Strongyloidiasis in Africa: Systematic Review and Meta-Analysis on Prevalence, Diagnostic Methods, and Study Settings.

BACKGROUND

is an intestinal parasitic infection mainly caused by . Although it is a predominant parasite in tropics and subtropics where sanitation and hygiene are poorly practiced, the true prevalence of s is not known due to low-sensitivity diagnostic methods.

OBJECTIVE

This systematic review and meta-analysis is aimed at determining the pooled prevalence of s in African countries, stratified by diagnostic methods, study settings, and patients.

METHODS

Cross-sectional studies on strongyloidiasis published in African countries from the year 2008 up to 2018 in PubMed and Google Scholar databases and which reported at least one spp. infection were included. Identification and screening of eligible articles were also done. Articles whose focus was on in animals, soil, and foreigners infected by spp. in Africa were excluded. The random effects model was used to calculate the pooled prevalence of s across African countries as well as by diagnostic methods and study settings. The heterogeneity between studies was also computed.

RESULT

A total of 82 studies were included. The overall pooled prevalence of s was 2.7%. By individual techniques, the pooled prevalence of strongyloidiasis was 0.4%, 1.0%, 3.4%, 9.3%, 9.6%, and 19.4% by the respective direct saline microscopy, Kato-Katz, formol ether concentration, polymerase chain reaction, Baermann concentration, and culture diagnostic techniques. The prevalence rates of strongyloidiasis among rural community, school, and health institution studies were 6.8%, 6.4%, and 0.9%, respectively. The variation on the effect size comparing African countries, diagnostic methods, study settings, and patients was significant ( ≤ 0.001).

CONCLUSIONS

This review shows that strongyloidiasis is overlooked and its prevalence is estimated to be low in Africa due to the use of diagnostic methods with low sensitivity. Therefore, there is a need for using a combination of appropriate diagnostic methods to approach the actual rates in Africa.