Background: Hookworm infestation is an important public health concern especially in regions with poor sanitation and limited resources. In healthcare institutions in Ethiopia, wet mount microscopy with low performance has been used as the sole diagnostic technique. Sensitive diagnostic methods are essential for the proper identification of hookworm infection in national strategies for hookworm prevention and management. Thus, the objective of the article was to evaluate the performance of diagnostic techniques in the detection of hookworm infestation among school children in the Gozamin district, Northwest Ethiopia.

Methods: A cross-sectional study with 530 school children was conducted from February to April 2022 in Ethiopia. The study participants were selected by using systematic random sampling technique. Direct wet mount (DWM), Richie^'s, Kato-Katz (KK), and spontaneous tube sedimentation (STS) diagnostic techniques were utilized to process the stool samples. The data were entered into the Epi-data version 4.2 and the data was analyzed using SPSS version 25.0. The sensitivity, specificity, predictive values and test efficiency of the test were calculated with respect to the Composite Reference Standard (CRS) as the reference method. The degree of agreement with the methods of diagnosis was assessed by the Kappa value.

Results: The overall prevalence of hookworm was 34.9 %. The detection rate of STS, Richie's, KK and DWM techniques in hookworm detection was 30.2 %, 27.0 %, 22.3 % and 15.1 %, respectively. The sensitivity and test efficiency of STS to detect hookworm were 86.5 % and 95.3 %, for Richie^'s 77.3 % and 92.1 %, for KK 63.8 % and 87.4 %, for DWM method 43.2 % and 80.2 %, respectively. The agreement of STS, Richie^'s, KK and DWM techniques with CRS were perfect (κ = 0.893), perfect (κ = 0.816), substantial (κ = 0.696) and moderate (κ = 0.498), respectively in detecting hookworm parasites.

Conclusion: The prevalence of hookworm among school children was high. The STS method is superior to other methods for detecting hookworm infections. The Richie's technique was more successful in detecting the hookworm parasite than the KK and DWM techniques. It is important to implement the STS technique in routine diagnostic methods and in endemic areas of hookworm infection because it cheaper, easy to perform, and identifies a wide range of parasitic species.