The burden, clinical outcomes, and risk factors related to neglected tropical diseases and malaria in migrant populations in the Middle East and North Africa: A systematic review and meta-analyses

IntroductionThis systematic review investigates the burden, clinical outcomes, and risk factors of neglected tropical diseases (NTDs) and malaria in the Middle East and North African region (MENA), highlighting the urgency and scope of these health challenges. MethodsWe searched six databases for peer-reviewed literature and additional sources to capture grey literature in any language from 2000 to 28 August 2024. Studies were included if they provided primary data on outcomes in migrants. Primary outcomes were prevalence, incidence, and mortality. Peer-reviewed articles were critically appraised using JBI tools, while the AACODS checklist was used for grey literature. Estimates were pooled using random-effects meta-analysis where possible or synthesised narratively. (PROSPERO-CRD42023401694) ResultsWe included 39 studies with 81,678 migrants across 11 countries for NTDs and 16 studies encompassing 12,823 migrants across five countries for malaria. The pooled prevalence of specific NTDs among migrants was 4.7% for hookworm (95% confidence interval [CI] 0.9-11.3, I{superscript 2}=99%), 1.8% for Trichuris trichiura (0.3-4.3, I{superscript 2}=98%), 1.75% for Ascaris lumbricoides (0.6-3.5, I{superscript 2}=96%), and 1.8% for taeniasis (0.3-4.4, I{superscript 2}=98%). Compared with non-migrants, migrants exhibited higher prevalence rates for hookworm (1.8% vs. 0.03%), Ascaris lumbricoides (0.3% vs. 0%), Trichuris trichiura (0.5% vs. 0%), dengue (26% vs. 3.5%), and chikungunya (4.2% vs. 0.5%). Migrants had a higher proportion of confirmed cases of schistosomiasis (0.21%-20.3% vs 0-0.013%), cystic echinococcosis (7.4% vs 3.5%), and dengue (57.2% vs 56.4%) among suspected cases compared to non-migrants. Case fatality rates were 3.1% for dengue and 0.2%-1.5% for malaria. Malaria incidence was only reported in Sudan (Internally displaced persons: 6.8/1,000; refugees: 2.72/1,000; refugees <5 years old: 7.3/1,000). While hospitalisation and ICU rates for malaria were 25.8% and 1.3%, respectively, severe malaria was higher in non-migrants compared to migrants in Qatar (50% versus 5.2%, respectively). ConclusionsDespite a wide range of diseases reported in 55 studies, there were gaps in the evidence, primarily related to risk factors, clinical outcomes, and the sub-region of North Africa. We generally found that migrants were disproportionately affected by both NTDs and malaria, especially in the Middle East. Key questionsO_ST_ABSWhat is already known?C_ST_ABSO_LIThe Middle East and North African (MENA) region has experienced a rise in migration from neglected tropical diseases (NTDs)- and malaria-endemic countries. C_LIO_LIWithout adequate access to prevention and treatment, there is a risk of reintroducing or increasing the burden of NTDs and malaria in MENA countries that have achieved or made progress towards their elimination. C_LIO_LIDespite the critical importance of understanding the burden, clinical outcomes, and risk factors of NTDs and malaria among migrants in the MENA region, little is known about these diseases in this population. C_LIO_LISuch knowledge is essential for designing effective interventions, delivering targeted care, and monitoring morbidity and mortality. C_LI What are the new findings?O_LIOverall, migrants in the MENA region were disproportionately affected by NTDs and malaria. C_LIO_LIThey had a higher prevalence of soil-transmitted helminths and a higher seroprevalence of dengue and chikungunya than non-migrants. C_LIO_LIThere was also a higher proportion of confirmed cases of schistosomiasis, cysticercosis, echinococcosis, dengue, scabies, and malaria among suspected cases. C_LIO_LIMigrants also represented a higher percentage of reported cases of malaria, dengue, scabies, leprosy, schistosomiasis, and CL. C_LIO_LIOutcome and risk factor data and North African data on NTDs and malaria were limited. C_LI What do the new findings imply?O_LIMigrants in most MENA countries are disproportionally affected by NTDs and malaria, highlighting their vulnerability as at-risk groups. C_LIO_LIHowever, their needs have not been prioritised in research. There is an urgent need to strengthen research on NTDs and malaria for migrants in the region to fill existing knowledge gaps and guide evidence-based approaches for effective prevention, early diagnosis, and treatment of NTDs and malaria to serve migrant populations better. C_LI