Waterborne species and in resources of MENA: A systematic review and meta-analysis.

This review explores our understanding of species and distribution in Middle East and North African (MENA) water resources. Results emphasize that species (sp.) and (oo)cysts are present in distinct categories of water in ten MENA countries. sp. proportional prevalence in the MENA region was 24.5% (95% CI 16.3-33.8), while . prevalence was 37.7% (95% CI 21.9-55.1). Raw wastewater and surface water were the water categories most significantly impacted. Both parasites were reported in the various types of MENA drinking waters. The most frequent species/genotypes reported were , , and assemblage A. Despite the high prevalence of (oo)cysts reported, we should consider the absence of waterborne outbreaks. This indicates significant underestimation and underreporting of both parasites in MENA. Stakeholders should apply water contamination legislation to eradicate sp. and (oo)cysts from water resources/categories.