Adamu Tesfa MPH - Mattu
Adamu Tesfa MPH - Mattu
Adamu Tesfa MPH - Mattu
OCTOBER, 2023
MATTU, ETHOPIA
MATTU UNIVERSITY
ADVISORS:
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
Advisors:
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.
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.
IX
ABBREVIATIONS AND ACRONYMS
DC Data collectors,
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
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
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).
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).
9
affordable, secure, and successful in lowering morbidity associated with helminthiasis spread via
soil(14).
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
11
CHAPTER FOUR: METHODS AND MATERIALS
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).
12
4.2. Study Design
4.4. Population
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
Table 1: Sample size calculation for factors associated with soil-transmitted among pregnant
women Dorenni,Ilu Aba Bor,August,2023(Table.1.docx)
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.
Proportionally allocated
n1=254 n2=168
n=422
15
4.6.2. Independent variables
Socio demographic factors:Age, marital status, educational status, occupation, residence, income,
family size.
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
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.
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.
18
Figure 3: Evidences for thesis Manuscript Submission
Table 2: Socio-demographic characteristics of pregnant women in Doreni ,Ilu Aba Bor, Oromia,
August ,2023(N=416)
15-19 45 10.8
Tigre 89 21.4
Merchant 39 9.4
Student 44 10.
Single 18 4.3
Table 3: Health service related characteristics of pregnant women attending ANC in Doreni, Ilu
Aba Bor ,Oromia August , 2023(N=416)
>11g/dl 262 63
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)
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)
30%
70%
No STH Had STH
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)
No 291 70
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)
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
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
27
COR: Crude odds ratio and, AOR: Adjusted odds ratio
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
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
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
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-
30
7.2. RECOMMENDATION
Based on the findings, recommendations are forwarded to:
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
31
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33. Alula GA, Munshea A, Nibret E. Prevalence of Intestinal Parasitic Infections and Associated
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35. Dagnaw A, Sahlie M, Mulugeta H, Shine S, Bediru W. Magnitude of Intestinal Parasite Infection
and Associated Factors Among Pregnant Women Attending Antenatal Care Service in
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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
Koumdji Kouakam, Martinobrie Hermione Weladji Cheubou, Edouard Francky Nganti
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2022;11(6):3161–6.
40. Ojurongbe O, Okorie PN, Opatokun RL, Ojurongbe TA, Mabayoje VO, Olowe OA, et al.
Prevalence and associated factors of Plasmodium falciparum and soil transmitted helminth
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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
Catagory
Category Cumulative Prevalence percentage of heavy intensity infections
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______________
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
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)
4. Diplomaandabove
105 Occupations
1. House wife 2. Daily labor
2. Urban
Partone:-Socio-demographiccharacteristicsoftheparticipants
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
2. Water flushed
3. VIP
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
409 Where you dispose child excreta? 1. Outside toilet2. In the toilet
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
508 If yes what type ofspecies for double infection? 1.Ascaris and Hook worm
52
Question Response Skip
602 Does the Cause of STHs is parasitic worm infection? 1.No 2. Yes
53
Unkaalee, waliigaltee fi agarsiistuumarsariitii
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.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
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
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2.Boolii bishaaniindeemu
3.Manafinaccaaniifooliihinqabn
e /VIP
2. ManaFincaniitti
58
411 Kuduraaleeosoohinbilcheessiinnisoorattuu 1.Eeyyee 2.Lakki
3.Burqaa gabbate
4.Burqaa hingabbanne
5.Bishaanboollaahingabbate
6.Bishaan boollaagabbate
ArgannooBu’aaLaboraatooriii
2. 5000-49,999 epg
2. 2000-3,999 epg
3. 1-1,999 epg
2.1000-9,999 epg
59
3.1-999 epg
2.Askarisisii fi Trikurisis
3.Hookwom fi Tricurisii
60
Kutaashanaffaa :HubannooRaammoowwanMaxxantootagaraabiyyoofaalamaniindhufaniii
rrattihaadholiinulfaaqabanii
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Yaadanuufkennitaniifgalatoomaa!!!!!!!!!!!!!!!!!!!!!!.
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