Soil-transmitted helminthiasis in the aftermath of conflict: assessing prevalence, intensity, and associated factors among school-age children in Tigray, Ethiopia, 2025

Soil-transmitted helminths (STH) remain a significant public health concern in children, particularly in tropical and subtropical areas of the world. Even though these infections are preventable, the World Health Organization (WHO) considers school-aged children to be at elevated risk of soil-transmitted helminth morbidities. Hence, we aimed to assess the prevalence, intensity, and associated factors of soil-transmitted helminthiasis among school-age children in Tigray, Ethiopia, in the aftermath of conflict. A school-based cross-sectional study was conducted from September 2024 to February 2025. Data on socio-demographic characteristics and possible associated factors were collected using a structured questionnaire. Four hundred eighteen school-age children were included and recruited using a systematic random sampling technique. The collected stool specimens were examined using wet mount, formal ether, and the Kato Katz technique. A logistic regression model was employed to assess the associations between dependent and independent variables. Data was analyzed by using SPSS version 25. P value < 0.05 at a 95% confidence interval was considered statistically significant. Out of 418 school-aged children enrolled, the overall prevalence of soil-transmitted helminth infections was 52.6%. The most identified species were Ascaris lumbricoides (35.5%), followed by hookworm (34.0%) and Trichuris trichiura. Co-infections were seen at 3.8%, and triple infection in 0.8% of participants. Most infections were of light intensity, particularly for hookworm (78.7%) and T. trichiura (79.1%), while moderate to heavy intensities were more frequent in A. lumbricoides. Soil-transmitted helminth infections were significantly associated with lower grade levels, large family size, lack of latrines, use of river water, and low paternal education. Protective factors included being male, consistent hand washing, and avoiding river crossings (p < 0.05). CONCLUSIONS: Soil-transmitted helminth infections are still a significant public health concern among school-age children in the Aftermath of the Conflict of Tigray, with over half of the children infected (52.6%). Ascaris lumbricoides was most prevalent, and risk was intricately linked to poor hygiene, unsafe water, and lack of sanitation. Targeted interventions such as regular deworming, improved access to latrines, safe water supply, and hygiene education, particularly hand washing, are essential. Strengthening these efforts through school and community-based programs can reduce infection rates and improve child health in post-conflict settings. WHAT IS KNOWN: • Soil-transmitted helminth infections are common among school-age children in low-resource settings. • Conflict and displacement disrupt deworming, hygiene, and sanitation programs, increasing infection risk. WHAT IS NEW: • This study provides the first post-conflict data on STH prevalence and intensity among school-age children in Tigray, Ethiopia. • The findings highlight the need to restore and strengthen deworming and sanitation programs in conflict-affected communities.