Assessment of seasonality in soil-transmitted helminth infections across 14 schools in Jimma Town, Ethiopia

Abstract

Introduction: Up to date, the frequency of preventive chemotherapy based on the prevalence is the only strategy in the control programmes of soil-transmitted helminths (STHs). However, prevalence of STHs may be affected by climatic and/or seasonal changes, particularly when these are important determinants of transmission of STH infections. Our objective was to describe the prevalence and infection intensity and seasonal variation (mainly dry vs rainy season) of any STHs among school age children.

Methods: Assessment of infection intensity and prevalence of STHs was carried out during dry season (February-March, 2012) and end of rainy season (September-October, 2012) across 14 primary schools in Jimma Town, Jimma, Ethiopia. A total of 1,680 school children (840 in each season) were included. All stool samples were processed by the McMaster egg counting method. Odds of infection and intensity was performed to assess any differences in prevalence and infection intensity between the schools and the two seasons. The pooled odd ratio and their 95% confidence interval was also computed and presented using the "metafor" package of the statistical software R. The level of significance was declared at p < 0.05.

Results: Infections with any STH were observed in 824/1,680 (49.0%) subjects. T. trichiura was the most prevalent (35.5%), followed by A. lumbricoides (23.4%) and hookworms (9.9%). Among the schools there were a huge variation in prevalence, ranging from 16.7% to 68.3% for any STH, 6.7% to 39.2% for A. lumbricoides, 10.8% to 55.0% for T. trichiura and 0 % to 28.3% for hookworms. A significant difference in prevalence (for T. trichiura) and in infection intensity (for A. lumbricoides and T. trichiura) across seasons was observed. Generally, STH infections were more prevalent in the dry season (52.4%) compared to the rainy season (45.7%) and as well intensity of all three STH infections was higher in the dry season.

Conclusion: Our data suggested that there were huge variation in STH prevalence among schools and a significant difference in infection intensity and prevalence across seasons. This in turn might limits how national governments and international organizations define and target resources to combat the disease burden due to STH infection. Long term studies are needed to confirm the influence of seasonal factors and related ecological, environmental and socio-economic factors.

Keywords: Ethiopia; Jimma; Soil-transmitted helminths; intensity; prevalence; seasonality.

Figure 1

(A) map of Jimma zone; (B) map of Jimma city indicating specific study sites (=14 Schools) with in the Jimma Town, Capital of Jimma Zone

Figure 2

Flow chart illustrating number of schools and stool samples for assessing the seasonality of infection intensity and prevalence of STHs in Jimma (Ethiopia). Eligibility criteria for schools was hosting grade 1-8 students (age from 5-18 years) and/or provision of < 60 samples per school per season

Figure 3

The odds of any STH infection during dry season and rainy season (95% confidence interval)

Figure 4

Significant difference in Trichuris trichiura prevalence and infection intensity across seasons

Figure 5

Difference in hookworms' prevalence across seasons and infection intensity across seasons

Figure 6

The odds ratio A. lumbricoides infections across the seasons