Burden of intestinal parasitic infections in children and its association with hand washing practice in Ethiopia: a systematic review and meta-analysis

Background Intestinal parasitic infections (IPIs) are a major public health challenges in developing countries including Ethiopia, although few studies previously estimated the magnitude of IPIs and associated factors in the country. Reports from these scarce studies were also widely varied and remained inconsistent. This study thus aimed to synthesize the pooled magnitude of IPIs and factors affecting it. Methods Internationally broad based medical database including MEDLINE/PubMed, EMBASE, PsychINFO and Web of Science, and Google Scholar for grey literature were exhaustively searched using a priori set criteria to identify studies estimating the prevalence of IPIs among children from 2000-2018. PRISMA guideline was used to systematically review and meta-analyze these studies. Details of study characteristics including sample size, magnitude of effect sizes (including odds ratios (ORs)) and standard errors were extracted. Random-effects model was used to calculate pooled estimates in Stata/se version-14. I2 and meta-bias statistics assessed heterogeneity and Egger’s test for publication bias. Sub-group analyses were also carried out based on age of children and regions. Results Forty-three studies were included in the final analysis (N = 20,008 children). The overall prevalence of IPIs, with one or more species, was 48.2% (95% CI: 40.1, 56.3) in Ethiopian children. Based on sub-group analyses, the highest prevalence of IPIs was observed among school-age children (52.4% (95% CI, 41.3, 63.5)) and in Amhara regional state (52.1% (95% CI, 37.3-66.8)). The odds of having IPIs was nearly six times higher in children who were not practicing hand washing as compared to their counterparts (pooled OR = 5.6 (95% CI: 3.4,9.3). Funnel plot analysis and Egger’s test detected no publication bias. Conclusion On aggregate, the pooled prevalence of IPIs among Ethiopian children is significantly high. Not hand washing before eating was a risk factor for IPIs. The establishment of applicable sanitation services and health education will help reduce the magnitude of IPIs and promote a healthier childhood. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Not applicable ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Not applicable All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. * AA : Amanuel Abajobir AT : Aster Tadesse FW : Fasil Wagnew IPIs : Intestinal Parasitic Infections OR : Odds Ratio