Prevalence and risk factors of intestinal parasitic infections among preschool and school-aged children in Egypt: a systematic review and meta-analysis.

Abstract

Introduction: Intestinal parasitic infections (IPIs) are a major public health concern, particularly among children in low- and middle-income countries, where limited resources and data hinder effective interventions. This meta-analysis consolidates current evidence on the prevalence of IPIs among preschool and school-aged children in Egypt, identifies key risk factors, and examines trends in prevalence over time.

Methods: Six databases (African Journals Online, African Index Medicus, PubMed, Scopus, Google Scholar, and Web of Science) were systematically searched from January 1, 2010, to January 1, 2025. Studies conducted in Egypt on apparently healthy preschool or school-aged children were included if they reported IPIs prevalence or risk factors. A random-effects model was employed to estimate pooled prevalence or risk ratios. The meta-analysis was performed using the 'meta' package in R (version 4.4.1), with statistical significance set at p < 0.05.

Results: This meta-analysis included 21 studies conducted between 2009 and 2021, involving 54,282 school and preschooler children from both Lower and Upper Egypt. The pooled prevalence of at least one IPI was 46.5% (95% CI: 40.5-52.5). Sensitivity analyses confirmed the robustness of the finding, with no evidence of publication bias. Meta-regression analysis revealed that the prevalence of at least one IPI remained consistent from 2009 to 2021. The most prevalent parasite was Entamoeba spp. (10.9%), followed by Giardia duodenalis (7.3%) and Enterobius vermicularis (4.9%). Less common parasites included Schistosoma mansoni (1.3%), Ancylostoma duodenale (1.0%), Schistosoma haematobium (0.6%), Heterophyes heterophyes (0.7%), Trichuris trichiura (0.5%), and Fasciola spp. (0.3%). Key risk factors included age 6-10 years (RR = 1.5), rural residence (RR = 1.4), low socioeconomic status (RR = 2.4), poor handwashing practices (RR = 2.1), consuming unwashed vegetables (RR = 1.5), and low maternal education (RR = 1.62).

Conclusion: These findings highlight the substantial burden of IPIs among Egyptian preschool and school-aged children, with nearly half infected by at least one parasite. The consistently high prevalence from 2009 to 2021 underscores the urgent need to reevaluate current control measures and prioritize interventions targeting the high-risk groups identified in this study.