TY - JOUR
T1 - Epidemiology of Trichomonas vaginalis infection in the Middle East and North Africa
T2 - systematic review, meta-analyses, and meta-regressions
AU - Harfouche, Manale
AU - Gherbi, Wafaa Sekkal
AU - Alareeki, Asalah
AU - Alaama, Ahmed S.
AU - Hermez, Joumana G.
AU - Smolak, Alex
AU - Abu-Raddad, Laith J.
N1 - Publisher Copyright:
© 2024
PY - 2024/8
Y1 - 2024/8
N2 - Background Trichomoniasis, caused by the parasite Trichomonas vaginalis (TV), remains an underappreciated sexually transmitted infection (STI), primarily due to inadequate understanding of its epidemiology and public health implications. This study aimed to characterize TV epidemiology in the Middle East and North Africa (MENA). Methods Systematic review and analysis of evidence sourced from international, regional, and national databases were conducted. Findings were reported following PRISMA guidelines. Random-effects meta-analyses and meta- regressions were performed to determine pooled mean prevalence, investigate associations with prevalence, and identify sources of between-study heterogeneity. Findings The review identified fi ed 263 relevant publications, encompassing 462 TV prevalence measures. The pooled mean TV prevalence was estimated as follows: 4.7% (95% CI: 3.9-5.6%) - 5.6%) in the general population of women, 17.2% (95% CI: 5.4-33.6%) - 33.6%) among intermediate-risk populations, 10.3% (95% CI: 6.2-15.3%) - 15.3%) among female sex workers, 13.9% (95% CI: 12.3-15.6%) - 15.6%) among symptomatic women, 7.4% (95% CI: 1.9-15.5%) - 15.5%) among infertility clinic attendees, 2.3% (95% CI: 0.1-6.3%) - 6.3%) among women with miscarriages or ectopic pregnancies, and 1.6% (95% CI: 0.8-2.7%) - 2.7%) among STI clinic attendees. Limited data were found for men. Multivariable meta- regressions explained >40% of the prevalence variation, unveiling a hierarchical prevalence pattern by population type, an inverse correlation with national income, and a prevalence decline at a rate of 1% per calendar year. Interpretation Despite conservative sexual norms, MENA has a substantial TV prevalence, comparable to the global TV prevalence. The unexpectedly high prevalence of this curable infection may, in part, be attributed to limited access to and underutilization of STI screening and treatment services.
AB - Background Trichomoniasis, caused by the parasite Trichomonas vaginalis (TV), remains an underappreciated sexually transmitted infection (STI), primarily due to inadequate understanding of its epidemiology and public health implications. This study aimed to characterize TV epidemiology in the Middle East and North Africa (MENA). Methods Systematic review and analysis of evidence sourced from international, regional, and national databases were conducted. Findings were reported following PRISMA guidelines. Random-effects meta-analyses and meta- regressions were performed to determine pooled mean prevalence, investigate associations with prevalence, and identify sources of between-study heterogeneity. Findings The review identified fi ed 263 relevant publications, encompassing 462 TV prevalence measures. The pooled mean TV prevalence was estimated as follows: 4.7% (95% CI: 3.9-5.6%) - 5.6%) in the general population of women, 17.2% (95% CI: 5.4-33.6%) - 33.6%) among intermediate-risk populations, 10.3% (95% CI: 6.2-15.3%) - 15.3%) among female sex workers, 13.9% (95% CI: 12.3-15.6%) - 15.6%) among symptomatic women, 7.4% (95% CI: 1.9-15.5%) - 15.5%) among infertility clinic attendees, 2.3% (95% CI: 0.1-6.3%) - 6.3%) among women with miscarriages or ectopic pregnancies, and 1.6% (95% CI: 0.8-2.7%) - 2.7%) among STI clinic attendees. Limited data were found for men. Multivariable meta- regressions explained >40% of the prevalence variation, unveiling a hierarchical prevalence pattern by population type, an inverse correlation with national income, and a prevalence decline at a rate of 1% per calendar year. Interpretation Despite conservative sexual norms, MENA has a substantial TV prevalence, comparable to the global TV prevalence. The unexpectedly high prevalence of this curable infection may, in part, be attributed to limited access to and underutilization of STI screening and treatment services.
KW - Middle east and North Africa
KW - Prevalence
KW - Sexually transmitted infection
KW - Trichomonas vaginalis
KW - Trichomoniasis
UR - https://www.scopus.com/pages/publications/85198562682
U2 - 10.1016/j.ebiom.2024.105250
DO - 10.1016/j.ebiom.2024.105250
M3 - Article
C2 - 39024899
AN - SCOPUS:85198562682
SN - 2352-3964
VL - 106
JO - eBioMedicine
JF - eBioMedicine
M1 - 105250
ER -