Intestinal parasitic infections in Iranian preschool and school children: A systematic review and meta-analysis
Graphical abstract
Introduction
Intestinal parasitic infections (IPIs) are a health problem in most countries, especially so in developing countries. The infections cause iron deficiency anemia, growth retardation in children, weight loss, abdominal pain, dyspepsia, and other physical and mental health problems (Norhayati et al., 2003, WHO, 2008, Schmunis and López Antuñano, 2010).
According to a WHO report, 3.5 billion people are affected, and 450 million are sick because of parasitic infections, of which the majority is children. Of the total annual mortalities in developing countries, parasitic diseases accounts for 16 million deaths. Approximately 39 million disability-adjusted life years are attributed to IPIs and these infections represent a substantial economic burden. Preschool and school children are easily identifiable target groups. IPIs are transmitted directly among children through fecal contamination of soil and water, or indirectly through poor sanitation (WHO, 2007, Fan et al., 2012, Stephenson et al., 2000).
Epidemiological studies around the world have shown that the socio-economic status of the people is the main cause of prevalence of IPIs. Moreover, poor hygiene and environmental conditions are known to be related to the propagation of these infective diseases (Gamboa et al., 1998, Tellez et al., 1997).
Investigation of parasitic infections can consider sanitation as an important indicator of disease prevalenceat the community level (Phiri et al., 2000). Geographically, Iran is situated in the Middle East and borders the Caspian Sea, Persian Gulf, and Oman Sea. Iran has favorable conditions for the activity of various parasites because of the geographical location, climate, and biological and cultural characteristics.
Numerous studies have been performed on IPIs in preschool and school children from Iran. However, there is no study to gather and systematically analyze this information. The aim of this study was to provide summary estimates for the available data on intestinal parasitic infections in Iranian children. This study has been carried out to evaluate the prevalence of parasitic infections and demographic data (age and sex).
Section snippets
Search strategy and data extraction
We searched MEDLINE via PubMed, Scopus, Science Direct, Web of Science (ISI), Google Scholar (as English databases); Magiran, Iran Medex, Iran Doc, and SID (as Persian databases) during 1996 to April 2015 using the terms: intestinal parasites, Giardia, Cryptosporidium, Enterobiusvermicularis (oxyure), school, children, preschool, day care, kindergarten, Iran.
Owing to the high number and the importance of studies on Giardia, Cryptosporidium, and Enterobiusvermicularis (oxyure) in Iranian
Results
Of the 68,532 publications that were gathered for this systematic review, 103 were eligible for inclusion under intestinal parasitic infections (Fig. 1 and Table 1).
The mean score obtained for STROBE scale was 18.41, which indicated that the quality of studies was moderate to high (Von Elm et al., 2008).
In this study, the pooled prevalence of IPIs among Iranian preschool and school children was 38.3% (95% CI: 33.2%, 43.4%). Among 54 studies, Ahvaz (Ghafari et al., 2012) and Hamadan (Saeidi-jam
Discussion
This systematic review and meta-analysis will be beneficial for understanding the situation of IPIs in Iranian children. This study estimated the prevalence rate of IPIs in this group, using the documented data from the literature reviews, which have been gathered from different provinces of Iran.
After searching through 9 databases, unpublished data, and abstracts of scientific congresses, 103 articles were included in the study. According to our results, the prevalence rate of IPIs among
Conclusions
This is the first systematic review and meta-analysis that provides a comprehensive overview of the epidemiology of IPIs in Iranian preschool and school children. Our results showed that the prevalence of IPI is declining in Iranian preschool and school children. Improved sanitation, personal hygiene, increased awareness, and health education can be effective in reducing parasitic infections in different communities. Moreover, the establishment of appropriate sanitation facilities and education
Acknowledgments
We thank Mr. Mohammad-Taghi Rahimi for critical review of the manuscript and technical assistance. This work was supported by grant (No. 2044) from the deputy of research, Mazandaran University of Medical Sciences, Sari, Iran.
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