Helminth and protozoan infections remain a significant public health problem among preschool children, particularly in developing regions. Conventional stool microscopy, widely used in routine practice, is known to have limited sensitivity, potentially leading to underdiagnosis and delayed treatment.

Objective: To evaluate the diagnostic performance of conventional stool microscopy in detecting helminth–protozoan infections in preschool children and to identify clinical predictors associated with missed diagnoses.

Methods: A cross-sectional study was conducted involving 186 preschool children aged 3–6 years. Each child underwent three consecutive stool examinations using direct microscopy and concentration methods. A subset of 72 samples was additionally analyzed using enzyme-linked immunosorbent assay (ELISA) as a reference method. Diagnostic accuracy indicators including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Logistic regression analysis was performed to assess clinical predictors of infection.

Results: Overall prevalence of helminth–protozoan infection was 41.9% based on combined diagnostic methods. Single stool microscopy detected infection in only 27.4% of cases. The sensitivity of single-sample microscopy was 62.8%, while three consecutive examinations increased sensitivity to 84.3%. ELISA-based detection revealed an additional 13.5% of cases missed by microscopy. Recurrent abdominal pain (OR = 2.6; 95% CI: 1.4–4.8; p = 0.003) and persistent eosinophilia (OR = 3.1; 95% CI: 1.6–6.0; p = 0.001) were independent predictors of infection.

Conclusion: Conventional single-sample stool microscopy significantly underestimates helminth–protozoan infection prevalence in preschool children. Repeated sampling and adjunct immunodiagnostic methods substantially improve detection rates. Incorporating enhanced diagnostic strategies may reduce underdiagnosis and improve clinical outcomes.

Helminth infection, Protozoan infection, Preschool children

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