Intestinal parasitic infections among school children in Shendi, Sudan (2021–2024): prevalence, risk factors, and diagnostic comparison

Intestinal parasitic infections remain a major global public health concern, particularly in tropical and subtropical regions of Africa, Asia, and Latin America. This study aimed to determine the prevalence of intestinal parasites, identify associated risk factors, and compare diagnostic techniques among school children in both central and rural areas of Shendi locality, Sudan. A school-based cross-sectional study was conducted from January 2021 to April 2024. A total of 1,200 students were selected using a simple random sampling method. Data were collected through direct interviews using a pretested questionnaire. Stool specimens were collected in clean, labeled plastic containers and examined microscopically for eggs, cysts, and trophozoites using three diagnostic techniques: Wet preparation, Formol-ether concentration (FECT), and Flotation (FLO). Data were analyzed using SPSS^V22 software. The overall prevalence of intestinal parasitic infections was 35.3% (423/1200; 95% CI: 32.7-38.0), with a mean infection intensity of 12.04 ± 1.9 eggs per gram (EPG), (Estimation of Egg Per Gram (EPG); mean ± standard deviation (SD)). Prevalence was higher in males (38.1%) than females (33.7%) but the difference was not statistically significant (p = 0.09). Infection decreased significantly with increasing age (p < 0.001); It peaked among children aged 5-7 years (47.0%), then declined to 33.8% at 8-10 years and 27.0% at 11-13 years. Regarding diagnostic performance, FECT tended to show slightly higher fecal egg counts (mean = 7.1 ± 1.2 EPG) compared to FLO (mean = 5.1 ± 0.8 EPG), (where ± represents the standard deviation). Six genera of intestinal parasites were identified: protozoa (Entamoeba coli 11.7%, Entamoeba histolytica 8.8%, Giardia duodenalis 7.3%) and helminths (Enterobius vermicularis 2.6%, Hymenolepis nana 4.7%, Taenia spp. 0.3%). Infection prevalence showed significant variation by residential area, age group, awareness of transmission, handwashing practices, and presence of symptoms (p < 0.05). The study demonstrated a moderate prevalence of intestinal parasitic infections among school-aged children in Shendi locality (35.3%), with higher rates among younger children and those residing in rural areas. Six parasite genera were identified. Infection was significantly associated with hygiene behaviors, handwashing practices, and awareness of transmission (p < 0.05). The formol-ether concentration technique showed higher diagnostic sensitivity than flotation. These findings highlight the need for integrated interventions combining deworming, water, sanitation and hygiene (WASH) improvements, and school-based health education to reduce reinfection and achieve sustainable parasite control in Shendi and similar settings.