A meta-analysis of Entamoeba histolytica/dispar in Iraq

Abstract

BackgroundAmebiasis is a major health problem caused by the protozoan parasite Entamoeba histolytica with a worldwide distribution, especially in developing countries. The aim of this systematic review and meta-analysis was to estimate the proportion prevalence of E. histolytica/dispar in human in Iraq. Methodology/Principal FindingsPublished studies on human infection with E. histolytica/dispar in Iraq were searched in electronic databases using Google scholar, Iraqi Academic Scientific Journals (IASJ), PubMed, ScienceDirect and WHO Global Health Library (GHL). Eligible studies were cross-sectional and used fecal and/or serological methods to diagnose E. histolytica/dispar infection in human in Iraq, and published between 1970 and July 2017. The pooled prevalence was calculated using random effect model meta-analyses with 95% confidence interval (CI). Ninety nine studies were eligible for the meta-analysis that included 117694 individuals. The pooled proportion for E. histolytica/dispar infection in Iraq was estimated at 20.61% with a 95% confidence interval (CI) of 17.83, 23.53. A high level of heterogeneity was found among the studies. The prevalence among Iraqi population ranged between 1.66 and 90.5% per study (mean: 22.36%). The pooled prevalence of infection was 58.43% (95% CI: 54.71%?62.1%) and 43.10% (95% CI: 39.66%-46.6%) for males and females respectively. Parasite screening using microscopy did not differentiate between the pathogenic and nonpathogenic species of Entamoeba resulted in higher proportion prevalence than PCR proportion prevalence, (20.32%, 95% CI: 17.80%-22.96%) (17.57%, 95% CI: 8.07%-29.75%) respectively. Hospital based studies recorded the highest prevalence of E. histolytica/dispar infection at 22.69% (95% CI: 19.55%-25.99%). The prevalence decreased into 18.46 (95% CI: 14.28%-23.04%) between 2010 and 2017. Conclusions/SignificanceAlthough there was a reduction in prevalence of amebiasis since 2010, the prevalence of amebiasis is still considerable in population of Iraq. Therefore, prevention strategies of fecal contamination are required to reduce the infection. Author summaryAmebiasis is the infection with Entamoeba histolytica an invasive parasite dwelling the intestine or other organs such as liver, lungs, or skin of human. Infection with this parasite could be acquired by consumption of contaminated water, vegetables, and fruits with feces of infected human. The infection may be asymptomatic or symptomatic causing dysentery. We performed this meta-analysis to estimate the prevalence of amebiasis in the population of Iraq between 1970 and 2017. Ninety nine published studies were identified and the data were extracted from them to use in our meta-analysis and the total included individuals were 117694. The prevalence of population infection in Iraq was evaluated at 20.61%. The infection prevalence was higher in males than in females. The infection prevalence decreased during the period 2010 to 2017 in Iraqi population. This level of infection needs further efforts to eradicate amebiasis, these efforts begin with the prevention of the disease transmission through water and food and treatment of infected people. So awareness of simple hygienic principles can control the disease by boiling water and washing vegetables and fruits thoroughly.