Epidemiology of intestinal parasitic infections among school-aged children in low- and middle-income countries of Africa and Asia: a systematic review and meta-analysis

Background and Aims Intestinal parasitic infections (IPIs) remain a significant public health challenge, particularly among school-aged children in low- and middle-income countries (LMICs). This systematic review and meta-analysis aimed to estimate the pooled prevalence of IPIs and identify associated risk factors in Africa and Asia. Method A systematic search of Medline/PubMed, Embase, Scopus, ScienceDirect, Epistemonikos, and additional searches such as Google and Google Scholar was conducted between January 2019 and April 2024. The review followed the PRISMA guidelines. Data extraction was performed using Microsoft Excel, and meta-analyses were conducted using STATA. Methodological quality was assessed using the Newcastle–Ottawa Scale. A random-effects model was used to estimate the pooled prevalence, while heterogeneity was assessed using the I2 statistic. Publication bias was evaluated through funnel plots and Egger’s regression test. The study protocol was registered in PROSPERO (CRD42024536604). Results 47 studies comprising 20,334 school-aged children were included. The pooled prevalence of at least one intestinal parasitic infection was 39% (95% CI: 33%–45%). Regional analysis showed a higher prevalence in Africa (41%) compared to Asia (35%). Protozoan infections (29%) exceeded those of helminths (19%) and mixed infections (2%). The most common parasites were Blastocystis hominis (16%), Endolimax nana (16%), Entamoeba histolytica (15%), Entamoeba coli (12%), and Ascaris lumbricoides (11%). Infections were primarily single (37%), followed by double (10%), triple (3%), and quadruple (1%). Significant risk factors included school type, socioeconomic status, larger family size, presence of domestic animals, and finger-sucking habits. Conclusion Intestinal parasitic infections remain a significant public health challenge among school-aged children in Africa and Asia. The findings underscore the need for sustained, school-based health programs that integrate regular deworming, hygiene education, and targeted sanitation improvements. Strengthening surveillance and addressing behavioral and environmental risk factors are essential to reducing infection burden and promoting child health.