16Background: Over 28 million school-aged children are at risk of intestinal parasite infection in Ethiopia. Few studies have 17 investigated household-level risk factors or applied multilevel analysis to account for the nested data structure. This study aimed to 18 assess the prevalence, intensity, and risk factors of parasite infection among schoolchildren in rural South Ethiopia.
19Methodology/Principal Findings: Using multistage random sampling, we recruited 864 students in the Wonago district. We 20 applied multilevel-logistic and zero-inflated negative binomial regression models (ZINB). Risk factors were concentrated at the 21 individual level; school-level and class-level variables explained less than 5% of the variance. The overall intestinal parasite 22 prevalence was 56% (479/850); Trichuris trichiura prevalence was 75.2% (360/479); and Ascaris lumbricoides prevalence was 33.2% 23 (159/479). The rate of infection increased among children with anemia (AOR: 1.45 [95% CI: 1.04, 2.03]), wasting (AOR: 1.73 [95% 24 CI: (1.04, 2.90]), mothers who had no formal education (AOR: 1.08 [95% CI: 1.25, 3.47]), and those in households using open 25 containers for water storage (AOR: 2.06 [95% CI: 1.07, 3.99]). In the ZINB model, A. lumbricoides infection intensity increased with 26 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 27 (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 28 [AOR: 0.46 (95% CI: 0.28, 0.77)] were found to be protective against parasitic infection. 3 29Conclusions/Significance: After controlling for clustering effects at the school and class levels and accounting for excess zeros 30 in fecal egg counts, we found an association between parasite infections and the following variables: age, wasting, anemia, unclean 31 fingernails, handwashing, de-worming treatment, mother's education, household water source, and water storage protection.
32Improving hygiene behavior, providing safe water at school and home, and strengthening de-worming programs is required to 33 improve the health of schoolchildren in rural Gedeo. 34 35 36Author summary 37 Intestinal parasite infections are common among school-aged children in Ethiopia. Several cross-sectional studies have investigated 38 the prevalence and risk factors of these intestinal parasite infections. However, most were conducted in an urban setting in northern 39 Ethiopia; they collected household-level risk factor information from the children, not the parents; and they restricted intestinal 40 parasite infection data to binary outcomes. Therefore, we aimed to assess the prevalence and intensity of intestinal parasite infections 41 and the related individual-, household-, and school-level risk factors among rural schoolchildren in southern Ethiopia. Using a 42 multivariate, multilevel, regression model, we found minimal variation across class-and school-level factors for intestinal parasite 4...