1

CHAPTER I

INTRODUCTION

Background of the Study

Two billion individuals worldwide have intestinal helminth infections, with

non-industrialized nations having the most. Hookworms, whipworms (Trichuris),

roundworms (Ascaris), and tapeworms (Cestode) spread through soil (Mishra

et al, 2014). Chronic inflammatory illnesses such chronic anemia, growth

retardation, protein-calorie deficit, and fatigue are caused by intestinal helminth

infestation (Teshale et al, 2018). Children's nutrition is greatly affected by

intestinal parasites. Asian, African, and Latin American regions have high rates

of intestinal parasites such Ascaris lumbricoides and Trichuris trichiura

(Gutierrez-Jimenez et al, 2013).

Deworming programs have been shown to be effective in improving the

health and well-being of children. Chronic soil-transmitted helminth (STH)

infections can have detrimental effects on children's development, including

their health, cognition, and education Deworming interventions have been

associated with positive outcomes such as reduced anemia rates, improved

nutrient absorption, and enhanced physical and cognitive development These

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programs have also been found to increase school attendance and improve

educational outcomes While there is ongoing debate and research regarding

the overall impact of deworming on child health, deworming interventions have

been considered cost-effective strategies to address the health and educational

challenges associated with parasitic infections in children. It is important to note

that the effectiveness of deworming programs may vary depending on factors

such as the prevalence of STH infections and the specific program

implementation (Ahuja et al, 2017).

Deworming programs, while widely implemented, are not always 100%

effective in improving the health and well-being of children. A study analyzing

data from the Kenyan Life Panel Survey found that the effect of deworming on

long-term happiness was small and statistically non-significant, and even

became negative over time 1. Additionally, there is ongoing debate and varying

evidence regarding the overall impact of deworming on child health and

education Factors such as the variability in efficacy, potential for reinfection,

development of resistance in worm populations, and potential immune

impairment due to helminth infections contribute to the limitations of deworming

interventions (Dupret et al, 2022). However, despite these limitations,

deworming programs are still considered cost-effective strategies to address

the health and educational challenges associated with parasitic infections in

children Ongoing research and monitoring are necessary to better understand

the effectiveness of deworming interventions and to refine strategies for

maximum impact (Stetter et al, 2021).

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Intestinal parasite infections are prevalent among children in various

developing countries. In Yemen, a study found a high prevalence of intestinal

parasites, malnutrition, and anemia among orphaned children (Al halani et al,

2023). Another study in India assessed the prevalence of intestinal parasitic

infections in under-five children and found a significant association with

malnutrition (Deka et al, 2022). In Nigeria, a case-controlled study revealed a

high prevalence of intestinal parasitic infections among malnourished children

(Onyemelukwe et al, 2021). Similarly, a study conducted in Eritrea showed a

high prevalence of intestinal parasitosis, malnutrition, and anemia among

elementary and junior school students (Kesete et al, 2020) Additionally, a study

in Pakistan found a high frequency of urinary tract infections in malnourished

children (Rehman et al, 2022). These findings highlight the need for integrated

efforts to address malnutrition and parasitic infections in children, including

improved hygiene practices, access to clean water, and nutritional interventions.

Philippine intestinal parasite studies have illuminated their prevalence

and impact. A cross-sectional study in Metro Manila reported 12.98%

Blastocystis infection, with dog ownership being a strong correlate (Belleza et

al., 2015). In Metro Manila, 90% of slaughterhouse workers and food vendors

had parasitic illnesses, mostly helminthic (Lirio et al, 2018). The Philippines has

endemic intestinal helminth prevalence, severity, and consequences on

children's nutrition, although there is insufficient evidence. A cross-sectional

survey included 693 children from five rural villages in Northern Samar.

Intestinal parasites, diet, and eating habits were assessed. Intestinal parasitic
 4

medications must be utilized with vitamin supplements and health education to

break the parasite life cycle and control it long-term (Ross et al, 2017).

This study aims to assess the effectiveness of deworming

programs in children, they are considered to be ideal for identifying parasitic

infections because this group of children is particularly vulnerable to infections

(Bordoloi et al, 2021). Also, children in this age range are more likely to engage

in behaviors that increase their risk of infection, such as poor sanitation

practices and lack of personal hygiene (Glynn & Moss, 2020). Assessing the

effectiveness of deworming programs in children will benefit many stakeholders.

Healthcare providers will grasp the link between intestinal parasites and

malnutrition, improving diagnosis and treatment. Government agencies can use

the study's findings to create evidence-based policies and initiatives to address

these challenges. The research will influence child health NGOs' initiatives and

budget allocation. Learning about child health and prevention will also benefit

parents. Increasing knowledge and improving children's health status can result

in improved health behaviors, better health outcomes, empowered caregivers,

reduced health disparities, prevention of chronic conditions, and enhanced

healthcare utilization. These outcomes collectively contribute to the overall well-

being and quality of life for children.

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Statement of the Problem

The study aimed to assess the effectiveness of deworming programs

among children in selected areas in Kidapawan City.

Specifically, it answered the following sub-problems:

1. What are the socio-demographic profiles of the respondents in terms of:

A. Age

B. Gender

2. What is the BMI of the respondents?

3. What is the parasite present in relation to their BMI?

4. What is the prevalence rate of the parasitic infection among children in

Kidapawan city in relation to BMI?

5. Is there a significant association between BMI and prevalence rate of

parasitic infection?

Hypothesis

H0= There is no significant association between BMI and prevalence rate of

parasitic infection.
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Significance of the Study

This study about the assessment of the effectiveness of deworming

programs among children in selected areas in Kidapawan City can have

significant benefits for various groups of people:

Parents. This knowledge can empower parents to take necessary

precautions and seek appropriate medical care for their children, leading to

improved overall health and well-being.

Medical technology students. MedTech student can benefit from this

research by gaining practical insights into the real-world implications of their

studies, fostering a deeper understanding of the parasitic infections among

children.

Local Communities. It allows to raise awareness within the local

community about the importance of hygiene, and sanitation.

Healthcare Providers. Healthcare professionals and organizations can

use this data to design targeted intervention programs. By addressing parasitic

infections simultaneously, healthcare providers can improve treatment

outcomes and reduce the burden of diseases among children. It can also help

in the early detection and management of these health issues.

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Educational Institutions. Educational institutions can benefit from this

research by implementing health education programs aimed at promoting

proper hygiene practices. By creating awareness among students, teachers,

and parents, schools can contribute to reducing the spread of intestinal

parasites.

Local Government Unit. LGU responsible for public health can utilize

this research to allocate resources effectively. They can implement policies and

programs focused on sanitation, clean water supply, and nutritional support,

especially in areas with higher prevalence rates.

Future Researchers. Future Researchers can use this study as a basis for

further investigations and contribute valuable data to the academic community.

Scope and Limitation of the Study

` This study is limited to children between the ages of 5 and 12 years old

who have received deworming medications. The number of respondents will be

based on the study of Jameel., et.al (2017). Also, A Body Mass Index (BMI) will

be utilized in classifying the children. The stool samples and the cellulose tape

method samples will be collected from the areas of Sudapin, Nuangan, and

Poblacion in Kidapawan City.

The study is limited only to determine the effectiveness of the deworming

program among children in selected areas in Kidapawan City.

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Conceptual Framework

Input
Process Output

Fecalysis
(Direct Fecal Microscopic
Smear or Examination Prevalence of
Cellulose intestinal
Tape parasite
Method)

Figure 1. Conceptual Framework of the Study

This research utilized the input-process-output paradigm as the

conceptual framework. The Input-Process-Output (IPO) Model is a functional

graph that lists the inputs, outputs, and steps needed to convert inputs into

outputs.

Input, A method that we will be using is fecalysis to obtain fecal samples

in children that are malnourished such as Direct Fecal Smear and Cellulose

Tape Method.

Process, this is the part of identification of intestinal parasitic cyst,

trophozoite, and or larvae through microscopic examination.

Output, the output is the data and materials flowing from the

transformation process. In short, it is the results built from the input and process.
 9

This is where the prevalence rate of parasite in relation to BMI will be

determined and reported.

These results, therefore, conclude the production of intervention plans on the

effectiveness of deworming program among children in selected areas in

Kidapawan city.

Operational Definitions of Terms

The following terms were defined in order to have a better understanding to this

study.

BMI- Is a measurement utilized in this study to assess the children's nutritional

condition. It is calculated by dividing the respondent’s weight in kilograms by the

square of their height in meters.

Cellulose Tape Method- Alternatively referred to as the Scotch tape method,

this technique will be used in this study in order to collect parasites such as

Enterobius vermicularis. The researcher will use a glass slide and tape in this

procedure, and they will examine it under a microscope.

Children- Children ages 5-12 from the selected areas in Kidapawan City are

the respondent of this study. These respondents are the subjects of

investigation serving as the primary focus group for the research.

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Direct Fecal Smear (DFS) – A method to be used in the study in order to

examine the stool sample collected from children in the selected areas of

Kidapawan City. Further Direct Fecal Smear will be using a microscope to

determine the presence of parasite.

Fecal Sample- A sample obtained from children in selected areas of Kidapawan

City that needs to be examined for this study.

Parasites- a specific microorganism targeted for isolation in this study.

Prevalance- is the proportion of the children with parasitic infection at a given

point in time.
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CHAPTER II

REVIEW OF RELATED LITERATURE

Intestinal parasitic infections (IPIs) are major health problems in many

developing countries, particularly among pre-schooled and schooled children.

(Chelkeba et al, 2020) Intestinal helminths and protozoans are among the

commonest infections in humans living in developing countries.(Houweling et

al, 2016). In tropical and subtropical regions, Soil-transmitted helminth (STHs)

and parasitic intestinal protozoa are causes for an immeasurable amount of

morbidity, discomfort and often mortality. Those living in poverty are more

vulnerable to infection and almost 2 billion people are infected with STHs

worldwide. Fact sheet on STHs, globally over 568 million school-age children

live in intestinal helminth prevalent area.(WHO, 2020).

Parasite

Parasite is an organism that lives on or in a host organism and gets its

food from or at the expense of its host. There are three main classes of parasites

that can cause disease in humans: protozoa, helminths, and ectoparasites

(CDC, 2022.)
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Intestinal Parasite

Intestinal parasites are responsible for one of the major health problems

like food contamination with socioeconomic effects in the world with a

prevalence rate of 30-60%, in developing countries that lie within tropical and

subtropical areas. They pose a reasonable public health burden, particularly in

low- and middle-income countries, including Ethiopia. Globally, due to intestinal

parasitic infections, around 3.5 billion people are affected and more than

200,000 deaths are reported annually. Around 50000 deaths yearly are caused

by intestinal parasites in Ethiopia (Hajare et al, 2021).

Intestinal parasitic infections (IPIs) have been major public health

problems in low income countries primarily affecting school children. Previous

studies in Ethiopia have shown high burden of intestinal parasitic infections in

most children. In order to gain a deeper insight into the magnitude of the

problem more information is needed from different localities where similar

studies have not been conducted. The aim of this study was to assess the

prevalence of IPIs and associated risk factors among school children in Jawi

Primary School, Jawi town, northwest Ethiopia (Sitotaw et al, 2019).

Intestinal parasitic infections are distributed throughout the world, with

high prevalence in poor and socio-economically deprived communities in the

tropics and subtropics. Amebiasis, ascariasis, hookworm infection and

trichuriasis are among the top ten most common infections in the world!. These
 13

infections continue to be a global health problems, particularly among children

in poor communities in developing countries. Intestinal helminths of importance

to man are E. vermicularis (pinworm), soil-transmitted helminths (STH) - A.

lumbricoides (round worm), T. trichiura (whip worm), N. americanus and A.

duodenale (hookworm) and S. stercoralis (threadworm). The other intestinal

nematodes (Anisakis sp., Capillaria philippinensis), trematodes and cestodes

are less widespread in man. Their distribution is limited to certain areas' in the

world and the infections are usually confined to certain communities (Noryhati

et al, 2014).

Children and teenagers' nutritional condition might suffer from dietary

deficits and infectious illnesses. Intestinal helminth infections can harm a child's

internal mucosa, resulting in poor nutrient absorption and reduced digestion.

Inadequate intakes of macro- and micronutrients during childhood can stunt

physical and cognitive development and raise mortality risks. Additionally, a lack

of certain micronutrients might weaken the immune system and make a person

more susceptible to infection (Papier et al, 2014).

Intestinal Parasite and Deworming

Intestinal parasite infections in children are gaining attention. Multiple

solutions are sought by global health organizations, governments, and

communities. The programs cover cleanliness, deworming, clean water,

sanitation, and nutrition. Addressing intestinal parasite infections and

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malnutrition improves children's health, growth, and future. The dedication to

preventing parasitic infections demonstrates a commitment to child health and

has the potential to improve child health outcomes, reduce mortality, strengthen

healthcare systems, and foster global collaboration in the fight against these

infections (WHO, 2023).

Soil-transmitted helminth infections are among the most common

infections in humans, caused by a group of parasites commonly referred to as

worms, including roundworms, whipworms and hookworms. Those living in

poverty are most vulnerable to infection which can impair nutritional status by

causing; internal bleeding which can lead to loss of iron and anaemia, intestinal

inflammation and obstruction; diarrhoea; and impairment of nutrient intake,

digestion and absorption. Evidence shows that preventive chemotherapy, or the

periodic large-scale administration of anthelminthic medicines to populations at

risk, can dramatically reduce the burden of worms caused by soil-transmitted

helminth infections (WHO, 2023).

Deworming

Worms or helminths have historically infected more than half the world's

population, but were largely neglected by medical science and public health

interventions because they were considered non-fatal and of minimal clinical

significance. During the 1980s, several oral drugs that were originally developed

for veterinary use were discovered to cure, in a single dose, most human

helminth infections. This allowed the first systematic population-based studies

 15

of the morbid sequelae of chronic worm infection and their potential reversibility

after treatment. Based on these studies, we now know that almost all infected

children and many adults, particularly pregnant and lactating women, suffer

adverse effects from worms, including growth stunting, anemia, decreased

cognitive development, and poor birth outcomes as well as poor school and

work performance. Worm-infected people also respond less well to vaccinations

and are more susceptible to several co-conditions such as HIV and cirrhosis.

Based on these findings, several vertically organized national control programs

were initiated in developing countries against schistosomiasis and the soil-

transmitted helminths (hookworm, ascariasis, and whipworm). In 2005, the

impact of helminth infections was redefined in terms of disability-adjusted life

years (DALYs). All worm infections amenable to population-based mass

chemotherapy are thought today to cause 30 million DALYs worldwide or very

close to the worldwide impact of tuberculosis (TB) or malaria. In addition, almost

all worm-induced DALYs are potentially reversible or preventable with periodic

treatment. In 2001, the World Health Assembly advocated for mass deworming

to reach 75% of the at-risk school-aged children of the world, but by 2011 only

13% had been reached. The recent large donations of anti-helminth drugs by

major pharmaceutical companies linked to the inclusion of the “neglected

tropical diseases” into current priorities for AIDS/TB and malaria now represent

the best hope for closing this gap (Olds, R., 2013).
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Hygiene and Parasites

Helminth and protozoa parasitic infection can occur through different

routes. In an infected person with helminths, infective stages develop into adult

worms in the intestinal tract, which then lay eggs . Intestinal protozoa spread

easily through fecal-oral route of contaminated food or water with the infective

stages (Centers for Disease Control and Prevention (CDC), 2019; WHO, 2015).

The high rates of IPIs reflect the poor hygienic behavior in the society. Climate

conditions, inadequate sanitation, economic issues, a lack of access to safe

drinking water, poor nutrition, and cultural norms are all linked to IPIs.

Individuals are more vulnerable to IPIs than others, including those who reside

in or travel to tropical or subtropical locations, immune impaired patients,

youngsters, and the elderly (El-Sherbini & Abosdera, 2015).

When sanitation is not practiced, the food handlers may transmit

intestinal protozoa and some helminth directly by the fecal-oral route without the

need for intermediate hosts (Duboscq, Romano & MacIntosh, 2019).

The idea of an evolutionary mismatch is discussed in this review in

connection with the decline in the number of so-called "dirty old friends." These

made up the diverse group of prokaryotic and eukaryotic parasites and

microbes that co-evolved with humans and their ancestors over a long period of

time, living in their digestive systems and other bodily regions. It is believed that

this community of metazoan parasites and microbial symbionts has developed

a complex web of interdependence with the host, particularly in connection to

their ability to stimulate the host's immune system and the ensuing adaptation
 17

of the host immune response to this persistent stimulation. Inflammatory bowel

disorders (IBDs) are a significant group of these illnesses. Based on these

suppositions, this review outlines the state of our understanding on how

differences in the bacterial microbiota's composition in the gut and its

interactions with fungal communities affect the immune system as a whole,

either promoting or inhibiting intestinal inflammation in inflammatory bowel

disease (IBD) patients. Furthermore discussed will be the impact of worm

parasites on the immune system, both directly and indirectly, by their ability to

alter the bacterial and fungal microbiota (Panelli et al, 2020).

Body Mass Index and Parasites

It has long been recognized that intestinal parasite infections and undernutrition

are closely linked. However, little is known about the role of intestinal parasite

infections (IPIs), or parasite clearance, in these processes. The aim of this

scoping review was to summarize published evidence on the association

between IPIs and body composition. PRISMA guidelines, PubMed/MEDLINE,

EMBASE and Cochrane Library databases were searched up until June 2021.

Studies reporting on IPIs in relation to (proxies for) body composition were

eligible. Study quality and risk of bias were assessed using Joanna Briggs

Institute (JBI) critical appraisal tools. Twenty-four studies were included, two

Randomized Control Trials (RCTs) and 22 observational. Most observational

studies showed IPIs to be associated with lower Body Mass Index (BMI) or

being underweight as proxies for body composition. One RCT showed no effect
 18

of antiparasitic treatment on body composition, while the other one showed a

significant post-treatment increase in body fat, as measured by BMI z-scores

and skinfolds. This review lends support to distinct associations between IPIs

and body composition. More longitudinal studies are needed using direct

measures of body composition to investigate whether weight gained after

antiparasitic treatment concerns an increase in body fat or healthy weight gain

( Chen Y., 2022).

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CHAPTER III

METHODOLOGY

This chapter employed a descriptive methodology, utilizing purposive to

gather stool samples from 90 children aged 5–12 in three selected barangays

of Kidapawan City (Houweling et al., 2016). Descriptive methodology was

chosen to provide a comprehensive understanding of the prevalence and

intensity of parasites, allowing for the exploration of socio-demographic factors

(Gizaw et al., 2019). The collected samples will be analyzed using direct fecal

smear and cellulose tape methods, and the prevalence of parasites was

determined through microscopic examination (Chelkeba et al., 2020). Statistical

analysis was employed to assess the effectiveness of deworming program

among children, contributing to evidence-based policies and initiatives (Mishra

et al., 2014). Direct stool examination is the gold standard technique for

diagnosing parasitic infections, including helminths and intestinal protozoa

(Abdel Aziz et al, 2015). Ethical considerations included participant

confidentiality, informed consent, and adherence to safety protocols during

sample collection (World Health Organization, 2020).

This chapter provides an overview of the study's design, research setting,

demographic and sample, data collection instrument, data collection, analytical

techniques, statistical treatment, and ethical considerations.

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Research Design

In this comprehensive study investigating practices and knowledge, a

quantitative experimental descriptive analysis, quantitative methodologies,

offers a robust approach to gain deep insights into individuals' experiences while

also collecting numerical data for statistical analysis. This comprehensive

strategy ensures a more nuanced understanding of the research question, as

quantitative methods capture contextual details and personal perspectives,

while quantitative methods provide broader, quantifiable insights (Creswell et al,

2017).

Utilizing purposive sampling in our study appears appropriate, especially

considering our focus on children. Purposive sampling allows researchers to

deliberately select participants who meet specific criteria, ensuring that the

study focuses on the population of interest. In this case, targeting children aged

5–12 in selected barangays aligns with the objectives of the research, providing

a focused examination of their prevalence and intensity of parasites in relation

to BMI.
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Locale of the Study

Figure 2. Map of Kidapawan City: Poblacion and Barangay Sudapin - Pin Traveler

LCC (2018), "Pin Traveler: Trip Tracker

Map" (Version 3.12.0) [Mobile application].

Figure 3. Map of Kidapawan City: Barangay Nuangan - Google Maps

LCC (2024), “Google Maps - Transit and Foods”

(Version 6.107.3) [Mobile application].

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This research will conduct in Kidapawan City, North Cotabato. To

enhance the objectivity of location selection, the choice of Barangay Nuangan,

Sudapin, and Barangay Poblacion as study areas was based on a systematic

approach. This strategy helps mitigate potential biases and aligns with best

practices in research methodology (Smith et al., 2018). The utilization of a

systematic approach in selecting diverse barangays ensures a more impartial

representation of Kidapawan City's demographic landscape, fostering a

comprehensive analysis of malnutrition factors (Jones, 2020). The selection of

Barangay Nuangan, Sudapin, and Barangay Poblacion aligns with the research

objective of gaining a nuanced understanding of parasitic infection factors

among children. These barangays exhibit variations in socio-economic status,

ensuring a spectrum of economic (Anderson et al., 2019). Additionally,

differences in access to healthcare facilities enable the examination of

healthcare disparities and their potential impact on child nutrition (World Health

Organization, 2020). The diverse community resources in these areas, such as

educational programs or local support systems, offer insights into the resilience

and vulnerabilities that contribute to the overall nutritional landscape (UNICEF,

2018). By exploring these multifaceted aspects, the research aims to provide a

holistic perspective on the effectiveness of deworming programs, recognizing

the unique challenges and opportunities inherent in each selected barangay.

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Research Participants

The study's participants will be dewormed children in Kidapawan City,

North Cotabato, ranging in age from 5 to 12. The researchers will specifically

have a list of the names of children from each barangay in Kidapawan City. The

study's participants will be drawn from Barangays Sudapin, Nuangan, and

Poblacion in Kidapawan City. The number of respondents was based on the

study of Jameel., et al (2017) and was calculated by Raosoft sample size that

was based on the study of Nisha (2020). A total of 90 participants out of the

1000 population, has a 90% confidence level and margin of error of 8%.

For this study, purposive sampling will be used to choose the

respondents. It is referred to as a kind of probability sampling in which the

researchers deliberately choose participants base on specific criteria relevant

to the study's objectives, ensuring a targeted and purposeful selection. Base on

the proportion of malnourished children in each barangay, the researchers will

select the participants. Researchers will examine a property or characteristic of

a particular subgroup using this sampling technique.

Research Instruments

A. Equipment for sample collection

• Mask
 24

• Gloves

• Cellulose scotch tape

• Glass slides

• Tongue depressor

• Stool container

B. Materials for Direct Fecal Smear

• Glass slides

• Cover slip

• Applicator stick

• Lugol’s Iodine

• NSS

C. Materials for identifying the Intestinal Parasite Eggs

• Brightfield Microscope

• “Medical Parasitology in the Philippines” book by Vicente Y.

Belizario Jr, and Winifreda U. de Leon

Data Gathering Procedure

A. Application for approval to Conduct Research

The Researchers will ask permission to conduct a study from the

Kidapawan Doctors College Incorporated – Research and extension

Department (KDCI – RED) and give a letter to the 3 Barangay’s where the
 25

researchers are going to conduct the study. Approval of assigned BHW is

needed to conduct research in their Barangay

B. Sample Collection

The researchers will wear a personal protective gear such as gloves,

headcap and masks. Careful collection and handling of samples will be made

to minimize errors and contamination as well as to protect the health of the

researchers. In sample collection, stool sample and the cellulose scotch tape

method will be used in the three selected Barangays in Kidapawan City.

The researchers will need thirty children for every barangay. A criteria

will be used in choosing the participants, and that is they should have undergone

deworming. In total, the sample that will be obtained in the three Barangays will

be ninety samples for stool examination and another ninety samples using

cellulose/scotch tape method. The researchers will keep the sample in the safe

box and bring it to the laboratory to examine it.

Direct Fecal Smear

Prepare the Stool sample and the materials that needed for smearing.

In a clean slide, put a small amount of the collected fecal sample. Using an

applicator stick spread the sample thinly on the slide, add a drop of NSS to the

smeared sample after that carefully place a cover slip over on the sample and

examine the smeared fecal sample under the microscope.

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Identifying the Intestinal Parasite Eggs

The slides will be examine using Brightfield Microscope. The Intestinal

Parasite that the researchers collected will be microscopically evaluate and will

identifies according to its morphological characteristic. The researchers are the

one who is responsible for the initial identification of the Intestinal Parasite Eggs

will be verifies by a Registered Medical Technologist using the book “Medical

Parasitology in the Philippines” by Vicente Y. Belizario Jr, and Winifreda U. de

Leon as a reference.

90 samples collected from the 3 selected

Barangay in Kidapawan City.

Cellulose Tape Method

Sample labelling
(Time, Date, Place)

Transportation

Direct Fecal Smear

Identification

Verification

Waste Disposal

Figure V. Schematic Diagram of the Study

 27

Data Analysis

Through the use of quantitative experimental descriptive analysis, the

collected data will be examined. In this study, the prevalence rate of parasites

infections, will be measure through the data by crutinizing the stool of the

participants. In order to statistically analyze the data of this, the statistician will

use the Chi-squared to test. Chi-square tests will be used to assess the

prevalence of intestinal parasites in several studies by comparing the observe

result and expected result in our study which can help us better understand and

interpret the relationship of Prevalence of intestinal parasite in malnutrition of

Children in our selected Barangays. In one study conducted in Imo State,

Nigeria, the difference in infection rates between urban and rural schools was

found to be statistically significant using chi-square (x2) test (Kamalu et al,

2013).

Ethical Considerations
 28

Rights to Withdraw of the Participants. The researchers will ensure that

the participants voluntarily participate and that any information given were kept

confidential. Participants were fully informed of what will be asked of them, how

the data will be used, and what were the consequences there could be. The

participants provided explicit, active, and signed consent in taking part in the

research, including understanding their rights to access their information and

the right to withdraw at any point. The informed consent process can be seen

as the contract between the researcher and the participant.

Privacy and Confidentiality. The researchers will adhere to the provisions of RA

10173 or the Data Privacy Act of 2012. In order to avoid leakage of information

about the research participants, the researchers made sure that the information

were kept confidential. The personal information of the participants remained

confidential. The opinions of each respondent were kept confidential by the

researchers. It is vital that the identity of participants is kept confidential or

anonymous, and the assurances extend beyond protecting their names to avoid

using self-identifying statements and information. Anonymity and confidentiality

are essential steps in protecting the participants from potential harm.

Risk and Discomforts. The researchers will conduct the study through face-to-

face. Safety health protocols were followed, such as wearing a facemask and

face shield, one-meter social distancing, and disinfecting participants and

researchers. In line with the discomforts that the respondents may experience
 29

while answering the questionnaires, the researchers' contact information was

made available in the Informed Consent Form for assistance.

Benefits and Privilege. In order to show our gratitude for their cooperation and

involvement in this study, the researchers gave the respondents a token. Since

the respondents voluntarily provide the researchers with their time in exchange

for the data, compensation is not necessary.

 30

REFERENCES

Abdel-Hamid., Abeer, Fathy, Badawy., Ayman, Nabil, Ibrahim. (2015). An

original simple technique for diagnosis of Microsporidia using
glycerol jelly direct smear. Parasitology Research, 114(2):453-456.
doi: 10.1007/S00436-014-4202-4

Ahuja A, Baird S, Hicks JH, et al. Economics of Mass Deworming Programs. In:
Bundy DAP, Silva Nd, Horton S, et al., editors. Child and Adolescent
Health and Development. 3rd edition. Washington (DC): The
International Bank for Reconstruction and Development / The World
Bank; 2017 Nov 20. Chapter 29. Available from:

Al-Halani, Ali, Ahmed, W, Edrees., Lutf, Mohammed, Alrahabi. (2023).

Prevalence of intestinal parasites, malnutrition, anemia and their risk
factors among orphaned children in sana'a city, yemen. Universal journal
of pharmaceutical research, doi: 10.22270/ujpr.v8i2.923

Assemie MA, Alamneh AA, Ketema DB, et al. High burden of undernutrition
among school‐aged children and its determinant factors in Ethiopia; a
systematic review and meta‐analysis. Ital J Pediatr. 2020;46(1):1
14. 10.1186/s13052-020-00881-w

Anderson, R., Garcia, M., & Lee, S. (2019). Healthcare Disparities and
Nutritional Outcomes

Belleza, Maria, Luz, B., Jessa, Louise, C., Cadacio., Maridel, P., Borja., Juan,
Antonio, A., Solon., Mildred, A., Padilla., Pilarita, Tongol-Rivera., Windell,
L., Rivera. (2015). Epidemiologic Study of Blastocystis Infection in an
Urban Community in the Philippines. Journal of Environmental and
Public Health, 2015(4):894297-894297. doi: 10.1155/2015/894297

Bordoloi Manish, Chowdhury Runumi, Barkataki Dipa. (2021). Prevalence of

intestinal parasitic infections among school going children below 12 years of
 31

age in kamrup metro, assam.. Indian journal of applied research, 18-20. doi:
10.36106/IJAR/7100787

Bustos, Angelina R. , Carmelita M. Rebancos, Corazon VC. Barba1, Victorio

B. Molina, Merlyne M. Paunlagui & Nancy A. Tandang, 2021, Environ
mental enteric dysfunction, soil transmitted helminthiasis and stunting
among 36- to 59-month-old children in Quezon Province, Philippines :
https://doi.org/10.31246/mjn-2020-0043

Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S,

Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, de van der Schueren
MA, Singer P. Diagnostic criteria for malnutrition - An ESPEN Consensus
Statement. Clin Nutr. 2015 Jun;34(3):335-40. doi:
10.1016/j.clnu.2015.03.001. Epub 2015 Mar 9. PMID: 25799486.

Candeias., Gabrieli, Maria, Huff., Adriana, Fiorini, Rosado., André, Luis,

Vriesman, Beninca., Laura, Zanella, Souza., Silvia, Cristina, Osaki.,
Nelson, Luis, Mello, Fernandes. (2022). Evaluation of fecal smear
methods for research on Cryptosporidium spp. oocysts in the feces of
dairy calves. 43(2):585-598. doi: 10.5433/1679-0359.2022v43n2p585

Center for Disease Control and Prevention, 2022, About Parasites, https://
www.cdc.gov/parasites/about.html?fbclid=IwAR2LbwHFiiWk3a7r
XOCE gPBC5Mdm0Ufkb_cMb7WSd5_YbS1YQFhf-1Um4z4
Chelkeba L, Mekonnen Z, Alemu Y, Emana D (2020). Epidemiology of intestinal
parasitic in-fections in preschool and school-aged Ethiopian children: a
systematic review and me-ta-analysis. BMC Public Health.
2020;20(1):117. doi:10.1186/s12889-020-8222-y31992252

Chelkeba, L., Mekonnen, Z., & Alemu, Y. (2020).Prevalence of intestinal

parasitic infections and associated risk factors among students at Dona
Berber primary school, Bahir Dar, Ethiopia. BMC Infectious Diseases,
20(1), 1-8.

Chen, Ya-Jun (2022). Association between Intestinal Parasite Infections and

Proxies for Body Composition: A Scoping Review. 10.3390/nu14112229

Clewes Christine A Northrop, Christopher Shaw, 2020, Parasites,

https://doi.org/10.1258/0007142001902897

Crompton & Nesheim (2002) Crompton DW, Nesheim MC. Nutritional impact
of intestinal helminthiasis during the human life cycle. Annual
Review of Nutrition. 2002;22:3559.doi:
10.1146/annurev.nutr.22.120501.134539.
 32

Creswell, J. W., & Creswell, J. D. (2017).Research design: Qualitative,

quantitative, and mixed methods approaches. Sage publications.

Damtie D, Sitotaw B, Menkir S, Kerisew B, Hussien K. Human intestinal

parasitic infections: prevalence and associated risk factors among
elemenary school children in Merawi Town, Northwest Ethiopia. J
Parasitol Res. 2021;2021(1):1‐10. 10.1155/2021/8894089

Debash, Habtu, Megbaru Alemu, and Habtye Bisetegn, 2023, The prevalence
of intestinal parasites, undernutrition and their associated risk factors
among school‐age children in Sekota Town, Northeast Ethiopia:
A community‐based cross‐sectional study, 10.1002/hsr2.1137

Deka S, Barua D, Bahurupi Y, Kalita D. Assessment of the prevalence of

soil- transmitted helminth infections and associated risk factors among
school-aged children in a flood affected area of Northeast India. Am J
Trop Med Hyg. 2021;105:480–9 10.4103/jfmpc.jfmpc_1742_21

Deka, Sangeeta., Deepjyoti, Kalita., Naba, Kumar, Hazarika. (2022).

Prevalence and Risk Factors of Intestinal Parasitic Infection in Under-
Five Children With Malnutrition: A Hospital Based Cross-Sectional Study.
Journal of family medicine and primary care, 11(6):2794-2801. doi:
10.4103/jfmpc.jfmpc_1742_21

Dent AE, Kazura JW. Enterobiasis (Enterobius vermicularis). In: Kliegman RM,
St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson
Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap
320.

Duboscq, Romano & MacIntosh (2019) Duboscq J, Romano V, MacIntosh

AJJ. Social behavior and infectious disease. In: Choe JC, editor. Ency
clopedia of animal behavior. Academic Press; London, UK: 2019. pp.
790– 800.

Dupret S., McGuire J., Dwyer R., and Plant M. (2022). A can of worms: non-
significant effect of deworming on happines in the KLPS. Textbook of
Happier Lives Institute. Retrieved in December 12, 2023.

El-Sherbini & Abosdera (2013) El-Sherbini GT, Abosdera MM. Risk factors
associated with intestinal parasitic infections among children. Journal
of the Egyptian Society of Parasitology. 2013;43:287–
294. 10.12816/0006385
 33

Farrell SH, Coffeng LE, Truscott JE, et al. Investigating the effectiveness
of current and modified World Health Organization guidelines for the
control of soil‐transmitted helminth infections. Clin Infect
Dis.2018;66(4):S253‐ S259 10.1093/cid/ciy002.

Fauziah, N.; Ar-Rizqi, M.A.; Hana, S.; Patahuddin, N.M.; Diptyanusa, A.

Stunting as a Risk Factor of Soil-Transmitted Helminthiasis in
Children: A Literature Review. Interdiscip. Perspect. Infect. Dis. 2022, 2022,
8929025. https://doi.org/10.1155/2022/8929025

Feleke BE. Nutritional status and intestinal parasite in school age children: a
comparative cross‐sectional study. Int J Pediatr. 2016;20(1):16.
10.1155/2016/1962128

Gebretsadik D, Tesfaye M, Adamu A, Zewde G. Prevalence of

intestinal parasitic infection and its associated factors among school
children in Harbu Town, North East Ethiopia. Pediatric Health Med
Ther. 2020;11(1):1‐9. 10.2147/PHMT.S252061

Gizaw Z, Addisu A, Dagne H. Effects of water, sanitation and hygiene

(WASH) education on childhood itestinal parasitic infections in rural

Dembiya, northwest Ethiopia: an uncontrolled before-and-after
intervention study. Environ Health Prev Med. 2019;24(1):16.
doi:10.1186/s12199-019-0774-z30851729

Garcia, Lynn, Arrowood, Michael* Evelyne Kokoskin,cc. a. (Published

online 2017 Nov 15). Practical Guidance for Clinical
Microbiology Laboratories: Laboratory Diagnosis of Parasites from the
Gastrointestinal Tract. Clinical Microbiology reviews.
doi:10.1128/CMR.00025-17

Glynn, Judith., Moss, Paul. (2020). Systematic analysis of infectious disease

outcomes by age shows lowest severity in school-age children.. Scientific
Data, 7(1):329-329. doi: 10.1038/S41597-020-00668-Y

Gustafsson Sendén, M. (2017b). Hen: Bakgrund, attityderoch användande

[Hen: Background, attitudes and use]. Psykologiska rapporter från Lund,
8(1),1–34.Retreived from https://www.psy.lu.se/sites/psy.lu.se/files/
plr_1801.pdf

Gutierrez-Jimenez1, M. G.-S.-M.-G.-C.-E.-F. (2013). Malnutrition and the

presence of intestinal parasites in children. 741-747.
doi:10.3855/jidc.2990
 34

Gizaw, Z., Adane, T., Azanaw, J., & Addisu, A. (2019).Childhood intestinal
parasitic infection and sanitation predictors in rural Dembiya, northwest
Ethiopia. Environmental Health and Preventive Medicine, 24(1), 1-9.

Hajare, Sunil Tulshiram, Robe Kuti Gobena, Nitin Mahendra Chauhan, Feleke
Eriso, "Prevalence of Intestinal Parasite Infections and Their
Associated Factors among Food Handlers Working in Selected
Catering Esta blishments from Bule Hora, Ethiopia",
BioMed Research International, vol. 2021, Article ID 6669742,
15 pages, 2021. https://doi.org/ 10.1155/2021/6669742

Hotez PJ, Brindley PJ, Bethony J, King CH, Pearce EJ, Jacobson J. Helminth
infections: the great neglected tropical diseases. J Clin Invest.
2008; 118(4):1311–1321. 10.1172/JCI34261 10.1172/JCI34261

Houweling TA, Karim-Kos HE, Kulik MC, et al (2016) Socioeconomiinequalities

in neglected tropical diseases: a systematic review. PLoS Negl Trop Dis.
2016;10(5):e0004546. doi: 10.1371/journal.pntd.000454627171166

Houweling, T. A., Kunst, A. E., & Mackenbach, J. P. (2016).Measuring health

inequality among children in developing countries: does the choice of the
indicator of economic status matter? International Journal for Equity in
Health, 15(1), 1-10.

Johnson, R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A

research paradigm whose time has come. Educational Researcher,
33(7), 14-26.

Jones, K. (2020). Exploring Multifaceted Factors Contributing to Childhood

Malnutrition: A Barangay-level Analysis.

Kamalu.,Nkiru,. Felicia, E., Uwakwe., Jacinta, A., Opara. (2013). Prevalence of

Intestinal Parasite Among High School Students in Nigeria. Academic
Journal of Interdisciplinary Studies, 2(7):9-.

Karki, S., et al. (2021). Risk Factors of Malnutrition among under Five Children
Admitted in Kanti Children's Hospital in Nepal. Kathmandu University
Medical Journal (KUMJ).

Kesete, Yafet., Huruy, Tesfahiwet., Ghimja, Fessehaye., Ghimja, Fessehaye.,

Yohana, Kidane., Yafet, Tekle., Asmerom, Yacob., Biemnet, Seltene.
(2020). Assessment of Prevalence and Risk Factors for Intestinal
Parasitosis, Malnutrition, and Anemia among School Children in Ghindae
Area, Eritrea.Journal of Tropical Medicine, 2020:4230260-4230260. doi:
10.1155/2020/4230260
 35

Liese B, Rosenberg M, Schratz A. Programmes, partnerships and governance

for elimination and control of neglected tropical diseases. Lancet. 2010;
375(9708): 67–76. 10.1016/S0140-6736(09)61749-9 10.1016/S0140-
6736(09)61749-9

Lirio., Gary, Antonio, C., Ryan, V, Labana., Iris, Rowena, A., Bernardo.,
Racidon, P., Bernarte., Julieta, Z., Dungca., Veeranoot, Nissapatorn.
(2018). Survey of Intestinal Parasites Including Associated Risk Factors
Among Food Vendors and Slaughterhouse Workers in Metro Manila,
Philippines. KnE Social Sciences, 3(6):493-505. doi:
10.18502/KSS.V3I6.2400

Marques, R.C.; Dórea, J.G.; Bernardi, J.V.E.; Bastos, W.R.; Malm, O.

Maternal fish consumption in the nutrition transition of the Amazon
Basin: Growth of exlusively breastfed infants during the first 5
years. Ann. Hum. Biol. , 35, 363–377
https://doi.org/10.1080/03014460802102495

Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, et
al. (2021) Soil-transmitted helminth infections and nutritional
indices among Filipino schoolchildren. PLoS Negl Trop Dis
15(12): e0010008.
https://doi.org/10.1371/journal.pntd.0010008

Mationg MLS, Williams GM, Tallo VL, et al. The Magic Glasses Philippines”: a
cluster randomised controlled trial of a health education package for the
prevention of intestinal worm infections in schoolchildren. Lancet Reg
Health - West Pac. 2021;18(100312):1–16
10.1016/j.lanwpc.2022.100597

McGuire S, FAO, IFAD, and WFP . The state of food insecurity in the world
2015: FAO, 2015. Advances in Nutrition. 2015;6(5):3‐4.
10.3945/an.115.009936

Mesquita, João, R., Fernando, Esteves., Carla, Santos., C, Mega., Catarina,

Coelho., Rita, Cruz., Helena, Vala., Helena, Vala., Carmen,
Vasconcelos-Nóbrega. (2017). ABC series on diagnostic parasitology
part 1: the Willis method. The Veterinary Nurse, 8(7):398-402. doi:
10.12968/VETN.2017.8.7.398

Mejia R, Weatherhead J, Hotez PJ. Intestinal nematodes (roundworms). In:

Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's
Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA:
Elsevier; 2020:chap 286.

Mishra. Kritika, Freeda, Maharjan., Reshma, Chitrakar., Nikita, Chhetri.,

 36

Monica, Shrestha., Richa, Chaudhary., Shashi, Bhushan, Chaturwedi.

(2020). Incidence of Intestinal Parasites in Government and Private
School Going Children. 7:62-66. doi: 10.3126/TUJM.V7I0.33798

Mishra, P., Palma, M., Bleich, D. et al.(2014) Systemic impact of intestinal

helminth infections. Mucosal Immunol 7, 753–762 (2014).
https://doi.org/10.1038/mi.2014.23

Mishra, S., Patro, R. K., & Swain, B. K. (2014). Effect of parasitic infections on
nutritional status of tribal preschool children of Vizianagaram district of
Andhra Pradesh. Journal of Tropical Pediatrics, 60(1), 69-76
.
M Norhayati, PhD, M S Fatmah, Dip Med Tech, S Yusof, Dip Med Tech, A B
Edariah, MPHTM (2014). Intestinal Parasitic Infections in Man: A Review.
https://www.e-mjm.org/2003/v58n2/Intestinal_Parasitic_Infections.pdf

Olds, Richard, MD, MACP, (2013). Deworming the World. 23874034

Onyemelukwe. N., F., Maduakor., U., C., Uchenna.,C., A., Okongwu., U.C.,
(2021). Prevalence of Intestinal Parasites among the Malnourished
Children in Enugu, Nigeria. Annual research & review in biology, 38-46.
doi: 10.9734/ARRB/2021/V36I730397

Panelli Simona, Sara Epis, Lucia Cococcioni , Matteo Perini , Moira Paroni,
Claudio Bandi , Lorenzo Drago , Gian Vincenzo Zuccotti., (2020)
Inflammatory bowel diseases, the hygiene hypothesis and the other side
of the microbiota: Parasites and fungi.
https://doi.org/10.1016/j.phrs.2020.104962

Paula C. Hernández ,Liliana Morales, Jacqueline Chaparro-Olaya, Diana

Sarmiento, Juan Felipe Jaramillo, Gustavo A. Ordoñez, Fabian Cortés,
Lizeth K. Sánchez, 2019Intestinal parasitic infections and associated
factors in children of three rural schools in Colombia. A cross-sectional
study (2019). https://doi.org/10.1371/journal.pone.0218681

Papier, Keren G. M.-C. (2014). Childhood Malnutrition and Parasitic Helminth

Interactions . Clinical Infectious Diseases, Volume 59, 234–243.

Pedro P. Chieffi, 2020, Assessment of Prevalence and Risk Factors for

Intestinal Parasitosis, Malnutrition, and Anemia among School
Children in Ghindae Area, Eritrea
https://www.hindawi.com/journals/jtm/2020/4230260

Prevention, C. f. (2019). Enterobiasis. DPDx - Laboratory Identification

of Parasites of Public Health Concern. Retrieved
from https://www.cdc.gov/dpdx/enterobiasis/index.html
 37

Raga, Antonio, Mercedes Fernández, Juan A. Balbuena, F. Javier Aznar,

2016, https://doi.org/10.1016/B978-0-12-373553-9.00193-0

Rajoo Yamuna ,Stephen Ambu, Yvonne Ai Lian Lim ,Siew Chang

Tey Chan Woon Lu,and Romano Ngui, 2017, Neglected Intestinal
Para sites, Malnutrition and Associated Key Factors: A Population
Based Cross-Sectional Study among Indigenous Communities in
Sarawak, Malaysia, 10.1371/journal.pone.0170174

Rehman, ur Sijad., Bilal, Noor., Muhammad, Ishaq., K., Ullah., Gul-e, Lala.,
Romana, Bibi. (2022). Infection of the Urinary Tract and its Prevalence
Among Children Presenting with Malnutrition. Pakistan Journal of
Medical and Health Sciences, 16(4):857-860. doi:
10.53350/pjmhs22164857

Ross, Allen G. K. P.-C.-K. (2017, September 21). Poverty, Dietary Intake,

Intestinal Parasites, and Nutritional Status among School-Age Children
in the Rural Philippines. Trop. Med. Infect. Dis. Retrieved from
https://www.mdpi.com/2414-6366/2/4/49

Smith, J., Brown, A., & Johnson, L. (2018). Evaluating Socio-economic

Disparities and Healthcare Accessibility in Diverse Barangays:
Implications for Child Malnutrition.

Simona Panelli, Sara Epis, Lucia Cococcioni, Matteo Perini , Moira

Paroni , Cl audio Bandi , Lorenzo Drago , Gian Vincenzo
Zuccotti, 2020, Inflam ma tory bowel diseases, the hygiene
hypothesis and the other side of the microbiota: Parasites and fungi,
https://doi.org/10.1016/j.phrs.2020.104962

Sitotaw, B., Mekuriaw, H. & Damtie, D. Prevalence of intestinal parasitic

infections and associated risk factors among Jawi primary school
children, Jawi town, north-west Ethiopia. BMC Infect Dis 19, 341 (2019).
https://doi.org/10.1186/s12879-019-3971-x

Stetter N, Hartmann W, Brunn ML, Stanelle-Bertram S, Gabriel G, Breloer M. A

Combination of Deworming and Prime-Boost Vaccination Regimen
Restores Efficacy of Vaccination Against Influenza in Helminth-Infected
Mice. Front Immunol. 2021 Dec 21;12:784141. doi:
10.3389/fimmu.2021.784141. PMID: 34992602; PMCID: PMC8724120.

Sunil Tulshiram Hajare, Robe Kuti Gobena, Nitin Mahendra Chauhan, Feleke
Eriso, "Prevalence of Intestinal Parasite Infections and Their Associated
Factors among Food Handlers Working in Selected Catering
Establishments from Bule Hora, Ethiopia", BioMed Research
 38

International, vol. 2021, Article ID 6669742, 15 pages, 2021.

https://doi.org/10.1155/2021/6669742

Tania A. Thomas, M. M. (2010, November 8). Malnutrition and Helminth

Infection . doi: 10.1542/peds.2010-0885

Tankeshwar, A. (2022). Cellophane (Scotch) Tape Preparation for Pinworm

Examination. Cellophane (Scotch) Tape Preparation for Pinworm
Examination.

Tashakkori, A., & Teddlie, C. (2010).Sage handbook of mixed methods in

social & behavioral research.Sage.

Teshale, T., Belay, S., Tadesse, D. et al. Prevalence of intestinal helminths

and associated factors among school children of Medebay Zana
wereda; North Western Tigray, Ethiopia 2017. BMC Res Notes 11, 444
(2018). https://doi.org/10.1186/s13104-018-3556-6

UNICEF. (2018). Community Resources and Vulnerabilities: Understanding

Nutritional Landscapes
in Cities.
World Health Organization, (2020). Malnutrition.Liam Reilly, Norman Nausch,
Nicholas Midzi, Takafira Mduluza, Francisca Mutapi, "Association
between Micronutrients (Vitamin A, D, Iron) and Schistosome-Specific
Cytokine Responses in Zimbabweans Ex posed to Schistosoma
haematobium", Journal of Parasitology Research, vol. 2012, Article ID
128628, 9 pag-es, 2012. https://doi.org/0.1155/2012/128628Bäck, E. A.,
Lindqvist

WHO. Nutrition for health and development. A global agenda for combating
malnutrition. Progress Report. Geneva: World Health Organization.
2013

World Health Organization, (2020).Malnutrition.https://www.who.int/news-

room/questions-and answers

World Health Organization, (2023). Deworming in children.

https://www.who.int/tools/elena/interventions/deworming?fbclid=IwAR3
8EjuaYXmomnYeI6KNlOrdXriYlu1L3tZgWH2a32o-
1rnHFYY0maGMZ8w

World Health Organization. Worldwide prevalence of anaemia WHO

global database on anaemia. 2015.

World Health Organization. (2020). Ethical considerations in biomedical HIV

prevention trials (No. WHO/HIV/2007.02). World Health Organization.
 39

World Health Organization. (2020). Urban level Healthcare Disparities and Child
Malnutrition