Evaluating the Performance of Diagnostic methods for soil transmitted helminths against the “Gold” standard in the Amhara National Regional State, Northwest Ethiopia

Abstract Background : Soil-transmitted helminths are more prevalent in tropics and sub-tropics including Ethiopia. Despite their high prevalence, direct saline microscopy with its low sensitivity has been used as a diagnostic method in almost all health facilities in Ethiopia. Alternative diagnostic methods which have higher sensitivity are not yet implemented. Therefore, this study aimed to compare and evaluate the performance of diagnostic methods for soil transmitted helminths against the “Gold” standard.Methods : A cross-sectional study among 520 school children was conducted from October to December, 2019 in Amhara National Regional State. The study participants were selected using systematic random sampling technique. Stool samples were processed via formol ether concentration, Kato-Katz, spontaneous tube sedimentation and agar plate culture techniques. Data was entered in to Epi-data version 3.1 and analysis was done using SPSS version 20.0. The sensitivity, specificity, and negative predictive value were calculated against combined result as “Gold” standard. Strength of agreement of the diagnostic methods was determined by Kappa value.Results: The Overall prevalence of soil transmitted helminths was 40.8% using combination of methods. The prevalence 24.4%, 22.5%, and 32.4%, respectively was recorded by using formol ether concentration, Kato-Katz and spontaneous tube sedimentation. The highest prevalence of hookworm (29.2%) was detected by the agar plate culture. The sensitivity and negative predictive value of formol ether concentration were 57.9 % and 78.4%, for Kato-Katz thick smear 55.2% and 76.4%, for spontaneous tube sedimentation were 79.2% and 87.5% to soil transmitted helminths detection, respectively. The sensitivity and negative predictive value of agar plate culture to hookworm detection were 86.4% and 93.5%, respectively.Conclusion: Spontaneous tube sedimentation shows higher sensitivity in the detection of soil transmitted helminths infections. Agar plate culture method also indicated better performance for hookworm detection than other methods. Therefore, the employment of STS technique as a confirmatory test in routine laboratory and APC in research purpose will significantly aid in accurate diagnosis of parasitic infections in school children.