Intestinal helminth infections during pregnancy are associated with adverse outcomes including low birth weight and prenatal mortality. The infections are a major public health problem in developing countries. A hospital based survey was undertaken for six months to determine the infection prevalence, intensity, and risk factors. The study involved expectant women attending antenatal clinic. Stool samples were screened microscopically for helminth ova using Kato Katz technique. Information on risk factors was collected using semistructured questionnaire and analyzed using SPSS. Epidemiological data was analysed using descriptive statistics and multivariate analysis. The overall prevalence of infection was 21 (13.8%). Ascariasis was the most prevalent 10 (6.5%), hookworm infection was 6 (3.9%), and trichuriasis was 2 (1.3%). Pregnant women aged below 29 years (OR = 3.63, CI = 0.87–11.75) and those with primary level of education (OR = 3.21, CI = 0.88–11.75) were at a higher risk of infection compared to those aged ≥ 29 years with secondary level of education. Hand washing was significantly associated with reduced likelihood of infection (OR = 0.18, 95% CI = 0.06–0.57). It was concluded that intestinal helminth infections were prevalent among pregnant women. We recommended that all expectant women visiting antenatal clinics be screened for intestinal helminth infections and positive cases be advised to seek treatment.
Intestinal geohelminthiases are among the most common andwidespread of human infections/diseases in the developing world. They contribute to poor nutritional status, anaemia, and impaired growth [
Globally there are 800–1000 million cases reported of
Hookworm infection, whose prevalence and intensity vary by geographic region, is an important aetiological agent of anaemia in women of reproduction age [
A study by van Eijk and others [
Geohelminthiases are transmitted through the practice of soil eating common amongst pregnant women in many communities in developing countries [
Previous surveys reported the prevalence of geohelminthiases among pregnant women in Kenya [
The study was conducted at Kitale District Hospital located in Kitale town, with an estimated population of 20,000 people as per 2009 census. Kitale is located between latitude 1°01′58′′ north and longitude 35°00′02′′ east. It consists of slum settlements such as Kipsongo, Folk land, and Shimo la Tewa. The residents can be categorised as town residents and rural set-ups such as Bikeke, Cherangany, Kiminini, and Moi’s Bridge.
The study was a hospital based survey in which consecutive sampling was used to recruit participants based on required criteria. The target population recruited in the study were pregnant women aged between 18 and 45 years, seeking antenatal services at Kitale District Hospital and who resided in the study area. The subjects who admitted to have received antihelmintics in 3 months prior to the study were excluded from the study. All subjects had to give written consent to participate in the study.
The required sample size for this study was calculated based on 95% confidence level and 5% marginal error; sample size (
A sample of fresh stool specimen was collected from all the 153 participants. Subjects were provided with a labeled leakproof stool container (polypots), toilet paper, and applicator stick. Approximately 5 gm of stool specimens was collected into polypots, using applicator sticks. The stool specimens were examined microscopically within 24 hours of collection using the Kato-Katz technique. The procedure was preferred because it has been widely used to evaluate prevalence and intensity of intestinal infections and provides an accurate measure of the number of eggs present per gram of stool [
Each stool specimen was prepared using a sieve and put on a calibrated template to weigh 47.1 mg of stool; this was used to calculate eggs per gram of faeces by multiplying eggs counted in the preparation by factor 50. The preparation on the glass slide was covered with glycerin/malachite green impregnated cellophane paper. The preparation was turned upside down on a flat surface and pressed gently to spread the stool sample before examination. The slides were examined within one hour to avoid over clearing of hookworm eggs. All eggs in each preparation were counted to determine the number of eggs per gram of faeces.
The egg counts were classified as light, moderate, and heavy infection as per WHO recommendations [
Overall prevalence was 21 (13.7%).
The intensity of intestinal geohelminthiases among (21) infected pregnant women was categorized as heavy 3 (14.3%), moderate 9 (42.9%), and low 9 (42.9%), respectively.
By use of a bivariate model age, waste disposal, hand washing, education level of the pregnant women, and type of housing were significantly associated with geohelminth infection. Younger pregnant women aged below 29 years had a higher probability of becoming infected compared to those aged over 30 years (85.7% versus 55.3%), respectively (
At adjusted multivariate logistic regression model, younger pregnant women aged below 29 years (OR 3.63, CI 0.87–11.75) and those with primary education (OR 3.21, CI 0.88–11.75) were at a higher risk of infection compared to those who were older and had secondary level of education. Washing of hands was significantly associated with low likelihood of infection (OR = 0.18, 95% CI = 0.06–0.57).
The prevalence and intensity of intestinal helminth infection among different populations are functions of many different factors, most importantly the environmental factors, parasitic factors, and host factors [
All the parasites species encountered in the study area had been reported in other parts of Kenya [
The overall prevalence was lower compared to findings from other studies [
The predominance of
The high prevalence of ascariasis may be attributed to poor personal hygiene and low economic status. Further, the eggs of the parasite are known to adhere to dust, fruits, and even vegetables and due to poor observance of personal hygiene, pregnant women inadvertently get infected by eating these contaminated food items. Pregnant women in many rural areas depend on pit latrines for waste disposal with no facilities for hand washing after defecation. Such scenario accompanied by seasonal flooding and possible latrine overflow of human waste into drinking water sources and gardens is likely to lead to the high prevalence of ascariasis reported. Hand washing, higher education levels, and availability of modern water and toilet facilities were significantly associated with low likelihood of infection. These findings suggest that schooling and availability of appropriate sanitary facilities play an important role in the prevention and control of parasitic diseases.
Human ascariasis was a more common infection because of ease of spread through faecal pollution of soil, and so the intensity of infection depends on the degree of soil pollution [
Hookworm infection with
The prevalence of trichuriasis at 1.3% was lower compared to 4.6% among 827 pregnant women in Nyanza Province of Kenya [
The prevalence of enterobiasisat 0.7% was comparable to 0.7–1.0% reported in pregnant women in Ghana [
The study established that intestinal geohelminthiases are an underestimated public health problem among pregnant women and that socioeconomic factors play an important role in the establishment and spread of the infections in communities.
Intestinal geohelminthiases were more prevalent in pregnant women of 29 years and below compared to their older counterparts. Those with basic primary education and living in mud/semipermanent houses had higher chance of infection compared to their counterparts with secondary level education and living in permanent houses. Eating of soil and lack of regular hand washing contributed to infection. These findings were in agreement with other research related findings in Africa [
Pregnant women living in rural areas had higher probability of becoming infected due to poor environmental sanitation, low socioeconomic status, and lack of appropriate methods of refuse disposal.
It is concluded that intestinal geohelminthiases are prevalent among pregnant women. Ascariasis, hookworm infection by
It is recommended that antenatal clinics should incorporate routine stool examination to detect parasitic infections in pregnant women and refer positive cases for appropriate treatment.
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors acknowledge all those who provided financial support and thank all who reviewed the paper and offered constructive suggestions. The authors thank Dr. Kasembeli, Dr. M. Wakwabubi of Kitale District Hospital for support and permission to conduct study at the hospital and staff at the Division of Vector Borne and Neglected Tropical Diseases, Kakamega, Kenya, for stool analysis.