Prevalence and factors associated with soil-transmitted helminthiasis in infants in Gulu, Northern Uganda

Abstract

Background: At least 1.5 billion people or 24% of the world's population are infested with soil-transmitted helminths globally, majority of cases are in sub-Saharan Africa, the Americas, China and East Asia. Close to 1 billion pre-school and school-age children live in soil-transmitted helminth high intensity transmission areas, mostly in sub-Saharan Africa, including Uganda where sanitation and hygiene practices are sub-optimal. One in every four Ugandans is at risk of infestation with soil-transmitted helminths, and soil-transmitted helminths remain an important contributor to morbidity and mortality in Ugandan children, including infants. However, the national deworming guideline does not provide for soil-transmitted helminthiasis control in infants despite having no scientific basis for making this decision.

Objectives: The overall objective of this study was to determine the prevalence of and factors associated with soil-transmitted helminthiasis in infants aged 6-12 months in a typical Ugandan rural community and urban municipality. The 6-12 months age bracket marks the oral stage of an infant’s growth and development where they derive great pleasure by placing every object in their mouths thus placing them at risk of infestation with soil-transmitted helminths.

Methodology: A quantitative cross-sectional community survey was conducted in Gulu district. Home-based fully structured interviews were performed with the caregivers of 768 infants aged 6-12 months old randomly selected through multistage cluster and probability proportional to size sampling. Using Standard Operating Procedures, 699 stool specimens were obtained for laboratory investigations from the study participants.

Results: Overall prevalence of soil transmitted helminthes (STH) was 4.58%, comprising; Hookworm (65.6%), Ascari (18.8%) and Tapeworm (6.3%). Several factors were associated with STH infestation including: age and marital status of the caregivers, average monthly income and nutritional status of the child. The odds of STH infestation were 64.7 times higher (CI: 12.6-332.6) for children with caregivers aged 15-18 years. Children with widowed caregivers had 34.9 odds (CI: 5.8-210) of STH infestation compared to those never married. Children with monthly caregiver income of less than 40,000 shillings had 8.7 odds (CI: 1.5-51.5) of STH infestation and this increased to 45.2 times (6.2-326.5) for those without any income. There was 8.9 times likelihood of STH infestation for those whose main source of drinking water was from unprotected sources compared to those with piped water. Children’s nutritional status was also significantly associated with STH infestation with 18.4 times higher likelihood of STH infestation for those with MUAC code of red.

Conclusion: This study has shown a relatively low prevalence of STH infestation among children aged 6-12 months in Gulu, Uganda. This prevalence points to the low socio-economic status in the study communities and combinations of behavioural, economic and structural interventions are required to reduce STH infestation among infants in Gulu district.