the prevalence
of any STHs was 19.7% the most common soil-transmitted helminthes was ascaris lumbricoides, which
was found in 56.2% of them, followed by tricuris trichiura 23.8% and hookworms 15%; there were 5%
cases of double infection with A. lumbricoides and T. trichiura; and overall, pregnant women 17.4%
indicated that they engaged in geophagia(21).According to the study done in Lalokile,wollega,in 2019

6
reveals, the overall prevalence of parasitic infection was 43.8% with the predominance of hookworm
33.7% followed by ascaris lumbricoides 7.3%(5).

2.2. Factors associated with Soil-transmitted helminthes

2.2. 1.Socio-demographic factors


Hospital based survey was undertaken in Kenya in 2014 those with primary level of education were at
a higher risk of soil transmitted infection compared to those with secondary level of
education(4).Another cross-sectional study was conducted in Mecha, north western Ethiopia in 2018,
showedthat illiteracy rises by 2.32 times the risk of intestinal parasite infection in pregnant women(6).A
cross-sectional survey conducted in state of India revealed that increasing age of pregnant women,was
significantly associated with STH in pregnant women(15).A study conducted in Mecha,north western
Ethiopia 2018, showed that Intestinal parasitic infection was higher in women aged less than 21
years(6).Study conducted in Butajarain southern Ethiopia,2010 revealed that being urban place of
residence was associated with a lower risk of soil-transmitted helminthes infection(31).Study done in
Dembia district, 2021 ,Ethiopia showed that rural residents had 1.9 times higher risks of contracting
soil-transmitted helminthiasis infestation(10).Study conducted in West Gojjam zone, northwest
Ethiopia 2020, being dwelling in rural area was 2.9 times likely hood of infected with soil transmitted
helminthes than urban residence(32). Another study done Mecha district of northwest Ethiopia in 2018,
showed that there were twice as many cases of intestinal parasite infection in rural areas than in urban
regions(6).

According to study done in 2019 Lalokile in Wollega, with hookworm predominating having an
average income of less than 35 dollars, was all strongly linked to the development of intestinal parasite
infection(5).Lack of environmental sanitation and personal hygiene in low and middle-income nations
contributes to the high prevalence of STHs there(21).A cross sectional study conducted in Debre Elias
western Ethiopia in 2022 showed that the odds of having intestinal parasites during pregnancy were
6.41 times higher in farmers pregnant woman thannon-farmers(23). Another study done in
Lalokile ,western Ethiopia 2019 indicate that being a farmer were significantly associated with
occurrence of the intestinal parasitic infection(5).Hospital-based cross-sectional study conducted in
northwestern Ethiopia,2021 revealed that being a house wife were 2.75 times more likely to be risk of
IPIs than among civil servant pregnant women(33).According to study conducted at NigistEleni
7
Mohammed Memorial Hospital, Hossana, Ethiopia in 2015 reported there is positive association
between family size and helminthic infection(2).Anotherthe study doneatnorthwestern
Ethiopia,2021,showed that there is positive association between daily labourers and helminthic
infection(33).Another study done inMecha district, northwest Ethiopia in 2018reported that due to their
close relationships with their children, pregnant women were also at a significant risk of contracting
parasites(6).

2.2.2. Environmental Factors


Study done in Dembia, Ethiopia 2021 showed that the odds of getting soil-transmitted helminthiasis
were 3.6 times higher in pregnant women who never use the latrine and 2.3 times higher in pregnant
women who use the latrine occasionally (10).Additionally study conducted at Shawura primary
Hospital western Ethiopia showedthat pregnant women who did not use latrine were 1.69 times, more
likely to be infected by IPIs compared with those who used toilet(33).
Another study done inDembia, Ethiopia, 2021,revealed that waste disposal practices nearly one-third
of households (31%) were burned waste, 29% dumped it in waste pits, and 40% dumped it outside,
which was significantly linked to soil-transmitted helminthes(10).Another study done in Debre Elias
Amhara region, revealed that due to poverty, poor living conditions, inadequate waste disposal
systems, and a lack of access to clean water, they are particularly common among the poorer parts of
the population(23).A hospital based study done in Ghana 2020 showed that untreated water
consumption during pregnancy increased the risk of intestinal parasite infections by 5.5 times than
treated water(29).Another study conducted in north western Ethiopia 2021 showed that unboiled water
from unprotected water sources, such as a well, river, or stream, increased the risk of IPI infection in
pregnant women by roughly 15 times compared to cooked water(33).
Women who were expecting were twice as likely to be anemic when they were unshod.Even those who
have shoes do not use them frequently; the majority of pregnant women in rural areas who are getting
prenatal care walk barefoot.Infected hookworms can spread through bare a foot, which increases the
risk of iron anemia, especially in pregnant women(34).Study conducted inMecha district, northwest
Ethiopia, 2018 indicatethat pregnant women who did not wear shoes had a 6.87-fold greater risk of
contracting helminthic infection than those who did(6).
E. Use human feces as fertilizer: A cross-sectional study conducted in Nigeria in 2017 showed that soil-
transmitted helminthes were higher in pregnant women’s who were using human feaces as fertilizer
(3).Study done at Shewarobit town in Amara region showed, that being lack of hand washing after
8
using toilet, was a significant association in bringing soil-transmitted helminthes(35).Another study
done in Dembia,2021 Ethiopia showed that the odds of getting STH infection were 2.7times higher in
pregnant women who do not wash their hands with soap (10). A cross-sectional research in the Mecha,
northwest Ethiopia in 2018,found that not regularly washing hands increases the risk of acquiring a
soil-transmitted illness by a factor of 3.33(6).

2.2.3 .The life style factors


A cross sectional study was conducted in Jimma town, southwestern Ethiopia 2021,showed that
pregnant women who practiced soil eating had a much greater rate of STHs infection than pregnant
women who did not,they were also 3 times more likely to have the STHs than pregnant women who did
not(21).Study conducted in Maytsebri primary hospital in Tigray region 2019 showed that pregnant
women who regularly ate soil had a 2.6-fold increased risk of contracting soil-transmitted helminthes
compared to women who did not(7).
According study done in Gilgalgibe dam area Jimma,Oromia 2013 revealed that hookworm was the
most common soil-transmitted helminthiasis ,pregnant women who habits of eating dirty and using
human feces as fertilizer were significantly related with STH infection(30).
According to a cross-sectional study done in the Mechadistrict in 2018, pregnant women who consume
raw vegetables had 2.65 times the risk of developing intestinal parasite infection(6).According to a
study done in 2021 at Shahura primary hospital in the Amhara region, pregnant women who ate raw
vegetables had a 1.91 times higher risk of contracting intestinal parasites than those who did
not(33).Study done Dembia, Ethiopia 2021 eating raw vegetables was significantly linked to soil-
transmitted helminthiasis, with risks of infection being 2.4 times higher in pregnant women who do
so(10).Study done in southwest Ethiopia showed lack of fruit washing before consumption were
significantly associated with soil-transmitted helminthic infection(36).

2.2.4. Healthservice related factors


A facility based cross-sectional study was conducted in Shewarobit Amara region,2021 reported that
lack of health informationwere predictors for parasitic infection among pregnant woman (35).Study
under taken recommendations in many scholars showed that health education providing for pregnant
women were reducing mortality and morbidity from soil-transmitted helminthes (4, 7, 14, 36).United
nations world population prospects in 2015, undertaken showed that deworming medications are

9
affordable, secure, and successful in lowering morbidity associated with helminthiasis spread via
soil(14).

2.2.5. Obstetric factors


Study done in Ibadan, Nigeria ,2011 revealed that compared to the other pregnancy trimesters, the soil-
transmitted helminthes was significantly higher in the second trimester of pregnancy (19).The parasite
infectionthat happen in the first trimester are linked to more serious fetal and placental
outcomes.Additionally, the infection worsens in women who are having their first pregnancy(16).
According to the study conductedin Woreilu, northeast Ethiopia showed that women in their second
and third trimester of pregnancy had likely hood of odds of soil transmitted infection by 3.94 and 3.32
times, respectively(37).A hospital-based cross-sectional study conducted in north western Ethiopia in
revealed that the odds of IPIs were higher among primigravida (pregnant for the first time)than other
trimesters (33). A study conducted in Yirgalem primary hospital 2022,showed that had a soil
transmitted helminthes in previous history increase a likely hood of intestinal parasite infection in
pregnant woman(16).

2.3. Conceptual frame work

Figure 1: Conceptual frame work soil-transmitted helminthes among pregnant women by reviewing different
literature which is adapted and modified from different articles (2,7,10,11,33,36)
10
CHAPTER THREE: OBJECTIVE

3.1. General objective


 To assess prevalence of soil-transmitted helminthes and its associated factors among pregnant
women attending antenatal care at Dorenni district public health Center, Ilu Ababor Zone,
Oromia, South westernEthiopia, 2023

3.2. Specific objectives

 To determine the prevalence of soil-transmitted helminthes among pregnant women


 To identify factors associated with soil-transmitted helminthes among pregnant women

11
CHAPTER FOUR: METHODS AND MATERIALS

4.1 Study area and period

A health facility-based cross-sectional study was conducted among pregnant women in two public
health centers in Doreni district, Ilu Aba Bor zone, southwestern Ethiopia, on June 30, 2023. Doreni
district is one of the Ilu Aba Bor zone’s 14 districts. It is located 576 kilometres southwest of Addis
Ababa, the capital city of Ethiopia (Fig.2).In district there are two governmental health centres, namely
Elemo health canter and DiduDorenni Health canter. A district is a local administration containing at
least 55,772 people, and it is then divided into kebele (the lowest administrative level), which contains
about 3000 people. The people in the area are subsistence farmers who largely rely on animal
husbandry and agriculture for their livelihoods. Several water bodies, including perennial rivers, small
streams, canals, and rain-filled ponds, are located in the study area. The district receives an annual
rainfall of 1200 mm, ranging from 900mm to 1500 mm, and the temperature varies from 15 oC to 32
oC.Each health centres has currently been delivering health care services in the OPD, MCH, Lab, IPD,
Pharmacy and through a total of 24 beds to give services for inpatient, MCH and
outpatient.Geographically located between 93’71’02 Northlatitude and 81’01’28 east longitude with
elevation on 1990 meter above sea level.( Mapssketched by GPS experts ,2023).

Figure 1: Map of Doreni district the study area,2023

12
4.2. Study Design

Institutionbased cross sectional study wasconducted

4.4. Population

4.4.1 .Source population


Allpregnant women living in Dorenni districts

4. 4 .2. Study population


All selected (by systematic random sampling) pregnant womencome for ANC follow up during the
study period.

4.5. Eligibility criteria

4.5. 1. Inclusion criteria


Pregnant womenwho were living more than six months prior to the study in Dorennidistricts, visit ANC
unit during data collection period, and have willingness for the interview.

4.5.2. Exclusion criteria


Pregnant women who wereunwilling toresponse

4.5. Sample size determination and sampling technique

4.5.1. Sample size determination


The sample size was calculated by using single population proportion formula based on the following
assumptions: proportion of soil-transmitted helminthes among pregnant woman in Ethiopia taken as
51.5%(7).at significant level α= 0.05, 95% confidence interval, margin of error 5% and 10%
nonresponse rate, the sample size was calculated by the following formula:
n= (Zα/2)2 P (1-P)

13
d2
= (1.96)2 0.515(1-0.515) = 384
2
(0.05)

Where:
n = the required sample size
p= proportion of soil transmitted helminthes (51.5% or P=0.515)
Z= the value of the standard normal curve score corresponding to the given confidence interval 1.96
d = the permissible margin of error (the required precision) = 5%. By adding 10% non-response rate,
total of 422clients was recruited as study units among women attending ANC unit in public health
centerin Dorenni district during study period.
B. For the second objective

For associated factors,the sample size was determined by Epi infoversion7-statisticalpackage

Table 1: Sample size calculation for factors associated with soil-transmitted among pregnant
women Dorenni,Ilu Aba Bor,August,2023(Table.1.docx)

%of Sample size with 10none


Ratio of % of
outcome response rate
Exposure or un outcome in AO
in un CI Power
Variables exposed Exposed R
exposed Ss 10% TSS Ref
toExposed Group
group

Fruit before
1 57% 78.9% 2.8 95% 80% 158 16 174 (36)
Consumption

Being House
1 41.6% 70% 1.36 95% 80% 108 11 119 (16)
wife

Hand washing
1 31.9% 52.8% 2.34 95% 80% 192 19 211 (33)
after toilet

Walking by bare
1 23.8% 74.1% 3.1 95% 80% 38 4 42 (35)
foot

Where ,P1: Was the proportion of exposed with the outcome; P2: the proportion of non-exposed with
the outcome Z α/2: taking CI 95%; Zβ: 80% power and the ratio of exposed to non-exposed 1:1.
14
The sample size was422and 211 (for the first objective and associated factors respectively) after adding
10% non-response rate. Therefore, the sample size determined for first objective was the final sample
size. Finally, minimum sample sizes of 422women were included in the study.

4.5. 2.Sampling technique


In this study, two public health centers in Dorenni district were included (two health centers). The
average monthly ANC flows of previous three months was estimated to be 661, (397 fromElemo HC
and 264 fromDiduDorenni health center). Then, the final sample size was proportionally allocated to
these health facilities by considering their monthly client flows. Lastly, subjects was taken by
systematic random sampling (i.e. Kth= N / sample size =661/422≈ 2 which means Kth= 2), thus every
2nd client who come for ANC service was recruited as study units in each health facilities until the total
sample size for this study was obtained.

Dorenni Woreda (N)=661

Elemo Health Center (N1=397) Didu Dorenni Health Center (N2=264)

Proportionally allocated

n1=254 n2=168

K=N/n =397/254 =2 K=N/n =264/168=2

n=422

Figure2: Schematic presentation of sampling techniques on STH among pregnant


women,Doreni,Ilu Aba Bor, Oromia August,2023(N=416)

4.6. Study variables

4.6.1. Dependent variable


 Presence of soil transmitted helminthes (Yes/No)

15
4.6.2. Independent variables
Socio demographic factors:Age, marital status, educational status, occupation, residence, income,
family size.

Life style factors. Eating unwashed vegetables, soil eating

Health facility related factors: health information, ANC follow up

Environmental factors: drinking water source, waste disposal system, latrineavailability, walking by
bare foot, hand washing
Obstetric factors: trimester of pregnancy, gravidity, parity, numberof ANC contact
Knowledge towards on soil transmitted helminthes

4.7. Operational definitions


Soil transmitted helminthiasis (STH):Detection of eggs/adult ascariasis, hook worm and or tricuris
worms in stool sample under microscope
Ascariasis: A pregnant women was categorized as “yes” when oval shape morphozoitesegg of ascariasis
was seen under microscope.
Hook worm: A pregnant women was categorized as “yes’when S-shaped morphozoitesegg/larvea of
hook worm like wasseenunder microscope.
Tricurisis;whipworm (tricuris trichiura): A pregnant women wascategorized as “yes “when a barley
shape morphozoites egg of Tricuriasiswas seen under microscope.
Single infection: infection from the one STH species, doubleinfection: infections from two of the
STHspecies, and tripleinfection: When the three of soiltransmitted helminthes diagnosed on one
participant
Good: Knowledge about soiltransmitted helminthes if respondent’sanswers the given knowledge
question more than mean score from knowledge based questions.
Poor Knowledge: When respondents answer the given knowledge questions less than mean.
Intensity of STH: Categorized as light intensity infection, moderate intensity infection and heavy
intensity infectionbased on the number of eggs observed in the stool sample.
Ascaris light intensity<4999epg), 5000-49999 epg, >50,000 epg were defined as light, moderate and
heavy intensity infection respectively

16
Hookworm intensity (<1999epg), 2000-3999 epg),>4000 epg weredefined as light, moderate and heavy
intensity infection respectively.
Trichuriaintensity (<999 epg), 1000-9999 epg),>10,000epg weredefined as light, moderate and heavy
intensity infection respectively
4.8. Data collection tools and procedures

Data were collected using an interviewer-administered questionnaire and collecting stool samples from
each pregnant woman interviewed. Four health workers (1 BSc nurse, 1 BSc MWN, and two lab
technicians) were recruited for the data collection process, and two supervisors with a first degree in
laboratory (BSc) and public health were recruited for supervision. The Kato-Katz-technique was used
to diagnose soil-transmitted helminthiasis and identify the intensity of infection. Accordingly; each
participant was provided with labeled screw capped 2gram fresh stool container and each stool
specimen was prepared using a sieve and put on a calibrated template to weigh 47.1mg of stool. To
estimate the intensity of infections, eggs counted in Kato-Katz thick smears multiplied by a factor of 24
to obtain the faecal egg count in units of eggs per gramme of stool (EPG). According to the World
Health Organisation (WHO), the intensity of ascaris infection was classified as light (1–4999 EPG),
moderate (5000–49999 EPG), and heavy (>50,000 EPG). Hookworm infection was classified as light
(1–1999 EPG), moderate (2000–3999 EPG), and heavy (>4000 EPG). Trichuriasis infection was
classified as light (1–999 EPG), moderate (1000–9999 EPG), and heavy (>10000 EPG)(8).To ensure
consistency in egg counting, 10% of the examined smears were re-examined by a senior laboratory
technician.

4.9.Data Quality Assurance


In order to assure the quality of data ,data collectors and supervisors was trained on ethical and friendly
data collection techniques and procedures, as well as other important issues during data collection such
as data collectors’ and supervisors’ roles and responsibilities, how to check data for completeness and
consistency (with a special emphasis on supervisors), and the study’s goal. Two BSc Laboratory health
worker who are experienced and haveskill and knowledge were recruited during data collection period
for handling the specimen, reagent, availing stool examination materials enough timely and clearly
examining the parasites based on the standard operating procedure. Apre-test was conducted in Yayo
Health Center,at 5%of sample size (40 pregnant women) inYayo woredabefore conducting the actual
study. The pretest was check validity and reliability of questionnaire. Then the necessary correction

17
was given on the questionnaire after the pre-test.The investigator assessed the quality of the data during
the analysis stage to ensure that it is complete.

4.10. Data processing and analysis


The data was entered into Epi-data version 4.6 and exported to SPSS version 25 for further analysis. All
questionnaires were checked for completeness after completion by the study participants. Descriptive
statistics, including frequencies and proportions, were computed. To identify the associated factors,
variables with a p-value of less than 0.25 in the Bivariable analysis were entered into the multivariable
logistic regression analysis for further analysis to control confounding factors. Finally, to demonstrate
the strength of the associations, an adjusted odds ratio (AOR) with 95% confidence intervals was
calculated. Then, using multivariable logistic regression analysis at a p-value less than 0.05, variables
significantly associated with Soil transmitted helminthes were identified. The model's fitness was
checked by the Hosmer and Lemeshow goodness-of-fit test.(P.value =0.712)

4.11. Ethical consideration


Before beginning the study, the Ethical Review Committee of Mattu University’s College of Health Science had
provided the approval. Additional permission letters was obtained from the Dorenni woreda health office. Clients
were given information after being asked if they are willing, and verbal consent was obtained prior to data
collection. The data collectors wereinform each study participant about the study’s purpose, data collection
methods, anticipated benefit, and risk. Privacy and confidentiality was maintained throughout the data collection,
analysis, and result dissemination processes

4. 12.Dissemination of the results


The study’s findings will be shared with Mattu University’s college of Health Sciences Department of
Public Health. The study’s findings will be disseminated and made available to others as a source of
information for further research and, in some cases, critique. It will also be distributed to, Dorenni
district health Office, IluAbabor Zonal Health Department and NGOs. The findings could be presented
at a scientific conference or meeting. Finally, the soft copy will be made available via the internet to all
research consumers and/or published in a scientific journal. Currently this thesis is already sent to BMC
journals and being under peer review for to be published.

18
Figure 3: Evidences for thesis Manuscript Submission

CHAPTER FIVE: RESULTS

5.1 Socio-demographic characteristics of pregnant women


Four hundred and sixteen (416) participants were involved in the study with a response rate of 98.6%,
and the mean age of the respondents was 26.72 + 3.72 (SD) (range from 19 years to 35 years). The
majority of them (64.9%) were from rural areas, and nearly half (49%) of the participants were aged
below 29 years. Three hundred and three (72.8%) of the respondents have primary education. More
than half of the women’s (50.5%) were housewives, and the majority (90.4%) of them were married.
(Table.2.docx)

Table 2: Socio-demographic characteristics of pregnant women in Doreni ,Ilu Aba Bor, Oromia,
August ,2023(N=416)

Variable Categories Frequency Percent (%)

Rural 270 64.1

Residence Urban 146 35.1

15-19 45 10.8

Age of mothers in 20-24 78 18.8


year
25-29 157 37.7

30-49 136 32.7

Ethnicity Amhara 162 38.9


19
Oromo 165 39.7

Tigre 89 21.4

Religion Orthodox 174 41.8

Muslim 122 29.3

Protestant 120 28.8

Occupation House wife 210 50.5

Daily labor 67 16.1

Merchant 39 9.4

Student 44 10.

Governmental Employ 46 11.1

Single 18 4.3

Marital status Divorced 22 5.3

Married 376 90.4

Non Formal Education 6 1.4

Educational Status Primary Education 303 72.8

Secondary Education 84 20.2

College and above 23 5.5

Family size More than five persons 206 49.5

Less than Five Persons 210 50.5

<5yr children presence in No 32 7.7


house
Yes 384 92.3

Children wears diaper No 182 43.8


20
Yes 129 31

5.2. Healthcare related characteristics


More than half of (50.7%) of women did not gethealth information on soil-transmitted helminths during
their contacts. The mean (SD) hemoglobin was 11.456+0.69624, ranging from 8.90 g/dl to 2.80 g/dl.
From respondents 154(37%) 7-11g/dl, have moderate anemia 262(63%) >11g/d was
normal(Table.3.docx)

Table 3: Health service related characteristics of pregnant women attending ANC in Doreni, Ilu
Aba Bor ,Oromia August , 2023(N=416)

Variables Categories Frequency Percent (%)

Number of ANC contact Below four ANC Contact 351 84.4

Above Four ANC Contact 65 15.6

Trimester of pregnancy Third trimester 171 41.1

Second trimester 147 35.3

Frist trimester 98 23.6

Have health Information on No 211 50.7


soil transmitted helminthes
Yes 205 49.3
during Antenatal care
follow up

Gravida Primigravida 168 39.9

Multigarvida 250 60.1

Hemoglobin result 7-11g/dl 154 37

>11g/dl 262 63

Deworming history No 44 10.6

Yes 372 89.4


21
ANC : Antenatal care, dl: deciliter,

5.3 Environmental and life style factors related characteristics of pregnant woman
Among the respondents, the majority of pregnant women were drinking from an unprotected water
source (236; 56.7%); more than half of the respondents did not wash their hands after using the toilet
(61.5%). Only 38.5% of women were washing their hands after the toilet; from this, 13.7% of women
had washed their hands with soap. More than half of women’s were experiencing walking on bare feet
(54.1%) (Table.4.docx)

Table 4: Environment and life style related factors STHamong pregnant women attending ANC
in Doreni, Ilu Aba Borzone,Oromia,2023(N=416)

Variables Categories Frequency Percent (%)

Water source for drinking Unprotected water source 236 56.7


Protected water source 180 43.3
Latrine availability No 53 12.7
Yes 363 87.3
Hand washing after toilet No 256 61.5
Yes 160 38.5
Hand washing with soap No 359 86.3
Yes 57 13.7
Walking on bare foot Yes 225 54.1
No 191 45.9
Child excreta disposal Out of the toilet 128 41.3
In the toilet 182 58.7
Yes 114 27.4
Soil eating No 302 72.6
Eating un washed raw No 237 57
vegetables
Yes 179 43

22
Cooked meals before eating Yes 294 70.7

No 122 29.3

5.4. Knowledge of the pregnant women about the soil transmitted helminthes
Among the respondents, 264 (63.5%) had not heard about soil-transmitted helminths. The majority
(83.9%) of women respond to contaminated soil and water, consumption of raw vegetables and fruits as
not the ways of transmission of soil-transmitted helminthes (STHs), and 356 (85.6%) respond to
diarrhea and abdominal pain, loss of appetite, general malaise, and weakness as not symptoms of soil-
transmitted helminthes. 42.1% and 57.9% of pregnant women had good and poor knowledge of STH,
respectively(Table.5.docx)

Table 5: Knowledge of pregnant women about soil-transmitted helminthes among attending ANC
in Doreni, Ilu Aba Bor zone, Oromia, 2023(N=416)

Variables Categories Frequency Percent (%)

Have heard about STHs No 264 63.5


Yes 152 36.5
Does the Cause of STHs is parasitic worm infection No 268 64.4
Yes 148 35.6
Is STHs a transmissible disease/contagious No 306 73.6
Yes 110 26.4
Mothers knowledge on the ways of transmission of STHs No 349 83.9
Yes 67 16.1
Mothers knowledge on the symptom of STHs No 356 85.6
Yes 60 14.4
Mothers knowledge on treatment for STHs No 349 83.9
Yes 67 16.1
Mothers Knowledge on the ways of STH prevention No 307 73.8
Yes 109 26.2
Knowledge of women on pregnant women are higher risk for No 292 70.2
STH
Yes 124 29.8
23
Knowledge score Good 175 42.1

Poor 241 57.9

5.5. Magnitude of soil transmitted helminthes among pregnant women (N=416)


Soil-transmitted helminthes were assessed by stool examinations using the Kato Katz technique. About
one hundred twenty-five 125 (30%) (95% CI: 26-34%) participants were identified to have soil-
transmitted helminthes. Hence, from the identified species Ascaris 77 (61%), Hookworm 33 (26.4%)
and Tricuris 9 (7.2%), Ascaris was the dominant one and also 6 (1.4%) of double infections of soil-
transmitted helminthes have been identified

30%

70%
No STH Had STH

Figure 4: Magnitude of soil-transmitted helminthes among pregnant women attending ANC in


Doreni,Ilu AbaBor Zone, Oromia, 2023 (N=416)

5.6.Stool examination and Kato Katz techniques


From the total study participants, 125 (30%) were positive for any STH infections. Among the STH
species detected, the most prevalent parasite was A. lumbricoides (77, 61.6%), followed by hookworms
(33, 26.4%), and T. trichiura (9, 15%). Double infections with A. lumbricoides and hookworm were
detected in 6 (4.8%) of pregnant women’s stool samples. Results of intensity infestations of each STH
species show that Ascaris have light-intensity infections, which range from 600–2952 EPG (egg per
gramme) (<4,999 EPG), Hook worm have run light to moderate -intensity infections, which range
from 672–2592 EPG (<1,999 EPG) and <3,999 EPG, respectively. Finally, Trichiura intensity were
light intensity infections (528–840) (<999 EPG).(Table.6.docx)

24
Table 6:Kato Katz techniques of STH diagnosis ,egg counts and intensity of STH among
pregnant women Attending ANC in Doreni, Ilu Aba Bor Zone ,Oromia , Ethiopia ,2023(N=416)

Variables Categories Frequency Percent (%)


Ascaris species No 48 38
Yes 77 61.6
Hookworm species No 92 73.6
Yes 33 26.4
Tricuris No 116 92.8
Yes 9 7.2
Double infection No 119 95.2
Yes 6 4.8
STH Yes 125 30

No 291 70

Ascaris intensity infection Light intensity infection <4999 epg 77 100


Hook worm Intensity Light intensity infection <1,999 23 69.69
infection epg
Moderate intensity infection 2000-3999 10 30
epg

Tricuris intensity infection Light intensity infection <999 epg 9 100


Count
epg=egg per gram ,STH (soil transmitted helminthes)

25
5.7. Factors associated with soil transmitted helminthes
The soil-transmitted helminthes was taken as a dependent variable and compared against each
independent variable for association. Bivariable logistic regression was done to identify factors
associated soil transmitted helminthes among pregnant women.Accordingly, residence of
respondents,walking barefoot, handwashing, occupational status ,latrine availability,<5yr children
available, health information, water source for drinking, soil eating and eating unwashed
vegetablesshows significant association with soil-transmitted helminthes among pregnant women.

In the multivariable logistic regression analysis residence in rural area, not hand washing, drinking
from un-protected water source, lack of health information, being daily laborer, andwalking on
barefoot,were found to be significantly associated with soil-transmitted helminthes among pregnant
women. Accordingly, the odds of soil-transmitted helminthes among pregnant women’s who live
inrural were more than three times higher compared with those urban residents,(AOR=3.36;95%CI:
(1.84-6.17),Also, the odds of soil-transmitted helminthes among pregnant womenwho were not hand
washing after using toilet were two times higher than their counterparts.(AOR=2.66;95%CI:(1.50-
4.73). Similarly the odd of soil-transmitted helminthes among pregnant women who hadexperience of
walking without shoes were more than three times higher than walking with shoes (AOR=3.83; 95%CI:
(2.18-6.73) and again the odds of soil-transmitted helminthes among pregnant women who had
drinking unprotected water source were more than two timeshigher compared withdrinking from
protected water source(AOR=2.56;(1.47-4.46).In addition, pregnant women who have lack ofhealth
information on soil- transmitted helminthes during ANC follow up were about two times higher
infected compared with had information (AOR=1.7;95%CI:(1.02-2.86), Furthermore, beingdaily
laborer among pregnant womenwere about three timeshigher infected with STH than not being daily
laborer(AOR)=2.88;95%CI:(1.01-8.22).Table.7.docx

26
Table 7:Biviariate and Multivariate analysis of factors associated with soil-transmitted
helminthes among pregnant women attending ANC in Dorenni district, Ilu Aba Bor
Zone,Oromia ,August 2023(N=416)

STH COR (95% CI) AOR(95%CI) p-value


Variables Categories Yes (%) No (%)

Residence Rural 104(38.52%) 166(61.48%) 3.73 (2.21,6.29) 3.36(1.84,6.17)0.000**


Urban 21(14.38%) 125(85.6%) 1

Occupation House wife 61(29%) 149(70.9%) 1.538(.782,3.024) 1.13(0.5, 2.58) ,0 .77


Daily labor 11(16) 56(83.5%) 3.205(1.321,7.779) 2.88(1.01,8.22),0.049 *
Merchant 17(30%) 39(69.6%) 1.444(.628,3.320) 1.132(0.41,3.14) ,0.81
Student 19(48.7%) 20(51.2%) 0.663(.277,1.587) 0.60(0.20, 1.77) ,0.35
Governmental 17(38.6%) 27(61.3%)
Employ 1

Water Source for Unprotected source 98(72%) 138(58.5%) 4.024 (2.48, 6.5 ) 2.56(1.47,4.46) 0.001**
drinking
Protected source 27(15%) 153(85%) 1

Walking on Yes 100(44.4%) 125(55.6%) 5.3 (3.24,8.72) 3.83(2.18,6.73)0 .000**


barefoot
No 25(13%) 166(86.9%) 1

Health No 79(35.26%) 145(64.7%) 1.73 (1.2, 2.62) 1.7(1.02,2.86) 0.044*


Information
Yes 46(23.95%) 146(76%) 1

Hand washing No 99(38.67%) 157(61.3%) 3.24 (1.99, 5.3) 2.66(1.5,4.73) 0.001**


after toilet
Yes 26(16.25%) 134(83.75%) 1

Latrine Available No 26(49.1%) 27(50.9%) 2.56(1.43, 4.614) 1.49(.74,2.98) ,0.265


Yes 99(27.2%) 264(72.7%) 1

Presence of<5 Yes 122(31.77) 262(68.22%) 4.501(1.345,15.64) 2.39(.61,9.27) 0.209


year children in
house No 3(9%) 29(90.6%) 1

Soil eating Yes 45(39.47% 69(60.5% 1.810(1.149, 2.850 1.5(0.85, 2.65) ,1.66

No 80(26.49%) 222(73.5%) 1

Eating Unwashed Yes 69(34.8%) 129(61.15%) 1.54(1.015,2.359) 1.24(0.74,2.09),0.414


Vegetables
No 56(25.68%) 162(74.3%) 1

Note: ** Significant at p-value <0.001 * significant at p-value <0.05 1=references

27
COR: Crude odds ratio and, AOR: Adjusted odds ratio

CHAPTER SIX: DISCUSSION


The prevalence of soil-transmitted helminthes among pregnant women attending ANC follow-up in the
study area was 30% (95% CI: 26-34%).The prevalence is moderate according to the Ministry of
Health's (MoH) STH endemic area classification. There are three categories: high transmission areas
(prevalence rate > 50%), moderate transmission areas (prevalence rate between 20% and 50%), and low
transmission areas (less than 20%) (10).

This finding is also in line with study done in Dembia northwest Ethiopia(27.6%)(10),Shewarobit
Amhara region (27.7%)(35),Hosanna town(29.5%)(2),Felege Hiwot(31.5%)(13),Systematic review and
meta-analysis Ethiopia (29%)(12).The reason may be due to similarity of socio economic
characteristics, and knowledge on prevention methods of the respondents.

However, this result is higher with previous studies conducted , Jimma town (19.7%)(21).EastWollega
(24.7%)(16).KitaleKenya(13.8%)(4),Ghana(14.3%)(29),Cameroon(13.46%)(38).India (8.34%)
(39).Osun State Nigeria(12%)(40).South east Asia (18%)(41),Iran(16.3%)(16).Global report (24%)
(42).Differences in findings among various studies can be explained by variations in geography,
socioeconomic conditions, difference in parasitological examination methods, the number of
studypopulation, and the level of awareness about the transmission of STHs.

This studies is lower than previous conducted in Ethiopia Gilgal gibe dam area (41%) (30),
WoreIlu,northeast Ethiopia (43.5%)(37).Mecha northwest Ethiopia (70.6%)(6),Maytsebri primary
hospital,(51.5%)(7).Alefa district in Amhara region (36.7%)(33).Lalo Kile district(43.8%)
(5),WestGojjam,zone(37.3%)(32),Sidama Ethiopia(35.8%)(16).Colombia (41%)(24).The reason might
be due to latrine coverage, geographic location,physical environment and study populations` socio
demographic status. Humidity and temperature status of any geographic location affect the viability of
most parasites.

According to the result of this study, among pregnant women who were living in rural area were three
times higher risk of having soil-transmitted helminthesthan pregnant women living in the urban areas.
This finding is consistent with previous study done in Mecha district Ethiopia (6).Yirgalem General
Hospital Sidama(16).Northwestern Ethiopia(33).The reason might be due to rural pregnant women's limited
access to primary medical services. Also, pregnant women in rural areas who frequently work barefoot
28
on contaminated soil run the risk of contracting STH. Additionally, due to their poor environmental and
personal hygiene habits, pregnant women residing in rural areas had a high risk of contracting an
intestinal parasite infection..

According to the current study, pregnant women who didn’t wash their hands after toileting were 2.6
times more likely to have STH than pregnant women who wash their hands after toileting. This finding
is supported by studies conducted in Lalo kile (5),Shewarobit town in Amhara.(35)Yirgalem general
hospital(16). This is due to the reason that proper hand washingpractices breaks the chain of
transmission

Similarly, the odds of getting soil-transmitted infection were 2.5 times higher among pregnant women
who use unprotected water source for drinking as compared with who use protected water source This
finding is supported with studies done in Yirgalemhospital Sidama(16). Shoa Zone Amhara region (35).
Woreilu, Northeast Ethiopia (37).North western Ethiopia(33), Ghana(29).The reason might be if water supplies
are not safeguarded, users may be more likely to be exposed to numerous parasites. Therefore, utilizing this can
increase the risk of getting soil-transmitted helminthes. The majority of respondents in study area is continued to
drink unprotected water sources including unprotected springs and rivers.

Moreover, soil-transmitted infections were about four times higher among pregnant women walking on
bare feet than those who were wearing shoes. This finding is supported with previous study conducted
inLalo kile district(5). Shewarobit town Amhara (35).state of India(39).This is due to the fact that soil-
transmitted helminths like hookworm infection will be prevented from entering the susceptible host.

The result of this finding also shows that pregnant women who have not gotten health information on
soil-transmitted helminthes during ANC follow-up were at greater risk than their counterparts. This
finding is also supported by studies done at Shewarobit in Amara region (35) ,West Gojjam (32).The
reason that the majority of pregnant women did not get health information on STHs during ANC
follow-up suggests that this may be related to the health-seeking behaviour of educated pregnant
women.

The present study showed that the odds of getting soil-transmitted helminthes were higher among
pregnant women who were daily labourers than with their counterparts. This finding is supported by a
study done at Shahura primary hospital in Amhara region(33).This is due to the absence of available
sanitation facilities around the work area and an infected environment with parasites.

29
6.1 STRENGETH AND LIMITATION OF THE STUDY

6.1.1. Strength of the study


This study was aimed to assess soil transmitted helminthes; by using Katz Katz techniques procedure
which is different from routine stool examination for the study area. This procedure enables to highly
detect the parasite and count the eggs of parasite simultaneously.

Parasitic STH species laboratory investigations were considered in this study

Since the study was conducted on institutional basis pregnant women’s were assessed for soil-
transmitted helminthes through structured interview and laboratory Kato Katz technique

6.1.2. Limitation of the study


The study was quantitative assessment but qualitative assessment was not assessed.

We suggest for future investigations that studies should be community based so that it can intervene
easily for specific population because the study was facility based and study participants were from
various parts of the district, making it difficult to generalize the study's findings

CHAPTER SEVEN: CONCLUSION AND RECOMMENDATION

7.1. CONCLUSION
The prevalence of STH was significantly moderate in the study area, where pregnant mothers were

mostly affected by ascariasis and hookworm. Findings of this study show that living in a rural area,

being a daily labourer, walking barefoot, not washing hands after the toilet, drinking from an

unprotected water source, and lacking health information were the determining factors. Interventions

including health education, the expansion of pure drinking water sources, the promotion of personal

hygiene, and the importance of wearing shoes are recommended to reduce the burden of soil-

transmitted helminthes in the study area.

30
7.2. RECOMMENDATION
Based on the findings, recommendations are forwarded to:

7.2.1. Zonal health Offices

 Zonal health office should invite different stakeholders who can able to support on the prevention of
soil transmitted helminthes from women’s especially on sanitation.
 Since STH were problems of sanitations, it is better if zonal health office Invites NGOs like Wash
program working on it.
 Furthermore, zonal water office should be design water project to distribute and make accessible
protected water source to the community so that affordable by majority.
7.2.2. To Woreda Water Office

 Woreda water office should be encourage community participation on developing and construction
spring water in addition to governmental budget
 Sustaining water quality through chlorine treatment by providing it
7.2.3.To Elemo, DiduDoreni health center staff and Woreda Health office

 Strengthening of intersectional collaboration especially on personal and environmental sanitation.


 Strengthening community participation on water source cleaning, developing protected spring
constructing fences around the source
 Providing proper health education on soil-transmitted helminthes among pregnant woman
duringantenatal care follow up.
7.2.4. To all functional health posts in Dorenni woreda
 Promotions of hand washing practice during critical time (before food preparations , before
eating ,after eating, after using toilet, and after changing children’s diaper
 To aware mothers about the soil transmitted helminthes its cause, ways of transmission, and
prevention method by providing health information on personal and environmental sanitation.
 Enhancing the importance of wearing shoes among pregnant women.
 Encouraging private sectors to offer sanitation facility at their coffee processing area.
 Giving more attention for pregnant women those living in rural areas.
7.2.5. Feature Research
 The study was conducted using cross-sectional study design at institution level to understand the
burden of soil transmitted helminthes so,
 Large scale future studies at community level are recommended

31
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Correlation with Haemoglobin Level. J Clin Diagnostic Res. 2014;8(10):OC07–9.

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31. Belyhun Y, Medhin G, Amberbir A, Erko B, Hanlon C, Alem A, et al. Prevalence and risk
factors for soil-transmitted helminth infection in mothers and their infants in Butajira, Ethiopia:
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32. Hailu T, Abera B, Mulu W, Kassa S, Genanew A, Amor A. Prevalence and Factors Associated
with Intestinal Parasitic Infections among Pregnant Women in West Gojjam Zone, Northwest
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33. Alula GA, Munshea A, Nibret E. Prevalence of Intestinal Parasitic Infections and Associated
Risk Factors among Pregnant Women Attending Prenatal Care in the Northwestern Ethiopia.
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PREGNANT WOMEN WITH EMPHASIS ON INTESTINAL HELMINTHIC INFECTION AT
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35. Dagnaw A, Sahlie M, Mulugeta H, Shine S, Bediru W. Magnitude of Intestinal Parasite Infection
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36. Tekalign E, Bajiro M, Ayana M, Tiruneh A, Belay T. Prevalence and Intensity of Soil-
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37. Kebede E, Asefa N, Daba C, Gebretsadik D. Prevalence of Intestinal Parasitic Infections and
Their Associated Risk Factors among Pregnant Women Attending Antenatal Care Center at
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38. Cherry Suzanne Kengne, Christian Ngounouh Taheu, Julienne Louise Ngo Likeng, Lucien
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Prevalence and associated factors of Plasmodium falciparum and soil transmitted helminth
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Available from: http://dx.doi.org/10.1186/s13071-015-1135-4

36
ANNEX I
10.3. Information Sheet and Consent Form: (English version)
Information Sheet
Greeting!
Hello dear respondent! My name is________________ and I am working as data collector for the study
being conducted in this health institution by Mr. AdamuTesfa who is studying for his master’s degree
at Mattu University, college of health sciences, department of Public Health postgraduate study. I
kindly request you to lend me your attention to explain you about the study and how you have been
selected as study participant.
Study title– Assessment of Soil transmitted helminthes and its associated factors among pregnant
women’s attending ANC unit at Dorenni woreda public health institutions, , IluAbaBor zone, Oromia,
Ethiopia, 2023
Purpose-- To assess factors Associated with soil transmitted helminthes among women attending ANC
units in Dorenni Public Health Institutions.
Procedure and duration: First of all I selected you to take part in this study randomly. There are
different questions to answer. Interview questionnaire will be used which will be take 15-20 minutes.
Risks: The risks of being participating in this study are very minimal, only taking few minutes.
Benefit: At this moment you may not get any direct benefit by being involved in this study but the
information you provide is very important to solve problems associated with unintended pregnancy.
Confidentiality: The information that you provide us will be confidential. The questioner will be coded
to exclude showing your name on questionnaire and consent form.
Rights: Participation in this study is fully voluntary. You have the right to declare not to participate in
this study and you have the right to withdraw from participating at any time.
Contact address: If there is any questions or unclear idea any time about the study or the procedures,
do not hesitate to contact and speak to principal investigator with cell phone number: 0910856110 or e-
mail address : ademan351@gmail.com
I have read this form and I comprehend and understand all condition stated above.
Are you willing to participate in this study?
1. No (say thank you) 2. Yes (continue interviewing)

37
ANNEX II

10.4 Stool Sample for detection of Soil transmitted helminthes

Sample type Amount Transport and Stability Equipment


required storage
Fresh stool 2gram NA No more than Microscope with 10X /40X objective
30 minutes
The Kato-Katz: Technique enables the diagnosis of soil-transmitted helminthiasis .The technique
consists of a microscopic examination of a fixed quantity of faecal material; this enables a semi-
quantitative diagnosis based on the number of eggs in faeces.(8)

Catagory
Category Cumulative Prevalence percentage of heavy intensity infections

I High prevalence/high intensity Any >10


II high prevalence /low intensity >50% <10
II Low prevalence/low intensity <50% <10(8)

The prevalence is moderate according to the Ministry of Health's (MoH) STH endemic area
classification. There are three categories: high transmission areas (prevalence rate > 50%), moderate
transmission areas (prevalence rate between 20% and 50%), and low transmission areas (less than 20%)
(10).

38
Consent form
I have read the information sheet concerning this study (or have understood the verbal
explanation) and I understand what will be required of me and what will happen to me if I take part in
it. I also understand that any time I may withdraw from this study without giving a reason and without
me or my families’ routine service utilization being affected for my refusal.
Participant’s signature___________________Date___________________
Interviewer signature certifying that the informed consent will be given verbally.
Interview‘s name ______________
Interview’s signature ______________
Date______________

May I continue the interview?


1. Yes ____________Continue the interview
2. No ______________Stop the interview and thank the respondent
Result: (to confirm for completeness)
A. Questionnaire completed _____________________
B. Questionnaire partially completed ______________
C. Participant refused ___________________________
D. Others (please Specify) _______________________
Checked by Supervisor:
Supervisor’s Name _____________________________
Supervisor’s Signature ___________________________
Date ___________________________________________

39
ANNEX III
MATTU UNIVERSITY
COLLEGE HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH
10.4. English version Questionnaire
10.4. 1. General information about the respondents
Englishversionquestionnaire

Questions onSoil-transmitted helminthes and its associated factors among pregnant


woman in Dorenni district, Ilu Aba Bor, and Oromia, Ethiopia.

Instruction; -Circletheresponseinthebest matcheswiththeanswer oftherespondent.

01. Questionnaireidentification number-------------------------------------------

02. Clientcode

Date

Partone:-Socio-demographiccharacteristicsoftheparticipants
Question Response Skip
101. Age(inyear) ____________________________

40
102 Maritalstatus
1. Single 2 .Divorced

3.Separated 4. Married
103 Religion 1.Orthodox 2. Muslim

3.Protestant 4.Catholic

5; Otherspecify-----
104 Educationalstatus
1. Noformaleducation

2. Primary education(1–8)

3. Secondary education (9–12)

4. Diplomaandabove
105 Occupations
1. House wife 2. Daily labor

3.Merchant4.Student_____ 5.Governmental Employ


106 Residency
1. Rural

2. Urban

Partone:-Socio-demographiccharacteristicsoftheparticipants

Question Response Skip


107 Family size _____________________

108 Family monthly income


____________ ETB

41
Part two: Health and health related factors
Q.no Question Response Skip
201 Status of gravida 1.Primigravida
2.Multigravida
202 Statusofpregnancy 1, Wanted
2,Unwanted
203 Trimester of pregnancy: 1. Third trimester of pregnancy
2,Secondtrimenestr of pregnancy
3,Frist trimester of pregnancy
204 Number of ANC Contact:
1. Frist 2. Second
3. Third 4. > Fourth
205 History of IP in the previous
1. Yes 2. No
pregnancy
206 Hgb result
1. _____________g/dl
Q.no Question Response Skip
301 1.No
Have you got health information on soil transmitted
2.Yes
helminthes during ANC follow up?

42
Part three: Factors associated with soil- transmitted helminthes among pregnant women
Question Response Skip

401 Have you experiencing soil eating? 1.Yes 2.No

402 Do you have latrine? 1.No 2.Yes If no 405

403 If yes What types of latrine do you have 1.Pit latrine

2. Water flushed

3. VIP

404 Does you utilized it 1. No2. Yes

405 Does You wash your hands after toilet 1.No 2.Yes If no skip to
406

406 If your answer is “yes “hasusing soap for hand washing? 1. No2. Yes

407 Does you have <5 year children living in house? 1,Yes 2.No If no skip to
410

408 If yes does the children wear diaper 1.yes 2.No

409 Where you dispose child excreta? 1. Outside toilet2. In the toilet

410 Have you ever eating un washed raw vegetable 1. Yes 2. No

411 Do you cook your vegetablesbefore eating 1. No. 2. Yes

412 Does you have experiences walking on bare foot 1. yes2. No

413 What is your water source of drinking 1.River2. Pipe line

3. Unprotected Spring

4. Protected Spring

5. Un Protected Well

6. Protected well

51
Laboratory findings Response Skip

500 Does the respondents diagnosed with STH 1.yes 2.No If no skip to
510

501 If yes, Ascarisis ? 1,yes 2.No If no 503

502 Askariasis egg counted _______________ epg

503 If yes Hookworm? 1,yes 2.No If no skip


505

503A If yes Is Ancylostomaduodenale? 1.Yes 2.No

503 B If yes is necatorAmericanos? 1.yes 2.no

504 Hook worm egg/larvae counted __________________epg

505 If yes. Tricuris? 1,yes 2.No If no 507

506 If yes ,Tricuris egg counted? ________________ epg

507 Is there double infection? 1. Yes 2. No

508 If yes what type ofspecies for double infection? 1.Ascaris and Hook worm

2.Ascaris and Tricuris

3. Hook worm and Tricuris

509 Is there triple infection? 1. Yes 2. No

510 Does human excreta/feaces used us fertilizer 1. Yes 2. No

Part four: Knowledge assessment towards of soil- transmittedhelminthes

52
Question Response Skip

601 Have you heard about STHs? 1. No 2. Yes

602 Does the Cause of STHs is parasitic worm infection? 1.No 2. Yes

603 Is STHs a transmissible disease/contagious? 1. No 2. Yes

604 Contaminated soil and water, consumption of raw 1. no. 2 yes


vegetables and fruits are ways of transmission of STHs?
605 Diarrhea and abdominal pain, loss of appetite, general 1. No 2. yes
malaise and weakness are symptom of STHs ?

606 Is there a treatment for STHs? 1 no 2.yes

607 Can STHs be prevented? 1 no 2.yes

608 Doesthe pregnant women is higher risk for STHs? 1 no 2.yes

53
Unkaalee, waliigaltee fi agarsiistuumarsariitii

Maqaankoo___________________ jedhama, gaheenhojiikoo raga


sasaabaqorrannooObbooAddaamuuTasfaa(BSc), barataa ‘Mattuu University college of health
science and department of public health’ gaggeefamudha .

Mata dureeQorannookanaa:
Raammoowwanbiyyooirrattifaalamuunharkangaraafaaniitiingaraahaadholiiulfaaseenuundhiigaisaani
xuuxanii fi sababootadhibeewwankanaairrattixiyyeeffatudha.

Kaayyoo :Galmiiqo’annoo fi
qorrannookanaarammoowwanbiyyooirrattfaalamuunharkaagaraafaaniingaraaseenuunhaadholiiulfaa
miidhaanqo’annoo fi
qorannoogaggeessuunaddabaasuunkaraadhibeewwankunneenittiindaddarbanittisuu fi
rakkoowwansababakananmudatanxiqqeessuunhaadhaanagaa fi
daa’imafayyaata’eakkadeessutaasissudha.

Qorrannookeenyagalmaangahuudhafhaamilee,amanamummaa fi hirmmaannadhugaaaf-
gaafiikeenyadeebisuufisinqabdanshooraguddaadha.
Hirmaananqorrannookeenyakeessattiisintaasisttanfedhiifi
murtoodhuunfakeessanirrattihunda’a.Sababahirmachuudhiisukeessaniinaddabbii fi
bu’aanisindhabdanhinjiru.

HiccittiiDhuunfa fi Atoommii

Jireenyahawwaassumadhuunfaakeessanirrattihubbannooisiniilaachuubarbaanna.deebii, ilaalcha fi
yaadniaf-gaaffii kana irrattidhiyeessitaniccitiidhanqabama.Maqaankeessangalmee kana
irrattihinbara’uu/hincaqasamu.Adeemsaaf-gaaffii
kanakeessattigaaffiitokkoyknhundadeebisuudhiisuu fi
yeroobarbaaddanaddaankutuudhaafmirgaguutuuqabdu.Fedhiihirmaanaisinqabdaniifgalataguddaaqab
du !.Af-gaaffinkunyeroodaqiiqaa 25-30 fudhata.

54
Oddeeffannoonarmaanoliikunafaaninnaafibsameejira. Qorrannookana
keessattigaheekoowaananhubadheeffedhiiguutuudhanhirmaachufmurteesseenjira.

______________________ _________________

Mallattooguyyaa

Mata dureeqorrannoo;-.
Raammoowwanbiyyooirrattifaalamuunharkaanafaniigaragaraahaadholiiulfaaseenanii fi
Sababootaisaaniiirrattiqo’annoo fi qorannoogaggeessuuDoorannii,G/I/A/Bora 2015
Section 0: RagaaBu’uraHirmmaattotaa
Lakkoofsamana ____________Guyyaaaf-gaafii______________
Magaala __________Baaddiyya___________
Maqaanamaaf-gaafiigaggeesse ___________________ mallatto__________guyyaa_________
Maqaato’ataa ____________________mallattoo__________guyyaa__________
Nagaagaafachuu!
Fedhiihirmaachufqabdaniifguddaagalatooma,
deebinsirriiykndogongorajedhamuhinjiruyaadnikeessanguutuunccitiidhanqabama.
Tole,gaafiiisiniidhiyaatudeebisuufqophooftanijirttu?
Lakkoofsahirmaata ; ________________________

55
Unkatokko: Demograafii fi jijjiramaahawwas-dinagdee
Question Response Skip
101. Umurii(waggaadhaan ) ___________________________

102 HaalaHeerumaa
1.Hin heerumne2.Heerumeera

3.Wal hiikneerra4.Homaa hinqabu


103 Amantaa 1.Ortodooksii2.Musliima

3.Pirootestaantii4.Kaatalokii

5.Gara biraa-----
104 SadarkaaBarumsaa
1.Homayyuu hinbaranne

2. Sadarkaajalqabaa (1-8)

3.Sadarkaa 2ffaa(9-12)

4.Dipiloomaa fi andisaaol
105 Hojiikeeessanmaali
1.Haadha warraa

2.Hojiiguyyaaguyyaa

3.Daldaltuu 4.Barattuu

5.HojjetamaaMootummaa6.Other(specify) _
106 Iddoonjireenyakeessane
1. Baadiyyaa
ssa?
2. Magaala
56
Kutaatokko: Demograafii fi jijjiramaahawwas-dinagdee

Question filannookeessan Skip


107 Baay’innimaatiikeesssanmeeqa? ____________________

108 Galiinkeessanji’aanmeeqaa?
________ETB

Kutaalama:haalaulfaa fi ulfaankanwalqabatanii
Q.no Question Deebiifilannookeessanii Skip
201 HaalaUlfaa 1.Jalqaba kooti
2.Lamaa fi isaaol
202 Ulfata’uukeessan 1, karooraan
2,Osoohinfedhiin
203 Umuriin/jiiniUlfaakeessaniihagami 1.Torban 12 guuteera
2,Toorban 24 guuteera
3,Toorban 36 guuteera
204 Marsaameeqatajaajilada’umsaduraabuf/
1.Tokko2. Lama
fayyaattihordofatan
3. sadii 4. >Afur
205 Kanaanduradhibeeraammoogaraakeessaaqab
1.Eeyyee 2.Lakki
duisiniinjedhameturee
206 Bu’aahemoogilobinii
2. __________________g/dl
Part Three: Rakkookenninsatajajilafayyaawaliinhidhatu
Q.no Question Filannoo Skip
301 1.lakki
Yerootajaajilada’umsaaduraafgarabuf/
57
2.Eeyyee
fayyaadhufaaturtanittiwaa’eeraammoogaraakeessaadhiiganamaaxuxxuuo
geessotnisinittihimaniiru

Kutaa4ffaa: AgarsiiftuuwwanSababarakkoorammoogaraakeessaanwalhidhataniijiranii
Question Deebiifilannoo Skip

401 Yerooulfakeessankanaakeessattifedhiinbiyyoogaraafaa 1.Eeyyee 2.Lakki


nkeessaniittifudhachuunnyaachuutureera?

402 ManaFincaaniiqabduu? 1.lakki 2.Eeyyee Lakki y/c

403 GosaManafincaaniikeessanii 1.Boolla mukaanijaarame

2.Boolii bishaaniindeemu

3.Manafinaccaaniifooliihinqabn
e /VIP

404 (402)Eeyyeeyoota’eittifayyadamaajirtuu? 1. Lakki 2. Eeyyee

405 Manafinaaniibooddeeharkakeessannidhiqattuu 1.lakki 2.Eeyye lakki


407ce’i

406 (404) eeyyeeyoota’e“saamunaadhaandhiqattuu? 1.Lakki 2. Eeyyee

407 Daa’immanwaggaashaniigadiimanakeessankeessajiruu 1,Eeyyee 2.laki lakki


? 410ce’i

408 Daa’immankeessandiapperiinifayyadamuu 1. Lakki 2 .Eeyyee

409 Udaanii fi fincaandaa’immaniieessattimaqsitu? 1.Dirree irratti

2. ManaFincaniitti

410 Kuduraalee fi Fuduraaleosoohinmiichiinsorattuu? 1. Eeyyee 2.lakki

58
411 Kuduraaleeosoohinbilcheessiinnisoorattuu 1.Eeyyee 2.Lakki

412 Yeroobaay’eeCaammaaosoohinhidhattaniideemtuu 1. Lakki 2. Eeyyee

413 MaddiBishaandhugaatiikeessaniiMaali? 1.Laga2. Paampaa

3.Burqaa gabbate

4.Burqaa hingabbanne

5.Bishaanboollaahingabbate

6.Bishaan boollaagabbate

ArgannooBu’aaLaboraatooriii

500 Dhibeen STH isaankeessattiargameeraa? 1. Eeyyee . 2.Lakki Lakkiyoota’


e510ce’i

501 Eeyyeeyoota’e ,Ascarisis ? 1. Eeyyee 2. Lakki Lakki 503

502 HangihanqaaquuAskarisii 1.>50,0000 epg

2. 5000-49,999 epg

3.1- 4,999 epg

503 Eeyyeeyoota’e Hook Wormiidhaa `1.Eeyyee 2. lakki Lakk 505

503A Ancykilostmadodinaaleedhaa 1. Eeyyee 2. lakki

503B NecatorAmericunus 1. Eeyyee 2. Lakki

504 HangiHanqaaquu Hook wom 1. >4000 epg

2. 2000-3,999 epg

3. 1-1,999 epg

505 Eeyyeyoota’eTrikurisisiidhaa? 1.Eeyyee 2.lakki

506 HangihanqaaquuTrikuurisiisiimeeqa ? 1.>10,000 epg

2.1000-9,999 epg
59
3.1-999 epg

507 Gostisanyiidhibeeraammoo lama argameera? 1eeyye 2. Lakki Lakkiyoo

508 Eeyyeeyoota’eGostilamaanargamankami? 1.Askarisisii fi Hook worm

2.Askarisisii fi Trikurisis

3.Hookwom fi Tricurisii

509 Gostiraammoosadanuuargamaniiruu ? 1 .Eeyyee 2. Lakki Lakki

510 BooliiakkaXaa’oottifayyadamuunjiraa 1.Eeyyee lakki

60
Kutaashanaffaa :HubannooRaammoowwanMaxxantootagaraabiyyoofaalamaniindhufaniii
rrattihaadholiinulfaaqabanii
* Gaafannoo Filannoo Skip

601 Waa’eedhibeewwanraammooMaxxantuubiyyooirrattifalamaniindhufaniidhageesa 1. Lakki 2. Eeyyee


niibeektuu?

602 SababnidhibeeraammoobiyyooirraadhufaniiRaammooMaxxantuudhaa? 1. lakki 2. Eeyyee

603 RammoowwanMaxxantuugaraabiyyooirraanamaqabannidaddarbuu? 1. Lakki 2. Eeyyee

604 Biyyoonfaalame , Bishaan , Kuduraalee fi Fuduraaleehinmiicamnee fi 1 Lakki. 2. Eeyyee


hinbilchaatnesoorachuunraammoomaxxantuunidaddabarsuu
605 Garaagadibaasaan and dhukkubbiingaraa , 1. Lakki 2.Eeyyee
fedhiinnyaataahir’achuun,fidadhabbiinqaamaamallattoodhibeewwwanmaxxantuu
garaabiyyoofaalameendhufaniiti

606 Dhibeewwanrammoomaxxantuugaraayaaliiniqabuu? 1.Lakki 2.Eeyyee

607 Dhibeewwanraammoomaxxantuubiyyoonfaalamaniindhufanittsuunidandeenyaa? 1 Lakki 2.yes

608 Haadholiinulfaadhibeewwanraammoomaxxantuubiyyoofaalameendhufaniifsaaxil 1 lakki 2.Eeyyee


amoodhaa?

Yaadanuufkennitaniifgalatoomaa!!!!!!!!!!!!!!!!!!!!!!.

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