Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Esp&eacute;rance University Hospital Center

lufuluabu mpemba Alphonse; Tshishimbi kalala Jean Hubert; Tshodi bulanda Arsène

doi:10.12688/f1000research.160135.1

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Research Article

Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Espérance University Hospital Center

[version 1; peer review: 2 approved with reservations, 1 not approved]

lufuluabu mpemba Alphonse¹, Tshishimbi kalala Jean Hubert², Tshodi bulanda Arsène³

PUBLISHED 09 Jan 2025

Author details Author details

¹ internal medecine, University of Mbuji-Mayi, Mbuji-mayi, Kasai oriental, Democratic Republic of the Congo
² pediatrics, University of Mbuji-Mayi, Mbuji-Mayi, Kasai oriental, Democratic Republic of the Congo
³ gynecology obstetric, university of Mbuji-Mayi, Mbuji-Mayi, Kasai oriental, Democratic Republic of the Congo

lufuluabu mpemba Alphonse
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tshishimbi kalala Jean Hubert
Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tshodi bulanda Arsène
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Intestinal parasitoses are one of the main causes of morbidity and mortality in Africa, with a prevalence of 42.18%. The tropical climate in the D.R. Congo provides parasites with an environment conducive to their proliferation. The prevalence rates of intestinal parasitoses remain poorly understood in the D.R. Congo.

Objective

This study aims to estimate the overall and specific prevalence of intestinal parasitosis and to determine an association between intestinal parasitosis and the season.

Methods

From January 1, 2020, to December 31, 2021, patients for whom a direct stool examination was requested at the Notre Dame de l’Espérance University Hospital Center were included in this study. Stool samples were collected and examined under an optical microscope.

Results

During the period of the study, we recorded 187 patients aged 2 to 77 years. The prevalence of intestinal parasitosis was 75.40%. The specific prevalence rates for parasites were as follows: Entamoeba H., the most common, with a prevalence of 55.08%, followed by Trichomonas I. and Giardia L. with respective prevalence rates of 9.09% and 6.24%. Ascaris L. had a prevalence of 27.81%, followed by Schistosoma M., Ankylostoma D., and Enterobius V. with respective prevalence rates of 3.74%, 1.60%, and 1.07%. There was no association between the season and the overall prevalence of intestinal parasitosis.

Conclusion

The prevalence of intestinal parasitosis was higher during the dry season. There is no statistically valid association between the season and the prevalence of intestinal parasitosis.

Keywords

University of Mbujimayi/Intestinal Parasitosis/Season/ Association/Protozoa/Helminths

Corresponding author: lufuluabu mpemba Alphonse

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Alphonse lm et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Alphonse lm, Jean Hubert Tk and Arsène Tb. Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Espérance University Hospital Center [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2025, 14:50 (https://doi.org/10.12688/f1000research.160135.1) First published: 09 Jan 2025, 14:50 (https://doi.org/10.12688/f1000research.160135.1) Latest published: 09 Jan 2025, 14:50 (https://doi.org/10.12688/f1000research.160135.1)

Introduction

Intestinal parasitic infections are serious diseases worldwide. However, doctors working in these regions tend to give them little attention due to the commonality of their occurrence. As a result, they are rarely a reason for regular consultation.^1,2 Although they attract little interest today compared to diseases such as AIDS, tuberculosis, malaria, and onchocerciasis, they remain a public health issue in tropical and impoverished areas.³

Climatic conditions are one of the main factors that contribute greatly to the spread of intestinal parasitic infections, by increasing their transmission and perpetuating the parasitic cycles.⁴

According to World Health Organization (WHO) estimates, more than three billion people are affected, with 450 million severely ill; of these, over 50% are school-aged children.⁵ The global prevalence is 35.8% in the world population.⁶ These diseases have disastrous health, social, and economic consequences for more than one billion people (WHO, 2023).

In Africa, a study conducted in Morocco in 2019 among migrants from sub-Saharan Africa (Equatorial Guinea “30.6%”, Côte d’Ivoire “16.6%”, Senegal “9.29%”, Cameroon “8.01%”, with the remaining patients coming from Niger, Togo, Congo, Burkina Faso, Mali, Gabon, and Benin “35.5%”) showed a prevalence of 43.18% for intestinal parasitic infections. Among these individuals, 63.15% were infested with various digestive parasites simultaneously.⁷ A study conducted at the University Hospital of Tlemcen, ABOU BEKR BELKAID University in Algeria in 2016 showed that among the identified protozoa, Blastocystis Hominis was the most common (76.6%), followed by Endolimax Nanus and Giardia Intestinalis, with 10.6% each.⁸ In Senegal, a study conducted in 2010 by Diallo on the prevalence of helminths revealed the following frequencies: Ascaris Lumbricoides (1.9%), Strongyloides Stercoralis (0.8%), Trichuris Trichiura (0.4%), Enterobius vermicularis (0.1%), and Taenia Saginata (0.04%).⁹

In the DRC, parasitic infections pose a public health problem due to multiple crises that have led to displacement and a lack of potable water, food hygiene, and sanitary facilities.¹⁰ A study conducted in Bukavu in 2016 on the impact of seasons on intestinal parasitic infections showed a prevalence of 94%. The identified helminths, in decreasing order of frequency, were: Schistosoma M. (30.6%), Strongyloides S. (21.3%), Ankylostoma D. (13.6%), Ascaris L. (12.6%), Trichuris T. (9.0%), and Taenia S. (6.6%). Identified protozoa included Trichomonas I. (13.69%), Entamoeba H. (6.75%), and Giardia L. (4.76%).¹¹ According to a 2019 study conducted in Kinshasa by Dr. Mulumba, Ntumpa, and Muhido on geo-helminth prevalence, Ascaris lumbricoides had the highest prevalence (27%), followed by T. trichiura (10.3%), S. stercoralis (2.9%), and Ankylostoma sp. (2.8%). All these nematodes showed a decline during the study period, except for A. lumbricoides, which increased at a rate 3.2 times faster in children than in adults.¹²

The East Kasai region is dominated by a humid tropical climate. The population living in the eastern part of its capital, Mbujimayi, and the surrounding villages, served by CHUNDE, is poor and lives in very poor hygienic conditions. We have not identified any study that could inform us about the prevalence of intestinal parasitic infections here.

The prevalence of intestinal parasitic infections is likely very high at CHUNDE and may be associated with the season.

General objective

To determine the prevalence of intestinal parasitic infections via stool examination at CHUNDE and to assess the impact of the season on the frequency of intestinal parasitic infections in general and on each specific type.

Specific objectives

• To determine the specific prevalence of each identified intestinal parasitic infection;
• To determine the prevalence of intestinal helminths and protozoa;
• To determine the association between the season and the prevalence of intestinal parasitic infections.

Methods

Study population

This study included patients who consulted at the Notre Dame de l’Espérance University Hospital Center (CHUNDE) and were requested to have a direct stool examination. This center serves the East Kasai province, particularly the rural-urban areas to the east of Mbujimayi city in the DRC. These areas are characterized by poor sanitary and economic conditions. The study period was from January 1, 2020, to December 31, 2021.

Inclusion and exclusion criteria

The study included all patients who consulted at CHUNDE during the study period and were requested by physicians to have a direct stool examination. Patients who did not provide a sample for this examination were excluded.

Sample collection

Fresh stool samples of approximately 10-20 grams (5-6 milliliters if liquid) were collected by the patient. For this collection, the laboratory provided each patient with a clean container and rod.

Direct stool examination

The direct stool examination was conducted within 30 minutes of sample collection. Approximately 2 grams of stool were mixed with 1 milliliter of saline solution (0.9%) on a slide. After homogenization, this preparation was covered with a slide and observed under an optical microscope at 10x and 40x objectives. The results were recorded in the laboratory register and entered into an Excel database as follows: Parasitic infection (yes, no), type of parasite (helminths, protozoa), multiple infestation (yes, no), types of combined parasites, Entamoeba Histolytica (yes, no), Giardia Lamblia (yes, no), Trichomonas Intestinalis (yes, no), Ascaris Lumbricoides (yes, no), Schistosoma mansoni (yes, no), Ankylostoma Duodenalis (yes, no), Enterobius Vermicularis (yes, no). Cases of Entamoeba Histolytica also included those of Entamoeba Dispar due to the difficulty in distinguishing them microscopically.

Statistical analysis

The prevalence of intestinal parasitic infections was calculated by dividing the number of patients with at least one identified parasite in a direct stool examination by the total number of patients who underwent this examination. The prevalence in a given population group was calculated by dividing the number of patients in that group with at least one identified parasite by the total number of patients in that group who underwent this examination. The prevalence of a specific intestinal parasitic infection was calculated by dividing the number of patients with a specific parasite by the total number of patients who underwent the examination. The confidence interval (CI) for each prevalence rate is 95%. Statistical analyses were performed using EPI INFO 7.2.6.0 and R version 4.3.3.

Ethical considerations and informed consent

This study received approval from the ethics committee of the University of Mbujimayi on N52/CEUM1209 of 11th December 2019. It was conducted in accordance with the requirements of good clinical practices and the principles of the Helsinki Declaration of the World Medical Association, along with any subsequent relevant amendments.

All patients who have participated in this study have provided their consent by signing a written Document, the consent form.

Declaration of interest

We have no conflicts of interest to declare for this work.

Study results

Characteristics of the study population

From January 1, 2020, to December 31, 2021, 187 patients were included in our study.

Table 1 and Figure 1 summarize their demographic characteristics: Among the 187 patients included in our study, 94 were female and 93 were male. The sex ratio was one woman for one man. A total of 158 patients were adults [≥18 years <70], 20 were children [<18 years], and 9 were elderly [≥70 years]. The mean age was 41.68 ± 17.95 years. The youngest patient was 2 years old, and the oldest was 77 years.

Table 1. Demographic characteristics of patients undergoing direct stool examination between 2020 and 2021.

	Frequencies (N=187)	%
Sex
Women	93	49.73
Men	94	50.27
Ratio	1F/1H
Age groups
childreen (<18 years old)	20	10.69
Adults (18-70 years old)	158	84.49
Senior adults (˃70 years old)	9	4.81
Mean age	41.68±17.95
Median age	46

Figure 1. Age description.

Frequency of intestinal parasitic infections

As shown in Table 2, a total of 141 patients, or 75.40%, had at least one intestinal parasitic infection. Forty-seven patients (24.13%) had multiple infestations, of which 37 (19.79%) combined at least one helminth and one protozoan, and 10 (5.35%) combined at least two protozoa. The most frequent combination was Entamoeba histolytica and Ascaris lumbricoides, with 27 cases (14.44%). Intestinal parasitic infections were more frequent among children (95.00%) and elderly adults (88.89%). They were also more common in women (78.49%) than in men (72.34%). A total of 114 patients (60.96%) had at least one intestinal protozoan, and 66 patients (35.29%) had an intestinal helminth infection.

Table 2. Frequency of intestinal parasitic infections, intestinal helminth infections, and intestinal protozoa.

	Fréquences (N=187)	%
Intestinal parasitic infections	141	75.40
Type of parasitoses
Protozoa	114	60.96
Helminths	66	35.29
Multiple infestation
Yes	47	24.13
No	94	50.27
Différent combinations
Protozoai-helminth	37	19.79
Entamoeba H. Ascaris L.	27	14.44
Entamoeba H. Ankylostoma D.	1	0.53
Entamoeba H. Schistosoma M.	2	1.07
Entamoeba H. Ascaris L. Schistosoma M.	1	0.53
Entamoeba H. Trichomonas I. Ascaris L	1	0.53
Giardia L. Trichomonas I. Ascaris L.	1	0.53
Giardia L. Trichomonas I. Schistosoma M.	1	0.53
Trichomonas I. Ascaris L.	2	1.07
Trichomonas I. Schistosoma M.	1	0.53
Protozoa2	10	5.35
Entamoeba H. Trichomonas I.	2	1.07
Entamoeba H. Trichomonas I. Giardia L.	4	2.14
Giardia L. Trichomonas I.	4	2.14
Age group
Enfants	19 (n=20)	95.00
Adultes	114 (n=158)	72.15
Adultes de troisième âge	8 (n=9)	88.89
Sex
Men	68 (n=94)	72.34
Women	73 (n=93)	78.49

Frequencies of intestinal protozoa

Figure 2 shows that Entamoeba histolytica was the most frequent protozoan, with 103 cases (55.08%), followed by Schistosoma M., Ankylostoma D., and Enterobius V. with respective prevalence rates of 3.74%, 1.60%, and 1.07%.

Figure 2. Frequency of different types of intestinal protozoa.

Frequencies of intestinal helminths

As shown in Figure 3, Ascaris lumbricoides was the most frequent helminth, with 52 cases (27.81%), followed by Schistosoma mansoni, with 7 cases (3.74%), Ancylostoma duodenale, with 3 cases (1.60%), and Enterobius vermicularis, with 2 cases (1.07%).

Figure 3. Frequency of different types of intestinal helminth infections.

Frequency curves of intestinal parasitic infections

Figure 4 shows the evolution of frequency of intestinal parasitoses by year (2020 and 2021). It allows to analyse this evolution in the relation with the season(dry season: from 15/5 to 15/8 and rainy season: from 1/1 to 14/5 and from 16/8 to 31/12).

Figure 4. Frequency curves of intestinal parasitic infections in 2020 and 2021.

In 2020, the frequency of intestinal parasitic infections was high, with peak values during the dry season (83-100% in May, June, and July) and in October. In 2021, the frequency also remained high, particularly with peak values observed during the dry season (87-90% in May and June) and in September.

Intestinal parasitosis prevalence and season relationship

Table 3 shows that the frequency of intestinal parasitic infections was higher during the dry season (83.33%) compared to the rainy season (72.66%). When considered by year, the frequency was higher during the dry season (87.50%) than during the rainy season (62.69%) in 2020, whereas in 2021, the rainy season recorded a slightly higher frequency than the dry season, with 81.94% and 79.17%, respectively. But the chi-square test showed that there was no association between intestinal parasitic infections and the season.

Table 3. Distribution of intestinal parasitic infection cases by year and season.

	Fréquency	%
Rainy season (2020-1)	(n=139) 101	72.66
2020	(n=67) 42	62.69
2021	(n=72) 59	81.94
Dry season (2020-1)	(n=48) 40	83.33
2020	(n=24) 21	87.50
2021	(n=24) 19	79.17
Chi-square	1.6531
P Value	0.1985

Frequency curves of intestinal protozoan infections

Figure 5 shows that the frequency of intestinal protozoa was high in both 2020 and 2021. In 2020, two peaks of this frequency were observed during the dry season (100% in May and July). In 2021, two high values of this frequency, 80% and 85%, were observed in May and September, respectively.

Figure 5. Curve of the frequency of intestinal protozoa in 2020 and 2021.

Intestinal protozoan prevalence and season relationship

As shown in Table 4 the dry season recorded a higher frequency of intestinal protozoa (64.58%) compared to the rainy season (59.71%). This superiority remained stable in both 2020 and 2021. There is no association between the frequency of intestinal protozoa and the season. The frequencies of Entamoeba H., Trichomonas I., and Giardia L. are not associated with the season.

Table 4. Distribution of cases of protozoa according to year and season, and relation statistical tests.

	Frequency	%
Rainy season (2020-1)	(n=139) 83	59.71
2020	(n=67) 40	59.70
2021	(n=72) 43	59.72
Dry season (2020-1)	(n=48) 31	64.58
2020	(n=24) 19	79.17
2021	(n=24) 12	50.00
Chi-square	0.18049
P Value	0.671
Entamoeba histolytica
Chi-square	0.12764
P Value	0.7209
Trichomonas intestinalis
Fisher test
P Value	0.5666
Giardia lamblia
Fishier test
P Value	0.5081

Frequency curves of intestinal helminthiasis infections

The frequency of intestinal helminthiasis was higher in 2021 than in 2020. In 2020, three high frequencies were recorded during the dry season (66% and 40% in May and July) and in October (74%). In 2021, three other high frequencies (72%, 56%, and 60%) were recorded in February, June, and October, respectively (Figure 6).

Figure 6. Curve of the frequency of intestinal helminthiasis in 2020 and 2021.

Intestinal helminthiasis prevalence and season relationship

The frequency of intestinal helminthiasis (37.50%) was higher during the dry season than during the rainy season (34.53%). In 2020, the dry season recorded a frequency of 25.00%, higher than that of the rainy season (17.91%). In 2021, both seasons recorded the same frequency (50.00%).

There is no association between the frequency of intestinal helminthiasis and the season. The frequencies of Ascaris L., Schistosoma M., Ankylostoma D., and Enterobius V. are not associated with the season (Table 5).

Table 5. Distribution of cases of helminthiasis according to year and season, and relation statistical test.

	Frequency	%
Rainy season (2020-1)	(n=139) 48	34.53
2020	(n=67) 12	17.91
2021	(n=72) 36	50.00
Dry season (2020-1)	(n=48) 18	37.50
2020	(n=24) 6	25.00
2021	(n=24) 12	50.00
Chi-square	0.038326
P Value	0.8448
Ascaris lumbricoides
Chi-square	9.4562
P Value	1
Schistosoma Mansoni
Fisher test
P Value	1
Ankylostoma duodenalis
Fisher test
P Value	1
Enterobius vermicularis
Fisher test
P Value	0.4485
Odds Ratio	2.92

Discussion

In this study, we estimated the prevalence of intestinal parasitoses in general, as well as the prevalence of different types of intestinal parasitoses, among patients who underwent direct stool examination at CHUNDE in 2020 and 2021. These patients were aged between 2 years and 77 years, with an odds ratio of one woman for every man. The strength of this study lies in providing prevalence data for different types of intestinal parasitoses in Kasai Oriental, where such data had not been published until now.

1. Prevalence of intestinal parasitoses: The overall prevalence of intestinal parasitoses was 75.40%. The prevalence of intestinal protozoa and helminths was 60.69% and 35.29%, respectively. The most prevalent intestinal protozoa were Entamoeba histolytica (55.08%), followed by Trichomonas intestinalis (9.09%) and Giardia lamblia (6.24%). The most prevalent intestinal helminths were Ascaris lumbricoides (27.81%), followed by Schistosoma mansoni (3.74%), Ankylostoma duodenale (1.60%), and Enterobius vermicularis (1.07%). Worldwide, a study in Brazil estimated the prevalence at 10.8% (95% CI: 8.6–13.4). Endolimax nana was the most frequent parasite (4.8%), followed by Entamoeba histolytica/dispar (1.7%). In Africa, the prevalence of intestinal parasitoses remains high in many studies. Studies in Algeria and Morocco on sub-Saharan migrants showed high frequencies of intestinal parasitoses but lower than ours, with prevalences of 34.45% (protozoa 78.75%, helminths 21.25%) and 43.18%, respectively.^7,13,14
In Tunisia, F. Cheikhrouhou et al. (2009) in a retrospective study from 1997 to 2006 in the Sfax region found an overall prevalence of intestinal parasitoses of 26.6%, one-third of which were children. Protozoa accounted for 96.5% of isolated parasites, with flagellates (54.3%) dominated by Dientamoeba fragilis (30.3%) and Giardia lamblia (17%). Amoebas represented 41.9%, with E. histolytica/E. dispar making up 2.2%. Helminths (3.5%) included Enterobius vermicularis (49%), Hymenolepis nana (31.4%), Strongyloides stercoralis (0.3%), Taenia saginata (0.3%), and Ankylostoma duodenale (one case).¹⁵
In the DRC, Serge Nimo Ngbabo (2008) found a global prevalence of intestinal parasitoses at C.S. Boyoma in Kisangani of 62%. In his study, Ankylostoma was the most frequently encountered parasite (32.4%), followed by Entamoeba histolytica (18.4%), Ascaris lumbricoides (10.7%), Strongyloides stercoralis (8.2%), Trichuris trichiura (7.5%), Trichomonas intestinalis (1.1%), and Enterobius vermicularis (0.2%).⁶
In all these studies, the prevalence of intestinal parasitoses remains high, with intestinal protozoa being more frequent than helminths. We note some differences, which we attribute to the fact that these studies were conducted in different regions with varying hygienic conditions. Specifically, studies in Tunisia provide percentages of intestinal helminths and protozoa relative to the total number of people affected by intestinal parasitoses, while our study shows the actual prevalence of each specific parasite type within the total population studied.
2. Polyparasitism: 45 patients (24.13%) were infested by multiple intestinal parasites simultaneously, with 19.79% combining at least one helminth and one protozoan. The most frequent combination was Entamoeba histolytica and Ascaris lumbricoides, with 27 cases (14.44%). Other studies have noted cases of polyparasitism. A study conducted in Benin between 2005 and 2013 by Sissinto et al. showed a polyparasitism rate of 17.4% (3.09% of the total study population). The most common associations were Blastocystis hominis + Entamoeba histolytica/dispar (20.1%), Entamoeba coli + Entamoeba histolytica/dispar (17.2%), and Blastocystis hominis + Endolimax nana (11.7%). In Morocco, Zouitni reported a polyparasitism rate of 63.15% (27.2% of their study population). In the DRC, Woolf K. et al. reported a polyparasitism prevalence of 23.41%. We note similarities between our polyparasitism rate and those found in the last two studies mentioned.^7,10,16
3. Age and gender prevalence: Intestinal parasitoses were more frequent among children (95.00%) and elderly adults (88.89%). They were also more frequent among women (78.49%) than men (72.34%). In their study among children under 5 years old in Kivu, DRC, Woolf K. et al. recorded a prevalence of intestinal parasitoses of 94%, very close to the rate recorded in our study for children. In Tunisia, F. Cheikhrouhou et al. showed a predominance of intestinal parasitoses among children under 12 years (50.2% of cases). A study in Bangui by Lango Y. et al. showed a higher prevalence of intestinal parasitoses in women (35.10%) compared to men (32.89%).^3,10,15,17
4. Seasonal variation: Intestinal parasitoses were more prevalent during the dry season than during the rainy season. However, there was no statistically significant association between season and the prevalence of intestinal parasitoses in general, nor with intestinal helminthiasis or protozoan infections. In the DRC, a study conducted in Sake (Kivu) among 504 children under 5 years old showed no association between season and the prevalence of intestinal parasitoses.¹⁰ This result underscores the need to study the behaviors adopted by the population during different seasons to identify factors that directly affect the prevalence of parasitoses. As highlighted in the introduction, this region is known for its poor hygiene conditions, with frequent shortages of drinking water and poor waste management, especially for fecal matter.

Author contributions

• Conception and implementation: All authors
• Financial support: All authors
• Administrative support: Lufuluabu M. Alphonse and Tshishimbi Jean Hubert
• Provision of study material or patients: All authors
• Data collection and assembly: Lufuluabu M. Alphonse and Tshodi B. Arsène
• Data analysis and interpretation: All authors
• Manuscript writing: All authors
• Final manuscript approval: All authors
• Responsible for all aspects of the work: All authors

Disclosure statement

The authors are employees of the University of Mbujimayi, all in training at its medical faculty and assigned to its University Hospital Center Notre-Dame de l’Espérance.

Ethics and consent

This study received approval from the ethics committee of the University of Mbujimayi on N52/CEUM1209 of 11th December 2019. It was conducted in accordance with the requirements of good clinical practices and the principles of the Helsinki Declaration of the World Medical Association, along with any subsequent relevant amendments. All patients who have participated in this study have provided their written informed consent by signing a written document, the consent form.

Context

Key findings

• The prevalence of intestinal parasitoses was high, at 75.40%.
• Intestinal amebiasis had the highest prevalence, at 55.08%.
• The prevalence of intestinal parasitoses was higher during the dry season.
• The prevalence was higher in children.

Additional knowledge

• There is no statistically significant association between season and intestinal parasitoses.

Global health impact on policies and actions

• Intestinal parasitoses are a major global public health problem.
• Intestinal amebiasis, in particular, should be considered part of the Neglected Tropical Diseases (NTDs).
• In relation to SDG 6, there is a need to raise awareness and educate the population on hygiene.
• Funding longitudinal data collection is necessary to better understand the factors influencing the prevalence of intestinal parasitoses across seasons.

Data availability

Figshare: Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Espérance University Hospital Center. [Dataset]. figshare. 2023. https://doi.org/10.6084/m9.figshare.28050665.v1.¹⁸

This study contains the following underlying data: Data.xls (anonymised results of microscopic examination of stools, yes=positive, no=negative, na=not attributable, p=rainy season, s=dry season, pro=protozoa, hel=helminth, adu=adult, enf=child, vieu=elder, eh=entamoeba, h giar=giardia, tric=trichomonas, al=ascaris l, sm=schistosoma mansoni, ank=ankylostoma, ox=entérobius v).

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

We would like to thank the University of Mbujimayi for allowing us to conduct our study at its University Hospital Center Notre-Dame de l’Espérance.

Bibliography

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10. Kapiteni W, Kivukuto J, Mamba C: Impact des saisons sur les parasitoses intestinales chez les jeunes enfants de moins de 5 ans au Centre de Santé de Référence Afia - Sake dans la province du Nord Kivu en RD Congo, [Impact of the seasons on intestinal parasitosis in young children under 5 years of age at the Afia - Sake Reference Health Center in the province of North Kivu in DR Congo]. Int. J. Innov. Appl. Stud. 2019.
11. Kyambikwa B, Jabari M, Mulongo M: Profile of intestinal parasitosis among school-aged children in Kiliba (Eastern DR Congo). Medecine et Sante Tropicales. 2016; 2017.
12. Mulumba M, Ntumpa M, Muhindo M, et al.: Estimation de la prévalence des géo-helminthes à Kinshasa (Méta-analyse de 185 études), [Estimating the prevalence of soil-transmitted helminths in Kinshasa (Meta-analysis of 185 studies)]. Annales Africaines de Médecine. 2009.
13. Tiariaju E, Possanski J, Tatiani K, et al.: Intestinal parasitoses and associated factors in a Brazilian city of German’s descendants: a population-based study. Ann. Parasitol. 2022; 64(4): 787–795. PubMed Abstract
14. Kalthoum D, Najla F, Sleh B, et al.: Intestinal parasitosis among non-permanent resident students in Tunisia: a review of 23 years of monitoring in the department of Parasitology-Mycology at the Rabta Hospital of Tunisia. Tunis. Med. 2015; 93(7): 436–439. PubMed Abstract
15. Cheikhrouhou F, Trabelsi H, Sellami H, et al.: Parasitoses intestinales dans la région de Sfax (sud tunisien): étude rétrospective, [Intestinal parasitosis in the Sfax region (southern Tunisia): a retrospective study]. Rev. Tun. Infectiol. 2009; 3(2): 14–18.
16. Sissinto-savi T, Ogouyemi H, Attinsounon C, et al.: Prévalence des parasitoses intestinales au CNHU-HKM de Cotonou, Sud du Benin de 2003 à 2015, [Prevalence of intestinal parasitosis at the CNHU-HKM in Cotonou, Southern Benin from 2003 to 2015]. Journal de la Recherche Scientifique de l’Université de Lomé. 2018.
17. Lango-Yaya E, Ngalema T, Agboko F, et al.: Prévalence Des Infections Parasitaires Dues Aux Protozoaires Identifies Au Laboratoire National De Biologie Clinique Et De Sante Publique, Bangui République Centrafricaine, [Prevalence of parasitic infections due to protozoa identified at the National Laboratory of Clinical Biology and Public Health, Bangui, Central African Republic]. Eur. Sci. J. 2021; 17(21): 115–125.
18. Lufuluabu MA, Tshishimbi KJ, Tshodi BA: Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Espérance University Hospital Center. [Dataset]. figshare. 2023. Publisher Full Text

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VERSION 1 PUBLISHED 09 Jan 2025

Author details Author details

¹ internal medecine, University of Mbuji-Mayi, Mbuji-mayi, Kasai oriental, Democratic Republic of the Congo
² pediatrics, University of Mbuji-Mayi, Mbuji-Mayi, Kasai oriental, Democratic Republic of the Congo
³ gynecology obstetric, university of Mbuji-Mayi, Mbuji-Mayi, Kasai oriental, Democratic Republic of the Congo

lufuluabu mpemba Alphonse
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tshishimbi kalala Jean Hubert
Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tshodi bulanda Arsène
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Published: 09 Jan 2025, 14:50

https://doi.org/10.12688/f1000research.160135.1

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Alphonse lm, Jean Hubert Tk and Arsène Tb. Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Espérance University Hospital Center [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2025, 14:50 (https://doi.org/10.12688/f1000research.160135.1)

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Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 1

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PUBLISHED 09 Jan 2025

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Reviewer Report 27 Aug 2025

Albert Abaka-Yawson, University of Ghana, Legon, Ghana

Not Approved

https://doi.org/10.5256/f1000research.175968.r399022

ABSTRACT
i. Authors should remove prevalence figures from background since they would be no opportunity to add reference
ii. Methods section fails to talk about the study design and the sampling technique
iii. You used "parasitoses" and ... Continue reading

ABSTRACT
i. Authors should remove prevalence figures from background since they would be no opportunity to add reference
ii. Methods section fails to talk about the study design and the sampling technique
iii. You used "parasitoses" and "parasitosis" interchangeably in background and results section. Streamline that.
iv. At the results section, parasites are presented as "Enterobius V., Schistosoma M. etc." consider rewriting them as "E. vermicularis, S. mansoni etc". In other words rather write the species in full and abbreviate the genus.
v. Check spelling of various words throughout the manuscript. For instance, "Ancylostoma" not "Ankylostoma"

MAIN WORK
I. Remove general and specific objectives. Unless it aligns with journal's style
ii. The methods section fails to capture the study design and sampling technique
ii. Under results section, merge all 5 tables to one
iii. Table 1: Remove ratio under sex
iv. Authors should consider keeping just one. Either mean or median ages. Use only the best measure of central tendency
v. Table 2: Under age, various categories are in French i.e., Enfants, Adultes etc.
vi. Discussion should not be bulletins and also reduce the numbers and repetition of results. Focus on discussing the results in the light of other studies as well as its implications on patients and future studies.
vii. Also consider adding limitations to the latter part of the discussion

GENERAL COMMENTS
The manuscript is currently not in a indexing state but holds potential for improvement.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Neglected Tropical Diseases, Parasitology, Infectious Diseases Epidemiology, Laboratory Medicine

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 25 Aug 2025

Majed H. Wakid, Special Infectious Agents Unit, King Fahd Medical Research Center, Jeddah, Makkah Province, Saudi Arabia

Approved with Reservations

https://doi.org/10.5256/f1000research.175968.r399028

A- General Comments
- Mbuji-Mayi or Mbujimayi?
- Additional references are required.
- Scientific names need to be corrected throughout the manuscript (including Figures and Tables). The genus name should be written in italics and capitalized, while ... Continue reading

A- General Comments
- Mbuji-Mayi or Mbujimayi?
- Additional references are required.
- Scientific names need to be corrected throughout the manuscript (including Figures and Tables). The genus name should be written in italics and capitalized, while the species name should also be written in italics but in lowercase. After the first mention, the genus name should be abbreviated to its first capital letter, also in italics, followed by a period and a space. Thus, Entamoeba histolytica becomes E. histolytica. This must be done in both the abstract and the main text.
- The name Trichomonas intestinalis is no longer used.
- Some words were written in non-English letters.
- There is no Conclusion section at the end of the manuscript.
- There are some limitations to the study that should be mentioned.
- In Author roles, delete “Funding Acquisition”, as there is no fund for this study.
- Is it correct that the first letter of some authors name is written in lowercase?
- D. R. Congo or DRC? also was abbreviated without the full name at first mention.

B- Title
- Add the country name to the title.

C- Abstract
- In the “Background” you mentioned that the prevalence in Africa is 42.18%, but in the Introduction section it is 43.12.
- In the “objectives”, you must add the study area.
- Correct all scientific names in the “Result”.
- Use Ancylostoma, which is the preferred spelling, instead of Ankylostoma.
- in the “Conclusion”, relate your conclusion to the study area.

D- Introduction
- Line 2: correct to “As a result, they are rarely a reason for regular consultation and are often neglected”.
- Replace reference [2], with a recent study [Al-Refai MF, Wakid MH: Prevalence of intestinal parasites and comparison of detection techniques for soil-transmitted helminths among newly arrived expatriate labors in Jeddah, Saudi Arabia. PeerJ. 2024; 12: e16820].
- (WHO, 2023), should be given a reference number and added to the reference list.
- Correct “ABOU BEKR BELKAID” to “Abou Bekr Belkaid”.
- Correct all scientific names.
- Include the objectives as a separate paragraph at the end of the Introduction section.

E- Methods
- The authors didn’t mention the sample collection instructions provided to the patients.
- The authors didn’t explain how they obtained the patients' age and sex. A questionnaire?
- Which laboratory department received the samples and who performed the microscopic examination?
- Macroscopic examination of the stool is very important to detect its color, consistency, and presence of adult worms or tapeworm segments. Have you performed it?
- A direct stool examination alone is not a sufficient laboratory test for detecting intestinal parasites. Furthermore, the steps described above are completely unrelated to a direct smear. Two grams of stool equals approximately half a teaspoon, and when mixed with one milliliter of saline, it cannot be mixed on a microscope slide, (The correct amount is 1 mg of stool and one drop of saline). Direct iodine smear and permanent staining are also necessary methods to observe and confirm diagnostic features for identifying protozoan parasites. You can add this reference for these techniques (Macroscopic, Microscopic: direct saline, direct iodine, and permanent staining) [Bahwaireth EO, Wakid MH: Molecular, microscopic, and immunochromatographic detection of enteroparasitic infections in hemodialysis patients and related risk factors. Foodborne Path. Dis. 2022; 19: 830-838.]
- There is no need to list the names of the parasites, as other parasites may be detected.
- P value statistical significance was not mentioned in the statistical analysis.
- Written informed consent could not be obtained from the child. Please amend the sentence to read: "Written informed consent was obtained from the patients or their guardian, where applicable.".

F- Results
- Unify the name of each age group in the text, tables and figures.
- Correct scientific names in the text, figures and tables.
- Correct “women” and “men” to “male” and “female”, where applicable in the text, and tables.
- The "Frequencies of intestinal protozoa" results section needs correction as in this section you represented results for helminths compared to E. histolytica.
- The name “Trichomonas intestinalis” is no longer used. Are you referring to Retortamonas intestinalis or Pentatrichomonas hominis?
- Delete Figure 1, which adds no value to the results.
- Table 2, some words were written in non-English letters.
- Figures 2 and 3, are not in English, also these are not different types. What is yes and no used for?
- Represent Figures 4, 5 and 6 in English.

G- Discussion
- The discussion section should not contain subheadings.
- Correct the presentation of the scientific names.
- You should mention the limitations of this study, with the suggested reference: (Our findings are based on routine diagnostic procedures performed in CHUNDE on individuals referred to the study area. Therefore, despite its strategic geographic location and high patient population, these findings may not apply to the entire population. Furthermore, the stool samples in this study were not tested using any of the concentration techniques, which increases the possibility of detecting diagnostic stages of the intestinal parasites. Therefore, a major limitation of this study is the possibility that some intestinal parasite cases may be underreported due to the limitations of the direct wet examination [Alqarni AS, Wakid MH, Gattan HS. Prevalence, type of infections and comparative analysis of detection techniques of intestinal parasites in the province of Belgarn, Saudi Arabia. PeerJ. 2022; 10: e13889].).

H- Add a Conclusion section.

I- References
- After adding the three suggested references, the total becomes 21 references.
The references should be renumbered in the text citations and the references list.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Al-Refai M, Wakid M: Prevalence of intestinal parasites and comparison of detection techniques for soil-transmitted helminths among newly arrived expatriate labors in Jeddah, Saudi Arabia. PeerJ. 2024; 12. Publisher Full Text
2. Bahwaireth E, Wakid M: Molecular, Microscopic, and Immunochromatographic Detection of Enteroparasitic Infections in Hemodialysis Patients and Related Risk Factors. Foodborne Pathogens and Disease. 2022; 19 (12): 830-838 Publisher Full Text
3. Alqarni A, Wakid M, Gattan H: Prevalence, type of infections and comparative analysis of detection techniques of intestinal parasites in the province of Belgarn, Saudi Arabia. PeerJ. 2022; 10. Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Professor and Consultant in Diagnostic Medical Parasitology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 23 Aug 2025

Abayeneh Girma, Mekdela Amba University, Tulu Awuliya, Ethiopia

Approved with Reservations

https://doi.org/10.5256/f1000research.175968.r399027

General comments
This study investigates the prevalence of intestinal parasitosis and its association with seasonal variation among patients at the Notre Dame de l’Espérance University Hospital Center in the Democratic Republic of the Congo (DRC). The authors report a ... Continue reading

General comments
This study investigates the prevalence of intestinal parasitosis and its association with seasonal variation among patients at the Notre Dame de l’Espérance University Hospital Center in the Democratic Republic of the Congo (DRC). The authors report a high overall prevalence (75.40%), with Entamoeba histolytica and Ascaris lumbricoides being the most common parasites. The study also examines demographic and seasonal trends but finds no statistically significant association between parasitosis prevalence and seasons. While the topic is relevant to public health in tropical regions, the manuscript has several methodological and presentation issues that need addressing before it can be considered for publication.
Major comments
I. Methodology and analysis

Sample size and representativeness: The sample size (187 patients) is relatively small for a two-year study, and the inclusion criteria (only patients referred for stool examination) may introduce selection bias. The authors should clarify whether this sample is representative of the general population or specific subgroups (e.g., symptomatic patients).
Seasonal analysis: The definition of "dry" and "rainy" seasons is arbitrary (e.g., dry season: 15/5 to 15/8). The authors should justify this classification and consider regional climatic data.
Statistical power: The lack of association between season and parasitosis may reflect inadequate statistical power rather than a true absence of association. A power calculation should be included.
Confounding factors: The study does not account for potential confounders (e.g., hygiene practices, water sources, socioeconomic status) that could influence parasitosis prevalence independently of season.

II. Results and Interpretation

Contradictory findings: The abstract states that the prevalence was higher during the dry season, but the results section notes no significant association. This discrepancy should be resolved.
Polyparasitism: The high rate of polyparasitism (24.13%) is noteworthy, but the clinical or epidemiological implications are not discussed.
Comparative data: The discussion compares findings to studies in Tunisia, Morocco, and Brazil, but differences in study design, population, and diagnostic methods limit the validity of these comparisons.

III. Presentation and clarity

Tables and figures: Some tables (e.g., Table 2) are fragmented across pages, making them hard to follow. Figures (e.g., frequency curves) lack clarity in labeling and interpretation.
Language and grammar: The manuscript has numerous grammatical errors and awkward phrasing, which hinder readability. Professional editing is recommended.
Data availability: The dataset is available, but the description (e.g., "yes=positive, no=negative, na=not attributable") is unclear. A codebook or detailed metadata would improve reproducibility.

Minor comments

Abstract: The conclusion ("prevalence was higher during the dry season") contradicts the results ("no association"). Revise for consistency.
Introduction: The background could better highlight gaps in the DRC-specific literature.
Discussion: The high prevalence of Entamoeba histolytica should be contextualized with local diagnostic challenges (e.g., differentiation from E. dispar).

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Microbiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Abayeneh Girma, Mekdela Amba University, Tulu Awuliya, Ethiopia
Majed H. Wakid, King Fahd Medical Research Center, Jeddah, Saudi Arabia
Albert Abaka-Yawson, University of Ghana, Legon, Ghana

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Reviewer Report

3 Views

27 Aug 2025 | for Version 1

Albert Abaka-Yawson, University of Ghana, Legon, Ghana

3 Views Cite this report Responses(0)

Not Approved

ABSTRACT
i. Authors should remove prevalence figures from background since they would be no opportunity to add reference
ii. Methods section fails to talk about the study design and the sampling technique
iii. You used "parasitoses" and "parasitosis" interchangeably in background and results section. Streamline that.
iv. At the results section, parasites are presented as "Enterobius V., Schistosoma M. etc." consider rewriting them as "E. vermicularis, S. mansoni etc". In other words rather write the species in full and abbreviate the genus.
v. Check spelling of various words throughout the manuscript. For instance, "Ancylostoma" not "Ankylostoma"

MAIN WORK
I. Remove general and specific objectives. Unless it aligns with journal's style
ii. The methods section fails to capture the study design and sampling technique
ii. Under results section, merge all 5 tables to one
iii. Table 1: Remove ratio under sex
iv. Authors should consider keeping just one. Either mean or median ages. Use only the best measure of central tendency
v. Table 2: Under age, various categories are in French i.e., Enfants, Adultes etc.
vi. Discussion should not be bulletins and also reduce the numbers and repetition of results. Focus on discussing the results in the light of other studies as well as its implications on patients and future studies.
vii. Also consider adding limitations to the latter part of the discussion

GENERAL COMMENTS
The manuscript is currently not in a indexing state but holds potential for improvement.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Neglected Tropical Diseases, Parasitology, Infectious Diseases Epidemiology, Laboratory Medicine

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

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Reviewer Report

4 Views

25 Aug 2025 | for Version 1

Majed H. Wakid, Special Infectious Agents Unit, King Fahd Medical Research Center, Jeddah, Makkah Province, Saudi Arabia

4 Views Cite this report Responses(0)

Approved With Reservations

A- General Comments
- Mbuji-Mayi or Mbujimayi?
- Additional references are required.
- Scientific names need to be corrected throughout the manuscript (including Figures and Tables). The genus name should be written in italics and capitalized, while the species name should also be written in italics but in lowercase. After the first mention, the genus name should be abbreviated to its first capital letter, also in italics, followed by a period and a space. Thus, Entamoeba histolytica becomes E. histolytica. This must be done in both the abstract and the main text.
- The name Trichomonas intestinalis is no longer used.
- Some words were written in non-English letters.
- There is no Conclusion section at the end of the manuscript.
- There are some limitations to the study that should be mentioned.
- In Author roles, delete “Funding Acquisition”, as there is no fund for this study.
- Is it correct that the first letter of some authors name is written in lowercase?
- D. R. Congo or DRC? also was abbreviated without the full name at first mention.

B- Title
- Add the country name to the title.

C- Abstract
- In the “Background” you mentioned that the prevalence in Africa is 42.18%, but in the Introduction section it is 43.12.
- In the “objectives”, you must add the study area.
- Correct all scientific names in the “Result”.
- Use Ancylostoma, which is the preferred spelling, instead of Ankylostoma.
- in the “Conclusion”, relate your conclusion to the study area.

D- Introduction
- Line 2: correct to “As a result, they are rarely a reason for regular consultation and are often neglected”.
- Replace reference [2], with a recent study [Al-Refai MF, Wakid MH: Prevalence of intestinal parasites and comparison of detection techniques for soil-transmitted helminths among newly arrived expatriate labors in Jeddah, Saudi Arabia. PeerJ. 2024; 12: e16820].
- (WHO, 2023), should be given a reference number and added to the reference list.
- Correct “ABOU BEKR BELKAID” to “Abou Bekr Belkaid”.
- Correct all scientific names.
- Include the objectives as a separate paragraph at the end of the Introduction section.

E- Methods
- The authors didn’t mention the sample collection instructions provided to the patients.
- The authors didn’t explain how they obtained the patients' age and sex. A questionnaire?
- Which laboratory department received the samples and who performed the microscopic examination?
- Macroscopic examination of the stool is very important to detect its color, consistency, and presence of adult worms or tapeworm segments. Have you performed it?
- A direct stool examination alone is not a sufficient laboratory test for detecting intestinal parasites. Furthermore, the steps described above are completely unrelated to a direct smear. Two grams of stool equals approximately half a teaspoon, and when mixed with one milliliter of saline, it cannot be mixed on a microscope slide, (The correct amount is 1 mg of stool and one drop of saline). Direct iodine smear and permanent staining are also necessary methods to observe and confirm diagnostic features for identifying protozoan parasites. You can add this reference for these techniques (Macroscopic, Microscopic: direct saline, direct iodine, and permanent staining) [Bahwaireth EO, Wakid MH: Molecular, microscopic, and immunochromatographic detection of enteroparasitic infections in hemodialysis patients and related risk factors. Foodborne Path. Dis. 2022; 19: 830-838.]
- There is no need to list the names of the parasites, as other parasites may be detected.
- P value statistical significance was not mentioned in the statistical analysis.
- Written informed consent could not be obtained from the child. Please amend the sentence to read: "Written informed consent was obtained from the patients or their guardian, where applicable.".

F- Results
- Unify the name of each age group in the text, tables and figures.
- Correct scientific names in the text, figures and tables.
- Correct “women” and “men” to “male” and “female”, where applicable in the text, and tables.
- The "Frequencies of intestinal protozoa" results section needs correction as in this section you represented results for helminths compared to E. histolytica.
- The name “Trichomonas intestinalis” is no longer used. Are you referring to Retortamonas intestinalis or Pentatrichomonas hominis?
- Delete Figure 1, which adds no value to the results.
- Table 2, some words were written in non-English letters.
- Figures 2 and 3, are not in English, also these are not different types. What is yes and no used for?
- Represent Figures 4, 5 and 6 in English.

G- Discussion
- The discussion section should not contain subheadings.
- Correct the presentation of the scientific names.
- You should mention the limitations of this study, with the suggested reference: (Our findings are based on routine diagnostic procedures performed in CHUNDE on individuals referred to the study area. Therefore, despite its strategic geographic location and high patient population, these findings may not apply to the entire population. Furthermore, the stool samples in this study were not tested using any of the concentration techniques, which increases the possibility of detecting diagnostic stages of the intestinal parasites. Therefore, a major limitation of this study is the possibility that some intestinal parasite cases may be underreported due to the limitations of the direct wet examination [Alqarni AS, Wakid MH, Gattan HS. Prevalence, type of infections and comparative analysis of detection techniques of intestinal parasites in the province of Belgarn, Saudi Arabia. PeerJ. 2022; 10: e13889].).

H- Add a Conclusion section.

I- References
- After adding the three suggested references, the total becomes 21 references.
The references should be renumbered in the text citations and the references list.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Al-Refai M, Wakid M: Prevalence of intestinal parasites and comparison of detection techniques for soil-transmitted helminths among newly arrived expatriate labors in Jeddah, Saudi Arabia. PeerJ. 2024; 12. Publisher Full Text
2. Bahwaireth E, Wakid M: Molecular, Microscopic, and Immunochromatographic Detection of Enteroparasitic Infections in Hemodialysis Patients and Related Risk Factors. Foodborne Pathogens and Disease. 2022; 19 (12): 830-838 Publisher Full Text
3. Alqarni A, Wakid M, Gattan H: Prevalence, type of infections and comparative analysis of detection techniques of intestinal parasites in the province of Belgarn, Saudi Arabia. PeerJ. 2022; 10. Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Professor and Consultant in Diagnostic Medical Parasitology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

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Reviewer Report

6 Views

23 Aug 2025 | for Version 1

Abayeneh Girma, Mekdela Amba University, Tulu Awuliya, Ethiopia

6 Views Cite this report Responses(0)

Approved With Reservations

General comments
This study investigates the prevalence of intestinal parasitosis and its association with seasonal variation among patients at the Notre Dame de l’Espérance University Hospital Center in the Democratic Republic of the Congo (DRC). The authors report a high overall prevalence (75.40%), with Entamoeba histolytica and Ascaris lumbricoides being the most common parasites. The study also examines demographic and seasonal trends but finds no statistically significant association between parasitosis prevalence and seasons. While the topic is relevant to public health in tropical regions, the manuscript has several methodological and presentation issues that need addressing before it can be considered for publication.
Major comments
I. Methodology and analysis

Sample size and representativeness: The sample size (187 patients) is relatively small for a two-year study, and the inclusion criteria (only patients referred for stool examination) may introduce selection bias. The authors should clarify whether this sample is representative of the general population or specific subgroups (e.g., symptomatic patients).
Seasonal analysis: The definition of "dry" and "rainy" seasons is arbitrary (e.g., dry season: 15/5 to 15/8). The authors should justify this classification and consider regional climatic data.
Statistical power: The lack of association between season and parasitosis may reflect inadequate statistical power rather than a true absence of association. A power calculation should be included.
Confounding factors: The study does not account for potential confounders (e.g., hygiene practices, water sources, socioeconomic status) that could influence parasitosis prevalence independently of season.

II. Results and Interpretation

Contradictory findings: The abstract states that the prevalence was higher during the dry season, but the results section notes no significant association. This discrepancy should be resolved.
Polyparasitism: The high rate of polyparasitism (24.13%) is noteworthy, but the clinical or epidemiological implications are not discussed.
Comparative data: The discussion compares findings to studies in Tunisia, Morocco, and Brazil, but differences in study design, population, and diagnostic methods limit the validity of these comparisons.

III. Presentation and clarity

Tables and figures: Some tables (e.g., Table 2) are fragmented across pages, making them hard to follow. Figures (e.g., frequency curves) lack clarity in labeling and interpretation.
Language and grammar: The manuscript has numerous grammatical errors and awkward phrasing, which hinder readability. Professional editing is recommended.
Data availability: The dataset is available, but the description (e.g., "yes=positive, no=negative, na=not attributable") is unclear. A codebook or detailed metadata would improve reproducibility.

Minor comments

Abstract: The conclusion ("prevalence was higher during the dry season") contradicts the results ("no association"). Revise for consistency.
Introduction: The background could better highlight gaps in the DRC-specific literature.
Discussion: The high prevalence of Entamoeba histolytica should be contextualized with local diagnostic challenges (e.g., differentiation from E. dispar).

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Microbiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Impact of the season and prevalence of intestinal parasitosis at the Notre Dame de l’Espérance University Hospital Center

Abstract

Background

Objective

Methods

Results

Conclusion

Keywords

Introduction

General objective

Specific objectives

Methods

Study population

Inclusion and exclusion criteria

Sample collection

Direct stool examination

Statistical analysis

Ethical considerations and informed consent

Declaration of interest

Study results

Characteristics of the study population

Table 1. Demographic characteristics of patients undergoing direct stool examination between 2020 and 2021.

Figure 1. Age description.

Frequency of intestinal parasitic infections

Table 2. Frequency of intestinal parasitic infections, intestinal helminth infections, and intestinal protozoa.

Frequencies of intestinal protozoa

Figure 2. Frequency of different types of intestinal protozoa.

Frequencies of intestinal helminths

Figure 3. Frequency of different types of intestinal helminth infections.

Frequency curves of intestinal parasitic infections

Figure 4. Frequency curves of intestinal parasitic infections in 2020 and 2021.

Intestinal parasitosis prevalence and season relationship

Table 3. Distribution of intestinal parasitic infection cases by year and season.

Frequency curves of intestinal protozoan infections

Figure 5. Curve of the frequency of intestinal protozoa in 2020 and 2021.

Intestinal protozoan prevalence and season relationship

Table 4. Distribution of cases of protozoa according to year and season, and relation statistical tests.

Frequency curves of intestinal helminthiasis infections

Figure 6. Curve of the frequency of intestinal helminthiasis in 2020 and 2021.

Intestinal helminthiasis prevalence and season relationship

Table 5. Distribution of cases of helminthiasis according to year and season, and relation statistical test.

Discussion

Author contributions

Disclosure statement

Ethics and consent

Context

Key findings

Additional knowledge

Global health impact on policies and actions

Data availability

Acknowledgements

Bibliography

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