Evaluation of Hookworm Diagnosis Techniques from Patients in Amhara Region, Ethiopia: Cross sectional study

Abstract Background: Inappropriate diagnosis could intimidate the prevention and control of Hookworm infection. This study was aimed at evaluating the performance of Hookworm diagnosis methods.Methods: An institution based cross sectional study was conducted in Amhara region, Ethiopia. The study subjects were selected conveniently. Sensitivity, specificity, predictive values, test accuracy and agreements of the different hookworm diagnosis methods, namely; Test Tube Flotation (TFT), MacMaster (MM), Formol Ether Concentration (FEC), Kato katz (KK), and Direct wet mount microscopy (DWMM) were calculated. Composite reference standard (CRS) was used as a gold standard method. Kappa (κ) test was used to measure the level of agreement between diagnosis tests. Moreover, t-test was used to compare the diagnostic performance of the diagnosis methods.Result: a total of 389 stool samples were collected from patients in the study. The overall prevalence of hookworm was 63.24%. Test Tube Flotation (TFT) was found to be the highest both in terms of sensitivity and diagnosis accuracy (100%). MacMaster (MM) was the second most sensitive test (68.7%), followed by FEC (44.3%) and KK (38.2%). On the other hand, DWMM had the lowest sensitivity (37.4%) and its diagnosis accuracy was also the least (60%). Only TFT had a perfect (Agreement=100%, kappa=1) with the CRS. The sensitivity of DWMM, KK, and FEC showed an increase in sensitivity as a function of increasing intensity of infection, but TFT and MM methods were not affected by the infection intensity. Conclusion: Hookworm is still a public health problem in the study area. TFT is by far more sensitive than MM, FEC, KK and DWMM techniques.