School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Centre for International Health, University of Bergen, Bergen, Norway.
PLoS Negl Trop Dis. 2020 Dec 22;14(12):e0008002. doi: 10.1371/journal.pntd.0008002. eCollection 2020 Dec.
Although the prevalence of helminths infection among schoolchildren is known, there has been little progress in the application of count model for modelling the risk factors of helminths egg. Only a few studies applied multilevel analysis to explore the variation in helminths prevalence across schools and classes. This study aimed to assess the prevalence, intensity of helminths infection, and identify risk factors at the individual-, household-, and school-level among schoolchildren in Southern Ethiopia. Using multistage random sampling, we recruited 864 students in the Wonago District. We applied multilevel-logistic and zero-inflated negative binomial regression models (ZINB). Risk factors were concentrated at the individual level; school-level and class-level variables explained less than 5% of the variance. The overall helminths prevalence was 56% (479/850); Trichuris trichiura prevalence was 42.4% (360/850); and Ascaris lumbricoides prevalence was 18.7% (159/850). The rate of any helminths increased among thin children (AOR: 1.73 [95% CI: (1.04, 2.90]), anemic (AOR: 1.45 [95% CI: 1.04, 2.03]), mothers who had no formal education (AOR: 2.08 [95% CI: 1.25, 3.47]), and those in households using open containers for water storage (AOR: 2.06 [95% CI: 1.07, 3.99]). In the ZINB model, A. lumbricoides infection intensity increased with increasing age (AOR: 1.08 [95% CI: 1.01, 1.16]) and unclean fingernails (AOR: 1.47 [95% CI: 1.07, 2.03]). Handwashing with soap (AOR: 0.68 [95% CI: 0.48, 0.95]), de-worming treatment [AOR: 0.57 (95% CI: 0.33, 0.98)], and using water from protected sources [AOR: 0.46 (95% CI: 0.28, 0.77)] were found to be protective against helminths infection. After controlling for clustering effects at the school and class levels and accounting for excess zeros in fecal egg counts, we found an association between helminths infection and the following variables: age, thinness, anemia, unclean fingernails, handwashing, de-worming treatment, mother's education, household water source, and water storage protection. Improving hygiene behavior, providing safe water at school and home, and strengthening de-worming programs is required to improve the health of schoolchildren in rural Gedeo.
尽管已经了解了学龄儿童的寄生虫感染流行情况，但在使用计数模型来建模寄生虫卵的风险因素方面几乎没有进展。只有少数研究应用了多层次分析来探索学校和班级之间寄生虫流行率的变化。本研究旨在评估埃塞俄比亚南部学龄儿童个体、家庭和学校层面的寄生虫感染率、感染强度和风险因素。我们采用多阶段随机抽样方法，在沃纳戈区招募了 864 名学生。我们应用了多层次逻辑回归和零膨胀负二项回归模型（ZINB）。风险因素主要集中在个体层面；学校和班级层面的变量仅解释了不到 5%的方差。总体寄生虫感染率为 56%（479/850）；鞭虫感染率为 42.4%（360/850）；蛔虫感染率为 18.7%（159/850）。瘦弱儿童（AOR：1.73[95%CI：（1.04，2.90]）、贫血儿童（AOR：1.45[95%CI：1.04，2.03]）、母亲未接受正规教育（AOR：2.08[95%CI：1.25，3.47]）和家庭使用敞开容器储存水（AOR：2.06[95%CI：1.07，3.99]）的儿童中寄生虫感染率较高。在 ZINB 模型中，A. lumbricoides 感染强度随年龄增加而增加（AOR：1.08[95%CI：1.01，1.16]）和指甲不清洁（AOR：1.47[95%CI：1.07，2.03]）。用肥皂洗手（AOR：0.68[95%CI：0.48，0.95]）、驱虫治疗（AOR：0.57[95%CI：0.33，0.98]）和使用保护水源的水（AOR：0.46[95%CI：0.28，0.77]）被发现可预防寄生虫感染。在控制学校和班级层面的聚类效应并考虑粪便虫卵计数中的过零后，我们发现寄生虫感染与以下变量之间存在关联：年龄、消瘦、贫血、指甲不清洁、洗手、驱虫治疗、母亲教育、家庭用水来源和水储存保护。需要改善卫生行为，在学校和家庭提供安全用水，并加强驱虫方案，以改善农村 Gedeo 地区学龄儿童的健康状况。
