Prevalence and Distribution of Geo-Helminths and Intestinal Protozoa Infections among School-Going Children in Nyeri County, Kenya

Antony Muthee; Mary Gitahi; Rael Musili; Martin Mutuku

doi:10.51867/ajernet.5.2.69

Authors

Antony Muthee
antonymenaine@gmail.com
Kenyatta University, Kenya https://orcid.org/0000-0002-1247-0312
Mary Gitahi Kenyatta University, Kenya https://orcid.org/0000-0003-3589-1395
Rael Musili Kenya Medical Research Institute, Kenya https://orcid.org/0000-0002-1889-2102
Martin Mutuku Kenya Medical Research Institute, Kenya

Keywords:

Geo-Helminths, Intestinal Protozoa, Prevalence, School-going Children

Abstract

The goal of this study was to determine how common and widespread geo-helminths, STH, and intestinal protozoa infections are in the Mathira constituency of Nyeri County, Kenya. The study aimed to determine the prevalence of geohelminths and intestinal protozoa, as well as the distribution of STH and intestinal protozoa infections in school-going children. Cochran formulae guided the design of a cross-sectional study on a population of 174 children, yielding complete data for 164 of them. The social determinants of the health model guided this study. A structured questionnaire was applied to data collection to establish the demographic characteristics of the study participants in the identified three primary schools in the study site. They were examined for STH and protozoa infections by the quantitative Kato-Katz technique for STH and formal ether concentration techniques for intestinal protozoa infection. Statistical analysis was done using R Studio and the risk ratio. Findings showed that of the 56 samples examined in Kihuro primary school, 12 (21.4%) and 6 (10.7%) were positive for protozoan and STH infections. Similarly, 33% of the children in Gathuini primary school were found to be positive for protozoan infections, while 13% were infected with STH. In Gikumbo primary school, 20.4% of the children were infected with protozoan parasites, compared to 13% of STH infections. However, there was a variation in infection prevalence based on gender across the three selected sites. Children in Kihuro primary school were 0.12 times more at risk of STH infection compared to 0.3 times more at risk of protozoa infections. The intestinal protozoa infection was higher than that for the geohelminths infection in Gathuini primary school. Children in Gathuini primary school were 0.12 times more at risk of STH infection compared to 0.46 times more at risk of protozoa infections. Children in Gikumbo primary school were 0.1 times at risk of STH infection compared to 0.26 times at risk of protozoa infections, implying that they were more prone to protozoan infections than STH infections. The study concluded that the age and gender of students had no statistical significance. The study recommended that government institutions and non-governmental organizations should intervene and undertake adequate control measures against geo-helminth parasites by making sure there is access to safe water and improved sanitation in the area. Moreover, health education programs should be intensified in the area and beyond to raise awareness of geo-helminths and intestinal protozoa infection, means of transmission and control measures, and the improvement of hygiene practices for both children and parents.

Dimensions

REFERENCES

Adam, R. D. (2001). Biology of Giardia lamblia. Clinical Microbiology Reviews, 14(3), 447-475. https://doi.org/10.1128/CMR.14.3.447-475.2001 DOI: https://doi.org/10.1128/CMR.14.3.447-475.2001

Ahmed, M. (2023). Intestinal parasitic infections in 2023. Gastroenterology Research, 16(3), 127-140. https://doi.org/10.14740/gr1622 DOI: https://doi.org/10.14740/gr1622

Alemayehu, B., Mekonnen, B., Addisu, A., & Asres, A. (2024). Effects of household vectors on child health and its determinants in southwest, Ethiopia correspondence analysis. Frontiers in Public Health, 12(5), 1341422. https://doi.org/10.3389/fpubh.2024.1341422 DOI: https://doi.org/10.3389/fpubh.2024.1341422

Apidechkul, T. (2015). Prevalence and risk factors of intestinal parasitic infections among hill tribe schoolchildren, Northern Thailand. Asian Pacific Journal of Tropical Disease, 5(9), 695-699. https://doi.org/10.1016/S2222-1808(15)60915-X DOI: https://doi.org/10.1016/S2222-1808(15)60915-X

Aula, O. P., McManus, D. P., Jones, M. K., & Gordon, C. A. (2021). Schistosomiasis with a focus on Africa. Tropical Medicine and Infectious Disease, 6(3), 109. https://doi.org/10.3390/tropicalmed6030109 DOI: https://doi.org/10.3390/tropicalmed6030109

Becker, S. L., Lohourignon, L. K., Speich, B., Rinaldi, L., Knopp, S., N'Goran, E. K., Cringoli, G., & Utzinger, J. (2011). Comparison of the Flotac-400 dual technique and the formalin-ether concentration technique for diagnosis of human intestinal protozoon infection. Journal of Clinical Microbiology, 49(6), 2183-2190. https://doi.org/10.1128/JCM.01035-10 DOI: https://doi.org/10.1128/JCM.01035-10

Berhe, B., Mardu, F., Tesfay, K., Legese, H., Adhanom, G., Haileslasie, H., Gebremichail, G., Tesfanchal, B., Shishay, N., & Negash, H. (2020). More than half prevalence of protozoan parasitic infections among diarrheic outpatients in eastern Tigrai, Ethiopia, 2019: A cross-sectional study. Infection and Drug Resistance, 13, 27-34. https://doi.org/10.2147/IDR.S238493 DOI: https://doi.org/10.2147/IDR.S238493

Bernabeu, M., Cabello-Yeves, E., Flores, E., Samarra, A., Kimberley Summers, J., Marina, A., & Collado, M. C. (2024). Role of vertical and horizontal microbial transmission of antimicrobial resistance genes in early life: Insights from maternal-infant dyads. Current Opinion in Microbiology, 77(4), 102424. https://doi.org/10.1016/j.mib.2023.102424 DOI: https://doi.org/10.1016/j.mib.2023.102424

Bethony, J., Brooker, S., Albonico, M., Geiger, S. M., Loukas, A., Diemert, D., & Hotez, P. J. (2006). Soil-transmitted helminth infections: Ascariasis, trichuriasis, and hookworm. The Lancet, 367(9521), 1521-1532. https://doi.org/10.1016/S0140-6736(06)68653-4 DOI: https://doi.org/10.1016/S0140-6736(06)68653-4

Bisanzio, D., Mutuku, F., Bustinduy, A. L., Mungai, P. L., Muchiri, E. M., King, C. H., & Kitron, U. (2014). Cross-sectional Study of the Burden of Vector-Borne and Soil-transmitted Polyparasitism in Rural Communities of Coast Province, Kenya. PLoS Neglected Tropical Diseases, 8(7), e2992. https://doi.org/10.1371/journal. and.0002992 DOI: https://doi.org/10.1371/journal.pntd.0002992

Bosch, F., Palmeirim, M. S., Ali, S. M., Ame, S. M., Hattendorf, J., & Keiser, J. (2021). Diagnosis of soil-transmitted helminths using the Kato-Katz technique: What is the influence of stirring, storage time and storage temperature on stool sample egg counts? PLOS Neglected Tropical Diseases, 15(1), e0009032. https://doi.org/10.1371/journal.pntd.0009032 DOI: https://doi.org/10.1371/journal.pntd.0009032

Chakkaravarthy, D. N., & Balakrishnan, T. (2019). Water scarcity-challenging the future. International Journal of Agriculture, Environment and Biotechnology, 12(3), 187-193. https://doi.org/10.30954/0974-1712.08.2019.2 DOI: https://doi.org/10.30954/0974-1712.08.2019.2

Chelkeba, L., Mekonnen, Z., Alemu, Y., & Emana, D. (2020). Epidemiology of intestinal parasitic infections in preschool and school-aged Ethiopian children: a systematic review and meta-analysis. BMC Public Health, 20(1), 117. https://doi.org/10.1186/s12889-020-8222-y DOI: https://doi.org/10.1186/s12889-020-8222-y

Clasen, T., Akoko, D. O., Rheingans, R., Brooker, S. J., & Freeman, M. C. (2013). The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial. The American Journal of Tropical Medicine and Hygiene, 89(5), 875-883. https://doi.org/10.4269/ajtmh.13-0237 DOI: https://doi.org/10.4269/ajtmh.13-0237

Cochran, W.G. (1963). Sampling Technique (2nd ed.). John Wiley and Sons Inc., New York.

Colombo, S. A., & Grencis, R. K. (2020). Immunity to soil-transmitted helminths: evidence from the field and laboratory models. Frontiers in immunology, 11(3), 552189. https://doi.org/10.3389/fimmu.2020.01286 DOI: https://doi.org/10.3389/fimmu.2020.01286

Croke, K., & Atun, R. (2019). The long run impact of early childhood deworming on numeracy and literacy: Evidence from Uganda. PLoS Neglected Tropical Diseases, 13(1). e0007085. https://doi.org/10.1371/journal.pntd.0007085 DOI: https://doi.org/10.1371/journal.pntd.0007085

Desai, A. N., & Majumder, M. S. (2020). What Is Herd Immunity? JAMA, 324(20), 2113. https://doi.org/10.1001/jama.2020.20895 DOI: https://doi.org/10.1001/jama.2020.20895

Ercumen, A., Benjamin-Chung, J., Arnold, B. F., Lin, A., Hubbard, A. E., Stewart, C., Rahman, Z., Parvez, S. M., Unicomb, L., Rahman, M., Haque, R., Colford, J. M., & Luby, S. P. (2019). Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: A cluster-randomized controlled trial in rural Bangladesh. PLOS Neglected Tropical Diseases, 13(5), e0007323. https://doi.org/10.1371/journal.pntd.0007323 DOI: https://doi.org/10.1371/journal.pntd.0007323

Eslah, F., Jonoobi, M., Faezipour, M., Afsharpour, M., & Enayati, A. A. (2016). Preparation and development of a chemically modified bio-adhesive derived from soybean flour protein. International Journal of Adhesion and Adhesives, 71, 48-54. https://doi.org/10.1016/j.ijadhadh.2016.08.011 DOI: https://doi.org/10.1016/j.ijadhadh.2016.08.011

Fauziah, N., Aviani, J. K., Agrianfanny, Y. N., & Fatimah, S. N. (2022). Intestinal parasitic infection and nutritional status in children under five years old: a systematic review. Tropical Medicine and Infectious Disease, 7(11), 371. https://doi.org/10.3390/tropicalmed7110371 DOI: https://doi.org/10.3390/tropicalmed7110371

Firdu, Z., & Mulatu, K. (2023). Prevalence of Intestinal Parasites and Associated Risk Factors among Diarrheal Patients Attending Negelle Borena General Hospital: A Case-Control Study. Journal of Parasitology Research, 2023, 1-9. https://doi.org/10.1155/2023/1990468 DOI: https://doi.org/10.1155/2023/1990468

Garg, A., Homer, C. J., & Dworkin, P. H. (2019). Addressing Social Determinants of Health: Challenges and Opportunities in a Value-Based Model. Pediatrics, 143(4). https://doi.org/10.1542/peds.2018-2355 DOI: https://doi.org/10.1542/peds.2018-2355

Hajare, S. T., Chekol, Y., & Chauhan, N. M. (2022). Assessment of prevalence of Giardia lamblia infection and its associated factors among government elementary school children from Sidama zone, SNNPR, Ethiopia. PLOS ONE, 17(3), e0264812. https://doi.org/10.1371/journal.pone.0264812 DOI: https://doi.org/10.1371/journal.pone.0264812

Hajissa, K., Islam, M. A., Sanyang, A. M., & Mohamed, Z. (2022). Prevalence of intestinal protozoan parasites among school children in africa: A systematic review and meta-analysis. PLOS Neglected Tropical Diseases, 16(2), e0009971. https://doi.org/10.1371/journal.pntd.0009971 DOI: https://doi.org/10.1371/journal.pntd.0009971

Jember, T. H., Amor, A., Nibret, E., Munshea, A., Flores-Chavez, M., Ta-Tang, T.-H., Saugar, J. M., Benito, A., & Anegagrie, M. (2022). Prevalence of Strongyloides stercoralis infection and associated clinical symptoms among schoolchildren living in different altitudes of Amhara National Regional State, northwest Ethiopia. PLOS Neglected Tropical Diseases, 16(4), e0010299. https://doi.org/10.1371/journal.pntd.0010299 DOI: https://doi.org/10.1371/journal.pntd.0010299

Jourdan, P. M., Lamberton, P. H. L., Fenwick, A., & Addiss, D. G. (2018). Soil-transmitted helminth infections. The Lancet, 391(10117), 252-265. https://doi.org/10.1016/S0140-6736(17)31930-X DOI: https://doi.org/10.1016/S0140-6736(17)31930-X

Jourdan, P. M., Montresor, A., & Walson, J. L. (2017). Building on the success of soil-transmitted helminth control - The future of deworming. PLOS Neglected Tropical Diseases, 11(4), e0005497. https://doi.org/10.1371/journal.pntd.0005497 DOI: https://doi.org/10.1371/journal.pntd.0005497

Kalyoussef, S., Goldman, D., & Adam, H. M. (2010). Giardiasis and Cryptosporidiosis. Pediatrics in Review, 31(2), 81-82. https://doi.org/10.1542/pir.31-2-81 DOI: https://doi.org/10.1542/pir.31.2.81

Kawachi, I., & Berkman, L. F. (2014). Social Capital, Social Cohesion, and Health. In Social Epidemiology (pp. 290-319). Oxford University Press. https://doi.org/10.1093/med/9780195377903.003.0008 DOI: https://doi.org/10.1093/med/9780195377903.003.0008

KNBS. (2019). Kenya Population and Housing Census Volume I: Population by County and Sub-County. Vol. I, 2019. Kenya National Bureaus of Statistics.

Laidemitt, M. R., Gleichsner, A. M., Ingram, C. D., Gay, S. D., Reinhart, E. M., Mutuku, M. W., O Oraro, P., Minchella, D. J., Mkoji, G. M., Loker, E. S., & Steinauer, M. L. (2022). Host preference of field‐derived Schistosoma mansoni is influenced by snail host compatibility and infection status. Ecosphere, 13(4). https://doi.org/10.1002/ecs2.4004 DOI: https://doi.org/10.1002/ecs2.4004

Li, Y. Z., Hernandez, A. D., Major, S., & Carr, R. (2022). Occurrence of Intestinal Parasites and Its Impact on Growth Performance and Carcass Traits of Pigs Raised Under Near-Organic Conditions. Frontiers in veterinary science, 9, 911561. https://doi.org/10.3389/fvets.2022.911561 DOI: https://doi.org/10.3389/fvets.2022.911561

Marmot, M., & Bell, R. (2010). Health equity and development: the commission on social determinants of health. European Review, 18(1), 1-7. https://doi.org/10.1017/S1062798709990081 DOI: https://doi.org/10.1017/S1062798709990081

Masaku, J., Okoyo, C., Araka, S., Musuva, R., Njambi, E., Njomo, D. W., Mwandawiro, C., & Njenga, S. M. (2023). Understanding factors responsible for the slow decline of soil-transmitted helminthiasis following seven rounds of annual mass drug administration (2012-2018) among school children in endemic counties of Kenya: A mixed method study. PLOS Neglected Tropical Diseases, 17(5), e0011310. https://doi.org/10.1371/journal.pntd.0011310 DOI: https://doi.org/10.1371/journal.pntd.0011310

McCreesh, N., Nikulin, G., & Booth, M. (2015). Predicting the effects of climate change on Schistosoma mansoni transmission in eastern Africa. Parasites & Vectors, 8(1), 4. https://doi.org/10.1186/s13071-014-0617-0 DOI: https://doi.org/10.1186/s13071-014-0617-0

McGavin, G. C., Davranoglou, L.-R., & Lewington, R. (2023). Essential Entomology. Oxford: Oxford University Press. https://doi.org/10.1093/oso/9780192843111.001.0001 DOI: https://doi.org/10.1093/oso/9780192843111.001.0001

Mengistie, Z., Woldeamanuel, Y., Asrat, D., & Adera, A. (2014). Prevalence of bacterial vaginosis among pregnant women attending antenatal care in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. BMC Research Notes, 7(1), 822. https://doi.org/10.1186/1756-0500-7-822 DOI: https://doi.org/10.1186/1756-0500-7-822

Mody, R. (2004). Intestinal Parasites. In Immigrant Medicine (pp. 273-307). Elsevier. https://doi.org/10.1016/B978-0-323-03454-8.50024-3 DOI: https://doi.org/10.1016/B978-0-323-03454-8.50024-3

Mohamed, A. R., Sterkenburg, P., Yeatman, J. G., van Rensburg, E., & Schuengel, C. (2023). Using Attachment and Biobehavioral Catch-up with Young Children with developmental Delays: A multiple-baseline Trial of Attachment, sensitivity, and cortisol. Journal of Intellectual Disabilities, 27(4), 847-870. https://doi.org/10.1177/17446295221104614 DOI: https://doi.org/10.1177/17446295221104614

Mussel, P., Rodrigues, J., Krumm, S., & Hewig, J. (2018). The convergent validity of five dispositional greed scales. Personality and Individual Differences, 131, 249-253. https://doi.org/10.1016/j.paid.2018.05.006 DOI: https://doi.org/10.1016/j.paid.2018.05.006

Mwandawiro, C., Okoyo, C., Kihara, J., Simiyu, E., Kepha, S., Campbell, S. J., Freeman, M. C., Brooker, S. J., & Njenga, S. M. (2019). Results of a national school-based deworming programme on soil-transmitted helminths infections and schistosomiasis in Kenya: 2012-2017. Parasites & Vectors, 12(1), 76. https://doi.org/10.1186/s13071-019-3322-1 DOI: https://doi.org/10.1186/s13071-019-3322-1

Nasrallah, J., Akhoundi, M., Haouchine, D., Marteau, A., Mantelet, S., Wind, P., Benamouzig, R., Bouchaud, O., Dhote, R., & Izri, A. (2022). Updates on the worldwide burden of amoebiasis: A case series and literature review. Journal of infection and public health, 15(10), 1134-1141. https://doi.org/10.1016/j.jiph.2022.08.013 DOI: https://doi.org/10.1016/j.jiph.2022.08.013

Neto, A. F. R., Di Christine Oliveira, Y. L., de Oliveira, L. M., La Corte, R., Jain, S., de Lyra Junior, D. P., Fujiwara, R. T., & Dolabella, S. S. (2023). Why Are We Still a Worm World in the 2020s? An Overview of Risk Factors and Endemicity for Soil-Transmitted Helminthiasis. Acta parasitologica, 68(3), 481-495. https://doi.org/10.1007/s11686-023-00701-1 DOI: https://doi.org/10.1007/s11686-023-00701-1

Ngonjo, T., Okoyo, C., Andove, J., Simiyu, E., Lelo, A. E., Kabiru, E., Kihara, J., & Mwandawiro, C. (2016). Current Status of Soil-Transmitted Helminths among School Children in Kakamega County, Western Kenya. Journal of Parasitology Research, 2016, 1-9. https://doi.org/10.1155/2016/7680124 DOI: https://doi.org/10.1155/2016/7680124

Njenga, D., Mbugua, A. K., Okoyo, C., & Njenga, S. M. (2022). Intestinal Parasite Infections and Associated Risk Factors among Pre-School Aged Children in Kibera Informal Settlement, Nairobi, Kenya. East African Health Research Journal, 6(1), 86-97. https://doi.org/10.24248/eahrj.v6i1.683 DOI: https://doi.org/10.24248/eahrj.v6i1.683

Obala, A. A., Simiyu, C. J., Odhiambo, D. O., Nanyu, V., Chege, P., Downing, R., Mwaliko, E., Mwangi, A. W., Menya, D., Chelagat, D., Nyamogoba, H. D. N., Ayuo, P. O., O'Meara, W. P., Twagirumukiza, M., Vandenbroek, D., Otsyula, B. B. O., & de Maeseneer, J. (2013). Webuye Health and Demographic Surveillance Systems Baseline Survey of Soil-Transmitted Helminths and Intestinal Protozoa among Children up to Five Years. Journal of Tropical Medicine, 2013, 1-7. https://doi.org/10.1155/2013/734562 DOI: https://doi.org/10.1155/2013/734562

Ojja, S., Kisaka, S., Ediau, M., Tuhebwe, D., Kisakye, A. N., Halage, A. A., Mugambe, R. K., & Mutyoba, J. N. (2018). Prevalence, intensity and factors associated with soil-transmitted helminths infections among preschool-age children in Hoima district, rural western Uganda. BMC Infectious Diseases, 18(1), 408. https://doi.org/10.1186/s12879-018-3289-0 DOI: https://doi.org/10.1186/s12879-018-3289-0

Paller, V. G. V., & Babia-Abion, S. (2019). Soil-transmitted helminth (STH) eggs contaminating soils in selected organic and conventional farms in the Philippines. Parasite Epidemiology and Control, 7, e00119. https://doi.org/10.1016/j.parepi.2019.e00119 DOI: https://doi.org/10.1016/j.parepi.2019.e00119

Pastorino, S., Hughes, D., Schultz, L., Owen, S., Morris, K., Backlund, U., Bellanca, R., Hunter, D., Kaljonen, M., Singh, S., Eustachio Colombo, P., & Milani, P. (2023). School meals and food systems: Rethinking the consequences for climate, environment, biodiversity, and food sovereignty. London School of Hygiene & Tropical Medicine.

Putignani, L., Del Chierico, F., Petrucca, A., Vernocchi, P., & Dallapiccola, B. (2014). The human gut microbiota: a dynamic interplay with the host from birth to senescence settled during childhood. Pediatric Research, 76(1), 2-10. https://doi.org/10.1038/pr.2014.49 DOI: https://doi.org/10.1038/pr.2014.49

Rahimi, B. A., Rafiqi, N., Tareen, Z., Kakar, K. A., Wafa, M. H., Stanikzai, M. H., Beg, M. A., Dost, A. K., & Taylor, W. R. (2023a). Prevalence of soil-transmitted helminths and associated risk factors among primary school children in Kandahar, Afghanistan: A cross-sectional analytical study. PLOS Neglected Tropical Diseases, 17(9), e0011614. https://doi.org/10.1371/journal.pntd.0011614

Rahimi, B. A., Rafiqi, N., Tareen, Z., Kakar, K. A., Wafa, M. H., Stanikzai, M. H., Beg, M. A., Dost, A. K., & Taylor, W. R. (2023b). Prevalence of soil-transmitted helminths and associated risk factors among primary school children in Kandahar, Afghanistan: A cross-sectional analytical study. PLOS Neglected Tropical Diseases, 17(9), e0011614. https://doi.org/10.1371/journal.pntd.0011614 DOI: https://doi.org/10.1371/journal.pntd.0011614

Shahsavari, E., Schmidt, J., Aburto-Medina, A., Khallaf, B., Balakrishnan, V., Crosbie, N. D., Surapaneni, A., & Ball, A. S. (2017). A modified assay for the enumeration of ascaris eggs in fresh raw sewage. MethodsX, 4, 186-190. https://doi.org/10.1016/j.mex.2017.04.001 DOI: https://doi.org/10.1016/j.mex.2017.04.001

Sharma, M. K., & Adhikari, R. (2022). Effects of Water, Sanitation, and Hygiene on the School Absenteeism of Basic Level Students in the Government School of Nepal. Frontiers in Education, 7. https://doi.org/10.3389/feduc.2022.869933 DOI: https://doi.org/10.3389/feduc.2022.869933

Shirley, D.-A., Hung, C.-C., & Moonah, S. (2020). Entamoeba histolytica (Amebiasis). In Hunter's Tropical Medicine and Emerging Infectious Diseases (pp. 699-706). Elsevier. https://doi.org/10.1016/B978-0-323-55512-8.00094-6 DOI: https://doi.org/10.1016/B978-0-323-55512-8.00094-6

Shokouh, S. M. H., Arab, M., Emamgholipour, S., Rashidian, A., Montazeri, A., & Zaboli, R. (2017). Conceptual models of social determinants of health: A narrative review. Iranian journal of public health, 46(4), 435-446.

Siwila, J., Mwaba, F., Chidumayo, N., & Mubanga, C. (2020). Food and waterborne protozoan parasites: The African perspective. Food and Waterborne Parasitology, 20, e00088. https://doi.org/10.1016/j.fawpar.2020.e00088 DOI: https://doi.org/10.1016/j.fawpar.2020.e00088

Soares, R., & Tasca, T. (2016). Giardiasis: an update review on sensitivity and specificity of methods for laboratorial diagnosis. Journal of Microbiological Methods, 129, 98-102. https://doi.org/10.1016/j.mimet.2016.08.017 DOI: https://doi.org/10.1016/j.mimet.2016.08.017

Spector, P. E. (2019). Do Not Cross Me: Optimizing the Use of Cross-Sectional Designs. Journal of Business and Psychology, 34(2), 125-137. https://doi.org/10.1007/s10869-018-09613-8 DOI: https://doi.org/10.1007/s10869-018-09613-8

Stürchler D. (2023). Infections transmitted via the faecal-oral route: a simple score for a global risk map. Journal of travel medicine, 30(6), taad069. https://doi.org/10.1093/jtm/taad069 DOI: https://doi.org/10.1093/jtm/taad069

Taherdoost, H. (2016). Sampling Methods in Research Methodology; How to Choose a Sampling Technique for Research. International Journal of Academic Research in Management (IJARM), 5, 18-27. https://doi.org/10.2139/ssrn.3205035 DOI: https://doi.org/10.2139/ssrn.3205035

Yahia, S. H., Etewa, S. E., Al Hoot, A. A. A., Arafa, S. Z., Saleh, N. S., Sarhan, M. H., Rashad, S. I., & Hassan, S. S. (2023). Investigating the Occurrence of Soil-Transmitted Parasites Contaminating Soil, Vegetables, and Green Fodder in the East of Nile Delta, Egypt. Journal of Parasitology Research, 2023, 1-16. https://doi.org/10.1155/2023/6300563 DOI: https://doi.org/10.1155/2023/6300563

Zouboulis, C. C., & Dassoni, F. (2018). Infestations and Parasitoses. In Pigmented Ethnic Skin and Imported Dermatoses (pp. 173-188). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-69422-1_16 DOI: https://doi.org/10.1007/978-3-319-69422-1_16