Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study

Abstract

BackgroundIntestinal protozoa are parasites transmitted by consumption of contaminated water and food and mainly affect children and elder people and cause considerable health problems. They are the leading causes of outpatient morbidity due to diarrhea in the developing countries. So, assessing water and food source of diarrheal patients and identifying the main associated factors for transmission of protozoan parasitic infections help for effective control measures of protozoan infections. Hence, the current study was aimed at determining the prevalence of foodborne intestinal protozoa infections and associated factors among diarrheic patients in North Ethiopia.MethodsA health facility based cross-sectional study was conducted among 223 patients with watery diarrhea in four selected government health facilities in North Ethiopia from November 2016–June 2017. A structured questionnaire was used to collect data on socio-demography of study participants and factors associated with foodborne protozoa infections. The diarrheic stool samples were collected, transported, and processed using direct wet mount, formal-ether concentration and modified ZiehlNeelson staining methods. The data were analyzed using SPSS version 21 and descriptive statistics, bi-variate, and multivariate logistic regressions were computed. P-value < 0.05 at 95% confidence interval was considered statistically significant.ResultsThe overall prevalence of foodborne protozoa infection was 101 (45.3%). The predominant protozoa species identified was Entamoeba histolytica/dispar 55 (24.7%), followed by Giardia intestinalis 25 (11.2%) and Cryptosporidium species 5 (2.2%). The highest proportion of protozoa infection was observed among males (23.3%) and the age group 15–24 years (13.5%). Statistically significant associations were observed between foodborne protozoan infection and not using any type of recipe to decontaminate salads and fruits (AOR = 2.64, 95 CI: 1.34–5.19, P = 0.005) and using vinegar as a decontaminant (AOR = 2.83, 95 CI: 1.24–6.48, P = 0.014). Eating out (meals at a restaurant) on the other hand was found to be protective for foodborne protozoan infection (AOR = 0.43, 95 CI: 0.23–0.78, P = 0.006).ConclusionOur study revealed that foodborne protozoa infections are of public health significance in the study area. Vinegar, which is frequently used as a recipe for decontaminating salads and fruits, is inversely related to foodborne protozoa parasite infection .

<p>More Than Half Prevalence of Protozoan Parasitic Infections Among Diarrheic Outpatients in Eastern Tigrai, Ethiopia, 2019; A Cross-Sectional Study</p>

“…[15][16][17] In this study, the overall prevalence of intestinal protozoan infection was 59.3%. Our finding was higher than the study conducted in Ethiopia 45.3%, 18 35.5%, 19 41.1%, 20 20.4%, 21 10.6%, 22 44.6%, 23 Iran, 30.1%, 24 37.5%, 25 Ghana 42.9%, 26 Nigeria 19.3%. 27 However, it was comparable with study conducted in South Africa 68%.…”

“…This was higher than studies conducted from Ethiopia; 5.6%, 34 10.3%, 35 2.2% 22 and lower than study conducted in other parts of Ethiopia 57.5%, 23 50.8% 19 This variation might be due to poor access to safe drinking water, personal hygiene, environmental sanitation, and waste disposal system as indicated in this and other study. 18 Similarly, in this study, the prevalence E. histolytica complex is higher than studies conducted Saudi Arabia 4.7%, 36 Malaysia 0.4%, 37 Italy 4.1%, 38 Myanmar 6.2%, 39 and Iran 0.25%. 24 In addition to the above variations the higher prevalence might be due to the over-diagnosis of E. dispar and E. moshkovskii as E.histolytica G. duodenalis was detected among 11% of the study participants which is comparable with studies conducted in Ethiopia 11.2%, 18 8.4%, 22 Iran 11%, 24 and lower than studies conducted in Ethiopia 42.4%, 23 32.7%.…”

“…18 Similarly, in this study, the prevalence E. histolytica complex is higher than studies conducted Saudi Arabia 4.7%, 36 Malaysia 0.4%, 37 Italy 4.1%, 38 Myanmar 6.2%, 39 and Iran 0.25%. 24 In addition to the above variations the higher prevalence might be due to the over-diagnosis of E. dispar and E. moshkovskii as E.histolytica G. duodenalis was detected among 11% of the study participants which is comparable with studies conducted in Ethiopia 11.2%, 18 8.4%, 22 Iran 11%, 24 and lower than studies conducted in Ethiopia 42.4%, 23 32.7%. 19 The higher prevalence of G. duodenalis in other part of Ethiopia this might be due to lack of access to safe drinking water, inadequacy of medical care and lower degree of sanitation.…”

International Laws and Food-Borne Illness

“…There are several intestinal protozoa that cause diarrhea, but Entamoeba histolytica, Giardia intestinalis, and Cryptosporidium species are the most dreadful culprits of diarrhea (Thompson and Ash, 2016). In a recent study, it was estimated that different species of protozoa cause 45.3% of food-borne illnesses, of which E. histolytica is the major causative agent with 24.7% followed by G. intestinalis with 11.2% and Cryptosporidium species with 2.2% contribution (Berhe et al, 2018).…”

“…Amebiasis claims 50 million lives, and 450 million individuals suffer from it every year (Ohnishi et al, 2004;Ravdin and Petri, 1995). In a recent study, it was reported that out of a total 45.3% of protozoan born disease, E. histolytica is major etiological agent with 24.7% contribution (Berhe et al, 2018). There are six species of Entamoeba (E. histolytica, E. dispar, E. moshkovskii, E. polecki, E. coli, and E. hartmanni), which harbor human intestines (Fotedar et al, 2007).…”