Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression
Summary: Background: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods: We did a systematic review of C trachomati...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-09-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X19302797 |
| _version_ | 1829115019001856000 |
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| author | Alex Smolak, PhD Hiam Chemaitelly, MSc Joumana G Hermez, MPH Nicola Low, ProfPhD Laith J Abu-Raddad, ProfPhD |
| author_facet | Alex Smolak, PhD Hiam Chemaitelly, MSc Joumana G Hermez, MPH Nicola Low, ProfPhD Laith J Abu-Raddad, ProfPhD |
| author_sort | Alex Smolak, PhD |
| collection | DOAJ |
| description | Summary: Background: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods: We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. Findings: We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3–3·8) in general populations, 2·8% (1·0–5·2) in intermediate-risk populations, 13·2% (7·2–20·7) in female sex workers, 11·3% (9·0–13·7) in infertility clinic attendees, 12·4% (7·9–17·7) in women with miscarriage, 12·4% (9·4–15·7) in symptomatic women, and 17·4% (12·5–22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2–12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation: C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. Funding: National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation). |
| first_indexed | 2024-12-12T16:05:11Z |
| format | Article |
| id | doaj.art-9e07737c7acd4fe7a5961003c32d9951 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-12T16:05:11Z |
| publishDate | 2019-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-9e07737c7acd4fe7a5961003c32d99512022-12-22T00:19:19ZengElsevierThe Lancet Global Health2214-109X2019-09-0179e1197e1225Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regressionAlex Smolak, PhD0Hiam Chemaitelly, MSc1Joumana G Hermez, MPH2Nicola Low, ProfPhD3Laith J Abu-Raddad, ProfPhD4Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation–Education City, Doha, QatarInfectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation–Education City, Doha, QatarDepartment of Communicable Diseases, HIV/Hepatitis/STIs Unit, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, EgyptInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInfectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar; Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, NY, USA; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar; Correspondence to: Prof Laith J Abu-Raddad, Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation–Education City, PO Box 24144, Doha, QatarSummary: Background: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods: We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. Findings: We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3–3·8) in general populations, 2·8% (1·0–5·2) in intermediate-risk populations, 13·2% (7·2–20·7) in female sex workers, 11·3% (9·0–13·7) in infertility clinic attendees, 12·4% (7·9–17·7) in women with miscarriage, 12·4% (9·4–15·7) in symptomatic women, and 17·4% (12·5–22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2–12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation: C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. Funding: National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).http://www.sciencedirect.com/science/article/pii/S2214109X19302797 |
| spellingShingle | Alex Smolak, PhD Hiam Chemaitelly, MSc Joumana G Hermez, MPH Nicola Low, ProfPhD Laith J Abu-Raddad, ProfPhD Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression The Lancet Global Health |
| title | Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression |
| title_full | Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression |
| title_fullStr | Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression |
| title_full_unstemmed | Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression |
| title_short | Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression |
| title_sort | epidemiology of chlamydia trachomatis in the middle east and north africa a systematic review meta analysis and meta regression |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X19302797 |
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