Hindawi

Journal of Parasitology Research

Volume 2023, Article ID 3230139, 6 pages
https://doi.org/10.1155/2023/3230139

Research Article
Prevalence and Associated Factors of Intestinal Parasites among
Food Handlers Working in Food Service Establishments in
Northwest Ethiopia, 2022

1 2
Hailegebriel Wondimu and Mestawut Mihret
1
Department of Medical Laboratory, Debre Tabor Health Science College, Debre Tabor, Ethiopia
2
Department of Nursing, Debre Tabor Health Science College, Debre Tabor, Ethiopia

Correspondence should be addressed to Hailegebriel Wondimu; [email protected]

Received 7 October 2022; Revised 5 May 2023; Accepted 10 May 2023; Published 18 May 2023

Academic Editor: José F. Silveira

Copyright © 2023 Hailegebriel Wondimu and Mestawut Mihret. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

Background. As in most of African countries, intestinal parasites have been widely distributed in Ethiopia and are among the 10
top causes of morbidity and mortality nationwide. Statistics for food-borne illness in various industrialized countries show that up
to 60% of cases may be caused by poor food handling techniques and by contaminated food served in food service establishments.
Epidemiological information on the prevalence of various intestinal parasitic infections in different regions/localities is a
prerequisite to develop appropriate strategies. Objective. This study aimed to determine the magnitude of intestinal parasites
among food handlers working in different food service establishments in Gondar city. Methods. A cross-sectional study was
conducted with food handlers working in different food service establishments in Gondar city. Stool samples were collected
from 350 food handlers and processed using the formol-ether concentration method and then microscopically examined for
intestinal parasitic infections. Pre-tested and structured questionnaire was used to study the socio-demographic characteristics
of food handlers. Chi-square test and p-value were used to assess the associations between risk factors and the parasite
isolation rate. The p-value ≤0.05 was considered as statistically significant. Results. Of the 350 food handlers, 160 (45.71%) had
parasites. Among the isolated parasites, Ascaris lumbricoides was found to be the most prevalent parasite 35.63%, followed by
hookworm 19.38%, Entamoeba histolytica/dispar 16.25%, Trichuris trichiura 10.00%, Strongyloides stercoralis 8.13%,
Schistosoma mansoni 6.88%, and Cystoisospora belli, Hymenolepis nana, and Taenia species each accounting 1.25%. Conclusion.
The result of the study indicated that the magnitude of intestinal parasitosis among food handlers working at different levels of
food establishments in Gondar, Ethiopia, was found to be high. Being at lower educational level and inactive role of the town’s
municipality are determined as a risk factor for parasitic positivity of food handlers.

1. Introduction Globally, due to intestinal parasitic infections, around

3.5 billion people are affected and more than 200,000 deaths
Food-borne diseases are caused by bacteria, viruses, fungi, are reported annually. Around 50,000 deaths yearly are
and parasites. Intestinal parasitosis refers to a group of caused by intestinal parasites in Ethiopia [5, 6].
diseases caused by one or more species of protozoa and As in most of African countries, intestinal parasites have
helminths. These parasites are responsible for the major been widely distributed in Ethiopia and are among the 10
share of morbidity and mortality in a community where top causes of morbidity and mortality nationwide [3].
there is overcrowding, poor environmental sanitation, According to the Ministry of Health of Ethiopia, intestinal
and poor personal hygienic practices, economic and parasitism accounts for 8.5% of all male and 10.4% of all
social conditions also affect the distribution of human female outpatient infections. Prevalence rates higher than
parasites [1–4]. 70% and high rate of multiple infections in those infected
2 Journal of Parasitology Research

individuals have been reported from many parts of the 2.2. Study Design. A descriptive institution-based cross-
country [7]. Although the prevalence rates of individual par- sectional study design was conducted.
asites vary considerably latitudinal in different parts of the
country, several studies show that Ascaris lumbricoides is 2.3. Source Population. All individuals employed as food
the most prevalent intestinal parasite, followed by Trichuris handlers to work in food service establishments in Gondar.
trichiura, a hookworm, and Strongyloides stercoralis [8]. 2.4. Study Population. All randomly selected food handlers
The prevalence of A. lumbricoides infection was 29% in the working in food service establishments in Gondar city dur-
highlands, 35% in the temperate areas, and 38% in the low- ing the study period.
lands. The prevalence of hookworm infection was highest in
the lowlands 24%, followed by highlands 17% and temperate 2.5. Eligibility Criteria. Food handlers working in food ser-
15% areas, and the differences were significant. T. trichiura vice establishments in Gondar city were included in the
infection exhibited similar prevalence in all altitudinal study. However, those food handlers who were ill, took any
regions (13% on average). Earlier work showed that intesti- antiparasitic drugs at the time of the study or 2 weeks prior
nal parasitism had prevalence rates of 20–70% in Gondar to the study, and unable to give a response were excluded.
region [9]. High prevalence of intestinal parasitic infections
affects the health status of individuals, mainly affecting 2.6. Sample Size Determination. The sample size was based
physical and mental development, causing malnutrition, on the assumption of the proportion of pooled prevalence
anemia, stunting, cognitive impairment, lowered educa- estimate of intestinal parasites among food handlers of food
tional achievement, and interfering with productivity [4]. service establishments in Ethiopia, which was 33.6% [14].
Parasitic infections, especially helminthic infections, are With 5% marginal error and 95% confidence interval of
clearly persistent within human communities in endemic certainty (alpha (a) = 0.05), the actual sample size for the
areas and hence remain infectious for other healthy study is computed using one sample population proportion
individuals [10]. formula as indicated below:
Transmission of intestinal parasites is affected directly or
indirectly through faecally contaminated objects such as ðZ a /2Þ2 pq
n= , ð1Þ
food, water, soil, and fingers [2]. d2
Accordingly, food handlers with poor personal hygiene
working in food service establishments could be potential where: n = sample size, p = proportion of women who knew
sources of infection for many of the intestinal helminths about obstetric danger signs, q = proportion of failure (1 − p),
and protozoa [11]. Food handlers who harbor and excrete Za/2 = critical value 1.96, d = precision (marginal error) = 0.05,
intestinal parasites may contaminate food from their faeces N = total sample size.
to their hands and then to the food process, and healthy per- Thus, the sample size was
son may be infected by eating contaminated food [4].
Statistics for food-borne illness in various industrialized ð1:96Þ2 × 0:34 × 0:66
countries show that up to 60% of cases may be caused by n= = 345, ð2Þ
ð0:05Þ2
poor food handling techniques and by contaminated food
served in food service establishments [12].
N = n + n × 10%ðcontingencyÞ = 345 + 35 = 380: ð3Þ
Hence, in order to implement safe food processing up to
consumption practices in food service establishments, deter- Therefore, 380 food handlers working in food service
mining the magnitude of intestinal parasitosis among food establishments in Gondar town were enrolled in the study.
handlers working in different levels of food service establish-
ments is mandatory for the most practical and economical 2.7. Sampling Procedure. The lists of food service establish-
control and prevention measures to be undertaken. ments were obtained from Industry Investment and devel-
opment office of Gondar town. Each level of food service
establishment was considered as a cluster, and the number
2. Methods and Materials of clusters to be studied was determined using a probability
proportional to the size technique for each stratum. Simple
2.1. Study Area and Period. The study was conducted in random sampling technique was used to select the number
Amhara Regional State, Central Gondar Zone, Gondar, from of subjects from each cluster to be studied. There were about
June to September 2022. The city of Gondar is situated in 1043 food handlers working in different levels of food service
Northwestern part of Ethiopia, Amhara Regional State. It establishments. Out of which 380 were the sample size for
is at 12°3′N latitude and 37°28′E. Gondar is located 727 km this study, 29 from bars and restaurants, 214 from hotels,
from Addis Ababa, the capital city of Ethiopia, and 120 km 93 from restaurants, and 44 from tea and breakfast rooms.
from Bahir Dar, the capital city of Amhara National The questionnaire was pretested by 10% of samples from
Regional State. Gondar has a total area of 192.3 km2 with food handlers in a nearby town of the study area, Maksegnit.
undulating mountainous topography. According to the Cen- Pre-tested and structured questionnaires were used to pro-
tral Statistics Agency (CSA) population projection (2013), duce general information on socio-demographic characteris-
the population of Gondar was estimated to be 360,600 in tics of food handlers. They were asked for their views on the
2017 [13]. determinants of hygienic and sanitary conditions within the
Journal of Parasitology Research 3

Table 1: Socio-demographic characteristics of food handlers working in different food service establishments in Gondar.

Restaurant Bar and Tea and

Variables Level Hotels n (%) Total n (%)
n (%) restaurant n (%) breakfast n (%)
≤20 2 (10.53) 5 (26.32) 4 (21.05) 8 (42.11) 19 (100.00)
21–30 71 (47.33) 59 (39.33) 7 (4.67) 13 (8.67) 150 (100.00)
Age 31–40 54 (35.53) 60 (39.47) 9 (5.92) 29 (19.08) 152 (100.00)
41–50 6 (31.58) 2 (10.53) 0 (0.00) 11 (57.89) 19 (100.00)
>50 7 (70.00) 0 (0.00) 0 (0.00) 3 (30.00) 10 (100.00)
Female 127 (39.81) 120 (37.62) 18 (5.64) 54 (16.93) 319 (100.00)
Sex
Male 13 (41.94) 6 (19.35) 2 (6.45) 10 (32.26) 31 (100.00)
Illiterate 55 (33.95) 72 (44.44) 15 (9.260) 20 (12.350) 162 (100.00)
Educational level Primary level 53 (42.40) 39 (31.20) 5 (4.00) 28 (22.40) 125 (100.00)
Secondary and above 32 (50.79) 15 (23.81) 0 (0.000) 16 (25.40) 63 (100.00)
Married 46 (38.33) 48 (40.00) 13 (10.83) 13 (10.83) 120 (100.00)
Marital status
Single 114 (45.60) 78 (31.20) 7 (2.80) 51 (20.400) 250 (100.00)
<1000 0 (0.00) 1 (33.33) 0 (0) 2 (66.67) 3 (100.00)
1001–2000 83 (41.92) 63 (31.82) 11 (5.56) 41 (20.71) 198 (100.00)
Income per month in Birr
2001–4000 46 (35.380) 58 (44.62) 7 (5.38) 19 (14.62) 130 (100.00)
>4000 11 (57.890) 4 (21.05) 2 (10.53) 2 (10.53) 19 (100.00)
Private 140 (41.30) 124 (36.58) 20 (5.90) 55 (16.22) 339 (100.00)
Type of latrine
Public 0 (0.00) 2 (18.18) 0 (0.00) 9 (81.82) 11 (100.00)
Water source Pipe 140 (40.00) 126 (36.00) 20 (5.71) 64 (18.29) 350 (100.00)
Food service utensils
By water with detergents 140 (40.00) 126 (36.00) 20 (5.71) 64 (18.29) 350 (100.00)
washing style
Municipality role in Present 70 (43.21) 45 (27.78) 20 (12.35) 27 (16.67) 162 (100.00)
waste disposal Absent 70 (37.23) 81 (43.09) 0 (0.00) 37 (19.68) 188 (100.00)

establishments they work. Stool samples were taken from the between risk factors and the parasite isolation rate. The
selected food handlers using leak-proof plastic caps contain- p-value ≤0.05 was considered as statistically significant.
ing 8 ml of 10% formalin.
2.10. Ethical Consideration. Ethical approval of the research
was obtained from Ethical Review Committee of School of
2.8. Stool Sample Collection and Examination. From each
Biomedical and Laboratory Sciences, College of Medicine
study subject, a sufficient amount of fresh stool samples were
and Health Sciences, University of Gondar, and an official
collected using small clean plastic cups containing 8 ml of
letter was directed to Gondar town municipality. Written
10% formalin preservative. All specimens were processed
informed consent was obtained from the study participants.
by the formol-ether concentration technique, which is con-
Food handlers with parasitic infections were treated in
sidered as the most sensitive for most intestinal helminths
accordance with the Ethiopian national treatment guideline.
and protozoan cysts [15]. About 1 g of stool was added to
Information obtained in any course of the study was kept
a clean 15 ml conical test tube containing 7 ml of 10% formal
confidential.
saline. The stool was gently suspended with formal saline
using an applicator stick. The suspension was filtered
through a sieve into a second centrifuge tube. After adding 3. Results
3 ml of diethyl ether, contents in the second tube were cen-
3.1. Socio-Demographic Characteristics. Out of the total
trifuged at medium speed (2500 rpm) for 5 minutes. The
selected 380 food handlers in all establishments, 350 of them
supernatant was poured off, and a smear on a clean slide
responded making an overall coverage of 92.11%. Majority
was prepared from the sediment and covered with a clean
of the respondents were less than 30 years, 307 (87.86%)
cover slip. The preparation was examined in the same way
with a mean age of 30, female 319 (91.14%), with an infor-
as that of the direct saline method. Negative results were
mal educational level 162 (46.29%), and the average income
reported after assessing the whole smear under the 10×
of food handlers were 2000 Ethiopian Birr per month
objective [15]. Investigators supervised all aspects of data
(Table 1).
collection and laboratory procedures.
3.2. Prevalence of Intestinal Parasitosis. From the total 350
2.9. Data Analysis. Data were analyzed using SPSS version 21. sampled stool specimens, 160 (45.71%) were positive for
Chi-square test and p-value were used to assess the association the parasite. Among the isolated parasites, A. lumbricoides
4 Journal of Parasitology Research

Table 2: Parasitological stool examination results of food handlers working in different food service establishments in Gondar.

Types of intestinal parasites Hotels n (%) Restaurant n (%) Tea and breakfast n (%) Bar and restaurant n (%) Total n (%)
Number of infections from
60 (17.14) 51 (14.57) 42 (12.00) 7 (2.00) 160 (45.71)
the total sample n (%)
Protozoa
E. histolytica 6 (10.00) 7 (13.73) 10 (23.81) 3 (42.86) 26 (16.25)
C. belli 2 (3.33) 0 (0.00) 0 (0.00) 0 (0.00) 2 (1.25)
Helminths
A. lumbricoides 29 (48.33) 18 (35.29) 8 (19.05) 2 (28.57) 57 (35.63)
Hookworm 7 (11.67) 11 (21.57) 11 (26.19) 2 (28.57) 31 (19.38)
T. trichiura 10 (16.67) 1 (1.96) 5 (11.90) 0 (0.00) 16 (10.00)
S. stercoralis 3 (5.00) 3 (5.88) 7 (16.67) 0 (0.00) 13 (8.13)
S. mansoni 3 (5.00) 7 (13.73) 1 (2.38) 0 (0.00) 11 (6.88)
H. nana 0 (0.00) 2 (3.92) 0 (0.00) 0 (0.00) 2 (1.25)
Taenia species 0 (0.00) 2 (3.92) 0 (0.00) 0 (0.00) 2 (1.25)
Total 60 (100) 51 (100.00) 42 (100.00) 7 (100.00) 160 (100.00)

Table 3: Factors having an association with parasitic positivity of food handlers working in food service establishments in Gondar.

Parasitic infections
Variables χ2 (p-value)
Positive n (%) Negative n (%)
Educational level
Without formal educations 87 (54.37) 75 (39.47) 3.71 (<0.001)
Primary level 58 (36.25) 67 (35.26)
Secondary and above 15 (9.38) 48 (25.27)
Municipality role
Absent 107 (66.87) 81 (42.63) 2.72 (<0.001)
Present 53 (33.13) 109 (57.37)
Total 160 190

was found to be the most prevalent parasite 57 (35.63%), identify high risk communities and formulate an appropri-
followed by hookworm 31 (19.38%), Entamoeba histoly- ate intervention [16]. In line with this view, the current
tica/dispar 26 (16.25%), T. trichiura 16 (10.00%), S. ster- study attempted to assess the prevalence of intestinal para-
coralis 13 (8.13%), Schistosoma mansoni 11 (6.88%), and sitic infections in food handlers working in different types
Cystoisospora belli, Hymenolepis nana, and Taenia species of food service establishments in Gondar town. The results
each accounting 2 (1.25%) (Table 2). of this study showed the occurrence of several intestinal
Of the four types of food service establishments, hotels parasites of public health importance among food handlers
showed a greater prevalence of intestinal parasites among working in different types of food service establishments in
food handlers 60 (17.14%), followed by restaurants 51 Gondar town.
(14.57%), tea and breakfast rooms 42 (12.00%), and bars Absent and/or low prevalence of intestinal parasites
and restaurants 7 (2.00%) (Table 2). might be due to the single technique used, which is consid-
ered as the limitation of the study. Specific methods such
3.3. Associated Factors with Intestinal Parasitosis among as adhesive scotch tape for Enterobius vermicularis [17]
Food Handlers. In the data analysis, based on the Chi- and Kato–Katz technique for most intestinal parasites were
square test and p-value to assess the association of risk fac- also good [18]. As a result, a much greater rate of parasites
tors with the intestinal parasitic infection rate, only the edu- would have been found if these methods in combination
cational levels of study participants and municipality role were used in this study. A review of the literatures reveals
were considered risk factors. The p-value ≤0.05 was used very few investigations of intestinal parasites in those food
as a cut-off point for the evaluation of association (Table 3). handlers working in different food service establishments
in different towns.
4. Discussion Earlier studies showed that intestinal parasites had a
prevalence rate of 20–70% in Gondar region [9, 19], and
Epidemiological study on the prevalence of infection of intes- the result of the current study was also found within this
tinal parasites in different localities is a primary objective to range of 45.71%. As well, intestinal parasites detected in
Journal of Parasitology Research 5

the stools of the food handlers were A. lumbricoides, hook- Acknowledgments

worm, E. histolytica/dispar, T. trichiura, S. stercoralis, S. mansoni,
C. belli, H. nana, and Taenia species, which is supported by the The authors would like to give their heartfelt gratitude to the
result of the study conducted by Andargie et al. [11]. This might study participants for their participation by devoting their
be due to similarity in the study area. time and patience during sample collection. The gratitude
The magnitude of intestinal parasites obtained in this also goes to Gondar city administration health office for
study was higher than the results of studies conducted their contribution during data collection.
among food handlers in Jimma 33% [20] and Wolaita Sodo
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