Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Malaria Parasite Prevalence Among Migrants: A Systematic Review and Meta-Analysis
26 Pages Posted: 14 Dec 2022
More...Abstract
Background: Asymptomatic infections with malaria parasite are highly prevalent in endemic areas. This systematic review aimed to estimate the pooled prevalence of malaria parasites in migrants arriving to non-endemic areas.
Methods: We systematically searched for original studies published between January 2000 and August 2022 with data on malaria parasite prevalence. Inclusion criteria were cross-sectional studies and observational cohorts; studies applying a systematic screening approach, studies conducted in Europe, USA, Canada, Australia, or New-Zealand, and diagnosis based on microscopy, rapid diagnostic rest (RDT) or PCR-based methods. For each method of detection, the primary outcome was calculated as the number of participants with a positive malaria test divided by the number of participants screened. Pooled estimates of the prevalence by PCR or other direct techniques were calculated with a random-effects model. Heterogeneity was explored by stratification by age, region of origin, migrant class, period of study, and quality of studies (PROSPERO: CRD42021262580).
Findings: Of 1819 studies, 23 studies were finally included with 4194 participant PCR data and 5212 RDT or microscopy data. Pooled prevalence based on PCR was 7·9% (95% CI 4·9-11·4; I2 92.6%) and 2·4% (1·0-4·3; 92.1%) for studies based on RDT and/or microscopy. Migrants from sub-Saharan Africa had the highest PCR-based prevalence (8·2% [4·9-12·0]) compared with migrants from Asia (0% [0-0·08]) or Latin America (0·5% [0-1·9]). Migrants from the Central African Region had the highest prevalence (9·5% [6·0-13·5]), followed by migrants from West Africa (2·0% [0·0-6·9]). Restricting the analysis to newly-arrived migrants, arriving to the host country within the previous year, the PCR-based prevalence was 11·4% (6·7-17·2).
Interpretation: We provide the best-known estimates so far on the malaria parasite prevalence in migrants. These findings can be used to inform screening strategies, as well as guidelines for targeting malaria in migrants.
Funding: ARM is funded from Strategic Research Program (Epidemiology), Karolinska Institutet. The study was supported by grants to AF from the Swedish Research Council [2021-03105], and Stockholm Region [ALF project grant FoUI-960104]. The study was also partly supported by the Italian Ministry of Health with funds to IRCCS Sacro Cuore Don Calabria hospital – Ricerca Corrente Linea. ARM is supported by the CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
Declaration of Interests: We declare no competing interest.
Keywords: malaria, Plasmodium, prevalence, PCR, rapid diagnostic test, migrant, Systematic review, meta-analysis
Suggested Citation: Suggested Citation