Systematic Review Faktor Risiko Infeksi Parasit Usus Systematic Review of Risk Factor of Intestinal Parasite Infection

Latar Belakang: Infeksi parasit usus adalah masalah umum di dunia. Infeksi parasit usus menyebabkan morbiditas, mortalitas dan komplikasi. Tujuan: Tujuan dari penelitian ini adalah untuk mengidentifikasi kejadian faktor risiko infeksi parasit usus dengan menggunakan tinjauan sistematis pada infeksi parasit usus terkait artikel yang dipublikasi. Metode: Populasi adalah artikel tentang prevalensi dan faktor risiko infeksi parasit antara tahun 2013 sampai 2019 yang berjumlah 35 artikel. Kriteria inklusi adalah penelitia yang mengkaji faktor risiko intestinal parasit dan menggunakan data primer. Kriteria inklusi adalah penelitian review dan menggunakan data sekunder. Data dianalsiis dengan analisis univariat dengan menghitung rata-rata, nilai minimum, nilai maksimum, dan frekuensi serta persentase. Ulasan: Hasil menunjukkan bahwa faktor risiko infeksi parasit usus yang paling banyak terjadi adalah karena usia, jenis kelamin, tempat tinggal, toilet, mencuci tangan dengan sabun sebelum makan, kebiasaan mengenakan sepatu, memotong kuku, makan makanan yang kurang matang, kebersihan pribadi, dan sumber air minum. Kesimpulan: Faktor risiko infeksi parasit meliputi faktor demgrafi, perilaku hidup bersih dan sehat dan gaya hidup. Memperbaiki pola hidup bersih dan sehat dan gaya hidup dapat mencegah terjadinya infeksi parasit.


INTRODUCTION
Intestinal parasites are a common problem in the world. Amoebiasis, ascariasis, hookworm infection, and trichuriasis are among the most common infections in the world (WHO, 2019). Parasitic infections, caused by intestinal helminths and protozoan parasites, are among the most prevalent infections in humans in developing countries. Infection caused by intestinal helminths is a soil-transmitted helminth infection. Species of parasitic worms are transmitted by eggs present in human feces, which are contaminated the soil in areas where sanitation is poor.
Intestinal parasitic infections are distributed virtually throughout the world, with high prevalence rates in many regions. Soil-transmitted helminths infection occurs in more than 1.5 billion people or 24% of the world's population. Infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China, and East Asia. Over 267 million preschool-age children and over 568 million school-age children live in areas where these parasites are intensively transmitted and require treatment and preventive interventions (WHO, 2019).
Intestinal parasites cause significant morbidity and mortality in endemic countries. Morbidity is related to the number of worms harbored. In general, mortality from these infections is relatively low, however, complications are not common and many cases need hospital care. In many countries, malabsorptions, diarrheas, blood loss, impaired work capacity, and reduced growth rate due to intestinal parasitic infections constitute important health and social problems. Furthermore, other parasitic infections such as abdominal angiostrongyliasis, intestinal capillariasis and strongyloidiasis are of local or regional public health concerns. In many countries, endemic intestinal parasitic infections are closely related to economic and social developmental processes and therefore their control may be a sensitive issue, both socially and politically (WHO, 2019).
In children, the infected are nutritionally and physically impaired. The infection to affect the digestive absorption and metabolism of foods that can result in loss of protein, carbohydrates fats, vitamins, and blood in large quantities can also cause an impaired immune response to the plasma insulin-like a growth factor (IGF)-1, increasing levels of serum tumor necrosis the A (TNS) and lower concentrations of hemoglobin. Besides, it can cause various symptoms of diseases such as anemia, diarrhea, the syndrome dysentery, iron deficiency anemia, and so the infection with a worm gut is a group of high risk for malnourished. This situation is in can cause a growth problem (Nursalim, Sari, & Aidinna, 2018).
The greater proportion of infections is associated with poor water, sanitation, and hygiene (WASH) (Gizaw, Adane, Azanaw, Addisu, & Hailed, 2018). In developing countries, intestinal parasite infections are major health problems. Epidemiological surveys on the intestinal parasite infections are important in this country because they reflect the sanitary conditions of the community and produce basic data for the control of parasitosis in the future.
There have been many publications that have reviewed the risk factors for intestinal parasites infection. Some research about the risk factors of intestinal parasites infection is inconsistent. Age and education have a significant effect on intestinal parasites infection (Bahrami et al., 2018), contrarily in Ashok et al. (2013) studied that age and education is an insignificant effect on intestinal parasites infection insignificant. The source of drinking water is a significant effect on intestinal parasites infection (Bakarman, Hegazi, & Butt, 2019), contrarily in Bahrami et al. (2018) studied. The inconsistency of the results of research on risk factors for intestinal parasites infection makes it interesting to study. This is because by conducting a review, it can determine the risk factors that most influence intestinal parasites infection.
Knowledge of risk factors for intestinal parasites infection can be a solution in preventing intestinal parasites infection. Therefore, this study uses a quantitative meta-analysis to systematically study research studies relating to intestinal parasites infection risk factors. The purpose of research using a systematic review approach is to find out the most risk factors for intestinal parasites infection based on the results of publications in health journals Public.

METHOD
This study used a systematic review method. The data source of this study was derived from the literature obtained through the internet in the form of research results from publications in journals. A systematic review of intestinal parasite risk factors was then performed following PRISMA guidelines. The searches were conducted in Hindawi, PubMed, emedicalj, tandfonline, knepublishing, portalnepas, ojs unud, plos, jurnal.umsb, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. 167 Media Gizi Kesmas, Vol. 10, No. 1, Juni 2021: Halaman : 165 -179 The population is the research paper about prevalence and risk factors for intestinal parasites infection from 2013-2019 and 35 studies were used. Inclusion criteria were researched that identifies risk factors intestinal parasites infection, use primary data for the research, and in Indonesian and English. Data collection was carried out on September 1 until 7 October 2019. The sample of the research consisted of ages 0 years to more than 60 years. Exclusion criteria were review study and use secondary data for the study. Data are presented in tabular form. Univariate analysis to see the average, minimum and maximum values, and frequency and percentage distribution.

RESULT AND DISCUSSION
The results of the screening research paper identified 35 research on risk factors of intestinal parasites infection. The general description of the risk factor of intestinal parasites infection was listed in Table 1.
Intestinal parasites infection 21 studies, Intestinal helminthic infection 12 studies and 2 studies did not explain in detail the type of parasite. The study was conducted with an age range of 0 to more than 60 years. A total of 25 studies are in the school-age range. The study examined the number of samples studied varied from 50 to 80.727 people and all of them are primary data. The research design used in the entire study was cross-sectional. The variables studied consist of 1 to 25 variables, and there are about 1 to 7 research variables that are significantly at intestinal parasites infection. Table 2 showed that of the 35 studies studied, there were 49 variables studied consisting of patient characteristics, parental characteristics, and lifestyle of the respondents. Variable characteristics of parents and respondent characteristics studied were 21 variables and lifestyle consisted of 28 variables. The most studied variables were washing hand with soap before meal 20 studies (57.14%), sex 19 studies (54.28%), shoe-wearing habit 19 studies (54.28%), age 16 studies (45.71%), toilets 16 studies (45.71%), source of drinking 11 studies (31.42%), eating undercooked food 11 studies (31.42%), and trimming nails 10 studies (28.57%), respectively. Other risk factors associated with intestinal parasites infection include education, father's educational level, mothers' knowledge, residence, mothers education, parents' educational level, parents jobs, mothers jobs, fathers jobs, parents' income, jobs, knowledge, monthly income, family members, student grade, season, go to river, reason for referrals, wealth status, number of animal owned, raised dog, raised cat, raised animal at home, barangay variance, household variance, anemia, nutritional status, contact with domestic animal, floor house condition, municipal tap network, daily bath, washing hand with soap after toilet, treatment of the waste, waste disposal system, swimming habit, wearing boots in the field, using soil as a medium for playing, use of anthelmintic drugs, personal hygiene, and sanitation.
Based on the variables examined by several studies related to risk factors for intestinal parasites infection, in this study the variables are divided into two groups i.e. variables that can be controlled and variables that cannot be controlled. The variables that cannot be controlled entry into the variable of respondent characteristics and variables that can be controlled entry into the lifestyle variable.   Based on lifestyle, from 35 studies of risk factors for intestinal parasites infection, most used the variable washing hand with soap before meal 20 studies (57.14%), toilets were 19 studies (54.28%) and Shoe wearing habits were 19 studies (54.28%). The results of the variable that significantly affect intestinal parasites infection are 13 studies (65%) washing hands with soap before a meal, 5 studies (31.25%) toilet, and 9 studies (47.37%) shoe wearing a habit. Other variables that significantly influence intestinal parasites infection are explained as follows. Reason for referral, go to the river, barangay variance, raised a dog, daily bath, are reported to have a significant effect on intestinal parasites infection in all studies (100%).
Trimming nails 8 studies (80%), personal hygiene 4 studies (80%), sanitation 3 studies (75%), the use of anthelmintic drug and waste disposal system each of the 2 studies (66.7%), household variance, raised animals at home, swimming habits, wearing boots in the field 1 studies (50%), eating undercooked food 5 studies (45.45%), washing hand with soap after toilet 3 studies (37.5%), source of drinking water 4 studies (33.33%), using soil as a medium for playing 2 studies (33.3%), and source of water supply 2 studies (22.22%) that were reported to have a significant effect on intestinal parasites infection. The number of animals owned, raised cats, Municipal tap networks, treatment of waste, and contact with domestic animals have reported no significant effect on intestinal parasites infection in all studies.
Research on intestinal parasites infection has been carried out and has been explained many findings related to risk factors, both those that can be controlled and those that cannot be controlled. Based on the results of a review of several scientific article publications representing research findings on worm disease risk factors in the form of research and publication in journals. The number of research samples is also increasing both those from school age, adults and infants under 2 years and the variables studied are increasingly diverse and complete. All studies reviewed related to risk factors for intestinal parasites infection in this study were 35 studies using cross-sectional studies.
Factors that are at risk for helminthiasis can be grouped into two, i.e risk factors that can be controlled and risk factors that cannot be controlled. Individual characteristics are factors that cannot be controlled. The variables examined from 35 studies included in the characteristics of respondents were gender, age, mothers 'job, fathers' job, knowledge, residence, mothers 'educational level, parents' income, student grade, and wealth status, family, parents job, educational level, fathers' educational level, mothers' knowledge, parents' educational level, jobs, monthly income, anemia, and nutritional status. Among these variables, the variables that significantly affect intestinal parasites infection are sex, age, mothers 'job, fathers' job, knowledge, residence, mothers 'educational level, parents' income, student grade, wealth status, family member, parents job, and educational level. Meanwhile, fathers' educational level, mothers' knowledge, parents' educational level, jobs, monthly income, anemia, nutritional status are reported insignificant effects on the incidence of helminthiasis in all studies studied.
Parents' income, family member and wealth status are related to the fulfillment of children's nutrition which can affect the child's immune system. Children who are fulfilled with good nutrition will increase endurance and become less easily infected by parasites. Knowledge, mothers' educational level and educational level relate to knowledge about parasitic infections so that the knowledge they have can be the basis for taking reactive actions against parasitic infections. The ages examined in this study varied, The prevalence of intestinal parasites infection was significantly higher in males (22.7%) than females (11.8%) (Suntaravitun & Dokmaikaw, 2018). The same thing was stated by Ross et al. (2017) that the prevalence of intestinal parasites infection in male (50.6%) was higher than female (49.4%). Suntaravitun and Dokmaikaw (2018) state that intestinal parasite infections are found more in more than 40 years old. In children, the prevalence of intestinal parasites is more common at the age of fewer than 13 years (Berhanu Elfu Feleke, 2016).
Variables that can be controlled are grouped into lifestyle factors. Variables examined from 35 studies included in the lifestyle are washing hands with soap before meal, toilet, shoe-wearing habit, reason for referral, going to river, barangay variance, raised dog, daily bath, trimming nails, personal hygiene, sanitation, use of anthelmintic drugs, waste disposal systems, household variance, raised animals at home, swimming habits, wearing boots in the field, eating undercooked food, washing hands with soap after toilet, source of drinking water, using soil as a medium for playing, source of water supply, number of owned animals, raised cats, Municipal tap networks, treatment of waste, and contact with domestic animals. Among these variables, variables that significantly affect intestinal parasites infection are washing hand with soap before meal, toilet, shoe-wearing habit, reason for referral, going to river, barangay variance, raised dog, daily bath, trimming nails, personal hygiene, sanitation, use of anthelmintic drugs, waste disposal systems, household variance, raised animals at home, swimming habits, wearing boots in the field, eating undercooked food, washing hands with soap after toilet, source of drinking water, using soil as a medium for playing , and source of water supply. Meanwhile, the number of animal owned, raised cats, municipal tap networks, treatment of waste, and contact with domestic animals reported no significant effect on helminthiasis in all studies studied.
Eating undercooked food is a risk factor of intestinal parasite infection. The most common detected intestinal parasite was B. hominis has a significantly higher prevalence in developed countries that could be related to contamination of food or water supplies and poor hygienic conditions (Bakarman et al., 2019). Shoe wearing habit is a significant effect on intestinal parasite infection. Footwear was a vital factor for helminth infection because having no footwear showed a higher prevalence (76.03%) than having foot ware (34.21%). Non-hand wash users (80%) and irregular nail trimmer (90%) were also more prone to helminth infestation. Long nail is a contributing factor for acquiring and ingesting egg of parasites more easily. Usually, children who pick up and eat food from the ground, possess a higher risk of helminth infection. Moreover, in the slum areas, meals remain unveiled and exposed to heavy wind, domestic animals containing parasite eggs. Treatment with anthelminthic drugs reduces the transmissibility of parasites by reducing worm load and shedding of eggs (Mukutmoni & Khanum, 2017). Intestinal parasite infections are important health problems among underprivileged children. Exposure to infection is influenced by climate, poverty, ignorance, lack of access to safety measures and personal hygiene. These infections affect the psychological and physical development of a child. Therefore, an extensive design is necessary to implement a proper control strategy to mitigate these infections.

CONCLUSIONS
The results of the systematic study analysis, it is known that the most risk factors for intestinal parasite infection are age, sex, residence, toilet, washing hand with soap before a meal, shoe-wearing habit, trimming nails, eating undercooked food, personal hygiene, and source of drinking water. Based on demographics, various intestinal parasite studies show that age, sex, and residence as dominant risk factors for intestinal parasite infection. Based on lifestyle, toilets, washing hands with soap before meals, shoe-wearing habits, trimming nails, eating undercooked food, personal hygiene, sources of drinking water are the major risk factors identified in various intestinal parasite infection studies.
Inconsistent research results regarding parasitic intestinal risk factors give rise to vague knowledge about parasitic intestinal risk factors. This research provides clarity regarding the most common risk factors in parasitic intestinal risk factors so that it becomes one of the studies that contribute to the development of the health sector. In the future, studies on intestinal parasite infection studies involving other variables besides characteristics and lifestyles such as social, economic and cultural variables.