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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 77-85

Prevalence and associated risk factors of intestinal parasitic infections among school children in Bamo no. 2 primary school, Adele town, East Arsi, Ethiopia


Hawassa University, College of Natural and Computational Science, Department of Biology, Hawassa, Ethiopia

Date of Web Publication04-Nov-2019

Correspondence Address:
Beyene Dobo
Hawassa University, College of Natural and Computational Science, Department of Biology, P. O. Box: 05, Hawassa
Ethiopia
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DOI: 10.4103/ssajm.ssajm_36_18

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  Abstract 


Introduction: Intestinal parasitic infection (IPI) is one of the major and serious medical and public health problems in developing countries including Ethiopia. Effective prevention and control of IPIs require the identification of local risk factors, particularly among school children. Objective: This article assesses the prevalence of IPIs and associated risk factors among school children in Bamo no. 2 primary school in Adele town, East Arsi in southeast Ethiopia. Materials and Methods: Study participants were selected by using multistage sampling technique. A total of 417 school children were enroled in Bamo no. 2 primary school in Adele town, East Arsi. Structured questionnaires were used to identify environmental, sociodemographic, and behavioral factors. Stool specimens were collected and examined for parasites using direct smear and formal–ether concentration technique. Data were analyzed using SPSS Version 20. A bivariate and multivariate logistic regression analysis was done. P value less than 0.05 was considered as statistically significant. Results: The overall prevalence of IPIs in the present study was 113/417 (27.1%), for at least one intestinal parasite. A total of six parasites were detected; the most prevalent were Ascaris lumbricoides [50 (12.00%)], Entamoeba histolytica/dispar [43 (10.3)], Trichuris trichiura [35 (8.4%)], Giardia lamblia [31 (7.4%)], Hymenolepsis nana [13 (3.1%)], and Teania saginata [12 (2.9%)]. In addition to these, single [49 (15.45%)] and multiple [64 (20.18%)] infections were identified. In this study, the most significantly associated risk factors for the occurrence of IPIs were grade level, water type used, hand washing habit before meal and after defecation, defecation habit, and eating unwashed/uncooked vegetable (P < 0.05). Conclusion: Intestinal parasites were prevalent in varying magnitude among the school children. Therefore, the Woreda health office, school community, and nongovernmental organizations need to give education on personal hygiene and environmental sanitation, and treatment should be taken into account to reduce the prevalence of IPIs.

Keywords: Adele town, associated risk factors, intestinal parasitic infections, prevalence school children


How to cite this article:
Tadesse M, Dobo B, Birmeka M. Prevalence and associated risk factors of intestinal parasitic infections among school children in Bamo no. 2 primary school, Adele town, East Arsi, Ethiopia. Sub-Saharan Afr J Med 2019;6:77-85

How to cite this URL:
Tadesse M, Dobo B, Birmeka M. Prevalence and associated risk factors of intestinal parasitic infections among school children in Bamo no. 2 primary school, Adele town, East Arsi, Ethiopia. Sub-Saharan Afr J Med [serial online] 2019 [cited 2019 Nov 17];6:77-85. Available from: http://www.ssajm.org/text.asp?2019/6/2/77/270249




  Introduction Top


Intestinal parasitic infection (IPI) is one of the major and serious medical and public health problems in developing countries. Globally, 2 billion individuals are infected with IPI; out of these, majorities were children in resource-poor settings.[1] Intestinal parasites are widely distributed in sub-Saharan Africa including Ethiopia largely due to the lower socioeconomic status, poor environments and personal hygiene, poor nutrition, and low literacy rate; overcrowding and climatic conditions that favor the development and survival of these parasites are some of the factors contributing to the high prevalence of intestinal parasitic inflection (IPI).[2],[15]

The most common IPIs include worms and protozoa infections. Frequent intestinal helminthes in tropical areas include soil-transmitted nematodes namely round worm (Ascaris lumbricoides), whipworms (Trichuris trichiura), hookworms (Necator americanus/Ancylostoma duodenale), tapeworms such as Taenia spp. And Hymenolepis spp. And flukes.

Parasitic infections caused by intestinal helminthes and protozoan parasites are among the most prevalent infections in humans in developing countries and cause significant morbidity and mortality, iron deficiency anemia, growth retardation in children, and other physical and mental health problems in endemic countries.[3]

IPIs are highly prevalent health problem among school children. One of the risk factors for the prevalence of intestinal parasite was hand washing habit before meals and after defecations.[23] Factors like low socioeconomic status and low hygienic habits such as lack of hand washing after defecation and eating improperly washed vegetables were significantly associated with IPI in the school children, in particular, and the community, in general.[4]

IPIs were a common health problem with varying magnitude among the school children.[5] School children carry the heaviest burden of the associated morbidity,[6] due to their dirty habits of playing or handling of infested soils, eating with soiled hands, unhygienic toilet practices, and drinking and eating of contaminated water and food,[7] respectively. Besides causing morbidity and mortality, infection with intestinal parasites have been associated with stunting, physical weakness, and low educational performance of school children.[1]

The distribution and prevalence of various species of intestinal parasites differ from region to region because of several environmental, social and geographical, and other factors mentioned above. Hence, study on the prevalence of various IPIs is a prerequisite not only for formulation of appropriate control strategies but also to predict risk for communities under consideration.[8] Thus, the objective of this study was to assess the current epidemiological prevalence of intestinal parasites and the associated risk factors favoring the spread of parasites.


  Materials and methods Top


Description of the study area

Adele town is located in Oromia regional state, Arsi Administrative zone, Amigna District at a distance of 263 km from Addis Ababa and 134 km from Assela (zonal capital). The climate in Adele town has an annual average temperature ranging from 10°C to 25°C and annual rainfall of approximately 500 to 900 mm. The area has altitudinal ranges of 900 to 2536 m above sea level. According to municipal office records, in 2016, total population in Adele was 9408. Of the total population, 4551 were males and 4857 females, of which those less than 5 years of age were 663, 6 to 15 years of age were 1505, 16 to 35 years of age were 3562, 36 to 65 years of age were 2945, and greater than 65 years of age were 736. Adele town has three primary schools, one secondary school, and one preparatory school. It has one health center and four clinics.

Study design and period

School-based cross-sectional study was conducted among children of the Adele town primary schools (grades 1–8) from February to March in 2017.

Population

Source of population

The study population was randomly selected Bamo no. 2 primary school children in Adele town.

Study population

The study participants were randomly selected Bamo no. 2 primary school children in Adele town. According to the data obtained from Bamo no. 2 primary school of Adele town, the total number of students from grade 1 to grade 8 who were enroled in the 2016/2017 academic year were 1002; of these, 492 and 510 were males and females, respectively. These constituted the study population of the present study.

Sample size determination and sampling technique

Sample size determination

The sample size was estimated using the following statistical formula[9]:

n = t2 × P (1−P)/m2

where n = sample required

t = 95% confidence interval (1.96)

m = margin of error (5%) (standard value of 0.05)

P = Estimated prevalence rate

Since the overall prevalence rate (P) of intestinal parasites is not known, for the study, area prevalence was taken as 50%. Hence, the required sample size was 384 to minimize errors arising from the likelihood of noncompliance, 10% of the sample size; 38 was added giving a final sample size of 422.

Sampling technique

One elementary school was selected from the three schools found in Adele town by simple random sampling technique. To select the study participants, the students were first stratified according to their educational level (grades 1–8) and allocation of student were done proportional to the number of students in each grade level. Finally, the study participants were selected using systematic random sampling by using class roster as the sampling frame.

Method of data collection

Questionnaire survey

Data about the sociodemographics such as sex, age, grade level, and risk factors were collected using structured questionnaire. The questionnaire was prepared in English and translated into local language, Afan Oromo. Then the questionnaire was translated back to English.

Stool sample collection and parasitological examination

After proper instruction, the students were given the labeled collection cups and applicator sticks and from each student about 2 g of fresh stool was collected. At the time of collection, the name of the participant, sex, age, and date of sampling were recorded for each participant on recording format. Stool examinations were done by laboratory technicians using direct technique (saline and iodine mounts) and formal–ether concentration technique to identify and detect each stage of intestinal parasites such as cyst, trophozoites, ova, and larvae under microscope.[10]

Method of data analysis

The data were computerized using Excel 2007, cleaned, and checked against original document before analysis. All statistical analyses were performed using SPSS software package (version 20.0) statistical package. Descriptive statistics were used to assess the prevalence and distribution of intestinal parasites. Logistic regression analysis was performed to determine the independent effect of the independent variables with dependent variable by calculating the strength of the association between IPI and associate factors. Bivariate and multivariate analyses were conducted and crude and adjusted odds ratio 95% confidence interval were calculated for statistical significance tests. Variables with significance at P < 0.05 in a bivariate analysis were candidate for multivariate analysis through multiple logistic regression. P value of <0.05 was considered as statistically significant.

Quality control

To ensure data quality control, all the laboratory procedures including collection and handling of specimens were carried out in accordance with standard protocols.[11] All the reagents were checked for contamination each time they were used. To ensure general safety, disposable gloves were worn and universal biosafety precautions were followed at all times.[12] All clinical procedures such as stool sample collection and laboratory parasitological examination were done by senior laboratory technicians from Adele Health Center.

Ethical considerations

Official letter of cooperation was written to all responsible bodies by the Biology Department, College of Natural and Computational Sciences, Hawassa University. Permission to conduct this study was sought from Amigna Woreda Education Office. Permission was also obtained from Adele health office before the study was conducted. The purpose of the study was explained to the school principal, other concerned authorities, and students. The participants were allowed to reconsider their participation and given the opportunity to withdraw from the study at any point in the course of the study period if they wish to do so. Additionally, confidentiality of all the information was assured. Finally, informed verbal consent was obtained from parents of the selected study children.


  Results Top


Sociodemographic characteristics of the study participants

A total of 422 school children were sampled from grades 1 to 8 in this study. Of these, 417 (98.8) responded positively for IPI examination by providing fresh stool samples and complete information. Two samples were discarded due to insufficiency of the amount of sample for examination and three students were dropout from the class. The proportion of male and female participants was nearly equal to 213 (51.1%) and 204 (48.9%), respectively. The age of study participants ranged from 6 to 16 years. Students were grouped into three age groups: 6 to 9-year-old students were 139 (33.3%), 10 to 14-year-old were 168 (40.3%), and 14 to 16-year-old were 110 (26.4%). Students were further grouped into two grade levels: grades 1 to 4, 232 (55.6%) and grades 5 to 8, 185 (44.4%) [Table 1].
Table 1 Sociodemographic characteristics among school children of Bamo no. 2 primary school in Adele town

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As [Table 1] showed, 334 (80.1%) of the study participants were from urban (Adele town) whereas the remaining 83 (19.9%) were from the rural areas. With regard to mothers’ educational status, illiterate were 136 (32.6%), primary education 126 (30.2%), secondary education 57 (13.7%), and above secondary were 98 (23.5%). Fathers’ educational status also showed illiterate to be 88 (21.1%), primary education 119 (28.5%), secondary education 113 (27.1%), and above secondary 97 (23.3%). Concerning the occupation of the students’ fathers, 129 (30.80%) were farmers, and the remaining 89 (21.3%), 111 (26.6%), and 89 (21.3%) were private workers, merchants, and civil servant, respectively. Occupation of the students’ mothers were as follows: housewives 173 (41.5%), private workers 101 (24.2%), merchants 81 (9.4%), and civil servants 62 (14.9%). Those with family size of ≤5 were 118 (28.3%) and >5 were 299 (71.7%) [Table 1].

Socioeconomic and sanitary habits of the study participants

The result showed that 156 (37.4) of the study participants were using protected water for drinking purpose; 261 (62.6%) of the study participants were using unprotected water. With regard to hand washing habit before eating, 224 (53.7%) children washed their hands before eating and 193 (46.3%) children did not wash their hands before eating. Furthermore, 280 (67.1%) of the study participants defecated in latrine, whereas the remaining 137 (32.9%) defecated in the open field [Table 2].
Table 2 Socioeconomic and sanitary habits among school children of Bamo no. 2 primary school

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Majority of the study participants [228 (54.7%)] did not wash their hands after toilet. Only 189 (45.3%) study participants washed their hands after toilet. Regarding eating unwashed fruits and vegetables, 137 (32.9) children ate unwashed fruits and vegetables whereas 280 (67.1%) study participants did not ate unwashed fruits and vegetables [Table 2].

As shown in [Table 2], 202 (48.4%) participants ate uncooked vegetables. The remaining 215 (51.6%) ate cooked vegetables. Furthermore, 307 (73.6%) of the study participants did not deworm in the previous 3 months and the other 110 (26.4%) study participants were dewormed.

Prevalence of intestinal parasites in Bamo no. 2 primary school children in Adele town, East Arsi, Ethiopia

Among 417 school children whose stool samples were examined, 113 (27.1%) were infected with at least one intestinal parasite. The major helminthes identified were A. lumbricoides [50 (12.00%)], T. trichiura [35 (8.4%)], Hymenolepsis nana [13 (3.1%)], and Teania saginata [12 (2.9%)]. On the other hand, the prevalence of protozoan identified were Entamoeba histolytica/dispar [43 (10.3%)] and Giardia lamblia [31 (7.4%)]. Moreover, 49 (15.45%) had single infection and 64 (20.18%) had multiple infections. Total prevalence of helminthic and protozoan infections were 110 (26.4%) and 74 (17.7%), respectively [Table 3].
Table 3 Prevalence of intestinal parasites in Bamo no. 2 primary school children

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Factors associated with IPI

Associated risk factors for IPIs were identified by bivariate followed by multivariate logistic analysis. Among the potential risk factors assessed using bivariate logistic regression analysis, grade level, residence, family size, water type used, hand washing before eating, defecation habit, hand washing habit after toilet, eating unwashed fruits and vegetables, eating uncooked vegetables, and dewormed in the previous 3 months were associated with IPI at P value less than 0.05 [Table 4].
Table 4 Univariate and multivariate analyses of some risk factors for IPI prevalence among school children of Bamo no. 2 primary school children

Click here to view


Finally, those variables were entered for multivariate analysis. After adjustment, grade level, water type used, washing hands before eating, defecation habit, washing hands after toilet, habit of eating unwashed fruits, and eating uncooked vegetables were significantly associated with intestinal parasite prevalence at P value <0.05. Accordingly, school children of grades 1 to 4 were two times more likely to be infected with IPI as compared to school children of grades 5 to 8. School children who did not consume protected water were three times more likely to be infected with IPI. School children who did not wash hands before eating were 3.18 times more likely to be infected with IPI. Similarly, school children who had habit of eating unwashed fruits and vegetables were 3.13 times more likely to acquire IPI as compared to those who did not eat. School children who defecate in open fields were 6.45 times more likely to be infected with IPI as compared to school children who use latrine. School children who had habit of eating uncooked vegetables were 3.26 times more likely to acquire IPI. Moreover, school children who washed hands after defecation were less likely to be infected with IPI. This means, washing hands habit after defecation was found to be protective from IPI and it revealed reduction by 92% from IPI [Table 4].

Factors associated with A. lumbricoides

In univariate analysis, grade level, washing hands before eating, defecation habit, washing hands after toilet, and habit of eating unwashed fruits and uncooked vegetable were associated with A. lumbricoides (P < 0.05).

By controlling confounder in multivariate logistic regression (P value <0.05), washing hands before eating, washing hands after toilet, and habit of eating unwashed fruits and uncooked vegetables were significantly associated with A. lumbricoides.

Children who did not wash their hands before eating were four times more likely to acquire A. lumbricoides than children who wash their hands before eating regularly. Moreover, children who washed their hands after toilet were protected from A. lumbricoides by 95% [Table 5].
Table 5 Univariate and multivariate analyses of some risk factors associated with Ascaris lumbricoids/dispar among the school children of Bamo no. 2 primary school in Adele town

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Children who had habit of eating unwashed fruits and vegetables were 2.45 times more infected with A. lumbricoides compared with those without such habits. Similarly, children who had habit of eating uncooked vegetables were five times more likely to acquire A. lumbricoids than those who had not the habit of eating uncooked vegetables [Table 5].

Factors associated with E. histolytica/dispar

Among the potential risk factors explored using univariate analysis, family size, water type used, washing hands before eating, defecation habit, washing hands after toilet, and deworming in the last 3 months were associated with E. histolytica/dispar (P value 0.025) prevalence [Table 6].
Table 6 Univariate and multivariate analyses of some risk factors associated with Entamoeba histolytica among the school children of Bamo no. 2 primary school in Adele town

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After adjustment, water type used, defecation habit, washing hands after toilet, and deworming were significantly associated with E. histolytica (P < 0.05) prevalence. Students who drink unprotected water were five times more likely to acquire IPI as compared to those who drink protected (pipe water) water. In addition, school children who did not use latrine or use open field for defecation had five times higher odds of being infected with E. histolytica compared to children who had used toilet for defecation.

School children who did not wash hands after defecation were 6.16 times more likely to be infected with E. histolytica. Similarly, school children who had not a habit of deworming were 9.15 times more likely to be infected with E. histolytica/dispar as compared to school children dewormed regularly [Table 6].

Factors associated with T. trichiura infections

Analyses of the risk factors in univariate for the association of T. trichiura infections revealed water type, washing hands before eating, defecation habit, washing hands after defecation, habit of eating unwashed fruits, and habit of eating uncooked vegetable were associated with intestinal T. trichiura at P value <0.25 [Table 7].
Table 7 Univariate and multivariate analyses of some risk factors associated with Trichuris trichiura among the school children of Bamo no. 2 primary school in Adele town

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In multivariate logistic regression (P value 0.05), washing hands before eating, defecation habit, and habit of eating unwashed vegetables were significantly associated with intestinal T. trichiura prevalence. Washing hands before eating and latrine availability were protective from T. trichiura infection. Washing hands before eating was found to be protective by 80% from T. trichiura infection. Availability of latrine was found to be protective from T. trichiura infection and it showed reduction by 83% [Table 7].


  Discussion Top


The present study attempted to assess the prevalence and associated risk factor for IPIs among school children in Bamo no. 2 primary school, Adele town, East Arsi, Ethiopia. In line with this view, the overall prevalence of IPI was found to be (27.1%). This is almost similar with the study conducted in Babile town, eastern Ethiopia, that reported a prevalence of 27.25%.[7] Arbaminch town in southern Ethiopia[5] also reported about 27.7%. This similarity might be due to the same socioeconomic conditions, the methods employed for stool examination, and the sample size taken. Still, this result was higher than the results from northwest Ethiopia, 16.6% reported by Gebreslassie et al.[13] The studies in other parts of the country also recorded occurrence of IPIs to be about 9.7%.[14]

The observed prevalence of intestinal parasites in this study was lower compared with the reports in other similar studies, 35.44% in Homesha Woreda northwest Ethiopia[15]; 44.4% in Aksum town, northern Ethiopia, eastern Wellega[4]; 79.8% in Delgi School children, north Gonder[16]; and 84.3% in Debre Elias primary schools, east Gojjam zone. The contradictory reports on the prevalence of IPI could be due to variation in geography, socioeconomic conditions, the category of the study population, the methods employed for stool examination, and the time of study.

Among the 317 school children who participated in the current study, 49 (15.45%) of the children had single infection, whereas 64 (20.18%) had multiple infections.

In the present study, identified predominant helminthic intestinal parasites were A. lumbricoides (12.00%), followed by T. trichiura (8.4%), H. nana (3.1%), and T. saginata (2.9%). The prevalence rate of A. lumbricoides (12.00%) is similar or comparable to studies conducted in Ethiopia: Welayta zone southern Ethiopia (12.3%), west Hararghe (11.1%), and Arba Minch Town, southern Ethiopia (10.6%).[5],[17],[18] However, the prevalence rate of A. lumbricoides (12.00%) was found to be higher than studies conducted in Babile town, eastern Ethiopia (4.3%); in Adwa town, northern Ethiopia (6.4%)[5],[19]; and other country among school-going children in Kathmandu valley (5.3%).[20] In contrast, the prevalence of A. lumbricoides is lower than the study done in Ethiopia, Lumame town, northwest Ethiopia (32.6%), and among Delgi school children in north Gonder (48%).[16],[21] The high prevalence of A. lumbricoides infection in the present study was due to lack of hand washing before eating and after toilet, and habit of eating unwashed fruits and uncooked vegetable.

In the present study, the prevalence rate of T. trichiura (8.4%) was almost similar to a finding from a study conducted in Welayta zone, southern Ethiopia (10.5%)[18] and 9.5% in south Gonder.[22] However, the finding was higher than studies conducted in Babile town, eastern Ethiopia (3.9%).[7] The difference in prevalence among the studies can be explained by variations in geography, the category of the study population, poor hygienic practice, and contamination of vegetables with fecal materials in the soil.

This study also revealed that among protozoan parasites, E. histolytica (10.35%) was frequently observed followed by G. lamblia (7.4%). Overall prevalence was 17.7%. Similarly, other studies reported comparable results. The prevalence of the two parasites was 14.17% and 12.65%, respectively, from the study in Homesha Woreda, north Ethiopia among school children.[15] In contrast to this study, the research conducted among school children of Delgi School, north Gonder, reported the prevalence of E. histolytica/dispar and G. lamblia to be 27.3% and 41.9%, respectively. This could be due to difference in environmental and living conditions of the study participants.

The present study also assessed the possible association of IPI with potential risk factors among school children. Several recent studies have identified a range of environmental, behavioral, and social risk factors associated with IPI.[4],[5],[15],[16],[20],[23] However, very few were significantly associated in this study making it comparable to earlier studies in Ethiopia and other developing countries.

According to this study, one of the factors significantly associated with IPI was grade level. School children of grades 1 to 4 were two times more likely to be infected as compared to grades 5 to 8. This finding was supported by another study in Homesha Woreda school children in northwest Ethiopia.[15] The possible explanation might be that those school children who were in grades 1 to 4 were less immuned and took poor care of themselves as compared to grades 5 to 8.The present study revealed that using unprotected water is also a significant associated risk factor for IPI. This finding was similar to a report in north Gonder.[16] This might be due to the contamination of water with animal and human waste that is flooding into unprotected water.

In this study, one of the factors significantly associated with IPI was lack of hand washing before eating and after defecation (P < 0.05). Habit of washing hands before eating and after defecation were found to be protective from IPI. This finding was similar to a report in Homesha Woreda, northwest Ethiopia,[15] and in school children of Delgi, north Gonder.[16] This might be due to low knowledge of children about the feco-oral transmission of intestinal parasite through their unwashed hands.

The other factor that exposed children to IPI identified in this study was the place to defecate and dispose of the feces. School children who defecate and dispose the feces in open fields were 6.45 times more likely to be infected with IPI as compared to school children who used latrine. This result was similar to the studies reported by Tadesse[7] with odds ratio of 0.307 for none latrine versus latrine. This study report indicated that toilet facilities are highly risky to the prevalence of human IPIs.

Regarding feeding habit, school children who ate unwashed fruits and uncooked vegetables were 3.13 and 3.26 times more likely to acquire IPIs as compared to those who ate washed fruits and cooked vegetables, respectively. Similar to this findings, study conducted in school children of Delgi, north Gondar, Ethiopia, revealed that children who had practiced eating unwashed/uncooked vegetables were more likely to be infected with intestinal parasites (P < 0.05).[16]


  Conclusion Top


The common intestinal parasite species diagnosed in the school children of Adele town in Bamo no. 2 primary school were A. lumbricoides, E. histolytica, T. trichiura, G. lamblia, H. nana, and T. saginata. The predominant IPIs were A. lumbricoides, E. histolytica, and T. trichiuria.

Our finding also revealed that grade level, water type used, washing hand before meal and after toilet, defecation habit, and habit of eating unwashed fruits and uncooked vegetables were significantly associated with the prevalence of IPIs. Provision of well protected and treated drinking water, proper toilet condition, washing fruits and feeding cooked vegetables, proper education on personal hygiene, environmental sanitation, and mass treatment for the effective control of IPI in the concerned area are very important parameters to improve the rate of prevalence of IPIs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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   Abstract
  Introduction
   Materials and me...
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   References
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