{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:40Z","timestamp":1783491520791,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intestinal parasitic infections (IPIs) remain highly prevalent in conflict-affected settings where water, sanitation, and health systems are disrupted. Simple, scalable tools for identifying high-risk populations are urgently needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study of 1,200 schoolchildren aged 5\u201315\u202fyears across nine districts in Al-Dhalea Governorate, Yemen (April\u2013October 2025). Stool samples were analyzed using direct microscopy and formalin-ether concentration. A novel Household Deprivation Score (HDS; range 0\u20133) was constructed from three indicators of socioeconomic and spatial disadvantage. Multilevel mixed-effects logistic regression was used to assess statistical associations with IPI positivity. All associations are correlational; causal inference is precluded by the cross-sectional design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, the IPI prevalence was 46.2% (95% CI: 43.4 to 49.0%). The\n                      <jats:italic>Entamoeba histolytica<\/jats:italic>\n                      dispar complex was the most frequently detected (38.6%), but sensitivity analyses suggest that 70 to 80% may be non-pathogenic\n                      <jats:italic>E. dispar<\/jats:italic>\n                      . The HDS showed modest screening performance (AUC\u202f=\u202f0.63; sensitivity: 67.2%, specificity: 61.4%) with a strong graded association with IPI positivity: compared with HDS\u202f=\u202f0, adjusted odds ratios increased from 1.45 (95% CI: 1.08 to 1.95) for HDS\u202f=\u202f1 to 2.89 (95% CI: 2.01 to 4.15) for HDS\u202f=\u202f3 (p for trend less than 0.001). Additional factors statistically associated with IPI included anemia (AOR\u202f=\u202f2.35), animals in the home (AOR\u202f=\u202f1.89), irregular nail trimming (AOR\u202f=\u202f1.82), and always washing hands before eating (compared to rarely), which was associated with 37% lower odds of IPI (AOR\u202f=\u202f0.63, 95% CI: 0.45 to 0.87).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>The HDS showed a graded association with IPI prevalence (AUC\u202f=\u202f0.63), indicating modest discriminative ability suitable for risk stratification rather than diagnosis. Species-stratified analyses excluding Entamoeba cases (29.4% of positives) attenuated the HDS-pathogen association, with the AOR for HDS\u202f=\u202f3 decreasing from 2.95 to 2.18 and HDS\u202f=\u202f1 losing significance. These findings suggest partial influence of non-pathogenic carriage. The HDS may support resource allocation but should not replace diagnostic testing. Molecular confirmation (PCR) and external validation in other conflict-affected settings are needed before broader implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1868011","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:56:43Z","timestamp":1783490203000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Household deprivation score demonstrates graded association with intestinal parasitic infections among schoolchildren in a conflict-affected setting: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Khalil A.","family":"Saleh","sequence":"first","affiliation":[{"name":"Department of Medical Surgical, College of Nursing, University of Ha'il","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naif Taleb","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Science and Technology","place":["Aden, Yemen"]},{"name":"Department of Laboratory Sciences, Radfan College University, University of Lahej","place":["Al-Houta, Yemen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waled A. M.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Community Health Nursing, Faculty of Nursing, Al-Baha University","place":["Al-Baha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer A.","family":"Alkubati","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical, College of Nursing, University of Ha'il","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad Fahmi","family":"Othman","sequence":"additional","affiliation":[{"name":"Department of Community Health, College of Nursing, University of Ha'il","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galal Faisal","family":"Albani","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health Nursing, College of Nursing, University of Ha'il","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","volume-title":"Soil-Transmitted helminth Infections: fact Sheet","year":"2023"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/S0140-6736(17)31930-X","article-title":"Soil-transmitted helminth infections","volume":"391","author":"Jourdan","year":"2018","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"62","DOI":"10.12703\/P7-62","article-title":"Advances in understanding Giardia: determinants and mechanisms of chronic sequelae","volume":"7","author":"Bartelt","year":"2015","journal-title":"F1000Prime Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1016\/S0140-6736(06)68653-4","article-title":"Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm","volume":"367","author":"Bethony","year":"2006","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"S23","DOI":"10.1017\/s0031182000006491","article-title":"Malnutrition and parasitic helminth infections","volume":"121","author":"Stephenson","year":"2000","journal-title":"Parasitology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1111\/j.1740-8709.2007.00127.x","article-title":"A review and meta-analysis of the impact of intestinal worms on child growth and nutrition","author":"Hall","year":"2008","journal-title":"Matern Child Nutr"},{"key":"ref7","volume-title":"Yemen Humanitarian Needs Overview 2024 (January 2024)","year":"2024"},{"key":"ref8","volume-title":"Yemen Humanitarian Situation Report No. 1, March 2024","year":"2024"},{"key":"ref9","first-page":"S189","article-title":"Intestinal parasitosis and nutritional status in schoolchildren of Sahar district, Yemen","volume":"12","author":"Raja'a","year":"2006","journal-title":"East Mediterr Health J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/5976640","article-title":"Prevalence of intestinal parasites among immunocompromised patients, children, and adults in Sana'a, Yemen","volume":"2022","author":"Al-Yousofi","year":"2022","journal-title":"J Trop Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.actatropica.2016.08.009","article-title":"School-based prevalence of intestinal parasitic infections and associated risk factors in rural communities of Sana'a, Yemen","volume":"163","author":"Al-Mekhlafi","year":"2016","journal-title":"Acta Trop"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"943","DOI":"10.22270\/ujpr.v8i3.943","article-title":"Prevalence of intestinal protozoa, helminths, and coccidian infections among primary school children in thala'a district at Amran governorate, Yemen","volume":"8","author":"Al-Mekhlafi","year":"2023","journal-title":"Univ J Pharm Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"Singer","year":"2017","journal-title":"Lancet"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1128\/CMR.00004-07","article-title":"Laboratory diagnostic techniques for Entamoeba species","volume":"20","author":"Fotedar","year":"2007","journal-title":"Clin Microbiol Rev"},{"key":"ref15","first-page":"195","volume-title":"District Laboratory Practice in tropical Countries. Part 1","author":"Cheesbrough","year":"2009"},{"key":"ref16","volume-title":"Basic Laboratory Methods in Medical Parasitology","year":"1991"},{"key":"ref17","volume-title":"Haemoglobin Concentrations for the Diagnosis of anaemia and Assessment of Severity","year":"2011"},{"key":"ref18","volume-title":"Pathologies of power: Health, human rights, and the new war on the poor","author":"Farmer","year":"2003"},{"key":"ref19","volume-title":"Global Multidimensional Poverty Index 2022 United Nations Development Programme","year":"2022"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1093\/ije\/dys037","article-title":"Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper","volume":"41","author":"Howe","year":"2012","journal-title":"Int J Epidemiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"539","DOI":"10.4269\/ajtmh.2002.67.539","article-title":"The role of dogs in transmission of gastrointestinal parasites in a remote tea-growing community in northeastern India","volume":"67","author":"Traub","year":"2002","journal-title":"Am J Trop Med Hyg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1016\/j.ijpara.2013.06.001","article-title":"Zoonotic potential of Giardia","volume":"43","author":"Ryan","year":"2013","journal-title":"Int J Parasitol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e0008378","DOI":"10.1371\/journal.pntd.0008378","article-title":"Enteric parasitic infections in children and dogs in resource-poor communities in northeastern Brazil: identifying priority prevention and control areas","volume":"14","author":"Harvey","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13104-019-4871-2","article-title":"Associations between intestinal parasitic infections, anaemia, and diarrhoea among school aged children, and the impact of hand-washing and nail clipping","volume":"13","author":"Mahmud","year":"2020","journal-title":"BMC Res Notes"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/j.trstmh.2008.05.012","article-title":"Anaemia and iron deficiency anaemia among aboriginal schoolchildren in rural peninsular Malaysia: an update on a continuing problem","volume":"102","author":"Al-Mekhlafi","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref26","first-page":"716","article-title":"Anemia and intestinal parasite infection in school children in rural Vietnam","volume":"16","author":"Le","year":"2007","journal-title":"Asia Pac J Clin Nutr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1093\/ajcn\/65.1.153","article-title":"Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: the importance of hookworms","volume":"65","author":"Stoltzfus","year":"1997","journal-title":"Am J Clin Nutr"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"616S","DOI":"10.1093\/jn\/131.2.616S","article-title":"Iron and its relation to immunity and infectious disease","volume":"131","author":"Oppenheimer","year":"2001","journal-title":"J Nutr"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/s1473-3099(02)00184-6","article-title":"What is the evidence for a causal link between hygiene and infections?","volume":"2","author":"Aiello","year":"2002","journal-title":"Lancet Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1868011\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:56:48Z","timestamp":1783490208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1868011\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":30,"alternative-id":["10.3389\/fpubh.2026.1868011"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1868011","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1868011"}}