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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
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