Intestinal parasitic infections (IPIs) continue to be a major public health issue, particularly in low- and middle-income countries, where they are associated with poor sanitation, inadequate access to clean water, and suboptimal hygiene practices. These infections are predominantly caused by protozoan parasites such as Giardia lamblia and Entamoeba histolytica, and soil-transmitted helminths like Ascaris lumbricoides, Trichuris trichiura, and Hookworm. Transmission occurs primarily through the fecal-oral route, via ingestion of contaminated food and water, or through contact with contaminated soil.

School-aged children (5–14 years) represent one of the most vulnerable groups affected by IPIs. This age group is particularly susceptible due to behavioral and environmental factors such as playing outdoors, inadequate handwashing, poor awareness of hygiene, and higher exposure to contaminated environments. IPIs in children are associated with a range of health problems including abdominal pain, diarrhea, malnutrition, anemia, impaired physical growth, and cognitive delays. These effects can severely impact academic performance, quality of life, and long-term development.

Globally, the World Health Organization (WHO) estimates that over 1.5 billion people are infected with soil-transmitted helminths alone, with school-aged children accounting for the highest burden. In many endemic regions, regular mass deworming programs are recommended as part of school health initiatives. However, in settings where deworming coverage is suboptimal and awareness is low, the prevalence of IPIs remains high despite public health efforts.

Several risk factors have been consistently linked to the occurrence of IPIs, including low socioeconomic status, lack of parental education, use of untreated water sources, poor sanitation facilities, and inadequate personal hygiene practices. While community-based prevalence data are available in some regions, hospital-based data can provide valuable insights into the burden of disease in symptomatic populations and help identify high-risk groups that may benefit from targeted interventions.

This study was undertaken to assess the prevalence of intestinal parasitic infections in school-aged children attending a tertiary care hospital and to identify the sociodemographic and environmental risk factors associated with these infections. By understanding the magnitude and determinants of IPIs in this population, the study aims to support evidence-based recommendations for prevention, control, and health promotion strategies.

This hospital-based cross-sectional study was conducted over a period of one year, from January to December 2024, in the Department of Pediatrics at a tertiary care teaching hospital. The study population included school-aged children between 5 and 14 years of age who presented to the pediatric outpatient department with gastrointestinal complaints such as abdominal pain, diarrhea, vomiting, or signs of malnutrition. Children who had received antiparasitic treatment within the three months preceding the study were excluded to avoid bias in prevalence estimation.

A total of 500 participants were enrolled using systematic random sampling. Informed consent was obtained from parents or legal guardians prior to inclusion in the study, and assent was taken from children when appropriate. A structured questionnaire was administered to collect detailed sociodemographic information and data on potential risk factors, including hygiene practices, sanitation facilities, source of drinking water, and parental education.

Each child was asked to provide a fresh stool sample in a clean, wide-mouthed, leak-proof container. Samples were transported to the microbiology laboratory and processed within two hours of collection. Microscopic examination was performed using both direct saline and iodine wet mounts to detect protozoan trophozoites, cysts, and helminth ova. In addition, a formalin-ether concentration technique was used to enhance the sensitivity of parasite detection. All microscopic examinations were performed by trained laboratory personnel blinded to the participants’ demographic and risk factor data.

Data collected through the questionnaires and laboratory reports were entered and analyzed using IBM SPSS Statistics version 25. Descriptive statistics were used to calculate the prevalence of various parasitic infections. The chi-square test was employed to assess associations between categorical variables, and logistic regression analysis was performed to identify independent risk factors. A p-value of less than 0.05 was considered statistically significant.

A total of 500 school-aged children participated in the study, comprising 264 males (52.8%) and 236 females (47.2%), with a mean age of 9.2 ± 2.7 years. Among them, 142 children (28.4%) were found to be positive for at least one intestinal parasitic infection (IPI). The most commonly identified parasites were Giardia lamblia, Entamoeba histolytica, and Ascaris lumbricoides. Multiple parasitic infections were present in 12 children (8.5% of the infected group).

Table 1: Demographic Characteristics of the Study Population (N = 500)

This table summarizes the age distribution, gender, residential background, and parental education level of the study participants.

Figure 1: The grouped set of bar graphs visualizes the demographic characteristics of the study population. Each subplot represents a category: age group, gender, residence, and parental education level.

Table 2: Prevalence of Intestinal Parasitic Infections (N = 500)

This table presents the overall prevalence of intestinal parasitic infections among school-aged children.

Figure 2: The pie chart represents the prevalence of intestinal parasitic infections in the study population. It clearly shows that 28.4% tested positive for IPIs, while 71.6% were negative.

Table 3: Distribution of Parasites Identified Among Positive Cases (N = 142)

This table shows the frequency and proportion of different parasitic organisms identified in stool samples of infected children.

Figure 3: The bar chart illustrates the distribution of parasites identified among the 142 positive cases. Giardia lamblia was the most frequently detected parasite, followed by Entamoeba histolytica and Ascaris lumbricoides.

Table 4: Association Between Hygiene and Sanitation Factors and IPIs (N = 500)

This table compares various hygiene and sanitation practices between infected and non-infected children, with statistical significance determined using chi-square testing.

Figure 4: The grouped bar chart shows the association between hygiene and sanitation factors and intestinal parasitic infections (IPIs). It clearly illustrates those behaviors like irregular handwashing, drinking untreated water, and open defecation are significantly more common among infected children.

Table 5: Logistic Regression Analysis of Significant Risk Factors for IPIs

This table presents the multivariate logistic regression results identifying independent predictors for intestinal parasitic infections among school-aged children.

Figure 5: The horizontal bar graph shows the logistic regression analysis of significant risk factors for intestinal parasitic infections. It visualizes the odds ratios and confidence intervals, highlighting that open defecation and drinking untreated water are the strongest independent predictors.

This study revealed a 28.4% prevalence of intestinal parasitic infections (IPIs) among school-aged children attending a tertiary care hospital over a one-year period. The high prevalence emphasizes that IPIs remain a significant public health concern in this vulnerable age group, particularly in settings with limited sanitation and hygiene infrastructure. Our findings are consistent with similar hospital- and community-based studies conducted in various parts of the world.

In terms of prevalence, our findings align closely with a study conducted in Eastern India by Nath et al. (2020), which reported a 29.1% prevalence rate among school-going children. However, lower prevalence was reported in a study from urban Chennai (Rajan et al., 2018), where improved sanitation infrastructure and routine school-based deworming may explain the reduced burden (18.6%). In contrast, much higher prevalence rates—exceeding 40%—have been reported in rural regions of Sub-Saharan Africa (Adamu et al., 2021) and certain districts in Nepal (Shrestha et al., 2019), where access to clean water and public health interventions remains limited.

Our study identified Giardia lamblia (38.7%) as the most prevalent parasite, followed by Entamoeba histolytica (25.4%) and Ascaris lumbricoides (21.1%). These findings corroborate with earlier studies conducted in both hospital and community settings across South Asia and Africa. For instance, a study in Pakistan by Iqbal et al. (2019) also reported Giardia as the predominant protozoan in pediatric infections. The high prevalence of Giardia in our cohort likely reflects widespread consumption of contaminated water and poor water-handling practices, a finding that is reinforced by the significant association we found between the use of untreated drinking water and IPIs (OR = 3.2, p < 0.001).

Open defecation was found to be strongly associated with IPIs (OR = 4.1, p < 0.001), which is consistent with multiple previous studies (e.g., Alemu et al., 2017 in Ethiopia and Kumar et al., 2020 in India). These findings highlight the critical role of sanitation infrastructure in breaking the cycle of transmission. Children practicing open defecation are more likely to be exposed to infective stages of helminths and protozoa in the environment, increasing the risk of re-infection and persistence of parasitic loads despite periodic treatment.

Hand hygiene was another key factor significantly associated with infection (OR = 2.8, p < 0.01). This is in line with the WHO’s emphasis on promoting handwashing with soap as a cost-effective method of reducing fecal-oral transmission of intestinal parasites. Several studies—including those by Freeman et al. (2014) and Ahmed et al. (2021)—have demonstrated a substantial reduction in IPIs with consistent handwashing interventions in schools and communities.

Interestingly, although contact with domestic animals was more frequent among children with IPIs in our study, the association was not statistically significant (p = 0.36). This finding contrasts with some studies suggesting zoonotic transmission of protozoa and helminths (e.g., Ballweber et al., 2018), indicating that the role of pets may vary by context, species, and hygiene practices associated with animal care.

The study also found that lower parental education levels were associated with higher risk of IPIs (p < 0.05), a finding echoed by multiple studies globally (Sarkar et al., 2017; Obeng et al., 2022). Educated parents are more likely to practice and enforce proper hygiene habits, seek prompt medical care, and understand health education messages. Thus, parental education emerges as a key social determinant in reducing the burden of parasitic infections in children.

Comparative analysis with deworming program outcomes in endemic areas suggests that mass deworming alone may be insufficient if not complemented by broader health promotion strategies. For instance, studies in Kenya and Bangladesh have shown temporary reduction in helminthic load after deworming, with rapid reinfection due to unchanged environmental conditions (Ngui et al., 2020; Hall et al., 2019). This underscores the need for integrated control strategies combining deworming with water, sanitation, and hygiene (WASH) initiatives.

Finally, the presence of mixed infections in 8.5% of cases indicates overlapping transmission routes and high environmental contamination. Mixed infections are particularly concerning as they may cause compounded nutritional and immunological effects, yet they often go underdiagnosed and undertreated. Awareness of such coinfections is important for clinicians and policymakers when designing intervention strategies.

 Strengths and Limitations

One strength of this study is the use of a combination of direct and concentration techniques for stool microscopy, improving detection sensitivity. Additionally, the structured questionnaire allowed a comprehensive evaluation of multiple behavioral and environmental risk factors. However, the study has limitations. Being hospital-based, the findings may not be generalizable to asymptomatic or community-based populations. Also, single stool samples may underestimate the prevalence due to intermittent shedding, particularly for protozoan infections.

Implications and Future Directions

Our findings highlight the urgent need for multi-pronged public health interventions targeting hygiene education, improved sanitation, access to clean water, and community-wide deworming. School-based health programs should integrate these components to achieve sustainable reductions in IPI prevalence. Further longitudinal studies involving community surveillance and molecular diagnostic techniques may provide more precise insights into parasite epidemiology and transmission dynamics.

This study demonstrates that intestinal parasitic infections remain a significant health burden among school-aged children, with a prevalence rate of 28.4%. The most commonly detected parasites were Giardia lamblia, Entamoeba histolytica, and Ascaris lumbricoides. Several modifiable risk factors—such as irregular handwashing, use of untreated drinking water, open defecation, and low parental education—were significantly associated with the occurrence of these infections.

The findings underscore the urgent need for integrated public health strategies that go beyond routine deworming. Health education, improvements in water and sanitation infrastructure, and promotion of hygiene practices are essential components for effective and sustainable control of parasitic infections in this vulnerable population.

Targeted interventions, especially in rural areas and among families with lower educational backgrounds, can play a vital role in reducing the burden of disease. School-based health programs, when combined with community engagement and policy support, can significantly improve child health outcomes and reduce the long-term impact of intestinal parasitic infections.

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