Knowledge and Practice on Prevention of Intestinal Parasitic Infection among mothers of under-five children in Bule Hora Town, Oromia Region, Southern Ethiopia, 2021

 

Girish Degavi¹, Pandiarajan Kasimayan², Hazaratali Panari³

¹Vice-Principal, Shri Guru College of Nursing, Belagavi, Karnataka.

²Professor, Indian College of Nursing, Bellary, Karnataka.

³Principal, Siddhivinayaka Institute of Nursing Science, Harugiri, Karnataka.

 

ABSTRACT:

Background: Intestinal parasitic infections (IPI) isone of the public health problems in many communities, particularly among children in rural areas of developing countries. Ethiopian studies have concentrated on the prevalence and distribution of intestinal parasitic infections, primarily among school children. Only a few studies have looked at the scope on knowledge of under-five children’s mothers regarding prevention of parasitic infections. Methods: A community-based cross-sectional study with a quantitative approach was conducted from November 30 to December 30, 2020, among mothers of under-five children in Bule Hora town. The sample size in this study was 403. The data will be coded, checked and cleaned data (edited) will be entered into Epi-Data version 4.4.3.1 and exported to   SPSS Statistics Version 25 for analysis. Result: The overall knowledge and practice level concerning mothers of under-five children regarding prevention of intestinal parasitic infections was, all among 51.6% had poor knowledge and 53.1% had poor practice. In Religious group wagefata, (AOR 2.199, 95% CI 1.05 - 4.59), mothers who not able to read and write (AOR 0.26, 95% CI 0.12-0.57) had poor knowledge than others. Further in age group (31-35) (AOR 2.94, 95% CI 1.38-6.24), Muslim (AOR 0.39, 95% CI 0.18-0.85) and mothers who had not able to read and write (AOR 3.97, 95% CI 1.26 - 12.49) had poor practice respectively. Conclusion: Mothers with children under the age of five have a considerably low degree of optimal awareness and experience when it comes to preventing intestinal parasitic infection. As a result, campaigns or formal training can be used to raise community consciousness about intestinal parasitic infestation prevention and control.

 

 

 

INTRODUCTION:

Intestinal parasitic infections (IPIs) caused by pathogenic helminths and protozoan species are reported widely.Parasitic diseases affect and cause illness approximately 3.5 billion and 450 million people worldwide, respectively¹.

 

 

 

Globally, intestinal parasites are highly prevalent, particularly in low-income regions². In Ethiopia, the number of infected parasites is high.

 

The overall national prevalence of any helminths infection was 29.8% with variable degree of prevalence among regions³

 

The most common intestinal parasites are Ascaris(A) lumbricoides, hookworms, Trichuris(T) trichiura, Giardia(G) lamblia, Entamoeba (E) histolytica, and Schistosoma species, through over 10.5 million new cases reported annually^4.

 

Ascarislumbricoides, Trichuristrichiura, and Schistosomes affect young children at a high rate, making a significant burden⁵. These parasitic infections cause hindering leading to inadequate nutrient use, restricting children from achieving success in sports and education⁶.

 

Several factors contribute to the increased prevalence of intestinal parasites in tropical and sub-tropical countries, such as climatic conditions, lack of sanitation, unsafe drinking water, and a shortage of toilet facilities⁷. Besides that, a lack of awareness as to how parasitic infections are spread increases the chance of infection. Hence, a better understanding of the above factors, as well as how social, cultural, behavioral, and community awareness affect the epidemiology and control of intestinal parasites may help to design effective control strategies for these diseases^8,9. Furthermore, there is a deficit of evidence on community awareness of the cause, transmission, and prevention of infection in Ethiopia. Therefore, this study was designed to assess the level of mothers’ knowledge and practice about the cause, effect, mode of transmission, and preventive methods of intestinal parasitic infections in Bule Hora town, in Southern Ethiopia.

 

METHODS:

The study will be conducted at Bule Hora town which is located in the West guji zone Southern Ethiopia Oromia regional state. This town found in the southern direction of the Capital city Addis Ababa around 470KM. In Bule Hora town, According to 2013 E.C, based on a zonal report in Bule Hora town, the total estimated population is 59,024. From the total population, the estimated under-five children in this area were 9698.

 

A community-based cross-sectional survey design will be conducted from November 2020 to December 2020 among mothers of under-five children at Bule Hora Town. The source population will be all mothers who have children less than five years of age in Bule Hora Town. 

 

The sample size is determined using the standard formula for single population proportion by taking 52.3 % prevalence from previous studies on Intestinal parasitic infection. From the formula, the sample size was 382. Since the study population less than 10,000, we use the Correction formula. From the formula, we get 367.  After adding 10% of non-respondent, the final sample size is 403. The systematic simple random technique was used to collect data; first by survey method required houses will be mapped. Finally, based on the k^th formula every 24th house was labeled and data were collected.                           

 

The data collected using pretested, structured, and semi-structured self-administered questionnaires. The questionnaire has three parts: Part I: Socio-demographic characters, Part II: Knowledge assessment questionnaire will contain 5 questions based on Guttmann Scale grading type, and Part III: Practice level questionnaire. It was prepared in English and Afan Oromo language and was reviewed by a language expert. Eight BSc nurses for data collection and two MSc nurses for supervision of the data collection were recruited in this study. The study assistants were trained for two days intensively.

 

During data collection, each respondent invited to participate in the study voluntarily and also be able to stop participation when necessary. The questionnaire was distributed and they were asked to return the filled questionnaire to data collectors within 24 hours. The supervisors have checked questionnaires for completeness.

 

The quality of the data assured by using standard, pre-tested questionnaires and proper data collection procedures.  Prior to the actual data collection, pre-testing was done on 10% of the total study subjects at Gerba village; which was not be included in the actual study and based on the findings necessary amendments made regarding its consistency, clarity, and logical adequacy and time it takes to complete Questionnaire.

 

The data coded, checked for error, the missing value must be dealt with, and cleaned data(edited) entered into  Epi-Data version  4.4.3.1  and exported to SPSS Statistics Version 25 for analysis. The results of descriptive statistics summarized and presented by tables, charts, and graphs. Percentage, frequency, and mean were calculated.

 

RESULT:

Socio-demographic Variable of mothers of under-five children, Bule Hora Town, 2021:

The study was conducted among 403 mothers of under-five children. The majority of the mothers in the age group of more than 36 years old about 149(37%). Regarding mother’s marital status, more than half of 222 (55.1%) was living with their husband. About religion 171(42.4%) where belongs to Wagefata. In addition to the educational status of the mother 149(37%) were not able to read and write. With regard to the occupation, 142(35.2%) were housewives. Further 248(61.5%) of mothers had two and more under-five children. Regarding the monthly income of the family 218 (54.1%) was earning more than 3001 birr per month. In relation to husband education, 152(37.7%) was unable to read and write and had secondary level education. (See table 1)

 

Table 1 Socio-demographic variables of mothers’ of under-five children in Bule Hora town, Southern Ethiopia, 2021.

 

Over all Knowledge level of mothers regarding prevention of intestinal parasitic infections in Bule Hora Town, 2021

 

Figure 1: Over all knowledge of mothers of under-five on prevention of intestinal parasitic infections

 

The data regarding knowledge was collected using a questionnaire containing 5 questions. Those five questions had multiple options as Guttmann (cumulative scale) type. From these multiple options, 0 was for the option “I don’t know” and 1 was for all other options and 2 was for a last correct option based on cumulative scale criteria. Therefore, the highest and lowest score would be 10, and the lowest will be 0 points. After recording, scores 0 and 1 coded as 0. Score 2 coded as 1. The mean and median were calculated as 3.93 and 3.60 respectively. After calculation of the central tendency, a group of knowledgeable and non-knowledgeable categorizations was made based on the mean. The results were considered as knowledgeable if the actual score was higher than the mean and categorized as non-knowledgeable if the calculated score was lower than the mean. According to the mean value, 48.4% of the mother had above the mean value and were considered as knowledgeable and 51.6% of mothers had below the mean value and were considered non-knowledgeable about intestinal parasite prevention in Bule Hora town. (See Figure 1)

 

Variable wise Knowledge level of mothers regarding prevention of intestinal parasitic infections in Bule Hora Town, 2021

 

Knowledge of Prevention mechanism:

Mothers of children were asked about which prevention mechanism they knew of. The majority of the mothers, 96(23.8%), reported that avoiding food and water contaminations.  86(21.3%) mentioned that washing vegetables, hand washing, avoid food, water contaminations, and use of latrine. 58(14.4%) listed only hand washing. 57(14.1%) mentioned washing vegetables. 18(4.5%) listed I don’t know any practice. (See Table 2)

 

Knowledge of the mode of transmission:

Related to the mode of transmission, nearly 93(23.1%) listed uncooked vegetables and unclean fruits. 77 (19.1%) mentioned soil contact. 56(13.9%) reported contaminated water and food. Nearly 23(5.7%) mentioned I don’t know. (See Table 2)

 

Knowledge of signs and symptoms:

Regarding signs and symptoms, about 82(20.3%) mentioned anorexia as the main symptom. 72(17.9%) listed diarrhea and vomiting. Only 64(15.9%) described abdominal cramps, diarrhea, and vomiting. Nearly 38 (9.4%) mentioned I don’t know. (See Table 2)

 

Knowledge of complication of IPI:

In relation to complications of IPI, nearly 110 (27.3%) described malnutrition and growth retardation. 87 (21.6%) mentioned growth retardation. 37 (9.2%) listed anemia. About 65 (16.1%) told I don’t know. (See Table 2)

 

 

 

Table 2 Variable wise knowledge of mothers of under-five on prevention of intestinal parasitic infectionsin Bule Hora town, Southern Ethiopia, 2021.

 

Figure 2:- Over all practice level of mothers of under-five on prevention of intestinal parasitic infection.

Knowledge on specific age for deworming a child:

Regarding specific age for deworming a child, nearly 94 (23.3%) mentioned I don’t know. 89 (22.1%) described starts from one year of age. 70 (17.4%) listed within 2-4 years of age. (See Table 2). 

 

Over all practice level of mothers of under-five regarding prevention of intestinal parasitic infection in Bule Hora Town, 2021:

The data on practice was collected using eleven “yes” and “no” questions, with the highest and lowest scores (Ordinal Scale) were 11 and 0 points, respectively. A group of good and poor practices was categorized based on the mean. The result was considered as a good practice if the score was higher than the mean value and considered as poor practices if the score was lower than the mean.

 

Table: 3 Variable wise practice levels of mothers of under-five on prevention of intestinal parasitic infection in Bule Hora town, Southern Ethiopia, 2021.

 

 

The mean and median of maternal practices were 0.7647 and 0.7273 respectively. Based on the mean value, 53.1% of mothers were below the mean and 46.9% of mothers were above the mean. Therefore, 53.1 % of mothers had poor practice and 46.9% of them had good practice regarding prevention of intestinal parasitic infestation. (See Figure 2)

 

Variable wise practice level of mothers of under-five regarding prevention of intestinal parasitic infection in Bule Hora Town, 2021

 

In his study, different Aspect in the practice of prevention of intestinal parasitic infections shows that the majority of the mothers reported their child doesn’t have any stool examination before (44.4%), about not washing of hands and legs after the play in the soil (46.7%) and not advising the child to wear footwear outside the home (56.1). Remaining all aspect shows considerably good practice from mother’s mention. (See Table 3).

 

Factors affecting knowledge and practice of mothers of under-five regarding prevention of intestinal parasitic infections in Bule Hora Town, 2021.

 

Bivariate regression was used at first, with predictor variables with p<0.01 to p<0.05 were included in multivariate analysis to assess factors strongly associated with the study outcome. Religion (AOR 2.199, 95% CI 1.05-4.59), mother’s education (AOR 0.26, 95% CI 0.12-0.57) were associated with knowledge on prevention of Intestinal parasitic infections. In addition, age (AOR 2.94, 95% CI 1.38-6.24), religion (AOR 0.39, 95% CI 0.18-0.85), and mother’s education (AOR 3.97, 95% CI 1.26-12.49) were also associated with the practice of prevention of intestinal parasitic infections.

In religious group; Wagefata group of people had two times(AOR 2.199, 95% CI 1.05-4.59)poor knowledge than other religious people. Mother’s education status mothers who not able to read and write had significant level of (AOR 0.26, 95% CI 0.12-0.57) poor knowledge than others. Further in age group of mothers (31-35) had three times poor practice (AOR 2.94, 95% CI 1.38-6.24)than other age group mothers on prevention of IPI.In religion, Muslim had significant (AOR 0.39, 95% CI 0.18-0.85) poor practice than other religion group and mothers who had not able to read and write had four times (AOR 3.97, 95% CI 1.26-12.49) poor practice than other educated mother regarding prevention of intestinal parasitic infections.(See Table 4, 5).

 

 

Table 4: - Bivariate and multivariate analysis of knowledge of mothers of under-five children regarding prevention of intestinal parasitic infections in Bule Hora town, Southern Ethiopia, 2021.

* Variables significant at level of p<0.01 and 0.05        ** Variables significant at the level of p<0.001

 

 

 

Table 5: - Bivariate and multivariate analysis of practice of mothers of under-five children regarding prevention of intestinal parasitic infections in Bule Hora town, Southern Ethiopia, 2021.

* Variables significant at level of p<0.01 and 0.05                        ** Variables significant at the level of p<0.001

 

DISCUSSION:

In this study, according to the mean value, 48.4% of the mother had above the mean value and were considered as knowledgeable and 51.6% of mothers had below the mean value and were considered non-knowledgeable about intestinal parasitic infections prevention in Bule Hora town. This is higher than a study that reported the knowledge of mothers as 45.2% regarding prevention and control of intestinal parasites in Sekota Town, Waghimara Zone, Ethiopia. In agreement with another study in Wondo Genet, Southern Ethiopia, mothers had relatively reasonable knowledge about intestinal parasitic infections, and they are very well aware of their impact^10,11.

 

In this study, the majority of the mother reported that avoiding contaminated food and water, hand washing, and least mentioned washing vegetables as prevention of Intestinal parasitic infections, which is similar to the study in which mothers mentioned washing vegetables, hand washing, and use of latrine as preventive strategies in IPI ¹⁰. Another studies in Wondo genet found that drinking river water, chewing sugar cane, and feeding a child uncooked cabbage and green pepper were all associated to intestinal parasitic infections in their children¹¹.

 

In this study, knowledge on the mode of transmission of intestinal parasites, majority of the mother listed uncooked vegetables; fruits and soil are the major modes of transmission. A similar study done in Tripura, India reported of eating food contaminated with soil, eating with unclean hands, eating sugary foods, eating with unwashed hands and sugary foods, and eating meats and sugary foods respectively were the cause of worm infestation¹².

 

Regarding knowledge on signs and symptoms associated with parasitic infestation most of the mothers mentioned that anorexia is the main symptom followed by diarrhea and vomiting. In a similar study in Wondo Genet, southern Ethiopia mothers mentioned diarrhea, vomiting, loss of appetite, abdominal discomfort, and an enlarged abdomen¹¹.

 

Regarding knowledge on complications in relation to parasitic infections, most of the mothers described malnutrition, growth retardation, and anemia as a primary complication. A similar study in Zouatta II, Ivory Coast; stated complications associated with liver damage, anemia, and other illnesses¹³.In Sekota Town, Ethiopia, mothers mentioned malnutrition, anemia, and growth retardation as the major complications of intestinal parasites. In wondo Gent, Ethiopia a study mentioned that intestinal parasites caused serious health problems including growth retardation, and malnutrition unless treated^{10, 11}.

 

Regarding specific age for deworming a child, majority of the mother mentioned doesn’t know about the age of deworming a child and half of the percentage described starts from one year of age and 2-4 years of age. In a similar study in east Nigeria, nearly half of the parents/guardians of school-aged children were aware of deworming, resulting in a very low level of child-deworming activities in the study population ¹⁴.

 

The overall level of good practice among mothers living in Bule Hora town regarding intestinal parasitic infestation prevention was 46.9%, which is less than the study done in Sekota Town (51.1%)¹⁰.From another similar study, practices observed by mothers were higher compared to that observed from Ichhawar (22%) and lower than Astha block (54%) in Rural Madhya Pradesh¹⁵.

 

The majority of the respondent in the present study washed their hands (90.8%) before a meal, cut nail regularly (91.1%), self-hand washing practice (83.1%), regular use of footwear (53.3%), food hygiene practice (83.9%) and clean body after the play in soil (53.3%). Comparing similar studies in Sekota town, shows good practice levels as washing their hand before meals (78%), cut nails regularly (65.6%), less practice level in self-hand washing (86.5%)¹⁰. A similar study in Tripura, India by comparing shows that of less practice level in regular use of footwear (57.27%) and good practice level in food hygiene (83.9%)¹². It was higher than the results from Ichhawar(8%) and Astha (22%) in rural Madhya Pradesh¹⁵. The difference might be due to educational background and socioeconomic factors between study subjects. Study findings of Mothers compared to others’ work and other areas level of knowledge and practice there was a limited study in this title and study populations cause to have restricted discussion.

 

In religious group; Wagefata group of people had two times (AOR 2.199, 95% CI 1.05-4.59) poor knowledge than other religious people, this because of this group of people living majority in this town and this specific group of people educational status also cause for this. Mothers who not able to read and write had a significant level of (AOR 0.26, 95% CI 0.12-0.57) poor knowledge than other at least educated mothers. A similar study in Ethiopia, among school-age children whose mother was illiterate, were 3.3 times more likely to develop intestinal parasites (AOR = 3.3; 95% CI: 1.20–9.37) than those whose mothers had at least basic school education¹⁶. Further in the age group of mothers (31-35 years) had three times poor practice (AOR 2.94, 95% CI 1.38-6.24) than other age group mothers on prevention of IPI. A study in Nepal, age of mothers associated (p<0.001)in solid waste management practice in the prevention of worm infestations¹⁵. In religion, Muslims had significant (AOR 0.39, 95% CI 0.18-0.85) poor practice than other religious group. A study in Nigeria, In various community-based parasitic infestation studies, particularly Ara community (14.81%) had the highest cases of intestinal parasites by their poor practice¹⁷. Mothers who had not able to read and write had four times (AOR 3.97, 95% CI 1.26-12.49) poor practice than other educated mothers regarding prevention of intestinal parasitic infections. A similar study in Nepal shows that the educational qualification of the mothers (p=0.0001) had a significant association on practice in control of worm infestations¹⁸

 

CONCLUSION:

Nearly half of the mothers of under-five had poor knowledge and practice. Even though the result is comparable with a similar study, it shows that people in the study setting had different practices and opinions about the prevention of intestinal parasitic infestations.

 

More the half of mothers didn’t know about what is the specific age for deworming a child. More than fifty percent of mothers stated that they didn’t have habits of advising the child to wear footwear while playing in the soil and also not washing legs and hands after a play in the soil.

 

As a result, through community educational campaigns or formal training for mothers, community awareness about intestinal parasite prevention should be developed. This study did not assess the degree of associations between independent variables and knowledge and practice. In addition, it did not address the association between knowledge and practice. Therefore, a further study with a large sample size is needed to assess the association of knowledge and practice.

 

ACKNOWLEDGMENTS:

We appreciate the contributions of both study participants and data collectors to the success of our research.

 

 

COMPETING INTERESTS:

There are no competing financial interests declared by any individual or organization in this manuscript, nor are there any competing non-financial interests such as political, medical, religious, ideological, scholarly, intellectual, commercial, or other.

 

AUTHORS’ CONTRIBUTIONS:

All authors and coauthors were involved in the data analysis and manuscript preparation, as well as conceived and planned the report, analyzed the data, wrote the manuscript, drafted the manuscript, and advising the entire research paper. Similarly, the final version of the manuscript has been read and accepted by all contributors.

 

ETHICAL APPROVAL:

Ethical clearance obtained from Bule Hara University, College of Health Science School Institutional Review Board (IRB). Permission from respective authorities and verbal consent of respondents’ was secured by explaining the objective of the study before the data collection. Respondents were reassured that their answers would be kept private in order to gain their complete cooperation. They have also ensured their voluntary participation and right to take part or terminate at any time they wanted. The research assistants were trained by the principal investigators on how to keep the confidentiality and anonymity of the responses of the respondents in all aspects.

 

CONSENT:

A well-informed written consent was obtained from each research participant after the possible risks and benefits as well as the investigational purpose of the study were identified.

 

CONFLICT OF INTEREST:

There is no conflict of interest on the publication of this research paper.

 

DUPLICATED PUBLICATION:

The authors confirm that the manuscript is original, has not already been published in a journal, and is not currently under consideration by another journal.

 

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Received on 07.11.2023         Modified on 06.12.2023

Accepted on 30.12.2023       ©A&V Publications All right reserved