Prevalence and risk factors associated with intestinal parasitic infections among adults in rural Itasy region of Madagascar: Prévalence et facteurs de risque associés aux infections parasitaires intestinales chez les adultes de la région rurale d'Itasy à Madagascar

Background: Intestinal parasitic infections (IPIs) are a major public health burden in rural Madagascar, but adult data are scarce. We aimed to estimate the prevalence of IPI and determine associated factors among adults attending a referral hospital in the Itasy region of Madagascar.Methodology: A hospital-based cross-sectional study was conducted between June and August 2023 on consecutively enrolled adults (≥18 years) at the Itasy Regional Referral Hospital. A single fresh stool sample per participant was examined by direct wet mount. Sociodemographic, clinical and behavioural data were collected. Factors associated with IPI prevalence were assessed using bivariate and multivariate logistic regression.Results: Among 101 participants (57 women, median age 37.8 years), IPI prevalence was 34.7% (n=35/101). The most frequent parasites were Entamoeba histolytica/dispar (37.1%), Schistosoma mansoni (34.3%) and Ascaris lumbricoides (31.4%). In multivariate analysis, low socioeconomic status (aOR = 8.90), proximity to rice fields or untreated water (aOR = 6.80), and farming occupation (aOR = 5.60) were associated with high IPI prevalence. Deworming within 12 months (aOR = 0.22) and safe food handling (aOR = 0.05) were associated with low IPI prevalence.Conclusion: IPIs affected more than one-third of adults in this rural Malagasy hospital sample. Low socioeconomic status, farming, and living near untreated water were strong correlates, while recent deworming and safe food handling were associated with lower risk. Because only one stool sample without concentration was used, the true prevalence is likely underestimated. Larger community-based studies with multiple samples and concentration techniques are needed.