Prevalence and associated risk factors of intestinal parasitic infections among children in pastoralist and agro-pastoralist communities in the Adadle woreda of the Somali Regional State of Ethiopia

BackgroundIntestinal parasitic infections (IPIs) can cause illness, morbidity, and occasional mortality in children. Agro-pastoralist and pastoralist children in the Somali Regional State of Ethiopia (ESRS) are especially at risk for IPIs, as access to safe water, sanitation, and health services is lacking. Minimal data on the prevalence of IPIs and associated risk factors exists in this region. MethodologyWe assessed the prevalence of IPIs and associated risk factors during the wet season from May-June 2021 in 366 children aged 2 to 5 years in four agro-pastoralist and four pastoralist kebeles (wards) in Adadle woreda (district) of the Shebelle zone, ESRS. Household information, anthropometric measurements, and stool samples were obtained from included children. Parasites were identified microscopically using Kato-Katz and direct smear methods. Risk factors were assessed using general estimating equation models accounting for clustering. Principal findingsOverall prevalence of IPIs was 35%: 30.6% for single infections and 4.4% for poly-parasitic infections. Intestinal protozoan prevalence was 24.9%: 21.9% Giardia intestinalis, and 3.0% Entamoeba spp.. Intestinal helminth prevalence was 14.5%: 12.8% Ascaris lumbricoides, 1.4% hookworm (Ancylostoma duodenale /Necator americanus.), and 0.3% Hymenolepis nana. G. intestinalis infection was associated with drinking water sourced from the river (aOR 15.6, 95%CI 6.84, 35.4) and from collected rainwater (aOR 9.48, 95%CI 3.39, 26.5), with toilet sharing (aOR 2.93, 95%CI 1.36, 6.31) and with household ownership of cattle (1-5 cattle: aOR 1.65, 95%CI 1.13, 2.41; 6+ cattle: aOR 2.07, 95%CI 1.33, 3.21) and chickens (aOR 3.80, 95%CI 1.77, 8.17). A. lumbricoides infection was associated with children 36 to 47 months old (aOR 1.92, 95%CI 1.03, 3.58). Conclusions/SignificanceImproving access to safe water, sanitation, and hygiene services in Adadle and employing a One Health approach would likely improve the health of children living in (agro-) pastoralist communities in Adadle and the ESRS; however, further studies are required. Author summaryIntestinal parasitic infections remain a silent threat to the health and life-trajectories of children living in areas with inadequate access to clean water, proper sanitation, and hygiene facilities, including the Somali region of Ethiopia. A large majority in this region live as pastoralists (semi-mobile animal herders), in close contact with their animals and nature, at risk for climate-related threats like drought and flooding, and at risk for infectious agents like intestinal parasites. We assessed the prevalence of intestinal parasitic infections in pastoralist children in the Adadle district of the Somali region of Ethiopia (ESRS), and the individual and household-level factors associated with these infections. We found that locally collected water, shared toilets, along with ownership of cows and chickens increased the risk for having an intestinal parasitic infection with Giardia intestinalis, which can cause diarrhea and is transmitted through water, food, and soil that have been contaminated by the feces of infected humans and animals. If access to clean water, sanitation, and hygiene infrastructure is not improved, these infections remain recurrent in these communities and their animals, continually affecting the health of children. This study is one of few involving pastoralists in this region, hopefully lending guidance to regional public health policies.