Segura S/ Enfermería Investiga Vol. 10 No. 3 2025 (Julio - Septiembre) 
46 
 
 
 
SOCIO-ENVIRONMENTAL  DETERMINANTS  AND  PREVALENCE  OF  INTESTINAL  PARASITOSIS  IN 
CHILDREN FROM A BRAZILIAN RURAL SETTLEMENT 
 
DETERMINANTES SOCIOAMBIENTALES Y PREVALENCIA DE PARASITOSIS INTESTINAL EN NIÑOS DE 
UN ASENTAMIENTO RURAL BRASILEÑO 
 
Bárbara  Faustino  Rodrigues1 https://orcid.org/0000-0003-1968-1451,  Guilherme  Sgobbi  Zagui2 
https://orcid.org/0000-0002-6104-4360, Gabriel Pinheiro Machado3 https://orcid.org/0000-0001-7038-3180, Helen 
Figueiredo Fumagalli4 https://orcid.org/0000-0002-4607-8976, Gabrielly Chura Conchetto5 https://orcid.org/0009-
0005-7659-6757, Rafaela Eduarda Artero5 , Isabelle Silva Marçal5 , Yasmin Victoria Silverio da Silva5 , Gerardo 
Fernando  Fernández  Soto6 https://orcid.org/0000-0002-0246-0380,  Danilo  Vitorino  dos  Santos7 
https://orcid.org/0000-0002-2653-5957, Susana Inés Segura-Muñoz8* https://orcid.org/0000-0002-6720-8231. 
     
1Nurse and Researcher. Interdisciplinary Group for Health Surveillance and  Environmental Health (GIVISA), Ribeirão Preto College of Nursing, 
University of São Paulo (USP), Ribeirão Preto, Brazil. 
2Professor and Researcher. University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil. 
3Biologist and Researcher. Laboratory of Ecotoxicology and Environmental Parasitology, Ribeirão Preto College of Nursing, University of São Paulo 
(USP), Ribeirão Preto, Brazil. 
4Biomedical. University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil. 
5Nursing undergraduate. Ribeirão Preto College of Nursing, University of São Paulo (USP), Ribeirão Preto, Brazil. 
6Professor and Researcher. School of Health Sciences. Technical University of Ambato (UTA), Ecuador. 
7Chemist and Researcher. Chemical Waste Management Center. School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo 
(USP), Ribeirão Preto, Brazil. 
8Professor and Researcher. Laboratory of Ecotoxicology and Environmental Parasitology, Maternal-Child and Public Health Department, Ribeirão 
Preto College of Nursing, University of São Paulo (USP), Ribeirão Preto, Brazil.  
 
Corresponding author: Susana Inés Segura-Muñoz. Email: susis@eerp.usp.br 
 
Received: June 4, 2025 
Accepted: June 27, 2025 
 
ABSTRACT 
 
Introduction:  Intestinal  parasitosis,  caused  by 
helminths and  protozoa, can lead to various  health 
issues.  These  infections  disproportionately  affect 
underdeveloped  and  developing  countries, 
particularly  in  areas  with  inadequate  sanitation. 
Transmission  is  more  prevalent  in  some  regions, 
such  as  peripheral  communities,  peri-urban  zones, 
and rural  settlements, thereby negatively  impacting 
the  population’s  quality  of  life.    Objectives:  To 
determine  the  prevalence  of  intestinal  parasites  in 
children  aged  0-12  living  in  a  peri-urban/rural 
settlement and identify associated factors. Methods: 
A  cross-sectional  study,  which  analyzed  142  fecal 
samples  from  50  children.  Also,  socioeconomic, 
environmental,  and  behavioral  data  from  families 
were  collected.  Results:  A  54%  prevalence  of 
intestinal  parasites  was  observed,  with Entamoeba 
coli, Giardia lamblia, and Ascaris lumbricoides being 
the most common, with monoparasitism occurring in 
48%.  All  families  had  income  class  E.  Ninety-four 
percent of the children's water source was from an 
artisanal  well  (without  chlorination).  94%  of  the 
children consumed raw vegetables; 66% of children 
used water alone to clean their vegetables, and 63% 
of  these  children  had  intestinal  parasitosis.  The 
adapted  Ecomapa  model  allows  for  a  qualitative 
representation  of  the  relationship  between 
socioenvironmental determinants and the  presence 
of parasites. Conclusions: The study highlights the 
multifactorial  causes  of  the  high  prevalence  of 
intestinal  parasites in  children living in  settlements, 
requiring analysis  at various levels. Effective policy 
action  at  the  federal,  state,  and municipal levels  is 
crucial  to  ensure  adequate  sanitation,  healthcare, 
and education for this vulnerable group, particularly 
children,  who  require  comprehensive  care,  quality 
services, and promotion of healthy habits to support 
their growth and development. 
 
Keywords:  intestinal  parasites,  Entamoeba  coli, 
Giardia  lamblia,  Ascaris  lumbricoides,  sanitation, 
childhood 
 
RESUMEN 
 
Introducción: Las parasitosis intestinales causadas 
por helmintos y protozoos, puede provocar diversos 
problemas  de  salud.  Estas  infecciones  afectan  de 
manera  desproporcionada  a  los  países 
subdesarrollados  y  en  vías  de  desarrollo, 
especialmente en zonas con condiciones sanitarias 
inadecuadas.  La  transmisión  es  más  frecuente  en 
algunas  regiones,  como  comunidades  periféricas, 
zonas  periurbanas y  asentamientos  rurales, lo  que 
repercute negativamente en la calidad de vida de la 
población.  Objetivos: El objetivo de este estudio fue 

determinar la prevalencia de parásitos intestinales

en niños de 0 a 12 años que viven en un

asentamiento periurbano/rural e identificar los

factores asociados. Métodos: Se realizó un estudio

transversal en el que se analizaron 142 muestras

fecales de 50 niños. También se recopilaron datos

socioeconómicos, ambientales y comportamentales

de las familias. Resultados: Los resultados

mostraron una prevalencia del 54 % de parásitos

intestinales, siendo Entamoeba coli, Giardia lamblia

y Ascaris lumbricoides los más comunes. Se diseñó

un modelo de Ecomapa adaptado para representar

cualitativamente la relación entre los determinantes

socioambientales y la aparición de parásitos. Es

probable que la alta prevalencia esté relacionada

con condiciones de vida deficientes, como la falta de

higiene, la insuficiencia de los servicios de salud y la

falta de infraestructura. Conclusiones: El estudio

destaca las causas multifactoriales de la alta

prevalencia de parásitos intestinales en los niños

que viven en asentamientos, lo que requiere un

análisis a varios niveles. Es fundamental adoptar

medidas políticas eficaces a nivel federal, estatal y

municipal para garantizar el saneamiento, acceso a

servicios de salud y a educación adecuada, para

comunidades vulnerables, en particular los niños,

que necesitan una atención integral, servicios de

calidad y la promoción de hábitos saludables para

estimular su adecuado crecimiento y desarrollo.

Palabras clave: parasitosis intestinales, Entamoeba

coli, Giardia lamblia, Ascaris lumbricoides,

saneamiento, infancia.

INTRODUCTION

Intestinal parasitosis are infections caused by a

relationship of endoparasitism, whereby protozoa

and/or helminths use the environment of a host's

digestive system as a shelter and food source, which

can reduce their quality of life. These diseases are

prevalent in tropical and subtropical regions, posing

a significant public health challenge. With an

estimated 3.5 billion people infected worldwide, they

can impair nutritional status and physiological

development, while also incurring substantial

economic costs for treatment and management (1).

These infections are often neglected,

disproportionately affecting underdeveloped and

developing countries with limited investment in health

promotion, disease prevention, and control

measures. Their transmission and maintenance are

influenced by the epidemiological triad, the interplay

between the etiological agent, host, and

environment, and can also be facilitated by vectors,

particularly insects (2).

According to the World Health Organization in 2024

(1), over 24% of the global population is affected by

intestinal helminth infections, primarily caused by

Ascaris lumbricoides, Trichuris trichiura, Necator

americanus, and Ancylostoma duodenale and most

common protozoal infections are triggered by Giardia

lamblia, Cryptosporidium spp., and Entamoeba

histolytica, together representing an underestimated

357 million global cases.

The potential of these parasites to provoke specific

responses, whether serious or not, depends on their

resistance to the host organism's immune system, as

well as the infecting dose and their ability to lodge,

multiply, and adapt (3). Thus, infected people can be

asymptomatic, but when symptomatic, they can

manifest diarrhea, vomiting, headache, asthenia,

irritability, apathy, intestinal obstruction, epigastric

and abdominal pain, including anaemia, rectal

prolapse, and impaired physical and mental

development, which can lead to death (4). The child

population is more susceptible to becoming ill

because, in addition to not having a fully developed

immune system, children have behaviors that

facilitate exposure, such as not knowing proper

hygiene practices, increasing contact with

contaminated surfaces, soils and objects more

frequently (5, 6).

Helminthic and protozoan intestinal diseases are

significant causes of morbidity and mortality,

affecting both urban and rural areas. However,

transmission is more prevalent in regions lacking

adequate sanitation, such as peripheral

communities, peri-urban zones, and rural

settlements, thereby negatively impacting the

population’s quality of life (4). Thus, this study aimed

to determine the prevalence of intestinal parasites in

children aged 0-12 living in a peri-urban/rural

settlement and identify associated factors.

METHODS

Type of Study and Location

This descriptive-exploratory, cross-sectional study

was conducted in the settlement Fazenda da Barra

Sustainable Development Program (7), spanning

approximately 1,500 hectares in a rural area of

Ribeirão Preto municipality, São Paulo state, Brazil.

This settlement was officially set up in 2007 to

conserve biodiversity by granting land to people who

base their livelihoods on family farming and other

activities with a low environmental impact, by

Ordinance No 477/1999 of the National Institute for

Colonization and Agrarian Reform (8).

According to the Integrated Primary Health Care

Information System (e-SUS APS), the area is home

to 2,875 settlers, including approximately 400

children aged 12 and under. The local population

lives in housing that lacks structural and sanitary

conditions, as illustrated in Figure 1.

Ethical Aspects

The study was approved by the Research Ethics

Committee (CEP) of the Ribeirão Preto School of

Nursing of the University of São Paulo under CAAE

number 28984320.1.0000.539378.

Sample Collection and Parasitological Analysis

Following informed consent from parents or

guardians, obtained through the signing of a Free

and Informed Consent Form (FICF), children aged 0-

12 years were enrolled in the study. Each person

responsible was given a kit containing three faecal

collection bottles, gloves, and instructions on the

sample collection and conservation procedure. The

samples, duly identified, were collected on previously

scheduled dates and transported under refrigeration

to the Environmental Ecotoxicology and Parasitology

Laboratory (LEPA) at the Ribeirão Preto School of

Nursing (EERP) at the University of São Paulo

(USP). A total of 142 faecal samples were obtained,

34 of which were in triplicate, 14 in duplicate, and 12

single samples.

The Hoffman, Pons, and Janer method (spontaneous

sedimentation) was used for parasitological

analyses. In addition, the Faust Method

(centrifugation-flotation in 33% zinc sulphate) was

used to detect cysts and oocysts of protozoa, as well

as light eggs. The parasite forms were identified

using light microscopy (5).

Collection of Socio-economic, Environmental,

and Behavioral Data

To identify the socioeconomic, environmental, and

behavioral factors associated with the transmission

of intestinal parasites, guardians completed a

structured questionnaire. The survey included

questions on family income, educational level, water

source, sewage disposal, hygiene practices,

presence of animals, and other relevant variables.

The questionnaire was adapted and validated by

Fregonesi (9).

Inclusion Criteria

The study included children of both sexes with family

members able to answer the questionnaire and

collect at least one of the three faecal samples.

Data Analysis

The data was analyzed using Jamovi statistical

software version 1.6.23, using Pearson's chi-square

test and Fisher's exact test to verify the association

between intestinal parasitosis and the socio-

economic, environmental, and behavioral aspects

experienced by the children. The significance level

adopted was 5% (p < 0.05). Additionally, to better

understand the socio-environmental determinants

related to intestinal parasitosis, an Ecomap was

developed using the Calgary Family Assessment

Model as a framework (5). The instrument was

adapted to reflect rural reality, considering the

number of families with parasitized children (nfp) and

the number of parasitized children (ncp) as its core,

including the most prevalent parasitosis. Based on

the answers, a diagram was constructed that

qualitatively represents the relationships between

socio-environmental determinants and the

occurrence of parasites.

Segura S/ Enfermería Investiga Vol. 10 No. 3 2025 (Julio - Septiembre)

RESULTS

Fifty children participated in the parasitological

examination, consisting of 29 males (58%) and 21

females (42%). Of these, 27 children (54%) tested

positive for intestinal parasites, with varying parasitic

conditions, as detailed in Table 1.

Table 2 presents the frequencies and co-occurrence

patterns of intestinal parasites identified in this study.

Protozoa were predominant, accounting for 80% of

the cases, compared to 20% for helminths, both in

terms of variety and quantity. The most commonly

detected species were Entamoeba coli, Giardia

lamblia, and Ascaris lumbricoides. Among these,

Entamoeba coli was the species most frequently

found in co-infections with other parasites.

Segura S/ Enfermería Investiga Vol. 10 No. 3 2025 (Julio - Septiembre)

The socio-economic profile of participating families is

presented in Table 3, revealing that low family

income and limited education are associated with a

higher prevalence of enteroparasitosis.

Regarding sanitation conditions, there is a

predominance of consumption of untreated water

after collection (60%), contrary to recommendations

in urban areas, probably contributing to the high

prevalence of parasitic infections among children

(63%).

Table 5 shows the data on the consumption, origin,

and hygiene aspects of the vegetables consumed

locally by the settlement's children. The results show

that the highest incidence of parasites among the

children participating in the study occurs when they

consume raw vegetables that have only been

sanitized with water, 63%.

Table 6 presents behavioral aspects of children's

daily life that may influence the risk of parasitic

infections. Eighty-nine percent of children who play in

the dirt carry parasites, while those who have contact

with domestic or farm animals are also found to be

infected, as are 82% of those who walk barefoot.

These behavioral aspects are associated with a

higher prevalence of parasitic infections.

Table 7 presents data on the clinical follow-up of the

children participating in the study. The findings

indicate that low demand for care at the local health

unit (sporadic visits to the care unit) is associated

with 59% of children with parasites, and that a delay

of more than 12 months in performing parasitological

tests leads to 74% of children with intestinal

parasitosis. Even among children who received

some antiparasitic treatment in the previous 12

months, 63% had a positive response for

enteroparasitosis, indicating that medication,

regardless of adequate socioenvironmental

conditions, is not sufficient to prevent infection. The

data did not reveal statistically significant differences,

despite the observed relationships.

Segura S/ Enfermería Investiga Vol. 10 No. 3 2025 (Julio - Septiembre)

Based on the results, a diagram adapted from the

Ecomap (Figure 2) was created, using the families of

parasitized children and the prevalent parasitosis as

the central focus (10). This diagram summarizes the

influence of socio-economic, environmental, and

behavioral factors on the prevalence of parasites

among the children in the settlement, drawing on

data collected from questionnaires completed by the

families.

The results highlight the multiple socio-

environmental determinants influencing the

prevalence of intestinal parasitosis in children,

particularly in peri-urban and rural settings like the

Fazenda da Barra PDS Settlement, where this study

was conducted.

DISCUSSION

Brazil's settlement situation is complex, with mixed

progress and challenges in areas like production,

employment, income, and infrastructure, which

significantly impact community health outcomes. The

lack of investment and public policies in sanitation in

settled communities with a peri-urban interface

determines the epidemiological profile of the

population, with the worsening spread of waterborne

diseases, including enteroparasitosis, perpetuating

the transmission cycle (11).

This study identified a high prevalence of intestinal

parasites (54%) in children aged 0 to 12 years in the

Fazenda da Barra PDS settlement (Table 1),

corroborating the findings of Silva et al.(12) who

found 57.1% positivity when analyzing the

parasitological exams of 21 settled children in the

same age group; and Alves et al.(13) who detected a

higher value (68%) in a study of 50 settled children

aged 0 to 13 years, among the parasites identified,

Entamoeba coli had the highest frequency (40%) in

the children examined. Entamoeba coli is a non-

pathogenic protozoan whose presence serves as an

indicator of hygiene conditions, highlighting the need

for improved sanitary practices to prevent the

transmission of pathogenic organisms. This explains

the biparasitic associations observed between

Entamoeba coli and Ascaris lumbricoides, as well as

between Entamoeba coli and Entamoeba histolytica

(Table 2), both waterborne species commonly found

in communities with compromised water quality, such

as settlements (5). Giardia lamblia was the second

most frequent protozoan in the samples analyzed in

this study (30%). Considering its capacity for

zoonotic transmission, the presence of Giardia

lamblia may be related to children's contact with

domestic and farm animals (14).

When evaluating the socioeconomic profile of the

families participating in the study, low monthly family

income and the parents' low level of schooling were

found to be critical aspects, justifying the prevalence

of enteroparasitosis, given that lack of knowledge of

proper hygiene practices and little insight into the

transmission mechanisms of enteroparasites put

children in this community at risk (15).

About the sanitation aspects of the houses, it is

known that the settlement, like the urban area of the

municipality of Ribeirão Preto, is entirely supplied by

the Guarani Aquifer. Although this reservoir has

excellent water quality, after extraction from artesian

wells, it is necessary to chlorinate the water. Table 4

shows that 96% of the study population relies on

water from artesian wells without chlorination, a

proportion significantly higher than the 73.4% of

households using untreated water in villages and

rural settlements reported by Harvey et al. (16).

Furthermore, during the study period, water

distribution via polyethylene hoses exposed to the

ground was observed. Mechanical pressures from

transportation caused ruptures, leaks, and

infiltrations (Figure 3), likely contributing to water

contamination and the high parasite rate.

Additionally, domestic and farm animals had

unrestricted access to the water distribution pipes,

increasing the risk of contamination by pathogenic

organisms, as noted by Portal et al. (17). Notably,

60% of families did not treat their water through

filtration, boiling, or chlorination, a practice that could

minimize parasite transmission (18). This finding is

consistent with Nakano et al. (19), who detected

helminth larvae in 20.8% of tap water samples from

the same area, suggesting a link to the high

prevalence of waterborne enteroparasites in local

children (19).

Regarding sewage disposal, 94% of the homes in the

studied population had septic tanks, consistent with

findings by Dornfeld et al. in a settlement in northwest

São Paulo (20). Although septic tanks are a low-cost,

easy-to-construct solution that can reduce water

contamination in rural areas, the data suggest they

are largely palliative measures. This is due to the risk

of sewage infiltrating the soil and potentially failing to

meet environmental legislation standards for effluent

release (21, 22).

Further discussing environmental sanitation, the

absence of household solid waste collection services

was noted until mid-2022, when municipal

community bins were installed for alternative waste

disposal, used by 70% of the settled families (Table

4). It is known that inadequate solid waste disposal

practices can favor the biological cycle of intestinal

parasites, consequently increasing the prevalence of

verminosis and even mechanical vectors, such as

flies and cockroaches, which can carry protozoan

cysts and helminth eggs after contact with human

and/or animal feces (23).

Table 5 reveals that most parasitized children

consume raw vegetables (96%) often without proper

sanitization (63%), consistent with published data

showing that settlers typically wash raw food with

water only (12). Study also detected high levels of

parasitic contamination in raw vegetables. These

findings suggest that inadequate food hygiene

contributes to enteroparasite infections, potentially

exacerbated by poor water quality used for washing

and irrigation (24). Notably, Ascaris lumbricoides

eggs can easily adhere to food due to their

morphology, and this study found a significant

prevalence of this parasite (20%), similar with

reported data in a rural settlement (13).

Regarding behavioral habits (Table 6), most

parasitized children in this study (82%) reported

walking barefoot. Similarly, it was reported that

walking barefoot facilitates the transmission of

intestinal parasites, which can be present in soil

contaminated by animal or human feces, especially

in areas lacking adequate sanitation, as observed in

the community studied (12, 25). In addition to walking

barefoot, parasitized children often play in the dirt or

sand. It should be noted that, in addition to Ascaris

lumbricoides, among the parasites that can be

present in the soil are Strongyloides stercoralis and

Ancylostoma spp., which have percutaneous

transmission and were not found in the samples in

this study. The exclusive use of the Faust and

55 
 
Hoffman,  Pons,  and  Janer  methods  without 
employing  more  specific  diagnostic  techniques  for 
geohelminths may have led to an underestimation of 
their true prevalence, representing a limitation of this 
study. 
 
Concerning  the  clinical  follow-up  of  parasitized 
children,  59%  of  families  sought  medical  attention 
sporadically, i.e., only when they fell ill, and 74% had 
their  last  parasitological  examination  more  than  a 
year ago (Table 7). Thus, based on these aspects, it 
can be seen that the characteristics of the biomedical 
care model are still ingrained in the settlers, where 
the focus is on interventions aimed only at the subject 
and their sick body, leaving aside the complexities of 
the  health-disease  process,  that  is,  the  social  and 
environmental determinants and their influences on 
health (26). Allied to this situation, it was found that 
although most of the parasitized children had  used 
antiparasitic drugs in the last 12 months (63%), their 
samples tested positive in the analyses carried out in 
this study. Given the parasitic occurrences, it's clear 
that  medication  alone  is  insufficient  for  control;  a 
broader approach is needed, one that considers the 
population's living conditions and promotes effective 
preventive  measures,  health  promotion,  and 
behavioral changes (26, 27, 28). 
 
The  Ecomap  (Figure  3)  revealed  that  parasitized 
children live in environments that facilitate the spread 
of intestinal parasites, given the frequency of factors 
such  as  poor  sanitation,  inadequate  food  hygiene, 
limited education, and healthcare access, as well as 
behavioral habits and animal contact. These factors 
likely contribute to the high prevalence of infections 
in this community. 
 
CONCLUSION 
 
The study highlights the multifactorial causes of the 
high  prevalence  of  intestinal  parasites  in  children 
living  in  settlements,  requiring  analysis  at  various 
levels.  Effective  policy action at  federal,  state,  and 
municipal  levels  is  crucial  to  ensure  adequate 
sanitation,  healthcare,  and  education  for  this 
vulnerable  group, particularly children,  who  require 
comprehensive care, quality services, and promotion 
of  healthy  habits  to  support  their  growth  and 
development. 
 
ACKNOWLEDGMENTS 
 
To the Community Health Agents (CHA) and nurses 
of the Dr. Luís Carlos Raya Family Health Unit (FHU) 
for  their  collaboration  in  guided  visits  and  sample 
collection in the community of the Fazenda da Barra 
PDS Settlement, Ribeirão Preto, Brazil. 
 
RESEARCH FUNDING 
 
This research was funded by the Unified Scholarship 
Program of the University of São Paulo (PUB/USP) - 
Scientific  Initiation  Scholarship  -  Research  Area, 
CNPq  -  PIBIC  Scientific  Initiation  Scholarship,  and 
Financial Aid from PRCEU/USP - UN-ODS Call for 
Proposals. 
 
CONFLICT OF INTEREST 
 
No conflicts of interest are declared. 
 
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