Seasonal Haematological and Biochemical Patterns of Paediatric Entamoeba Infection in Benghazi: One Health–Sustainability Implications

Abstract

Background: Paediatric intestinal amoebiasis remains clinically relevant in settings affected by limitations in water safety, sanitation and food hygiene. Evidence from Libya regarding its seasonal distribution and associated haematological, inflammatory and biochemical patterns remains limited. This study characterised these profiles among children with microscopy-detected Entamoeba histolytica/dispar complex in Benghazi and considered their One Health and sustainable development implications.

Methods: This retrospective laboratory-based analytical study included 799 microscopy-positive paediatric cases examined at Benghazi Children’s Hospital from January to December 2023. Demographic, temporal, haematological, inflammatory and biochemical variables were analysed. Months were grouped into four seasons, and anaemia was classified using the 2024 World Health Organization age- and sex-specific haemoglobin thresholds. Data were summarised using frequencies, percentages, medians and interquartile ranges. Group comparisons, Spearman’s correlations and robust multivariable regression were applied, with false-discovery-rate correction for multiple comparisons.

Results: Males accounted for 450 cases (56.3%), and 790 cases (98.9%) involved children aged one or two years. The highest number of positive cases occurred in summer (261/799; 32.7%), followed by autumn (251/799; 31.4%). Anaemia was identified in 371 cases (46.4%): 22.5% mild, 19.8% moderate and 4.1% severe. Two-year-olds had greater odds of anaemia than one-year-olds (odds ratio 2.65; 95% confidence interval 1.99–3.54). Serum iron correlated with haemoglobin (Spearman’s ρ=0.470; p<0.001), while white blood cell count correlated with C-reactive protein (ρ=0.314; p<0.001). After multiple-testing correction, haemoglobin, white blood cell count and C-reactive protein did not differ significantly by season. Seasonal differences in serum iron, calcium and urea had small effect sizes.

Conclusion: Microscopy-positive paediatric Entamoeba cases showed a high frequency of anaemia and coherent iron-related and inflammatory laboratory relationships. The summer–autumn concentration represented case distribution rather than seasonal prevalence because testing denominators were unavailable. Integrated paediatric laboratory assessment and strengthened surveillance linking clinical services with water, sanitation and food-safety sectors may support One Health-informed prevention and progress towards Sustainable Development Goals 2, 3, 6 and 17.