Intestinal parasitic infections (IPIs) are globally endemic and constitute one of the greatest causes of illness in developing countries [1]. IPIs can be transmitted directly (hand-to-hand contact) or indirectly (contact with contaminated food or water and from environmental surfaces) [2, 3] Varying climatic conditions, economic, cultural and sanitation practices are main contributing factors to the prevalence of intestinal parasites [3, 4]. People of all ages can be affected by IPIs, with most school children being more at risk. The helminths Ascaris lumbricoides, Trichuris trichiura, hookworms, Hymenolepis nana, and the protozoan Giardia duodenalis/Giardia intestinalis are the common intestinal parasites parasitizing more than 1 billion people worldwide [2–4]. In the last two decades, different studies have reported varying prevalences of IPIs among school children in Cuba (45–58%) [5], Pakistan (52.8%) [6], Mexico (65%) [7], Ethiopia (28% -95%) [8–11], Sudan (90%) [12], and Burkina Faso (84%) [13] to be associated with personal hygiene, socio economic status and educational levels of the parents.

The presence of IPIs can affect the mental and physical developments of children hence countries like Thailand, Uganda, Guatemala and Egypt have undertaken different programmes on nutrition, immunization and de-worming to promote health by influencing behaviour of parents towards preventing parasitic infections [14–17]. In Ghana, the Volunteer Partnerships for West Africa (VPWA) has supported the administration of de-wormers to some school children [18]. However, its impact has not been evaluated and the programme did not train or give guidance to parents and children on how to solve common health problems. Although previous studies in Ghana have reported 6.8% for G. lamblia and 5% for IPIs in children attending hospitals in the Greater Accra and Northern regions of Ghana, limited information is available on presumably healthy children living in urban slums in Accra, Ghana. This research was carried out to investigate the prevalence of intestinal parasites and the impact of socioeconomic factors, occupation, family size and education of parents on the transmission of IPIs among school children from 2–9 years of age residing in urban slums of Greater Accra.

In the present study, the prevalence of intestinal parasitic infections and their relationship with socio-demographic, family size, knowledge and occupation of parents of school children living in an urban slum in Accra, Ghana was studied. Previous studies have tackled intestinal parasitism in Ghanaian children [23, 24]; however, this is the first study to investigate influencing variables of parents and family sizes with paediatric parasitic infections in an urban slum in Accra, Ghana. The present study revealed 15% of primary school children, aged 2–9 years were infected by one or more intestinal parasites. Our findings are similar to Shakya et al., [25]) study from Nepal which reported a 14% prevalence. Compared to our findings, the prevalence of intestinal parasitic infections among the children was significantly lower than 85% reported by Osman et al., [26] and the 52.8% by Merhaj et al., [6] in children in Lebanon and Pakistan. The differences in prevalences in the countries may be associated with varying pathogenicity or asymptomatic carriage of the parasites and sampling methods. Young school going children have been reported to be at higher risk for intestinal parasitic infections (IPIs) [27, 28]. This study identified children aged 5 (13%), 6 (22.2%), and 7 (28.9%) years as the most infected with IPIs. Although our findings are similar to Tandukar et al., [29] study, the reasons for the increase in IPIs with age could be due to the fact that as children grow older, the exposure to IPIs increases, but further exploration through prospective studies with a bigger sample size is required.

In this study Giardia lamblia and Entamoeba coli were the common protozoan identified from the stool samples of 30 (10%) children. Whilst varying prevalence for Ascaris lumbricoides, Schistsoma mansoni, Taenia species, Hymenolepis nana, Strongyloides stercolaris were detected in 11 (3.7%) children, a few [4 (1.3%)] children had mixed infection with G. lamblia and H. nana, or E. coli and S. mansoni (Table 1). The prevalence of protozoan parasites detected are lower than reports from Cuba [5], Nepal [25], Pakistan [6] and Ethiopia [30]. Furthermore, in conformity to Mehraj et al., [6] and Ahmed et al., [31] representing studies from other urban localities in Pakistan, no hookworm was detected in this study. Although a previous study by Reither et al., [24] with children from northern Ghana which has rural characteristics (with hamlets and thatched mud-wall huts scattered over a vast area) identified hookworm, it is obvious that parasitic profile of urban slums is different from rural areas and further studies are required to make substantive conclusions. Transmission of the detected protozoan and helminths parasites have been previously reported to be associated with poor sanitation and contaminated water [5, 6, 24]. Our diagnostic sensitivity may have been improved if we had taken three consecutive stool samples, but this was not done because the children and their parents were not willing to co-operate.

Low socioeconomic status (SES) has been reported to be a risk factor for IPIs [32]. The effect of SES on risk of parasitic infections in particular is complex in nature and could be attributed to sources of drinking water and food, hygiene, environment, access to education, and living conditions of individuals. We took a combination of education [(maternal p = 1.0, OR = 0.9779) (paternal p = 0.3879, OR = 1.912)] and occupation [(maternal p = 0.422, OR = 1.750) (paternal p = 0.0534, OR = 1.491)] of the parents as a proxy measure of SES in this study, but we found they were not associated with IPIs in the school children.

However, in agreement with Shakya et al., [25], and Quihui et al., [7] studies from Nepal, and Mexico, children of illiterate and basic education fathers [(55.6%), and (22.2%)] and mothers [(62.2%) and (33.3%)] were often infected than the literate ones. This has revealed that the better educated the parents are, the lower the prevalence of IPIs in children as previously reported by Nematian et al., [32] and Wamani et al., [15] with children from Iran and Uganda. The differences in prevalences in the different countries may be due to varying social economic conditions and environmental behaviours in the different countries.

In addition, mothers who were traders many infected children (80.7%) compared to children (35.5%) from fathers who were traders. This could be that as mothers who are often the main care givers are busy with their trading activities, there is an increase in exposure to IPIs of school aged children in urban slums in Accra. Further exploration is required to link trading activities of mothers as an independent risk factor for IPIs.

Furthermore, children with no knowledge of intestinal parasitic infection [41 (14.6%)] were often infected with intestinal parasites. Persuasive education on IPIs, improving hygiene, and application of supportive programmes for parents to elevate socioeconomic conditions may assist in the reduction of parasitic infection in children.

Personal hygiene has been described to have an impact on parasitism [33]. Although children whose parents claimed to always have clean cut nails were often infected (16.1%), children from parents with more children (20.8%) were often infected. In agreement with Maia et al., [34] study from Brazil, the occurrence of IPIs was statistically associated with children with more household members (OR = 0.4750, p = 0.031). Overcrowded conditions of household members can lead to intra-family transmission from close contacts of crowded houses.

In conclusion, although intestinal parasitosis among the school children was found to be 15%, IPIs are important public health problem globally. Preventive programmes on awareness of the infectious diseases, improving hygiene, and application of supportive programmes to elevate socioeconomic conditions may reduce the burden of parasitic infection. In addition there is a need for continuous mass scale deworming programmes to enable eradication of IPIs and studies on parasitic infections in different population settings are required to help develop effective prevention and control strategies for the eradication of IPIs in children.

The current study had certain limitations; only one stool sample was examined instead of the ideal three consecutive samples due to poor cooperation of parents. The results of this study cannot be generalized to all Ghanaian school children as the variation of the included variable may vary in different seasons, or among ethnic groups in their geographic and socio-economic settings in Ghana. Other limitations include lack of baseline data on if the students have ever been infected or treated for parasitic infections.