Relationship between high rates of intestinal parasitic infections and knowledge, attitudes, and practices of Ndelele Health District populations (East Region, Cameroon): a cross-sectional mixed approach

BackgroundIntestinal parasitic infections remain of public health concern worldwide, especially among rural and poorest populations as a consequence of precariousness, lack of sanitation, non-availability of potable water and poor hygiene conditions. The present study aimed to better understand the epidemiology of intestinal parasitic infections in rural areas of forested Cameroon. MethodologyA cross-sectional survey was conducted in three Health Areas (Ndelele, Kentzou and Lolo) of the Ndelele Health District (East Region, Cameroon). Information on socio-demographic characteristics, knowledge, attitudes, and practices regarding intestinal parasitic infections were collected using a semi-structured questionnaire. Stool samples were collected and analyzed by the Kato-Katz and formalin-ether concentration techniques to complement simple direct examination. Principal FindingsA total of 406 individuals belonging to three main groups (Kako or Bantu, Baka or Pygmies and Central African Republic refugees) were enrolled in the study. The overall intestinal parasitic infection rate was 74.9%, including 57.2% cases of polyparasitism. Fourteen parasite species were identified, 89.1% being intestinal protozoa and 41.8% belonging to helminths. Infections with helminths were associated with Baka (P < 0.0001). Spring water consumption was associated with hookworm infection (OR = 3.87; P = 0.008). Garbage deposited near houses was positively associated with infection with Giardia lamblia (OR = 3.41; P = 0.003). Polyparasitism was positively linked to washing hand without soap before meal (OR= 11.64; p= 0.002). Conclusion/SignificanceIntestinal parasitic infections exhibited high rates in the Ndelele Health District, especially among indigenous and hard-to-reach populations (Pygmies). Hygiene measures appear as the main drivers sustaining transmission, and targeted strategies should be developed to efficiently fight against these debilitating diseases. Author summaryIntestinal parasitic infections such as soil transmitted helminthiasis and schistosomiasis, remain a public health concern in Cameroon. To better understand the epidemiology of these infections in hard-to-reach populations in rural areas, a cross-sectional study was carried out in three health areas of Ndelele health District in the Eastern-Cameroon. The rate of intestinal parasitic infections was high (74.9%) especially in indigenous populations (Baka-Pygmies) which exhibited high prevalence of soil transmitted helminth infections (83.3%). The study confirmed that the lack of sanitation and poor hygiene largely contribute to the endemicity of intestinal parasitic infections, particularly among indigenous populations. Targeted control strategies seem mandatory to reach these populations and offer them appropriate care to interrupt or reduce the transmission of these diseases.