Prevalence of Intestinal Parasitic Infections and Associated Risk Factors among Pre-treatment and Under-treatment Adult Cancer Patients at the Oncology Unit of JUCSH, Ethiopia

Abstract

Background: Intestinal parasitic infections (IPIs) are a significant public health concern, especially in low-resource settings such as Ethiopia, where cancer patients are increasingly vulnerable due to immunosuppression caused by chemotherapy and malnutrition. However, the prevalence and associated risk factors of IPIs among cancer patients remain poorly understood. Objective: This study aimed to determine the prevalence of intestinal parasitic infections and associated risk factors among adult cancer patients, comparing those before treatment and those under treatment at the Oncology Unit of Jimma Medical Center (JUCSH), Ethiopia. Methods: A comparative cross-sectional study with a follow-up component was conducted on 237 adult cancer patients (151 pre-treatment and 86 on treatment) from July 2024 to February 2025. Sociodemographic and clinical information (such as types and stages of cancer, duration of cancer, comorbidities, CD4 count, and nutritional status) were collected from study participants using a structured questionnaire. Stool samples were collected from 151 cancer patients before commencement of chemotherapy and from 83 patients during chemotherapy. Detection of intestinal parasites was performed by using direct wet mount microscopy, modified Ziehl-Neelsen staining, and Kato-Katz techniques. Data were entered using Epidata and exported to SPSS version 26 for analysis. Bivariate and multivariate logistic regression analysis were used to identify potential predictors of IPIs. Results: The overall prevalence of IPIs was (38%,90/237), with a higher rate among under treatment patients (44.2%,38/86) compared to pre-treatment patients (34.4%,52/151). Protozoan parasites were predominant, with Cryptosporidium spp. (12.65%), Entamoeba histolytica (6.75%), and Giardia lamblia (5%) were the most common. Five species of helminths were identified: Ascaris lumbricoides and Trichuris trichiura were the most prevalent, each found in 8(3.37%) and 9(3.8%) patients respectivly, while hookworm was detected in 2(1.3%) patients. Cancer patients with lower CD4 level (AOR = 3.292 before treatment; AOR = 7.482 under treatment), malnutrition (AOR = 2.732 before treatment; AOR = 3.889 under treatment), were at greater risk for IPIs. Conclusion: This study found a significant prevalence of intestinal parasitic infections among adult cancer patients, particularly among those undergoing treatment. Malnutrition and immunosuppression were the strongest predictors for IPIs among cancer patients. Routine V screening of cancer patients for IPIs, improved nutritional support, implement targeted deworming protocols and monitoring of immune status should be integrated into cancer care protocols in high risk settings like Ethiopia.