{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:17:58Z","timestamp":1793193478823,"version":"4.5.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Intestinal parasitic infections pose significant global health challenges, particularly in developing countries. Asymptomatic infections often present a considerable burden with food handlers serving as potential carriers. In Ethiopia, the prevalence of these parasites varies across regions, and accurate data in the study area is lacking. Therefore, this study aimed to investigate the prevalence of intestinal parasites among food handlers working in hotels and restaurants in Gondar City, Northwest Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study collected stool samples from food handlers alongside a structured questionnaire gathering socio-demographic and hygiene practice information. Stool specimens were screened for intestinal parasites using direct wet mount and formol-ether concentration techniques. The collected data were checked for completeness, entered into EpiData software version 3.1, and exported to SPSS version 20 for analysis. A multivariable logistic regression analysis was deemed statistically significant if the <jats:italic>p<\/jats:italic>-value was less than 0.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 257 food handlers working in hotels and restaurants in Gondar City participated in the study. Of these, 33.5% (86\/257) were found positive for one or more intestinal parasites, with a 95% confidence interval (CI) of 28.0\u201339.5%. The study identified nine types of intestinal parasites, with <jats:italic>E. histolytica\/dispar<\/jats:italic> (8.2%, 21\/257) and Ascaris lumbricoides (6.6%, 17\/257) being the predominant parasites, followed by hookworm (3.5%, 9\/257) and <jats:italic>S. mansoni<\/jats:italic> (2.3%, 6\/257). The prevalence of mixed infections was 9.3% (24\/257). A significant association was observed between intestinal parasitic infection and the educational level of food handlers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this study, a high prevalence of intestinal parasites was detected indicating poor hygiene practices of the food handlers at the study site. Even the prevalence of mixed infections was high. Regular training, strict adherence to personal hygiene and food-handling practices, and routine inspections and medical checkups for food handlers are crucial.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1362086","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T19:38:27Z","timestamp":1718134707000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Burden and factors influencing intestinal parasitic infections among food handlers in Gondar City, Northwest 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years (1970 to 2013) in Malaysia","volume":"31","author":"Sinniah","year":"2014","journal-title":"Trop Biomed"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"135","DOI":"10.29261\/pakvetj\/2022.040","article-title":"Anti-parasitic applications of nanoparticles: a review","volume":"42","author":"Kandeel","year":"2022","journal-title":"Pak Vet J"},{"key":"ref3","first-page":"296","article-title":"Intestinal parasitic infections in man: a review","volume":"58","author":"Norhayati","year":"2003","journal-title":"Med J Malays"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"6","DOI":"10.5897\/AJMR11.1533","article-title":"Prevalence of intestinal parasitic infections among food handlers in Khuzestan, southwest of Iran: a 10\u2013year retrospective study","volume":"6","author":"Saki","year":"2012","journal-title":"Afr J Microbiol Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1756-3305-7-37","article-title":"Global numbers of infection and disease burden of soil transmitted helminth infections in 2010","volume":"7","author":"Pullan","year":"2014","journal-title":"Parasit Vectors"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e110621","DOI":"10.1371\/journal.pone.0110621","article-title":"Prevalence and predictors of intestinal parasites among food handlers in Yebu town, Southwest Ethiopia","volume":"9","author":"Tefera","year":"2014","journal-title":"PLoS One"},{"key":"ref7","first-page":"27","article-title":"The sanitary conditions of food service establishments and food safety knowledge and practices of food handlers in Bahir Dar town","volume":"22","author":"Kibret","year":"2012","journal-title":"Ethiop J Health Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5365\/wpsar.2012.3.2.013","article-title":"Food safety surveillance and response","volume":"3","author":"Bishop","year":"2012","journal-title":"Western Pac Surveill Response J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"109151","DOI":"10.1016\/j.ijfoodmicro.2021.109151","article-title":"Measuring transfer of human norovirus during sandwich production: simulating the role of food, food handlers and the environment","volume":"348","author":"Derrick","year":"2021","journal-title":"Int J Food Microbiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/978-3-319-30723-7_5","article-title":"Epidemiology of viral foodborne outbreaks: role of food handlers, irrigation water, and surfaces","author":"Hedberg","year":"2016","journal-title":"Viruses Foods"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"266","DOI":"10.4103\/0300-1652.93802","article-title":"Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital","volume":"52","author":"Zaglool","year":"2011","journal-title":"Niger Med J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1590\/S0036-46652014000200004","article-title":"Prevalence of intestinal parasites among food handlers in Western Iran","volume":"56","author":"Kheirandish","year":"2014","journal-title":"Rev Inst Med Trop S\u00e3o Paulo"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12889-020-8167-1","article-title":"Intestinal parasites among food handlers of food service establishments in Ethiopia: a systematic review and meta-analysis","volume":"20","author":"Yimam","year":"2020","journal-title":"BMC Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12889-016-2790-x","article-title":"Prevalence and factors associated with intestinal parasitic infections among food handlers of southern Ethiopia: cross sectional study","volume":"16","author":"Mama","year":"2016","journal-title":"BMC Public Health"},{"key":"ref15","first-page":"1","article-title":"Prevalence of intestinal parasitic infections among food vendors in Accra, Ghana","volume":"32","author":"Ayeh-Kumi","year":"2009","journal-title":"J Trop Med Parasitol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"451","DOI":"10.3329\/jhpn.v26i4.1887","article-title":"Prevalence of bacteria and intestinal parasites among food-handlers in Gondar town, Northwest Ethiopia","volume":"26","author":"Andargie","year":"2008","journal-title":"J Health Popul Nutr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e061688","DOI":"10.1136\/bmjopen-2022-061688","article-title":"Prevalence of intestinal parasites and associated factors among food handlers in food establishments in the Lideta subcity of Addis Ababa, Ethiopia: an institution-based, cross-sectional study","volume":"12","author":"Abera","year":"2022","journal-title":"BMJ 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action","author":"Payment","year":"2002"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40794-020-00123-1","article-title":"Prevalence and factors associated with intestinal parasites among food handlers in Medebay Zana District, north West Tigray, northern Ethiopia","volume":"7","author":"Regassa","year":"2021","journal-title":"Trop Dis Travel Med Vaccines"},{"key":"ref26","first-page":"111","article-title":"Prevalence of intestinal parasites in food handlers of Bandar Abbas, southern Iran","volume":"47","author":"Heydari-Hengami","year":"2018","journal-title":"Iran J Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/1471-2458-13-151","article-title":"Prevalence of intestinal parasitic infections among highland and lowland dwellers in Gamo area, South Ethiopia","volume":"13","author":"Wegayehu","year":"2013","journal-title":"BMC Public 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southern Ethiopia: a cross-sectional study","volume":"7","author":"Kumma","year":"2019","journal-title":"Front Public Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/8889302","article-title":"Prevalence of intestinal parasites and Salmonella typhi among food handlers working in catering establishments of public institutes found in Dawuro zone, South-Western Ethiopia","volume":"2021","author":"Kumalo","year":"2021","journal-title":"J Parasitol Res"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/9321348","article-title":"Predictors of intestinal parasitic infection among food handlers working in Madda Walabu university, Ethiopia: a cross-sectional study","volume":"2020","author":"Kuti","year":"2020","journal-title":"Interdiscip Perspect Infect Dis"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/2230-8229.98065","article-title":"Pattern of intestinal parasitic infection among food handlers in Riyadh, Saudi Arabia","volume":"8","author":"Kalantan","year":"2001","journal-title":"J Family Community Med"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1590\/S0036-46652015000200007","article-title":"Prevalence of intestinal parasites among food handlers of sari, northern Iran","volume":"57","author":"Sharif","year":"2015","journal-title":"Rev Inst Med Trop S\u00e3o Paulo"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"2450","DOI":"10.1002\/vms3.590","article-title":"Prevalence of intestinal parasitic infection in food handlers of Iran: a systematic review and meta-analysis","volume":"7","author":"Sharifi-Sarasiabi","year":"2021","journal-title":"Vet Med Sci"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"681","DOI":"10.12688\/f1000research.14681.1","article-title":"Prevalence of intestinal parasites among food handlers attending public health laboratories in Khartoum state, 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