University of Ghana http://ugspace.ug.edu.gh
SCHOOL OF PUBLIC HEALTH 
COLLEGE OF HEALTH SCIENCES 
UNIVERSITY OF GHANA  
  
 
PREVALENCE OF INTESTINAL PARASITIC INFECTIONS AND ASSOCIATED 
FACTORS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN 
KASOA POLYCLINIC 
 
BY  
ALBERT ABAKA-YAWSON  
(10635162)  
 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON 
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF 
MASTER OF PUBLIC HEALTH DEGREE 
 
 
DECEMBER, 2018
   
 
University of Ghana http://ugspace.ug.edu.gh
DECLARATION 
I, Albert Abaka-Yawson, hereby declare that except for the references to other people’s work 
which has been duly acknowledged, this work is my original research and that this dissertation, 
either in whole or part has not been presented for the award of any degree in this university or 
elsewhere. 
 
 
…………………………………..                                        ………………………………….. 
ALBERT ABAKA-YAWSON                                                           DATE 
(MPH STUDENT) 
 
 
……………………………………                                ………………………………….. 
DR JOHN ARKO-MENSAH                                                                         DATE 
SUPERVISOR  
 
 
 
 i  
 
University of Ghana http://ugspace.ug.edu.gh
DEDICATION 
th
I dedicate this work to my mother, Rose Abaka-Yawson who celebrates her 60  anniversary this 
year. May you live long to benefit from the fruits of your labour. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ii  
 
University of Ghana http://ugspace.ug.edu.gh
ACKNOWLEDGEMENT 
I wish to express my profound gratitude to my supervisor, Dr. John Arko-Mensah for the 
valuable advice and encouragement given me throughout my project work.  
Special appreciation also goes to the teaching and research assistants of the Department of 
Medical Laboratory Science, University of Health and Allied Sciences, Ho for their assistance in 
pursuing this course.  
I am also thankful to the staff and pregnant women  at the Kasoa Polyclinic during the period of 
the study. I am grateful to them for their special interest and support they provided me 
throughout the work and beyond.  
To my parents, Mr.  & Mrs. Joseph Abaka-Yawson, I don’t want to imagine life without you. I 
am very grateful for the financial support throughout my life.  
Many thanks also to my friends (Maxwell Asiedu, Albert Awuku Kumi, Salomey Afari, 
Solomon Sosu and Gershon Zonyrah) who gave constructive criticism which helped the success 
of the work. 
 
 
 
 
 
 
 
 
 iii  
 
University of Ghana http://ugspace.ug.edu.gh
ABSTRACT 
Background: Intestinal Parasitic infections affect pregnant women worldwide. Such infections 
have life threatening implications on both mother and the developing foetus. Sub-Saharan Africa 
harbours the greatest proportion of intestinal parasitic infections due to socioeconomic and 
environmental factors. In Kasoa, in Southern Ghana, there is paucity of data on the prevalence 
and associated factors for intestinal parasitic infections among pregnant women. 
Objective: The aim of the study was to determine the prevalence of intestinal parasitic infections 
and associated factors among pregnant women attending antenatal care in Kasoa Polyclinic.  
Methods: A hospital based analytical cross-sectional study using simple random sampling was 
carried out among three hundred (300) pregnant women who attended the Kasoa Polyclinic for 
antenatal care. Structured questionnaires were administered to the study participants to assess 
socio-demographic and possible factors. Stool samples were collected from each pregnant 
woman and examined for the presence of intestinal parasites by microscopy using direct wet 
mount as well as formol ether sedimentation techniques. Data collected was entered into STATA 
version 15.0. Means, standard deviations, frequencies and percentages were calculated. 
Results: Overall, prevalence of intestinal parasites was 14.3% [95% CI 11-19%]. Prevalence of 
the different intestinal parasites studied were; Entamoeba histolytica (5.0%), Ascaris 
lumbricoides (4.3%), Giardia lamblia (2.3%), Trichuris trichiura (1.3%), Schistosoma mansoni 
(0.3%), Hookworm (0.3%), Hymenolepis nana (0.3%) and Isospora belli (0.3%) were identified. 
There was an association between age ≤30 years [AOR= 0.17, 95% CI= 0.06-0.48], 
nd rd 
Multigravidae [AOR= 0.43, 95% CI= 0.19-0.97] and 2  and 3 trimesters [AOR= 4.73, 95% 
CI= 1.36-16.49] and intestinal parasitic infections among pregnant women. 
 iv  
 
University of Ghana http://ugspace.ug.edu.gh
Conclusion: Compared to previous studies in Ghana, the (14.3%) prevalence of intestinal 
parasitic infections among pregnant women is relatively low. It however suggests that intestinal 
parasitic infection is still a problem. Age, gravidity and parity were the major factors for the 
prevalence observed. Routine stool examination and provision of public health education 
particularly to risk groups are recommended to prevent infection of pregnant mothers and their 
unborn babies. 
 
 
 
 v  
 
University of Ghana http://ugspace.ug.edu.gh
TABLE OF CONTENTS 
DECLARATION............................................................................................................................ I 
DEDICATION.............................................................................................................................. II 
ACKNOWLEDGEMENT .......................................................................................................... III 
ABSTRACT ................................................................................................................................. IV 
TABLE OF CONTENTS ........................................................................................................... VI 
LIST OF TABLES ....................................................................................................................... X 
LIST OF FIGURES .................................................................................................................... XI 
CHAPTER ONE ........................................................................................................................... 1 
1.0 INTRODUCTION................................................................................................................... 1 
1.1 BACKGROUND ........................................................................................................................ 1 
1.2 PROBLEM STATEMENT ............................................................................................................ 3 
1.3 RESEARCH QUESTIONS ........................................................................................................... 4 
1.4 GENERAL OBJECTIVE ............................................................................................................. 4 
1.5 SPECIFIC OBJECTIVES ............................................................................................................. 4 
1.6 CONCEPTUAL FRAMEWORK .................................................................................................... 5 
1.7 JUSTIFICATION ........................................................................................................................ 7 
CHAPTER TWO .......................................................................................................................... 8 
2.0 LITERATURE REVIEW ...................................................................................................... 8 
2.1 INTESTINAL PARASITES .......................................................................................................... 8 
2.2 INTESTINAL PROTOZOAN INFECTIONS .................................................................................... 8 
2.2.1 Global Distribution of Intestinal Protozoan Infections................................................... 9 
2.2.2 Intestinal Protozoan Infections in Africa ........................................................................ 9 
2.2.3 Intestinal Protozoan Infections in Ghana........................................................................ 9 
2.2.4 Symptoms and Mode of Transmission ......................................................................... 10 
2.2.5 Laboratory Diagnosis ................................................................................................... 11 
2.2.6 Treatment ...................................................................................................................... 12 
 vi  
 
University of Ghana http://ugspace.ug.edu.gh
2.2.7 Prevention and Control ................................................................................................. 12 
2.3 INTESTINAL HELMINTHIC INFECTIONS .................................................................................. 12 
2.3.1 Distribution of Intestinal Helminthic Infections ........................................................... 13 
2.3.2 Prevalence of Intestinal Helminthic Infections in Africa ............................................. 13 
2.3.3 Intestinal Helminthic Infections in Ghana .................................................................... 14 
2.3.4 Symptoms and Mode of Transmission ......................................................................... 15 
2.3.6 Laboratory Diagnosis ................................................................................................... 15 
2.3.7 Treatment ...................................................................................................................... 16 
2.3.8 Prevention and Control ................................................................................................. 16 
2.4 PREVALENCE OF INTESTINAL PARASITIC INFECTION AMONG PREGNANT WOMEN ............... 17 
2.5 FACTORS ASSOCIATED WITH INTESTINAL PARASITIC INFECTION AND PREGNANT WOMEN .... 17 
2.5.1 Age................................................................................................................................ 17 
2.5.2 Parity and Gravidity...................................................................................................... 18 
2.5.3 Availability and Type of Toilet Facilities Used ........................................................... 18 
2.5.4 Hand Washing Practices ............................................................................................... 19 
2.5.5 Deworming Practices .................................................................................................... 19 
2.6 INTESTINAL PARASITIC INFECTIONS AND ANAEMIA ............................................................. 20 
CHAPTER THREE .................................................................................................................... 21 
3.0 METHODS ............................................................................................................................ 21 
3.1 TYPE OF STUDY .................................................................................................................... 21 
3.2 STUDY LOCATION / AREA ..................................................................................................... 21 
3.3 VARIABLES ........................................................................................................................... 22 
3.3.1Outcome/ Dependent Variable ...................................................................................... 22 
3.3.2 Exposure/Independent Variable ................................................................................... 22 
3.4 STUDY POPULATION ............................................................................................................. 23 
3.5 SAMPLING ............................................................................................................................ 23 
3.5.1 Sample Size .................................................................................................................. 23 
3.5.2 Sampling Technique ..................................................................................................... 24 
3.6 DATA COLLECTION TECHNIQUES ......................................................................................... 24 
3.6.1 Questionnaire Administration....................................................................................... 24 
 vii  
 
University of Ghana http://ugspace.ug.edu.gh
3.6.2 Sample Collection......................................................................................................... 24 
3.6.3 Laboratory Analysis ..................................................................................................... 25 
3.7 QUALITY CONTROL .............................................................................................................. 26 
3.8 DATA PROCESSING AND ANALYSIS ...................................................................................... 26 
3.9 ETHICAL ISSUES / CONSIDERATION ...................................................................................... 26 
3.9.1 Potential Risk / Benefit ................................................................................................. 26 
3.9.2 Privacy and Confidentiality .......................................................................................... 27 
3.9.3 Data Storage and Usage ................................................................................................ 27 
3.9.4 Institutional Consent ..................................................................................................... 28 
3.9.5 Voluntary Consent / Withdrawal .................................................................................. 28 
3.9.5 Compensation ............................................................................................................... 28 
3.9.6 Declaration of Conflict of Interest ................................................................................ 28 
3.9.7 Research Funding ......................................................................................................... 29 
3.10 PRETEST OR PILOT STUDY .................................................................................................. 29 
CHAPTER FOUR ....................................................................................................................... 30 
4.0 RESULTS .............................................................................................................................. 30 
4.1 GENERAL CHARACTERISTICS OF STUDY PARTICIPANTS ....................................................... 30 
4.2 PREVALENCE OF INTESTINAL PARASITIC INFECTIONS .......................................................... 32 
4.3 FACTORS ASSOCIATED WITH INTESTINAL PARASITIC INFECTIONS ....................................... 34 
CHAPTER FIVE ........................................................................................................................ 38 
5.0 DISCUSSION ........................................................................................................................ 38 
CHAPTER SIX ........................................................................................................................... 41 
6.0 CONCLUSIONS AND RECOMMENDATIONS .............................................................. 41 
6.1 CONCLUSION ........................................................................................................................ 41 
6.2 RECOMMENDATIONS FROM RESEARCH ................................................................................. 41 
REFERENCES ............................................................................................................................ 43 
APPENDICES ............................................................................................................................. 51 
APPENDIX 1: INFORMED CONSENT .................................................................................. 51 
 viii  
 
University of Ghana http://ugspace.ug.edu.gh
APPENDIX 2: QUESTIONNAIRE .......................................................................................... 55 
APPENDIX 3: MEDICAL REFERRAL FORM ....................................................................... 57 
 
 
 
 
 
 
 
  
 ix  
 
University of Ghana http://ugspace.ug.edu.gh
LIST OF TABLES 
Table 4.1:  General characteristics of study participants .............................................................. 31 
Table 4.2: Univariate and multivariate analysis of intestinal parasitic infections across socio-      
demographic characteristics of pregnant women in Kasoa Polyclinic .................................. 35 
Table 4.3: Univariate and Multivariate Logistic Regression analysis of Intestinal Parasitic 
Infections  with regards to gravidity, deworming status and hygienic practices ................... 37 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 x  
 
University of Ghana http://ugspace.ug.edu.gh
LIST OF FIGURES 
Figure 1: Conceptual Framework ................................................................................................... 6 
Figure 2: Life Cycle of Intestinal Parasites ................................................................................... 11 
Figure 3: Map of Kasoa with arrow showing Kasoa Health Centre, now Kasoa Polyclinic ........ 22 
Figure 3: Prevalence of Intestinal Parasitic Infections among Pregnant Women ......................... 33 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 xi  
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER ONE 
1.0 INTRODUCTION 
1.1 Background 
Intestinal parasitic infections are primarily caused by protozoans and helminthes (Utzinger et al., 
2012). They are frequently transmitted via consumption of contaminated food and water and 
spread from person to person through fecal-oral contact. Intestinal parasitic infections are 
associated with socioeconomic and environmental factors. This owes to the fact that they are 
prevalent in areas where there is overcrowding, limited access to clean water and poor personal 
hygiene (Siziya et al., 2013; Wekesa et al., 2014). 
Several species of intestinal parasites can infect humans. However, the commonly occurring 
intestinal parasites are Entamoeba histolytica, Giardia lamblia, Cryptosporidium,  Ascaris 
lumbricoides, Trichuris trichiura and hookworms i.e. Ancylostoma duodenale and Necator 
americanus (Abu-Madi, Behnke, & Doiphode, 2010; Cook, Swanson, Eggett, & Booth, 2009; 
Mahande & Mahande, 2016). 
Pregnant women, especially those in Africa, are at greater risk of intestinal parasitic infections 
(Yakasai & Umar, 2013). A recent study in Ethiopia found 553 out of 783 (70.6%) pregnant 
women to be infected with intestinal parasites with helminthes being the predominant species 
(Feleke & Jember, 2018). In Nigeria, it was observed that 73 out of 401 (18.2%) pregnant 
women were living with intestinal parasite infections (Akinbo, Taiwo, Okaka, & Oriakhi, 2017). 
Data from studies in Ghana showed that intestinal parasitic infections among pregnant women 
was 41.2% (Fuseini, Edoh, Kalifa, & Knight, 2013) and 49.6% (Tay, Agbeko, & Walana, 2017). 
 1  
 
University of Ghana http://ugspace.ug.edu.gh
Variation in geographical location and hygienic practices are important factors that can 
contribute to prevalence of intestinal parasitic infections in any population. 
Intestinal parasites such as hookworms are known to cause anemia in pregnant women (Baidoo, 
Tay, & Abruquah, 2010). They contribute to adverse pregnancy outcomes such as low birth 
weight and impaired milk production. The roundworm, Ascaris lumbricoides infection has also 
been associated with diminished food intake and weight loss in pregnant women (Wekesa et al., 
2014). It has also been reported to affect survival, growth and cognitive performance of children 
born to infected mothers (Tay et al., 2017). 
Additionally, the trophozoites of the protozoan parasite, Entamoeba histolytica can invade the 
intestinal mucosa, the liver, lungs and blood circulation of the human host leading to abdominal 
discomfort, pulmonary abscesses, bleeding episodes and sometimes death (Walana, Crowther, 
Tay, Tetteh, & Ziem, 2014). 
This presents a significant public health situation that requires urgent attention. It is in view of 
this that the Ministry of Health, Ghana together with the Ghana Health Service set up the 
Neglected Tropical Diseases Control Program (NTDCP) with the sole aim of alleviating the 
occurrence of neglected tropical diseases including, intestinal parasitic infections in the country 
to an insignificant level (Walana, Aidoo, & Tay, 2014). 
 
 
 
 
 2  
 
University of Ghana http://ugspace.ug.edu.gh
1.2 Problem Statement 
An estimated 3.5 billion people are infected with at least one intestinal parasite and Africa 
contributes to about half the global burden (WHO, 2010). In the case of Ghana, the prevalence 
rate is thought to be between 2% and 78% (Duedu et al., 2015). 
Kasoa is among the fastest growing satellite communities in West Africa (Ministry of Finance, 
2018). Over the past 40 years, its population has increased by approximately 79 times (Nyarko, 
2013).  The growing population of Kasoa without commensurate provision of social amenities 
especially portable water and proper waste collection/disposal facilities has become a social 
burden for all. Additionally, about 73% of water sources available to inhabitants of Kasoa and its 
environs have serious issues with quality and safety (Peprah, Oduro-ofori, & Asante-wusu, 
2015). Epidemiological survey has suggested these factors to be linked with intestinal parasitic 
infections (Wekesa et al., 2014). 
Meanwhile, intestinal parasitic infections could result in anaemia in pregnant women. Additional 
health implications include impaired growth and congenital anomalies in newborns and can  
contribute to maternal and foetal deaths (Derso, Nibret, & Munshea, 2016). With anaemia among 
pregnant women in Ghana reported to be as high as 66.4% (Tay et al., 2017), there is the need to 
ascertain the prevalence of intestinal parasitic infections and factors among pregnant women 
resident in Kasoa. This research therefore determined the prevalence and associated factors of 
intestinal parasitic infections among pregnant women in Kasoa. 
 
 
 3  
 
University of Ghana http://ugspace.ug.edu.gh
1.3 Research Questions 
1. Is the prevalence of intestinal parasitic infections among pregnant women in Kasoa 
lower, similar or higher than that reported in other parts of Ghana? 
2. What are the possible factors associated with intestinal parasitic infections among these 
pregnant women in Kasoa? 
 
1.4 General Objective 
To determine the prevalence of intestinal parasitic infections and associated factors among 
pregnant women attending antenatal care in Kasoa 
 
1.5 Specific Objectives 
1. To determine the prevalence of intestinal parasitic infections among pregnant women in 
Kasoa 
2. To assess the factors associated with intestinal parasitic infections among pregnant 
women in Kasoa 
 
 
 
 
 4  
 
University of Ghana http://ugspace.ug.edu.gh
1.6 Conceptual Framework 
Lack of basic amenities for sanitation and hygiene and ineffective implementation of social 
interventions such as family planning and other birth control programs have direct impact on 
population growth (density). Increasing population density also increases waste generation, 
which has the likelihood of reducing environmental sanitation and hygiene. Provision of 
sanitation and waste collection facilities, portable drinking water, public places of convenience, 
adequate drainage systems etc significantly improves the environmental health and reduces 
transmission of diseases including infection with worms known to be associated with poor 
sanitation conditions and hygienic practices. Also government interventions have direct impact 
on the level of education of the citizenry. The level of education of an individual also has an 
impact on the frequency of uptake of dewormer and other antiparasitic agents. Environmental 
hygiene, personal hygiene and de-worming practices affect the prevalence and distribution of 
intestinal parasitic infections. 
 5  
 
University of Ghana http://ugspace.ug.edu.gh
SSOOCCIOIO-D-DEEMMOOGGRRAAPPHHICIC F FAA CCTTOORRSS   
   Age    Age   
 Ma  r iKtanl oSwtalteudsg e acquired  
 Leve  l o f E d ucation 
 
 INTESTINAL PERSONAL HYGIENE    UPTAKE OF    
  PARASITIC     Hand washing ANTIPARASITIC  
practices    INFECTIONS    AGENTS   
   Defecatory practices    
    
  
ENVIRONMENTAL  
HYGIENE   
   Waste  c ol lectio n and  
disposal    
   Cleaning and desilting of  
choked gutters   
   Adequate water supply   
   Availability of toilet  
facilities   
 
Figure 1: Conceptual Framework 
 
 
 
 
 
 
 
 
 
 6  
 
University of Ghana http://ugspace.ug.edu.gh
1.7 Justification 
Kasoa has been described as one of the fastest growing communities in West Africa (Ministry of 
Finance, 2018). Kasoa is also home to a large open food market, and overall, there is increased 
per capita waste generation without commensurable increase in waste management. This has led 
to high rate of fecal pollution of soil and domestic water supply around homes due to poor 
sanitation and improper sewage disposal. This phenomenon predisposes inhabitants to intestinal 
parasites particularly geohelminths (soil transmitted helminths). 
In these contemporary times, World Health Organization (WHO) and various governments have 
utilized chemotherapy based on Mass Drug Administration to reduce such infections (WHO, 
2010). To deliver this intervention successfully, there is the need to understand geographical 
distribution and estimates of local risks for comparison. Unfortunately, there is paucity of 
information on communities like Kasoa. There is therefore the need to investigate the prevalence 
of parasitic infections among risk groups like pregnant women as well as the predisposing factors 
to parasitic infection. This would give background information and overview on the prevalence 
rate of intestinal parasitic infection and factors among pregnant women attending antenatal care 
in Kasoa Polyclinic.  
 
 
 
 
 
 
 7  
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER TWO 
2.0 LITERATURE REVIEW 
2.1 Intestinal Parasites 
Intestinal parasitic infections of medical importance are mainly protozoa and worms (helminths). 
It is a characteristic of parasites that whilst deriving maximum benefit from an intimate 
association with their hosts, they also inflict harm and cause disease. Intestinal parasitic 
infections dwell in the small or large intestine and their survival depends on feeding on nutrient 
from the intestinal walls. Intestinal parasitic infections have worldwide coverage (Yakasai & 
Umar, 2013). Majority of these infections are found in poverty stricken areas where there is low 
quality drinking water, poor sanitation and hygiene, as well as reduced access to health care 
(Wekesa et al., 2014).  
2.2 Intestinal Protozoan Infections 
Intestinal protozoa are free-living, unicellular, eukaryotic cells. There are various intestinal 
protozoan species but the commonly occurring ones are the Giardia lamblia, Entamoeba 
histolytica and Cryptosporidium parvum. Intestinal protozoa Giardia spp causes giardiasis and 
Entamoeba histolytica is the causative agent for amoebiasis infections, and known to infect about 
50 million people worldwide (Erismann et al., 2016). In general terms, they occur in various 
sizes from 5µm to 2mm. They possess a cytoplasmic membrane and cellular organelles, 
including 1 or 2 nuclei, mitochondria, food vacuoles and an endoplasmic reticulum. Protozoa 
have a cytostome, a special mouth for ingestion of solid food materials. They also have a 
protective coat called cyst and a trophozoite that converts it to a motile form when ingested 
(Phuanukoonnon et al., 2015). 
 8  
 
University of Ghana http://ugspace.ug.edu.gh
2.2.1 Global Distribution of Intestinal Protozoan Infections 
Like all other intestinal parasitic infections, intestinal protozoa are known to infect people from 
all walks of life. However, it is particularly common in developing countries where there are 
sanitation problems. It is estimated that approximately 10% of the global population is currently 
living with Entamoeba histolytica (Chacon-cruz, 2009).It is also noted that most of the cases of 
intestinal protozoan infections are asymptomatic particularly Entamoeba histolytica. A higher 
prevalence of Entamoeba histolytica is also observed in institutionalized individuals in places 
like prisons and mental hospitals (Duedu et al., 2015). Again, children and pregnant women are 
at the highest risk of infection (Erismann et al., 2016). 
 
2.2.2 Intestinal Protozoan Infections in Africa 
Africa harbors the highest prevalence for intestinal protozoan infections. The commonly 
occurring intestinal protozoa infections in Africa are caused by Entamoeba histolytica, Giardia 
lamblia, Cryptosporidium parvum. The greatest impact is felt in sub-Saharan Africa. In West 
Africa, intestinal protozoan infection prevalence was found to be as high as 84.7% among school 
children (Erismann et al., 2016).The study further reported the predominant species to be 
Entamoeba histolytica/ Entamoeba dispar (66.5%), Entamoeba coli (37.4%). Additionally, 
studies in East Africa reported the combined prevalence of Giardia lamblia and Entamoeba 
histolytica to be as high as 21.1% (Derso et al., 2016).  
2.2.3 Intestinal Protozoan Infections in Ghana 
 9  
 
University of Ghana http://ugspace.ug.edu.gh
Prevalence of intestinal protozoan infection in Ghana is not particularly different from the rest of 
Africa. Various estimates have been made concerning the intestinal parasite infections. Giardia 
lamblia, Entamoeba histolytica and Cryptosporidium parvum seem to be the most prevalent. 
Prevalence of Giardia lamblia infections among children of school going age was found to be 
within 12.7% (Tetteh, 2012)and 16.8% (Walana, Crowther, Tay, Tetteh, & Ziem, 2014). A study 
among psychiatric patients in Ghana showed  a prevalence of parasitic infections of 13.5% of 
which majority were due to Giardia lamblia infections (Duedu et al., 2015). 
2.2.4 Symptoms and Mode of Transmission 
Intestinal protozoan infections, particularly Entamoeba histolytica, are mostly asymptomatic. 
The protozoa learn to live peacefully with it host carriers. Entamoeba histolytica has only 
humans as its natural host. The infections may be passed on from person to person by the 
infective stage, the cyst, through fecal-oral route. Giardia lamblia, however, infect both humans 
and animals.  In this case, contact with infected animals also serves as a risk factor for the 
contraction of giardiasis. The motile form of the amoeba is the trophozoite, which cruises along 
the intestinal wall eating bacteria, other protozoa species, and even human intestinal and red 
blood cells. The trophozoite can convert to a precyst form, with two nuclei, that matures into a 
tetranucleated cyst. It is the mature cyst that is eaten, infecting others. The motile trophozoites 
may penetrate the portal circulation, forming abscesses in the liver, followed by spread through 
the diaphragm into the lung. Infection by trophozoite causes pulmonary abscesses and often 
leading to death. 
 
     
 10  
 
University of Ghana http://ugspace.ug.edu.gh
                                         
                           Figure 2: Life Cycle of Intestinal Parasites 
                           Source: (Arcari, Baxendine, & Bennett, 2000) 
2.2.5 Laboratory Diagnosis 
Microscopic examination appears to be the less expensive and widely used method for the 
identification of intestinal protozoa especially in resource-limited settings. Several methods can 
be used in the microscopic examination. This includes the direct wet mount method, the formol-
ether concentration method as well as the modified Ziehl-Neelsen method. Stool samples are 
observed for the presence of cysts and trophozoites. With Entamoeba histolytica, the presence of 
trophozoites with red blood cells in the cytoplasm is indicative of an active infection. The 
opposite is also true as the presence of cysts or trophozoites without internalized red blood cells 
suggest asymptomatic infections. In the case of Giardia lamblia, the infected individuals usually 
present with greasy, frothy, diarrhea, along with abdominal gassy distension and cramps. The 
cysts and trophozoites of Giardia lamblia commonly occur in their stools. Other diagnostic 
 11  
 
University of Ghana http://ugspace.ug.edu.gh
procedures for Entamoeba histolytica include CT scan and ultrasound imaging on the liver to 
ascertain the presence of abscesses. Whilst for Giardia lamblia, Enzyme linked immunosorbent 
assay (ELISA) kits to detect the presence of antigens in watery extract of stool specimen could 
be used. 
2.2.6 Treatment 
Intestinal protozoan infections treatment is species specific and the dosages are dependent on the 
phase of the parasite and the intensity of the infection. Metronidazole proves effective for the 
killing Entamoeba histolytica and flagellates of Giardia lamblia. 
2.2.7 Prevention and Control 
Prevention of intestinal protozoan infections can widely be attained bya number of ways. 
Contaminated water could harbor the cyst of various intestinal protozoan. Therefore, all sources 
of water being pipeborne, dams, rivers, streams and boreholes should be protected from faecal 
contamination. Hygienic practices and geophagy (the act of eating soil or clay) should be 
avoided. Deworming practices should be encouraged regularly especially in parasitic endemic 
areas. Again, regular healthcare should be encouraged at all times. All of these could be achieved 
through regular health education of the citizenry on personal and environmental hygiene. 
2.3 Intestinal Helminthic Infections 
Helminths, unlike protozoa, are multicellular organisms. They are bilaterally symmetrical in 
shape and have three germ layers. They are large and could be seen with the unaided eye in their 
mature stage. Intestinal helminthes that infect humans are divided into three major categories; 
Nematodes, Cestodes and the Trematodes. The Nematodes include Ascaris lumbricoides, 
 12  
 
University of Ghana http://ugspace.ug.edu.gh
Trichuris trichiura, Enterobius vermicularis, Strongyloides stercoralis, hookworms 
(Ancylostoma duodenale and Necator americanus). Cestodes include; Taenia solium, Taenia 
saginata, Hymenolepis nana, Hymenolepis diminuta, Diphyllobothrium latum among others. 
Trematodes include; Schistosoma species, Paragonimus westermani, Fasciolopsis buski, 
Clonorchis sinensis etc. The four commonly occurring geohelminths are roundworm (Ascaris 
lumbricoides), whip worm (Trichuris trichiura) and the hookworms (Necator americanus and 
Ancylostoma duodenale). Intestinal helminthes have no global boundaries but are particularly 
common in resource limited countries (Mcclure et al., 2014). 
2.3.1 Distribution of Intestinal Helminthic Infections 
According to WHO, an estimated 24% of the world’s population representing more than 1.5 
billion are living with soil-transmitted helminth infections (WHO, 2010). These infections have 
no geographical boundaries as all human related intestinal parasitic infections can infect people 
from all walks of life. But like all other intestinal parasitic infections, the greatest impact are felt 
in resource limited settings limited settings like sub-Saharan Africa, the Americas, China and 
East Asia. The distribution of various intestinal helminthic infections is influenced by climatic 
factors, personal and environmental hygienic behaviours (Siziya et al., 2013; Wekesa et al., 
2014). 
2.3.2 Prevalence of Intestinal Helminthic Infections in Africa 
Africa is known to harbor the greatest proportion of intestinal helminthic infections. Today, it is 
estimated that over 50% of population of sub-Saharan have been documented to be infected with 
one species of intestinal helminth or the other(Sousa-Figueiredo, Gamboa, Pedro, Fancony, & 
Langa, 2012). The commonly occurring intestinal helminthes are the hookworms, Ascaris 
 13  
 
University of Ghana http://ugspace.ug.edu.gh
lumbricoides and Trichuris trichiura. In Nigeria, geohelminthic infections was found to be 
30.3% (Odinaka, Nwolisa, Mbanefo, Iheakaram, & Okolo, 2015). Hookworm (Necator 
americanus and Ancylostoma duodenale) infections have been reported have been reported to be 
the predominant helminthic infection especially among risk groups such as pregnant women and 
children (Mcclure et al., 2014; Odinaka et al., 2015). Recent findings in South West Cameroon 
also suggests that Ascaris lumbricoides and Trichuris trichiura rather presents the most harm 
(Nkengazong et al., 2010). Another research in Burkina Faso among schoolchildren reported 
rather contrasting finding with Hymenolepis nana being the predominant species (Erismann et 
al., 2016). 
2.3.3 Intestinal Helminthic Infections in Ghana 
Ghana contributes significantly to intestinal helminthic infections burden in Africa. The poor 
sanitation and lack of personal hygiene practices account for this phenomenon. Prevalence 
studies have been carried extensively on risk groups such as expectant mothers, children, food 
vendors and psychiatric patients with significantly elevated findings. The commonly occurring 
species of helminthes are the Schistosoma mansoni, Ascaris lumbricoides, Hookworm 
(Ancylostoma duodenale and Necator americanus). According toFuseini et al., ( 2013), an 
estimated 20.7% of pregnant women in the Kassena-Nankana District of Northern Ghana are 
infected with intestinal helminthes. The most prevalent helminthes according to their research 
include; Schistosoma mansoni (12.22%), Ascaris lumbricoides (0.7%), Hookworms (7.0%), 
Strongyloide sstercoralis (2.3%). Another related study by Yatich et al., (2009) also reported 
similar prevalence (25.7%). The latter study also reported Ascaris lumbricoides and hookworm 
as the most prevalent. 
 14  
 
University of Ghana http://ugspace.ug.edu.gh
2.3.4 Symptoms and Mode of Transmission 
Intestinal helminthes life cycle and mode of transmission vary from species to species. Ascaris 
lumbricoides are passed through the environment to form the infective eggs. They are ingested 
via contaminated food and hatch in their individual human host carriers. There is the release of 
larvae that migrates via the lungs and respiratory tract and reach again the intestinal tract where 
they mature. Trichuris trichiura follows a related lifecycle. It also requires a period of maturation 
in the environment before they develop into the infective stage. The ingested eggs, however, 
directly develop into the adult worm in the intestine without migration. For the case of the 
hookworms, their eggs leave the human body through stool to the soil where the larvae are 
released to develop to an infective larval stage. The filariform larvae actively penetrates the 
human skin and migrates via blood vessels, heart, lungs and the small intestines, where they 
mature to form the adult worm.  
Intestinal helminthes are usually accompanied by some extreme devastating symptoms and 
medical complications. These worms can cause abdominal pains, weight loss, diarrhoeal 
episodes and anaemia. These symptoms could have untold repercussions on risk groups such as 
pregnant women and children (Tay et al., 2017). 
2.3.6 Laboratory Diagnosis 
Microscopic examination serves as the primary diagnostic tool. With regards to the microscopic 
examination, several methods exist. Regis et al., (2012) describes some of these methods as 
spontaneous sedimentation method of Hofmman and Lutz; centrifugal floatation method of 
Faust; kato-katz method and centrifugation method of Ritchie. Diagnosis is made by the 
detection of the helminthic species of interest in the stool sample. The shapes of the intestinal 
 15  
 
University of Ghana http://ugspace.ug.edu.gh
helminthes vary from species to species. The eggs of Ascaris lumbricoides are oval in shape. 
Ancylostoma duodenale and Necator americanus have eggs that cannot be easily differentiated 
from each other except by culture. Trichuris trichiura eggs can also be detected in stool samples. 
The eggs appear barrel shaped, unembryonated with bipolar plugs. 
2.3.7 Treatment 
With regards to the treatment of intestinal helminthes, metronidazoles and bezimidazoles are 
usually administered. Metronidazole is very effective for the treatment of Trichuristrichiura 
whilst the benzimidazoles specifically the Albendazole and Mebendazole can effectively treat 
the hookworms (Ancylostoma duodenale and Necator americanus) and Ascaris lumbricoides 
related infections. Other three drug combinations that are reported to show strong synergistic 
properties are Mebendazole - Ivermectin , Mebendazole- Levamisole, Albendazole – 
Mebendazole (Keiser, Tritten, Adelfio, & Vargas, 2012). Research by Tay et al., (2017)suggests 
that there is an association between intestinal parasitic infections and anaemia. Therefore in 
treating intestinal helminthes infections, there is the need to investigate and subsequently 
treatment for anaemia if it exists. Iron supplement should then be supply to patients to treat 
anaemia. 
2.3.8 Prevention and Control 
Like all other intestinal parasitic infections, prevention of intestinal helminthic infections can be 
achieved through the protection of all sources of drinking water from faecal contamination, 
improved personal and environmental sanitation and regular deworming practices. Frequent 
health education and promotion is also vital in preventing and controlling such infections. 
 
 16  
 
University of Ghana http://ugspace.ug.edu.gh
2.4 Prevalence of Intestinal Parasitic Infection among Pregnant Women 
A study conducted in Asia, found the prevalence of intestinal parasite infection to be 37% among 
pregnant women by microscopy. Out of this number, 28 (32.2%) were infected with at least one 
parasite and 4 (4.6 %) with more than 2 parasites (Sehgal et al., 2010). In Colombia, in South 
America, the prevalence rate was found to be as high as 41% (Espinosa Aranzales et al., 2018). 
Additionally, a low prevalence was observed in Northern Tanzania. In this study, the prevalence 
for amebiasis and helminthiasis was 0.7 % , and 0.6 % respectively (Mahande & Mahande, 
2016). Again on helminths a study in Gilgel Gibedam Area, Southwest Ethiopia reported a 
prevalence of, Hookworm 114 (29.4%), A. lumbricoides 58 (14.9%), T. trichiura 13 (3.4%), H. 
nana 8 (2.1%), E. vermicularis 5(1.3%) (Getachew, Tafess, Zeynudin, & Yewhalaw, 2013). 
Further, a study conducted in West Africa, revealed relatively high prevalence of parasitic 
infections among the study population, suggesting that about three-quarters of the women are 
either single or co-infected with parasitic agents (Tay et al., 2017).Whilst another research 
among schoolchildren in the West African sub-region also recorded 84.7% prevalence for 
intestinal protozoa and 10.7% for helminth infections (Erismann et al., 2016). 
 
2.5 Factors associated with intestinal parasitic infection and pregnant women 
2.5.1 Age 
With regards to age, the odds for intestinal parasitic infection were approximately two folds 
higher (COR = 1.74, p = 0.64) in pregnant women whose age was between 30 and 34 years 
compared to those whose age was between 40 and 44 years (Derso et al., 2016).  Similar findings 
 17  
 
University of Ghana http://ugspace.ug.edu.gh
were also found among pregnant women in Ghana where young age was found to be associated 
with parasitic infections(Yatich et al., 2009).  On the contrary, other studies have also suggested 
that age is not significantly associated with intestinal parasitic infections (Akinbo et al., 2017; 
Dankwa et al., 2017; Espinosa Aranzales et al., 2018; Forson et al., 2017). 
2.5.2 Parity and Gravidity 
A study conducted in Northwest Ethiopia found primigravidae women to have 25% increased 
odds of intestinal parasitic infection compared to multigravidae women (Derso et al., 2016). 
Other findings in Ghana and Papua New Guinea support this claim where primigravidae was 
linked with intestinal parasitic infections (Phuanukoonnon et al., 2015; Yatich et al., 2009) 
In addition, a study by Espinosa Aranzales et al., (2018) found no association between stage of 
pregnancy and increased prevalence of intestinal parasite infection. Although Derso and 
colleagues did not find a direct association, they found that that there was a higher odd of 
increased infection during the second trimester compared to the third  (Derso et al., 2016). 
 
2.5.3 Availability and Type of Toilet Facilities Used 
The availability and type of toilet facility been used by individuals have been proven to be a risk 
factor for the contraction of various intestinal parasitic infections. A study in this regard 
conducted at the Kitale District Hospital, Kenya showed that, women who did not use pit latrines 
were 95.2% more likely to be infected compared to 4.8% who were using toilet as source of 
waste disposal  (Wekesa et al., 2014).  Whilst other contrasting findings have reported no 
association between type of toilet and intestinal parasitic infections (Forson et al., 2017). 
 18  
 
University of Ghana http://ugspace.ug.edu.gh
2.5.4 Hand Washing Practices 
Hand washing practices especially after visiting toilet facilities and before eating has been 
documented to reduce the likelihood of intestinal parasitic infections. Hand washing with soap at 
critical times has been associated with 68% reduction in intestinal parasitic infections (Mahmud 
et al., 2015). Similar findings were also reported in related studies (Dankwa et al., 2017). Though 
there was no statistical significance, Derso et al., (2016) observed that as hand washing practice 
before meal was decreased by one, the odds of intestinal parasitic infection were increased by 19 
%. Additionally, the statistical analysis showed that the odds of infection were about four times 
higher (COR = 3.74, p = 0.07) in pregnant women who had no habit of hand washing after toilet 
than those who had the habit of washing their hands after toilet (Derso et al., 2016).  
2.5.5 Deworming Practices 
Research among food vendors in Accra recorded a significant proportion (55.6%) of those who 
had a deworming history to be infected with parasitic infections while 68% of those with no 
deworming history were found to be infected (Ayeh-kumi et al., 2009). Another study has 
reported similar findings where more than half (55.4 %) of food vendors who admitted to not 
deworming for six (6) months or more being infected with various intestinal parasitic 
infections(Adams & Lawson, 2014). Yatich et al., (2009) also reported that the uptake of 
dewormer reduces the risk of intestinal parasitic infections but not significantly. This suggests 
that the uptake of dewormer alone may not necessarily be a protective factor against intestinal 
parasitic infections. 
 
 
 19  
 
University of Ghana http://ugspace.ug.edu.gh
2.6 Intestinal Parasitic Infections and Anaemia 
The mechanism by which intestinal parasitic infections cause anaemia is not fully understood. 
There is however found significant association between intestinal parasitosis and anemia during 
pregnancy. A recent study has reported that intestinal parasitosis accounted for an estimated one-
quarter of anaemia conditions in expectant Kenya mothers (Mcclure et al., 2014) whilst in Ghana 
it could be as much as three-quarters (Tay et al., 2017). Again, Baidoo et al., 2010 observed an 
association between hookworm infection and low iron stores. They further suggested that 
hookworm (Necator americanus) is a strong predictor of iron status.Low iron status is known to 
contribute tolow haemoglobin concentration, thereby causing anaemia (Ofojekwu et al., 2018). 
  
 20  
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER THREE 
3.0 METHODS 
3.1 Type of Study 
The study was a hospital based analytical cross – sectional study. It was conducted among 
pregnant women attending antenatal care at Kasoa Polyclinic. These pregnant women were 
interviewed using a structured questionnaire to collect data on their socio-demographic 
characteristics and risk factors for intestinal parasitic infections.  
3.2 Study Location / Area 
The study was conducted at the antenatal care clinic and laboratory department of the Kasoa 
Polyclinic. The Polyclinic is located in Kasoa Central. Kasoa is the capital of the Awutu Senya 
East municipality in the Central Region of Ghana. The town is situated along the Accra-Cape 
Coast road. The coordinates of Kasoa are: 05 31 12N, 00 28 48W (Latitude: 5.5345; Longitude: - 
0.4167). It lies approximately 28 kilometres (17 minutes), by road, west of the central business 
district of Accra. It has a total of  about  69,384 people, which represents more than 79 times its 
population 40years ago (Nyarko, 2013). Kasoa has the main regional market (Porter et al., 2008). 
It is also common knowledge that the town faces huge vehicular traffic jams as well as 
indiscriminate, unplanned, haphazard building of structures. 
 21  
 
University of Ghana http://ugspace.ug.edu.gh
 
Figure 3: Map of Kasoa with arrow showing Kasoa Health Centre, now Kasoa Polyclinic 
Source: Google Map, 2018 
 
3.3 Variables 
3.3.1Outcome/ Dependent Variable 
The outcome/ dependent variable for the study is the prevalence of parasitic infections. This was 
obtained by examining individual stool samples for presence of intestinal parasites. 
3.3.2 Exposure/Independent Variable 
 Environmental Hygiene 
 Personal Hygiene 
 Uptake of Dewormer 
 22  
 
University of Ghana http://ugspace.ug.edu.gh
 Level of Education 
3.4 Study Population 
The study participants were pregnant women. They were recruited at the Kasoa Polyclinic during 
attendance for antenatal care services. Women in all stages of their pregnancy were recruited.  
Study participants who did not seem to understand the study upon several explanations were 
excluded from the study. 
3.5 Sampling 
3.5.1 Sample Size 
The prevalence of parasitic infections among pregnant women was determined from a Ghanaian 
study by Fuseini et al., 2010 to be 23.0%. The prevalence rate from that study was used to 
calculate the sample size to be 272. Additional 28 samples were added as a buffer against non-
response. A final sample size of 300 study participants was chosen as illustrated below; 
The sample size for the study was calculated using Fisher’s sampling formula below; 
        
     
  
Where; 
N represents the estimated sample size 
Z represents the constant for 95% confidence interval given as 1.96 
P represents the average prevalence of intestinal parasitic infections of 23.0% obtained from a 
study conducted among pregnant women in Kassena-Nankana district of the Northern Region 
 23  
 
University of Ghana http://ugspace.ug.edu.gh
D represents the percentage margin of error taken as 5% 
               
     
     
N = 272 
  
Additional 10% of the sample, N =  x 272) + 272 
   
                                                N =  299.2 = 300 
3.5.2 Sampling Technique 
Simple random sampling technique was employed to collect data from pregnant women 
attending antenatal care at the health facility. Random numbers were generated and used to 
recruit participants until the sample size was obtained. 
3.6 Data Collection Techniques 
3.6.1 Questionnaire Administration 
Study participants were given structured closed ended questionnaires to obtain data pertaining to 
socio-demographic, behavioral and environmental factors in the community. The questionnaires 
were administered to pregnant women who had given their consent to take part in the study. 
3.6.2 Sample Collection 
Clean screw capped plastic stool containers with wide neck were given to the study participants. 
The stool containers were identified by pre-labeling them by marking with unique identification 
numbers. The study participants were requested to provide about 2g of stool sample. Early 
 24  
 
University of Ghana http://ugspace.ug.edu.gh
morning stool samples submitted by participants were analyzed for parasites by direct wet mount 
method and formol-ether concentration technique. Each stool sample collected was analyzed 
within 30 – 60 minutes. Also, samples that could not be analyzed within a particular day were 
0
refrigerated at 4 C. Early morning stool samples submitted by the study participants underwent 
laboratory analysis for the presence of parasites (trophozoites, cysts, ova and larvae etc.). Two 
slides were then prepared per sample by direct wet mount and two slides after formol-ether 
concentration method. The slides were examined and considered positive when there was a 
parasite in at least one of them. 
3.6.3 Laboratory Analysis 
Direct Wet Mount Method 
The collected stool samples were mixed in 3-4ml normal saline. A drop of the sample was then 
placed on a glass slide and covered with a coverslip. The preparation was first examined under a 
10x objective lens, then 40x for identification of parasites under low light intensity as described 
by with slight modification. 
 
Formol-Ether Concentration Technique 
One gram (1g) of each stool sample was mixed with 3-4 ml of 10% formol saline. An additional 
3-4ml of 10% formol saline was added; this was then mixed thoroughly and passed through 
gauze. Three-Four (3-4) ml of diethyl ether were added and mixed adequately. The mixture was 
then sedimented by centrifugation at 3000rpm for five (5) minutes. The supernatant was then 
discarded and the sediments re-suspended in formol saline. The sediments were examined 
 25  
 
University of Ghana http://ugspace.ug.edu.gh
microscopically under 10x and 40x magnification for the presence of parasitic organisms as 
described by with slight modification. 
3.7 Quality Control 
Known positive and negative slides for the various intestinal parasites were tested using the 
direct wet mount method and formol ether concentration method as indicated in the laboratory 
procedure. Samples and slides were declared positive when various stages of the parasites, such 
as trophozoites, cysts, ova and larvae, were observed. This was to ensure reliability of the test 
procedure as well as a refresher course for the researcher. 
3.8 Data Processing and Analysis 
Data collected from the questionnaires and results from the laboratory was checked for 
correctness and entered into Microsoft Excel software. The compiled data was analyzed using 
Stata SE version 15 (64bit). Descriptive method of analysis such as tables and graphs were used 
to analyze and illustrate the occurrence of the various factors in the study. The magnitude of 
association between intestinal parasitic infections and potential risk factors was then assessed 
using logistic regression and described in terms of odds ratio (OR) at 95% confidence interval.  
 
3.9 Ethical Issues / Consideration 
3.9.1 Potential Risk / Benefit 
This study did not pose any major risks to its respondents as clean and sterile materials were 
used for testing for the presence of intestinal parasitic infections among the pregnant women. 
The potential risk that could have arisen during the stool sample collection stage was where the 
 26  
 
University of Ghana http://ugspace.ug.edu.gh
study participants could have infected themselves with parasitic agents from the toilet if hands 
were not washed. In view of that, the researcher provided toiletries (toilet roll, soap and hand 
sanitizer) to participants that used the toilet facility. The study participants spent about 30 
minutes in answering questionnaires and stool sample collection for onward testing of the 
various intestinal parasitic infections. Study participants who wanted to know the outcome of 
their test had to wait not more than an hour. 
As stated earlier, there were direct benefits of the study to the participants. It provided them an 
opportunity to test for intestinal parasitic infections. Again, it afforded them the chance to seek 
early treatment should there be any parasitic infection among them.  
3.9.2 Privacy and Confidentiality 
Privacy and confidentiality of the respondents were ensured at all stages of the study.  
Questionnaires designed for the study did not make use of names but rather serial numbers. 
Again, the questionnaires were administered to the study participants individually in an enclosed 
room. Finally, the outcome of the laboratory testing were kept strictly confidential. 
 
3.9.3 Data Storage and Usage 
Materials for the study that contained information on study participants were kept strictly under 
lock and key by Principal Investigator. The data obtained from the study were cleaned and 
entered into Stata SE version 15 (64bit) software with the identification numbers and electronic 
files were made available only to the research team. 
 
 27  
 
University of Ghana http://ugspace.ug.edu.gh
3.9.4 Institutional Approval 
Ethical approval was sought from the ethical review committee of Ghana Health Service before 
the commencement of the study. Permission was also obtained from the management of Kasoa 
Polyclinic. 
3.9.5 Voluntary Consent / Withdrawal 
Informed written and verbal consent was sought from the study participants before inclusion in 
the study. The study objectives and procedure, as well as possible risks and benefits associated 
with participating in the study were explained to the study participants in English and the local 
language. Research was carried out only on those who agreed to participate and satisfied the 
inclusion criteria.  All responses were kept confidential. 
3.9.5 Compensation 
Study participants recruited did not benefit from any monetary compensation. There was 
however health education on intestinal parasitic infections and its documented risk factors to the 
pregnant women prior to the study. The hospital administration would also receive a copy of the 
final research findings. Additionally, the findings of the research would be discussed with the 
management of the hospital and the municipal assembly. Appropriate recommendation would 
also be made for onward implementation. 
3.9.6 Declaration of Conflict of Interest 
There were no conflicts of interest in the study. 
 
 
 28  
 
University of Ghana http://ugspace.ug.edu.gh
3.9.7 Research Funding  
The study was sponsored by the Principal Investigator. 
3.10 Pretest or Pilot Study 
The questionnaires were pretested at Winneba Government Hospital. Accuracy and correctness 
of spelling and willingness of respondents to answer certain questions were checked during this 
period. Again, it was evaluated for clarity of the questions asked. After pre-testing, the 
questionnaires were reviewed based on the information gathered prior to the commencement of 
the main survey. 
 
 
 
 
 
 
 
 
 
 
 29  
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER FOUR 
4.0 RESULTS 
4.1 General Characteristics of Study Participants 
The study recruited three hundred (300) pregnant women. The ages of the women ranged from16 
to 50 years with an average age of 28.2±0.34.  A hundred and eighty-six (62.0%) participants 
were within 21 to 30 years. Twelve (4.0%) participants were less than 20 years. Ninety-six 
(32.0%) participants were within 31 to 40 years whilst six (2.0%) participants were within 41 to 
50 years representing the least age group. 
With regards to educational background, 57 (19.0%) of the women had no formal education, 75 
(25.0%) had some level of primary education, 116 (38.7%) had up to the Junior High School 
education, 38 (12.7%) had Senior High School education and 14 (4.7%) had tertiary level. 
Furthermore, 70 (23.3%) of the women were single whilst 230 (76.7%) of them were married. 
Also, with respect to their employment status, 95 participants representing 31.7% were 
unemployed whilst 205 (68.3%) were gainfully employed. 
Additionally, about 57.3% and 73.7% of the pregnant women were primigravidae and in their 
late trimesters of pregnancy respectively. With regards to type of toilet facility used, 234(78%) 
participants had their own facility. Majority of them also practiced hand washing before meals 
and after visiting the toilet facility. 
Also, 85.7% of the participants prepared food at home and 96.3% of the participants drunk water 
from treated sources. Deworming practices among the pregnant women also saw 212 (70.7%) 
deworming in more than 6 months representing the majority as shown in Table 4.1. 
 30  
 
University of Ghana http://ugspace.ug.edu.gh
Table 4.1:  General characteristics of study participants 
Variable Frequency Percentage (%) 
Age in years   
  ≤ 20                                               12 4.0 
21-30 186 62.0 
31-40                                                   96 32.0 
41-50 6 2.0 
Educational Level   
None 57 19.0 
Primary 75 25.0 
J.S.S 116 38.7 
S.S.S 38 12.7 
Tertiary 14 4.7 
Marital Status   
Single 70 23.3 
Married 230 76.7 
Employment Status   
Unemployed 95 31.7 
Employed 205 68.3 
Gravidity   
Primigravidae 172 57.3 
Multigravidae 128 42.7 
Stage of Pregnancy   
First Trimester 79 26.3 
Late Trimesters 221 73.7 
Type of Toilet facility  
Owned 234 78.0 
Shared 66 22.0 
Handwashing before meals  
No 11 3.7 
Yes 289 96.3 
Feeding   
Prepare food at home 257 85.7 
Buy food outside 43 14.3 
Drinking water Sources  
Treated Sources 289 96.3 
Untreated Sources 11 3.7 
Deworming History   
≤ 6months 88 29.3 
>6months 212 70.7 
 
 31  
 
University of Ghana http://ugspace.ug.edu.gh
4.2 Prevalence of Intestinal Parasitic Infections 
Out of the 300 pregnant women whose stool samples were examined by direct wet mount and 
formol-ether concentration techniques, 43(14.3%) of them had intestinal parasites. Out of this, 
23(7.7%) participants had intestinal protozoan parasites and the remainder 20(6.7%) were 
infected by intestinal helminthes. 
The predominant protozoan parasite was Entamoeba histolytica which accounted for 15(5.0%) 
infections among pregnant women. This was followed by Giardia lamblia 7(2.3%) and Isospora 
belli, 1(0.3%). 
With regards to helminthic infections, the predominant parasite species was Ascaris lumbricoides 
which had a prevalence of 13(4.3%). Following closely was Trichuris trichiura, 4(1.3%). Other 
parasites seen were Schistosoma mansoni 1(0.3%), Hymenolepis nana 1(0.3%) and Hookworm 
1(0.3%) in Figure 3. 
 
 
 
 32  
 
University of Ghana http://ugspace.ug.edu.gh
Prevalence of Intestinal Parasites 
6.00
5.00
5.0 
4.00 4.3 
3.00
2.00 2.3 
1.00 1.3 
0.3 0.3 0.3 0.3 
0.00
Intestinal parasite 
 
Figure 3: Prevalence of Intestinal Parasitic Infections among Pregnant Women 
 
 
  
 
 
 
 
 
 33  
 
Percentage (%) 
University of Ghana http://ugspace.ug.edu.gh
4.3 Factors Associated with Intestinal Parasitic Infections 
Table 4.2 shows the logistic regression analysis of socio-demographic characteristics with 
intestinal parasitic infections. Three factors were identified to be associated with intestinal 
parasitic infections by the univariate logistic regression analysis. These include age [Crude 
OR=0.22; 95% CI= 0.83-1.57; p=0.002], education [Crude OR=0.41; 95% CI= 0.21-0.80; 
p=0.0029] and employment status [Crude OR=0.38; 95% CI= 0.20-0.73; p=0.004]. 
After adjusting for potential confounders using multivariate logistic regression analysis, only age 
showed a statistically significant association with intestinal parasitic infections. Pregnant women 
above 30years had 83% reduced odds of having intestinal parasitic infections compared to those 
who were 30years and below [AOR = 0.17; 95% CI = 0.06, 0.48; p< 0.001]. 
 
 
 
 
 
 
 
 
 
 
 
 
  
 34  
 
University of Ghana http://ugspace.ug.edu.gh
Table 4.2: Univariate and multivariate analysis of intestinal parasitic infections across 
socio-demographic characteristics of pregnant women in Kasoa Polyclinic 
Characteristics Number Number COR P-value AOR  P-value 
Examined (%) Of Positive (95% CI) (95% CI) 
Cases (%) 
Age       
≤ 30yrs 198 (66.0) 38 (19.2) 1 0.002 1 0.001 
> 30yrs 102 (34.0) 5 (4.9) 0.22(0.83-1.57)  0.17(0.06-0.48)  
Education      
Less  J.H.S 132(44.0) 27 (20.5) 1 0.009 1 0.125 
J.H.S and above 168 (56.0) 16 (9.5) 0.41(0.21-0.80)  0.55(0.26-1.18)  
Marital Status      
Single 70 (23.3) 9 (12.9) 1 0.688   
Married 230 (76.7) 34 (14.8) 1.18(0.53-2.59)    
Employment       
Unemployed 95 (31.7) 22 (23.2) 1 0.004 1 0.066 
Employed 205 (68.3) 21 (10.2) 0.38(0.20-0.73)  0.49(0.23-1.05)  
 
 
 
 
 
 
 
 
 
 
 
 35  
 
University of Ghana http://ugspace.ug.edu.gh
In the univariate analysis, factors such as type of toilet facility used, hand washing before meals 
and drinking water sources were associated with intestinal parasitic infections among pregnant 
women. Pregnant women who shared a toilet facility had 2.78 folds greater odds of intestinal 
parasite infections compared to those who owned a toilet facility [COR= 2.78; 95% CI= 1.40-
5.51; p=0.004]. 
Again, in this same model, pregnant women who washed their hands before meals had 82% 
reduced odds of intestinal parasite infections compared to their counterparts who didn’t [COR= 
0.18; 95% CI= 0.05-0.63; p=0.007]. Also, drinking water from untreated sources was associated 
with 5.5 times greater odds of intestinal parasitic infections [COR= 5.50; 95% CI= 1.60-18.92; 
p=0.007]. 
After adjusting for potential confounding among the study variables the following results were 
obtained. Gravidity was significantly associated with intestinal parasitic infections among 
pregnant women. There was 57% reduced odds of intestinal parasitic infections among 
multigravida women compared to their primigravida counterparts [AOR= 0.43; 95% CI= 0.19, 
0.97; p=0.043]. 
Additionally, the stage of pregnancy was also significantly linked with intestinal parasitic 
infections. The odds of intestinal parasitic infections among pregnant women in their late 
trimesters was 4.73 times higher compared to pregnant women in their first trimester [AOR= 
4.73; 95% CI = 1.36,16.49; p=0.015] as shown in Table 4.3. 
 
 
 36  
 
University of Ghana http://ugspace.ug.edu.gh
Table 4.3: Univariate and Multivariate Logistic Regression analysis of Intestinal Parasitic 
Infections  with regards to gravidity, deworming status and hygienic practices 
Characteristics Number Number COR P- AOR P-
Examined of Positive (95% CI) value (95% CI) value 
(%) Cases (%) 
Gravidity       
Primigravidae 172 (57.3) 31 (18.0) 1 0.037 1 0.043 
Multigravidae 128 (42.7) 12 (9.4) 0.47(0.23-0.96)  0.43(0.19-0.97)  
Stage of Pregnancy       
First Trimester 79 (26.3) 3 (3.8) 1 0.005 1 0.015 
Late Trimesters 221 (73.7) 40 (18.1) 5.60(1.68-18.65)  4.73(1.36-16.49)  
Type of Toilet Facility       
Owned 234 (78.0) 26 (11.1) 1 0.004 1 0.186 
Shared 66 (22.0) 17 (25.8) 2.78(1.40-5.51)  1.72(0.77-3.86)  
Hand washing Before       
Meals 
No 11 (3.7) 5 (45.5) 1 0.007 1 0.055 
Yes 289 (96.3) 38 (13.2) 0.18(0.05-0.63)  0.25(0.06-1.03)  
Feeding       
Prepare food at home 257 (85.7) 34 (13.2) 1 0.187   
Buy food outside 43 (14.3) 9 (20.9) 1.74(0.77-3.94)    
Source of Drinking       
water 
Treated sources 289 (96.3) 38 (13.2) 1 0.007 1 0.079 
Untreated sources 11 (3.7) 5 (45.5) 5.50(1.60-18.92)  3.42(0.87-13.48)  
Deworming History       
≤ 6 months 88 (29.3) 8 (9.1) 1 0.100   
> 6 months 212 (70.7) 35 (16.5) 1.977(0.88-4.46)    
 
 
 
 37  
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER FIVE 
5.0 DISCUSSION 
The overall prevalence of intestinal parasitic infections among pregnant women from the study 
was found to be 14.3% [95% CI 11.0-19.0%]. This finding is similar to a prevalence of 14.32% 
obtained from a previous study in Northwest Ethiopia (Alem et al., 2013), 13.8% in Kenya 
(Wekesa et al., 2014) and 13.0% in Ghana (Ayeh-Kumi et al., 2009; Baidoo et al., 2010). In 
contrast, relatively higher prevalence rates have been reported in other studies. For example, a 
prevalence of 49.6% has been reported in Ghana (Tay et al., 2017),70.6% in Ethiopia (Feleke & 
Jember, 2018). Furthermore, significantly lower infection rate of 3.73% was reported in Iran 
(Balarak et al., 2016).  
Entamoeba histolytica contributed to the majority of intestinal parasites identified in the study 
representing 34.97%. Although this finding differs from those of Obiakor-Okeke et al., 
(2014)and Forson et al., (2017), they are consistent with those of others including Omorodion et 
al., (2012) and Akinbo et al., (2017) where E. histolytica was the most prevalent. Entamoeba 
histolytica was followed by Ascaris lumbricoides (30.26%). The high prevalence of these two 
parasites poses a serious health threat to the pregnant women infected. These parasites are known 
to contribute to bleeding episodes and may lead to adverse pregnancy outcomes that can be life 
threatening if not addressed. 
With regards to Giardia lamblia, it accounted for 16.28% of the infections among the pregnant 
women. This finding is much higher than that obtained by similar studies in Nigeria (Akinbo et 
al., 2017; Obiakor-Okeke et al., 2014). 
 38  
 
University of Ghana http://ugspace.ug.edu.gh
Hookworm contributed to 2.31% of intestinal parasitic infections identified in the study. This 
results contrasts with that of similar studies which reported higher prevalence (Akinbo et al., 
2017; Fuseini et al., 2013; Umeh et al., 2018). The low prevalence rate of hookworm infections 
observed in this study could be due to good sanitation and proper sewage disposal, as seen in the 
fact that many participants (78%) had their own toilet facilities rather than shared. The other 
reasons are that majority eat food prepared at home (85.7%), drink potable water (96.3%) and 
wash hands with soap before meals (96.3%). 
For Trichuris trichiura, it accounted for 9.29% of the infections. This was comparable to results 
obtained among pregnant women in Kenya (Wekesa et al., 2014) but higher than findings 
observed in Papua New Guinea (Phuanukoonnon et al., 2015).Other parasites observed were; 
Schistosoma mansoni, Hymenolepis nana and Isospora belli with each of them contributing to 
2.31% of intestinal parasites infections. 
Intestinal parasitic infection among pregnant women was determined by age, gravidity and 
parity. Older age was associated with a reduction in intestinal parasitic infections. This may be 
due to older women having better knowledge on personal and environmental hygienic practices 
compared to pregnant women of lower age. Other studies did not find any association between 
age and intestinal parasite infections among pregnant women (Derso et al., 2016; Espinosa 
Aranzales et al., 2018;  Fuseini et al., 2013). 
The stage of pregnancy/ gestational age was also found to be associated with intestinal parasitic 
infections. The second and third trimesters were associated with increased odds of intestinal 
parasitic infections among women. This observation is consistent with previous findings where 
the second and third trimesters of pregnancy presented higher odds of intestinal parasite 
 39  
 
University of Ghana http://ugspace.ug.edu.gh
infections than their counterparts in their first trimester (Akinbo et al., 2017; Umeh et al., 2018). 
Espinosa Aranzales and her colleagues reported a rather contradictory finding where stage of 
pregnancy had no association with intestinal parasitic infections  (Espinosa Aranzales et al., 
2018).  
Additionally, the study found gravidity to be associated with the odds of intestinal parasitic 
infections. Multigravida women had reduced odds of intestinal parasitism compared to 
primigravida women. The findings are in line with that of Phuanukoonnon et al., (2015) and 
Yatich et al., (2009). This observation may be attributed to the fact that multigravida women 
have previous pregnancy experience and therefore may have benefitted from public health 
education on various practices to avoid intestinal parasitic infections. 
Finally, none of the sanitation and hygienic practices was associated with intestinal parasitic 
infections among pregnant women. Whilst the result is in line with those of Derso et al., (2016) 
and Espinosa Aranzales et al., (2018), they disagree with other findings obtained in Ethiopia 
where hand washing practices, availability of toilet facilities and feeding habits were found to be 
associated with intestinal parasite infections in pregnancy (Feleke & Jember, 2018). This makes 
the role of hygienic practices in intestinal parasite infections unclear. 
 
 
 
 
 
 40  
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER SIX 
6.0 CONCLUSIONS AND RECOMMENDATIONS 
6.1 Conclusion 
Intestinal parasitic infection was observed among pregnant women in this study. The 
predominant intestinal protozoan infection was Entamoeba histolytica, followed by Giardia 
lamblia and then Isospora belli.  The predominant intestinal helminth infection among the 
women was found to be Ascaris lumbricoides followed by Trichuris trichiura, Schistosoma 
mansoni, Hookworm, Hymenolepis nana. 
Additionally, the study revealed that women in the second and third trimesters of pregnancy had 
higher odds of intestinal parasitic infections compared to their counterparts in their first 
trimester. Multigravida women had reduced odds of intestinal parasitic infections compared to 
primigravida women. 
Finally, sanitation and hygienic practices were found to have no association with intestinal 
parasitic infections, even though they are key strategies for minimizing the transmission of such 
infections. 
6.2 Recommendations from Research 
1. There should be regular and effective public health education at the antenatal care clinics to 
increase the knowledge of pregnant women on intestinal parasitic infections and the 
predisposing factors such as age and gynaecological characteristics. 
 41  
 
University of Ghana http://ugspace.ug.edu.gh
2. Routine stool examination should be carried out for every pregnant woman particularly those 
with lower age, those in their second and third trimesters as well as those having their first 
pregnancies since they represent the most vulnerable group. 
  
 42  
 
University of Ghana http://ugspace.ug.edu.gh
REFERENCES 
Abu-Madi, M. ., Behnke, J. ., & Doiphode, S. . (2010). Changing trends in intestinal parasitic 
infections among long-term residents and settled immigrants in Qatar. Parasites & Vectors, 
3, 98. https://doi.org/10.1186/1756-3305-3-98 
Adams, A. ., & Lawson, B. . (2014). Prevalence Of Ascaris Lumbricoides Among Food Vendors 
On A University Campus In Ghana. Journal of Science and Technology, 34(1), 63–74. 
Akinbo, F., Taiwo, O., Okaka, C., & Oriakhi, M. (2017). Co-infection of malaria and intestinal 
parasites among pregnant women in Edo State , Nigeria. Journal of Medicine in the Tropics, 
19(1), 43–48. https://doi.org/10.4103/jomt.jomt 
Alem, M., Enawgaw, B., Gelaw, A., Kena, T., Seid, M., & Olkeba, Y. (2013). Prevalence of 
anemia and associated risk factors among pregnant women attending antenatal care in 
Azezo Health Center Gondar town , Northwest Ethiopia, 1(3), 137–144. 
https://doi.org/10.5455/jihp. 
Arcari, M., Baxendine, A., & Bennett, E. . (2000). Diagnosing Medical Parasites through 
Coprological Techniques. 
Ayeh-Kumi, P. F., Nti, S. A., Duedu, K. O., Addo-Osafo, K., Obeng, A. S., Mortu, S., … Obeng 
Nkrumah, N. (2009). Intestinal Parasitosis among pregnant women in Accra, Ghana. Ghana 
Journal of Allied Health Sciences, 9–14. 
Ayeh-kumi, P. F., Quarcoo, S., Kretchy, K. ., & Mortu, S. (2009). Prevalence of Intestinal 
Parasitic Infections among Food Vendors in Accra, Ghana. The Journal of Tropical 
Medicine and Parasitology, 32(1), 1–8. 
 43  
 
University of Ghana http://ugspace.ug.edu.gh
Baidoo, S. ., Tay, S. C. ., & Abruquah, H. . (2010). Intestinal helminth infection and anaemia 
during pregnancy: A community based study in Ghana. African Journal of Microbiology 
Research, 4(16), 17713–1718. 
Balarak, D., Modrek, M. J., Bazrafshan, E., Ansari, H., & Mostafapour, F. K. (2016). Prevalence 
of Intestinal Parasitic Infection among Food Handlers in Northwest Iran, 2016. 
Chacon-cruz, E. (2009). Intestinal protozoa diseases. General hospital Tijuana, Mexico, 23–28. 
Cook, D. ., Swanson, R. ., Eggett, D. ., & Booth, G. . (2009). A Retrospective Analysis of 
Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of 
Guatemala. Journal of Health, Population and Nutrition, 27(1), 31–40. 
Dankwa, K., Addy-lamptey, P., Latif, A., Essien-baidoo, S., Ephraim, R. K. D., Gavor-kwashi, 
C. E. K., & Nuvor, S. V. (2017). Community in Ghana, (3), 151–157. 
Derso, A., Nibret, E., & Munshea, A. (2016). Prevalence of intestinal parasitic infections and 
associated risk factors among pregnant women attending antenatal care center at Felege 
Hiwot Referral Hospital , northwest. BMC Infectious Diseases, 1–7. 
https://doi.org/10.1186/s12879-016-1859-6 
Duedu, K. O., Karikari, Y. A., Attah, S. K., & Kumi, P. F. A. (2015). Prevalence of intestinal 
parasites among patients of a Ghanaian psychiatry hospital. BMC Research Notes, 1–5. 
https://doi.org/10.1186/s13104-015-1634-6 
Erismann, S., Diagbouga, S., Odermatt, P., Knoblauch, A. M., Gerold, J., Shrestha, A., … 
Utzinger, J. (2016). Prevalence of intestinal parasitic infections and associated risk factors 
among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso. 
 44  
 
University of Ghana http://ugspace.ug.edu.gh
Parasites & Vectors, 1–14. https://doi.org/10.1186/s13071-016-1835-4 
Espinosa Aranzales, A. F., Radon, K., Froeschl, G., María, Á., Rondón, P., & Delius, M. (2018). 
Prevalence and risk factors for intestinal parasitic infections in pregnant women residing in 
three districts of Bogotá , Colombia, 1–15. 
Feleke, B. E., & Jember, T. H. (2018). Prevalence of helminthic infections and determinant 
factors among pregnant women in Mecha district , Northwest Ethiopia : a cross sectional 
study, 1–6. 
Forson, A. O., Arthur, I., Taiwo, M. O., Glover, K. K., Jonathan, P., Ashong, P., & Kumi, P. F. 
A. (2017). Intestinal parasitic infections and risk factors : a cross ‑ sectional survey of some 
school children in a suburb in Accra , Ghana. BMC Research Notes, 4–8. 
https://doi.org/10.1186/s13104-017-2802-7 
Fuseini, G., Edoh, D., Kalifa, B. G., & Knight, D. (2013). Plasmodium and intestinal helminths 
distribution among pregnant women in the Kassena-Nankana District of Northern Ghana. 
International Journal of Nematology and Entomology, 1(3), 37–41. 
Fuseini, G., Edoh, E., Kalifa, B. ., Hamid, A.-W., & Knight, D. (2010). Parasitic infections and 
anaemia during pregnancy in the Kassena-Nankana district of Northern Ghana. Journal of 
Public Health Epidemiology, 2(3), 48–52. 
Getachew, M., Tafess, K., Zeynudin, A., & Yewhalaw, D. (2013). Prevalence of soil transmitted 
helminthiasis and malaria co-infection among pregnant women and risk factors in Gilgel 
Gibbe dam area. BMC Research Notes, 6, 263. https://doi.org/10.1186/1756-0500-6-263 
Keiser, J., Tritten, L., Adelfio, R., & Vargas, M. (2012). Effect of combinations of marketed 
 45  
 
University of Ghana http://ugspace.ug.edu.gh
human anthelmintic drugs against Trichuris muris in vitro and in vivo, 1–7. 
Mahande, A. ., & Mahande, M. . (2016). Prevalence of parasitic infections and associations with 
pregnancy complications and outcomes in Northern Tanzania: a registry-based cross-
sectional study. BMC Infectious Diseases, 16. https://doi.org/10.1186/s12879-016-1413-6 
Mahmud, M. A., Spigt, M., Bezabih, A. M., Pavon, L., Dinant, G., & Velasco, R. B. (2015). 
Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in 
School-Aged Children : A Factorial Cluster Randomized Controlled Trial, 1–16. 
https://doi.org/10.1371/journal.pmed.1001837 
Mcclure, E. M., Meshnick, S. R., Mungai, P., Malhotra, I., King, C. L., Goldenberg, R. L., … 
Dent, A. E. (2014). The Association of Parasitic Infections in Pregnancy and Maternal and 
Fetal Anemia : A Cohort Study in Coastal Kenya, 8(2), 19–23. 
https://doi.org/10.1371/journal.pntd.0002724 
Ministry of Finance (2018). Composite Bdget for 2018-2021. Programme Based Budget 
Estimates for 2018. AwutuSenya East Municipal Assembly, 5-6.  
Nkengazong, L., Njiokou, F., Wanji, S., Teukeng, F., Enyong, P., & Asonganyi, T. (2010). 
Prevalence of soil transmitted helminths and impact of Albendazole on parasitic indices in 
Kotto Barombi and Marumba II villages ( South-West Cameroon ), 4(3), 115–121. 
Nyarko, P. (2013). 2010 Population & Housing Census. National Analytical Report. Ghana 
Statistical Service. 
Obiakor-Okeke, P. N., Nwaogu, T. C., Agugo, U. A., & Odigwe Nkechi, M. (2014). The 
Prevalence of Intestinal Parasites and Anaemia among Pregnant Women Attending 
 46  
 
University of Ghana http://ugspace.ug.edu.gh
Antenatal Clinic in Federal Medical Centre Owerri , Imo State , Nigeria, 4(25). 
Odinaka, K. K., Nwolisa, E. C., Mbanefo, F., Iheakaram, A. C., & Okolo, S. (2015). Prevalence 
and Pattern of Soil-Transmitted Helminthic Infection among Primary School Children in a 
Rural Community in Imo State , Nigeria, 2015. 
Ofojekwu, M. N., Nnanna, O. U., Okolie, C. E., Odewumi, L. A., & Isiguzoro, I. O. U. (2018). 
Hemoglobin and Serum Iron Concentrations in Menstruating Nulliparous Women in Jos , 
Nigeria, 44(2), 121–124. https://doi.org/10.1309/LMM7A0F0QBXEYSSI 
Omorodion, O. A., Isaac, C., Nmorsi, O. P. G., Ogoya, E. M., & Agholor, K. N. (2012). 
Prevalence of intestinal parasitic infection among tertiary institution students and pregnant 
women in south-south, Nigeria. Journal of Microbiology and Biotechnology Research, 2(5), 
815–819. 
Peprah, C., Oduro-ofori, E., & Asante-wusu, I. (2015). Analysis of Accessibility to Water Supply 
and Sanitation Services in the Awutu-Senya East Municipality , Ghana, 8(8), 310–325. 
https://doi.org/10.5539/jsd.v8n8p310 
Phuanukoonnon, S., Kirarock, W., & Pomat, W. S. (2015). Intestinal parasitic infections and 
anaemia among pregnant women in the highlands of Papua New Guinea Intestinal parasitic 
infections and anaemia among pregnant women in the highlands of Papua New Guinea, 
(October). 
Porter, G., Hampshire, K., Kyei, P., Adjaloo, M., Rapoo, G., & Kilpatrick, K. (2008). Linkages 
between livelihood opportunities and refugee-host relations; learning from the experiences 
of Liberia camp-based refugees in Ghana. Journal of Refugee Studies, 21(2), 230–252. 
 47  
 
University of Ghana http://ugspace.ug.edu.gh
Regis, S. ., Karina, A. ., Brisa Maris, F., Ana, P., Marines, D. ., Tania, M. ., … Susana, I. . 
(2012). Adaptation of Ritchie’s method for Parasites Diagnosing with Minimization of 
Chemical Products. Interdisciplinary Perspectives on Infectious Diseases. 
Rodriguez-Morales, A. ., Barbella, R. ., Case, C., Arria, M., Ravelo, M., Perez, H., & Riffakis, P. 
(2006). Intestinal Parasitic Infections among Pregnant Women in Venezuela. Infectious 
Diseases in Obstetrics and Gynecology. https://doi.org/10.1155/IDOG/2006/23125 
Sehgal, R., Gogulamudi, V. ., Jaco, J. ., & Atluri, V. S. . (2010). Prevalence of intestinal parasitic 
infections among school children and pregnant women in a low socio-economic area, 
Chandigarh, North India. Reviews in Infection, 1(2), 100–103. 
Siziya, S., Muula, A. ., & Rudatsikira, E. (2013). Correlates of diarrhoea among children below 
the age of 5 years in Sudan. African Health Sciences, 13(2), 376–383. 
https://doi.org/10.4314/ahs.v13i2.26 
Sousa-Figueiredo, J. ., Gamboa, D., Pedro, J. ., Fancony, C., & Langa, A. . (2012). Epidemiology 
of malaria, schistosomiasis, geohelminths, anemia and malnutrition in the context of a 
demographic surveillance system in Northern Angola. PLos One, 7. https://doi.org/e33189 
Tay, S. C. ., Agbeko, E. ., & Walana, W. (2017). Parasitic infections and maternal anaemia 
among expectant mothers in the Dangme East District of Ghana. BMC Research Notes, 1–9. 
https://doi.org/10.1186/s13104-016-2327-5 
Tetteh, P. (2012). A comparative study of intestinal parasitic infection and associated risk 
factors among primary school children in six neighbouring communities in Kumasi, Ghana: 
Ayigya, Kentinkrono, Aboabo, Manhyia, Gyinyase and Kyirapatre. Kwame Nkrumah 
 48  
 
University of Ghana http://ugspace.ug.edu.gh
University of Science and Technology. 
Umeh, J. C., Inyang-Etoh, P. C., Okpokam, D. C., & Otu-Bassey, I. B. (2018). Malaria and 
hookworm co-infection and their effects on anaemia of pregnant women attending ante-
natal clinic in University Teaching Hospital, Calabar, Nigeria. Asian Journal of Medical 
Sciences, 9(3), 27. https://doi.org/10.3126/ajms.v9i3.19294 
Utzinger, J., Becker, S. ., Knopp, S., Blum, J., Neumayr, A. ., & Keiser, J. (2012). Neglected 
tropical diseases: diagnosis, clinical management, treatment and control. Swiss Med Wkly, 
142. 
Walana, W., Aidoo, E. N. ., & Tay, S. C. . (2014). Prevalence of Hookworm Infection: A 
Retrospective study in Kumasi. Asian Pacific Journal of Tropical Biomedicine, 4S158-
S161. 
Walana, W., Crowther, S., Tay, K., Tetteh, P., & Ziem, J. B. (2014). Prevalence of intestinal 
protozoan infestation among primary school children in Urban and peri-urban communities 
in Kumasi , Ghana, 2(2), 52–57. https://doi.org/10.11648/j.sjph.20140202.12 
Wekesa, A. ., Mulambalah, C. ., Muleke, C. ., & Odhiambo, R. (2014). Intestinal Helminth 
Infections in Pregnant Women Attending Antenatal Clinic at Kitale District Hospital, 
Kenya. Journal of Parasitology Research. https://doi.org/10.1155/2014/823923 
WHO. (2010). Intestinal Parasites. 
Yakasai, I. ., & Umar, U. . (2013). A Review of Parasitic Infestation in Pregnancy. Asian Journal 
of Natural and Applied Sciences, 2(1), 31–38. 
Yatich, N. J., Yi, J., Agbenyega, T., Turpin, A., Rayner, J. C., Stiles, J. K., … Jolly, P. E. (2009). 
 49  
 
University of Ghana http://ugspace.ug.edu.gh
Malaria and Intestinal Helminth Co-infection Among Pregnant Women in Ghana : 
Prevalence and Risk Factors, 80(6), 896–901. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 50  
 
University of Ghana http://ugspace.ug.edu.gh
APPENDICES 
APPENDIX 1: INFORMED CONSENT 
Title of study 
Prevalence of intestinal parasitic infections and associated risk factors among pregnant women 
attending antenatal care in Kasoa Polyclinic. 
Introduction 
I am a master’s student of the Department of Biological, Environmental and Occupational Health 
Sciences, School of Public Health, University of Ghana, Legon. As part of the programme, we 
carry out research work. My work is on the intestinal parasitic infections among pregnant women 
and factors that predispose them to such infections. 
Purpose of the study 
The study aims at determining the prevalence of intestinal parasitic infections and its associated 
risk factors among pregnant women attending antenatal care clinic in Kasoa Polyclinic. 
Eligibility Criteria 
Any pregnant woman 16 years or older who seeks antenatal care services at Kasoa Polyclinic 
during the period of the research. Pregnant women who are already on antihelminthic drugs 
would be exempted from the study. 
Study Procedure 
A short interview will be conducted with the help of a questionnaire to obtain the contact 
information, age, highest educational level, stage of pregnancy, handwashing practices, 
defecatory practices, history of deworming as well as sources of food and drinking water.      
Early morning stool sample will be collected from the participant by the Principal Investigator   
(a Laboratory Technologist) and analysed for various intestinal parasites. 
 
 
 
 51  
 
University of Ghana http://ugspace.ug.edu.gh
Risks and Benefits 
This study would not pose any risk to its respondents as clean and sterile materials would be 
used for testing for the presence of intestinal parasitic infections among the pregnant women. 
The potential risk that may arise is during the stool sample collection stage where the study 
participants may infect themselves with parasitic agents from the toilet if hands are notwashed.In 
view of that, the researcher would provide toiletries (toilet roll, soap and hand sanitizer) to 
participants that use the toilet facility. The study participants may spend about 30 minutes in 
answering questionnaires and stool sample collection for onward testing of the various intestinal 
parasitic infections. Study participants who would want to know the outcome of their test would 
have to not more than an hour. 
The studywould provide the study participants an opportunity to test for the presence or absence 
of intestinal parasitic infections. Again, it would afford them the chance to seek early treatment 
should there be any parasitic infection among them. 
Voluntary Participation/Withdrawal 
Informed written and verbal consent will be sought from the study participants before inclusion 
in the study. The study objectives and procedure, as well as possible risks and benefits associated 
with participating in the study will be explained to the study participants in English and the local 
language.Research would be carried out only on those who agree to participate and satisfy the 
inclusion criteria.  Study participants who do not seem to understand the study upon several 
explanations would be excluded from the study. All responses would be kept confidential. 
Privacy and Confidentiality 
Privacy and confidentiality of the respondents will be ensured at all stages of the study.  
Questionnaires designed for the study would not make use of names but rather serial numbers. 
Again, the questionnaires would be administered to the study participants individually in an 
enclosed room. Finally, the outcome of the laboratory testing would be kept strictly confidential. 
 52  
 
University of Ghana http://ugspace.ug.edu.gh
Data Storage and Protection 
Materials for the study that contains information on study participants would be kept strictly by 
Principal Investigator. The data obtained from the study would be cleaned and entered into Stata 
SE version 15 (64bit) software with the identification numbers and electronic files would be 
made available only to the research team. 
Declaration of Conflict of Interest 
I, Albert Abaka-Yawson (Principal Investigator), declare that to the best of my knowledge there 
are no conflict of interest will or may arise as a result of my involvement in the study. 
Who to Contact 
All questions and suggestions regarding the research can be wired to: 
 GHS/ Ethical Review Committee administrator, Hannah Frimpong 
Mobile Number: 0507041223 
 School of Public Health, University of Ghana, Legon 
 Albert Abaka-Yawson (Principal Investigator) 
Mobile Number: 0241453096/ 0578387338 
Email: aabakayawson@uhas.edu.gh 
Before taking Consent 
Do you have any questions you wish to ask concerning the study? 
Yes [  ]      No [  ]   If Yes, Please specify ………………………………………………………… 
Statement of Consent 
I ………………………………………….., declare that the purpose, procedures to be followed, 
risks and benefits of the study have been read / explained and every question (s) have been 
answered to my satisfaction. I hereby give consent to participate in this study. 
Signature / Thumbprint of participant…………………….           Date: ………………………….. 
 
 53  
 
University of Ghana http://ugspace.ug.edu.gh
Statement by the Researcher 
I, undersigned, have explained the consent form to the subject in the language that she 
understands on information relating to the study. I agree to answer any future questions 
concerning the study and also adhere to the approved protocol. 
 
Signature………………………………………….                    Date: …………………………….. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 54  
 
University of Ghana http://ugspace.ug.edu.gh
 
APPENDIX 2: QUESTIONNAIRE 
My name is ………………………………………………. from the School of Public Health, 
University of Ghana. We are seeking your assistance in undertaking an important scientific study 
on the prevalence of intestinal parasitic infections and associated risk factors among pregnant 
women in Kasoa. 
The study will provide you with useful information on parasitic infection status. Your 
participation is very vital to the success of the study. All information you provide will be treated 
with utmost care and will not be used for any other thing except for research purposes. 
Confidential information provided will be kept as such and made accessible only to the research 
team. 
We would administer a questionnaire and also take stool sample from you. Please feel free to 
skip any question in the form or stop at any point of the interview/ procedure. 
Thank you for agreeing to participate in this research work. 
Respondent’s ID Number………..    
SECTION A: GENERAL INFORMATION 
1. Participant’s Identification Number: ……………………………………………. 
2. Contact Information                         : ……………………………………………. 
3. Name of Interviewer                        : ……………………………………………. 
4. Date of Interviewer                          : ……………………………………………. 
5. Place of Interviewer                        : ……………………………………………. 
 55  
 
University of Ghana http://ugspace.ug.edu.gh
 SECTION B: BIODATA OF RESPONDENTS  
1 Which age group do you belong to? 16-20yrs                 21-25yrs                     26-30yrs 
31-35yrs                 36-40yrs                     41-45yrs 
46-50yrs   
2 Formal education None             Primary              J.S.S                S.S.S 
3 Marital status Single                       Married 
4 Employment of respondents Unemployed              Employed  
           SECTION C: PERSONAL FACTORS THAT MAY PREDISPOSE RESPONDENTS TO STUDY OUTCOMES 
5 Is this your first pregnancy? Yes                   No   
st nd
6 What stage of pregnancy are you in? 1  trimester                 2  trimester                  
rd
3  trimester   
7 What type of toilet facility do you use? Pit latrine               W. C                 Public toilet 
8 Do you share the toilet facility with others? Yes                    No  
9 Do you wash your hands after defecation? Yes                      No                      Sometimes 
10 What is your major source of feeding? Prepare food at home                Buy food outside 
11 Do you wash your hands before and after eating? Yes                    No                        
12 If yes, with what? Soap and water                  Water only                  
13 What is your main source of drinking water? Pipe-borne water                 Borehole  
Well                River/ Stream                  Sachet 
14 When was your last deworming date? <=3 months            4-6 months           7-11 months 
>=12months            Not at all                  
15 Has any deworming exercise been organized in the Yes                     No 
community recently? 
 56  
 
University of Ghana http://ugspace.ug.edu.gh
APPENDIX 3: MEDICAL REFERRAL FORM 
 
Date: ………………………………………………….. 
         Patient Name:………………………………………….. 
Patient’s Date of Birth:………………………………… 
 
Dear Dr …………………… 
REFERRAL 
The above named client recently participated in a research work where stool samples were 
collected for analysis for various parasites. The following abnormalities were noted in her 
laboratory results; 
Parameter and Abnormalities Identified 
 
We are therefore referring her to your facility for appropriate medical care. We are most grateful 
for your assistance. 
Sincerely, 
 
Albert Abaka-Yawson 
Principal Investigator 
School of Public Health 
University of Ghana 
 
 57