Ascaris lumbricoides Infection Among Children: Prevalence and Risk Factors in a Peri-Urban Somali Community

Ascaris lumbricoides is a significant intestinal nematode causing ascariasis, a parasitic infection primarily transmitted via ingestion of eggs found in contaminated soil, food, or water. Globally, more than 800 million individuals are infected, particularly children in low- and middle-income countries [1].

While many infections are asymptomatic, ascariasis can cause abdominal pain, growth retardation, cognitive impairments, nutritional deficiencies, and intestinal obstruction. Endemic regions face high prevalence among children coupled with frequent reinfections, posing ongoing public health challenges.

Transmission is closely linked to poor sanitation, lack of safe water, overcrowding, and inadequate hygiene. Somalia, affected by prolonged conflict and displacement, experiences pervasive poverty and a weakened healthcare system, facilitating persistent soil-transmitted helminth (STH) transmission. Deyniile District, Mogadishu, characterized by dense population and limited access to services, exemplifies conditions conducive to sustained STH spread.

This study aims to quantify Ascaris lumbricoides prevalence among children aged 1–15 years in Deyniile and identify key risk factors influencing infection within the community, to inform targeted control efforts.

Study Design and Setting

A descriptive cross-sectional study was conducted from May to September 2024 in Deyniile District, Mogadishu, Somalia—a peri-urban area marked by poor sanitation infrastructure, limited clean water access, and a high concentration of internally displaced persons (IDPs).

Study Population

Children aged 1 to 15 years, residing in the district for at least six months, were eligible. Those whose parents or guardians provided informed consent participated. Children dewormed within the prior three months were excluded to avoid underestimating infection prevalence.

Sampling and Sample Size

Using a multistage sampling technique, neighborhood clusters were randomly selected. Within clusters, children were selected systematically. The sample size of 127 was calculated based on an anticipated prevalence of 20%, 5% margin of error, and 95% confidence interval, using the formula:

n = (Z² × p × (1-p)) / d²

where Z = 1.96, p = 0.20, and d = 0.05.

Data Collection

• Stool Examination:

• Participants provided stool samples analyzed using the Kato-Katz technique, a WHO-recommended method for helminth egg detection and quantification.

• Questionnaire:

Caregivers completed a structured, pre-tested questionnaire covering:

o Demographics: Age, gender, school attendance

o Socioeconomic status: Household head occupation, household size

o Hygiene practices: Handwashing methods (soap, water, soil), frequency after defecation

o Environmental factors: Domestic animals presence, water source type

o Health behavior: Prior parasitic diagnosis, abdominal symptoms, worm observation in stool, family health education exposure

Ethical Considerations

The Somali Institute of Health Sciences Ethics Review Committee approved the study (Approval No: [insert]). Written informed consent was obtained from caregivers. Children testing positive received referral for deworming treatment.

Data Analysis

Data were entered and analyzed using Python with Pandas and Statsmodels libraries. Descriptive statistics (frequencies, proportions) summarized variables. Chi-square tests assessed bivariate associations between categorical variables and Ascaris infection. Statistical significance was set at p < 0.05.

Prevalence Of 127 children examined, 26 were positive for Ascaris lumbricoides, yielding a prevalence of 20.47%.

Table 1: Prevalence of Ascaris lumbricoides Infection by Age Group.

Table 2: Prevalence of Ascaris lumbricoides Infection by Gender.

Table 3: Association of Selected Risk Factors with Ascaris Infection.

The observed prevalence of 20.47% confirms that Ascaris lumbricoides remains a significant public health issue in Deyniile District, consistent with reports from East African informal settlements where prevalence ranges between 15% and 30% [2,3].

The highest infection rates among children aged 1–5 years align with global evidence showing increased vulnerability in early childhood due to behaviors such as playing in contaminated environments and limited hygiene autonomy [4].

Poor hand hygiene—especially inconsistent washing after defecation and use of water or soil instead of soap—was strongly linked to infection risk, confirming the critical protective role of soap-based handwashing [5].

Unemployment of household heads emerged as a key socioeconomic risk factor, likely reflecting reduced access to hygiene resources and health information. Families without health education had elevated infection rates, underscoring the importance of community-based health promotion.

Although factors such as presence of domestic animals and unsafe water were not statistically significant in this sample, they remain recognized contributors in similar contexts and warrant consideration in comprehensive control programs.

This cross-sectional study cannot establish causality. Selfreported hygiene practices may be subject to recall and social desirability bias. The sample size, while adequate for prevalence estimation, limits generalizability beyond Deyniile District.

Ascaris lumbricoides infection persists in Somali peri-urban communities, with young children disproportionately affected. Key risk factors include inadequate handwashing, absence of hygiene education, and socioeconomic disadvantages. Sustainable control requires integrated multi-sectoral approaches beyond periodic deworming.

• Routine Deworming: National and local health authorities should sustain biannual deworming campaigns for children aged 1–15 years.

• WASH Promotion: Handwashing with soap should be prioritized through school and community-based programs.

• Community Health Education: Culturally appropriate health messages should be disseminated via health workers, religious centers, and media.

• Livelihood Support: Addressing poverty and unemployment will strengthen the impact and sustainability of health interventions.

• Further Research: Longitudinal and intervention studies are needed to evaluate the effectiveness of integrated control measures.

1. World Health Organization (2020) Soil-transmitted helminth infections.
2. Bethony J, Brooker S, Albonico M, Stefan M Geiger, Alex Loukas, et al. (2006) Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet 367(9521): 1521-1532.
3. Ahmed A (2021) Helminth infections in Somali IDP camps: A cross-sectional study. East African Medical Journal 98(2): 40-47.
4. Pullan RL, Brooker S J (2012) The global limits and population at risk of soil-transmitted helminth infections in 2010. Parasites & Vectors 5: 81.
5. UNICEF & WHO (2023) Progress on household drinking water, sanitation and hygiene 2000–2022.