Modifiable hygiene practices and the burden of protozoal and helminthic infections among undernourished children in Taiz, Yemen: a hospital-based cross-sectional study.

BACKGROUND: Intestinal parasitic infections and undernutrition create a combined health burden in children, especially in areas affected by long-lasting humanitarian crises. This study assessed the prevalence, types, magnitude of association and modifiable behavioral risks associated with intestinal parasitic infection in undernourished preschool children in Taiz, Yemen. METHODS: A hospital-based analytical cross-sectional study was carried out from January 2025 to January 2026. The study involved 1,200 undernourished children aged 6 to 59 months who received care from general public hospitals and randomly selected private clinics and primary healthcare centers. A range of anthropometric measures were standardized to compute the World Health Organization Z scores. The detection of intestinal parasites was performed via direct wet-mount microscopic microscopy, the formal-ether concentration technique, modified Ziehl-Neelsen staining and the adhesive cellophane tape perianal swab for pinworm detection. Multivariable binary logistic regression was employed to assess the predictors of parasitic infection, taking into account sociodemographic characteristics. RESULTS: The overall prevalence of IPIs was 38.5% (95% CI: 35.7-41.3%). Entamoeba histolytica/dispar and Enterobius vermicularis contributed the majority of the IPIs, with 14.5 and 11.5%, respectively. The nutritional status of infected children is significantly poorer than that of uninfected children, as shown by a lower mean weight-for-age Z score (-1.54 ± 0.82 vs. -1.11 ± 0.74, p < 0.001). Furthermore, a consistent pattern was also evident, with the IPI incidence increasing steadily from 33.3% in children with mild undernutrition to 79.2% in those with severe undernutrition (p < 0.001 for trend). Irregular nail trimming (aOR: 14.10; 95% CI: 10.15-19.55; p < 0.001) and drinking unfiltered water (aOR: 4.65; 95% CI: 3.10-6.95; p < 0.001) were identified as the most important modifiable independent risk factors in multivariable variable analysis. Infections also remained more common among females (aOR: 1.82, p < 0.001). CONCLUSION: Intestinal parasitic infections are prevalent in undernourished children and contribute to reduced anthropometric measurements. Strong, independent correlations with the drinking of untreated water and unhygienic nail cuttings revealed identifiable, modifiable behaviors that are important for health and development. The study data illustrate the need to integrate targeted hygiene and WASH programs and become standard in pediatric nutrition centers in unstable, low-resource contexts to curb fecal-oral disease transmission.