Global meta-analysis on Babesia infections in human population: prevalence, distribution and species diversity.

Human babesiosis is an emerging tick-borne protozoan zoonosis caused by parasites of the genus Babesia and transmitted by ixodid ticks. It was thought to be a public health problem mainly for the immunocompromised, however the increasing numbers of documented cases among immunocompetent individuals is a call for concern. In this systematic review and meta-analysis, we reported from 22 countries and 69 studies, an overall pooled estimate (PE) of 2.23% (95% CI: 1.46-3.39) for Babesia infections in humans. PEs for all sub-groups varied significantly (p < 0.05) with a continental range of 1.54% (95% CI: 0.89-2.65) in North America to 4.17% (95% CI: 2.11-8.06) in Europe. PEs for country income levels, methods of diagnosis, study period, sample sizes, Babesia species and targeted population ranged between 0.43% (95% CI: 0.41-0.44) and 7.41% (95% CI: 0.53-54.48). Babesia microti recorded the widest geographic distribution and was the predominant specie reported in North America while B. divergens was predominantly reported in Europe. Eight Babesia species; B. bigemina, B. bovis, B. crassa-like, B. divergens, B. duncani, B. microti, B. odocoilei and B. venatorum were reported in humans from different parts of the world with the highest prevalence in Europe, lower middle income countries and among individuals with history of tick bite and other tick-borne diseases. To control the increasing trend of this emerging public health threat, tick control in human settlements, the use of protective clothing by occupationally exposed people and the screening of transfusion blood in endemic countries are recommended.Abbreviations AJOL: African Journals OnLine, CI: Confidence interval, CIL: Country income level, df: Degree of freedom, HIC: Higher-income countries, HQ: High quality, I2: Inverse variance index, IFAT: Indirect fluorescent antibody test, ITBTBD: Individuals with tick-bite and tick-borne diseases, JBI: Joanna Briggs Institute, LIC: Lower-income countries, LMIC: Lower middle-income countries, MQ: Medium quality, NA: Not applicable, N/America: North America, OEI: Occupational exposed individuals, OR: Odds ratio, PE: Pooled estimates, PCR: Polymerase chain reaction, Prev: Prevalence, PRISMA: Preferred Reporting System for Systematic Reviews and Meta-Analyses, Q: Cochran's heterogeneity statistic, QA: Quality assessment, Q-p: Cochran's p-value, qPCR: Quantitative polymerase chain reaction, S/America: South America, Seq: Sequencing, UMIC: Upper middle-income countries, USA: United States of America.

Infection rates, species diversity, and distribution of zoonotic Babesia parasites in ticks: a global systematic review and meta-analysis.

Zoonotic Babesia species are emerging public health threats globally, and are the cause of a mild to severe malaria-like disease which may be life threatening in immunocompromised individuals. In this study, we determine the global infection rate, distribution, and the diversity of zoonotic Babesia species in tick vectors using a systematic review and meta-analysis. We used the random-effects model to pool data and determined quality of individual studies using the Joanna Briggs Institute critical appraisal instrument for prevalence studies, heterogeneity using Cochran's Q test, and across study bias using Egger's regression test. Herein, we reported a 2.16% (3915/175345, 95% CI: 1.76-2.66) global infection rate of zoonotic Babesia species (B. divergens, B. microti, and B. venatorum) in tick vectors across 36 countries and 4 continents. Sub-group infection rates ranged between 0.65% (95% CI: 0.09-4.49) and 3.70% (95% CI: 2.61-5.21). B. microti was the most prevalent (1.79%, 95% CI: 1.38-2.31) species reported in ticks, while Ixodes scapularis recorded the highest infection rate (3.92%, 95% CI: 2.55-5.99). Larvae 4.18% (95% CI: 2.15-7.97) and females 4.08% (95% CI: 2.56-6.43) were the tick stage and sex with the highest infection rates. The presence of B. divergens, B. microti, and B. venatorum in tick vectors as revealed by the present study suggests possible risk of transmission of these pathogens to humans, especially occupationally exposed population. The control of tick vectors through chemical and biological methods as well as the use of repellants and appropriate clothing by occupationally exposed population are suggested to curtail the epidemiologic, economic, and public health threats associated with this emerging public health crisis.

Animal reservoirs of zoonotic Babesia species: A global systematic review and meta-analysis of their prevalence, distribution and species diversity.

Zoonotic babesiosis caused by Babesia divergens, B. microti and B. venatorum is a vector-borne protozoan zoonosis of increasing public health importance worldwide. A complex system of animal reservoirs including a wide range of mammals and a limited number of birds play a central role in maintaining the infection. Governed by the PRISMA guidelines, we conducted a systematic review and meta-analysis to determine the global prevalence, distribution and the diversity of zoonotic Babesia species in animal reservoirs. We pooled data using the random-effects model and determined quality of individual studies, heterogeneity and across study bias using the Joanna Briggs Institute critical appraisal instrument for prevalence studies, Cochran's Q-test and Egger's regression test respectively. Seventy nine studies from 29 countries reported a total 9311 positive cases of zoonotic Babesia infections from 46,649 animal reservoirs, yielding an overall estimated prevalence of 12.45% (95% CI: 10.09-15.27). Continental prevalence ranged between 8.55 (95% CI: 1.90-31.11) in Africa and 27.81% (95% CI: 21.25-35.48) in North America. Estimated prevalence in relation to country income levels, methods of diagnosis, study periods, sample sizes and reservoir categories ranged between 4.97 (95% CI: 1.80-13.00) and 30.12% (95% CI: 22.49-39.04). B. divergens was the most prevalent (12.50%, 95% CI: 8.30-18.39) of the 3 species of zoonotic Babesia reported in animal reservoirs. Zoonotic Babesia infections are prevalent in animal reservoirs across the world with the highest prevalence in North America and domestic animals. B. microti had the widest geographic distribution. We recommend tick control as well as strategic and prophylactic treatment against these parasites in animal reservoirs to curtail the economic losses associated with zoonotic Babesia species and possible transmission to humans.

Epidemiology of Cryptosporidium Infections among People Living with HIV/AIDS in Nigeria: Results of Systematic Review and Meta-analysis.

PURPOSE: Cryptosporidium is implicated in diarrhea epidemics in many parts of the world and is said to be the most common protozoan cause of diarrhea among people living with HIV/AIDS (PLWHA) globally. To provide data on the burden of Cryptosporidium infections among Nigerians living with HIV/AIDS, we reported the prevalence, geographic distribution and Cryptosporidium species diversity among this population in Nigeria. METHODS: We used the PRISMA guidelines to perform a systematic review and meta-analysis of articles published between January 1, 1995 and April 21, 2020. Pooled estimate (PE), heterogeneity, quality of each study and publication bias were determined using the random-effects model, Cochran's Q test, the 9 point Joanna Briggs Institute Critical Appraisal Instrument and the Egger's regression asymmetry test, respectively. RESULTS: Forty-six articles reported 2612 positive cases of Cryptosporidium infections from 12,756 PLWHA examined in 20 Nigerian States and the Federal Capital Territory. Overall pooled estimate was 14.5% (95% CI 10.4-19.9) with a range of 0.3% (95% CI 0.0-1.8) to 43.7% (95% CI 35.6-52.3) across sub-groups, with the PEs in relation to CD4+ T cell count, species and age showing significant variations at p < 0.05. Cryptosporidium hominis was the most prevalent (3.5%, 95% CI 2.3-5.2) of the six Cryptosporidium species reported in Nigeria. CONCLUSION: Cryptosporidium infections are moderately prevalent among PLWHA in Nigeria with the highest regional prevalence in the north-east. In addition to personal hygienic practices, the inclusion of Cryptosporidium screening as part of HIV/AIDS clinics in Nigeria will reduce the burden of the parasite among PLWHA in Nigeria.

A systematic review and meta-analysis on the prevalence, distribution and nematode species diversity in small ruminants: a Nigerian perspective.

Despite the global projections that agriculture will have to feed an additional 3 billion of the world's population in the nearest future, the global trends and negative impacts of nematodes on livestock productivity are still on the increase. Here, we reported the burden of gastrointestinal nematodes in small ruminants in Nigeria. Six thousand, five hundred and eighty one of the 13,259 small ruminants reported in 40 eligible studies across 18 Nigerian States were infected with at least one nematode species, yielding an overall pooled prevalence (PP) of 58.3% (95% CI 48.8, 67.2). Regional PP varied significantly (P < 0.001) and ranged between 19.5 (95% CI 5.8, 48.7) and 83.7% (95% CI 68.5, 92.3). Seasonal PP was higher in the dry (Prev: 56.5%, 95% CI 34.2, 76.4) than the rainy (Prev: 43.2%, 95% CI 26.7, 61.3) season. Haemonchus species were the most prevalent 21.3% while, Trichuris ovis and Strongyloides species had the widest geographic distribution. Several species of nematodes of small ruminants are highly prevalent in Nigeria. An all-inclusive approach involving public education and standardised management practices that involve adequate hygiene and sanitation, strategic and prophylactic use of anthelmintics, rotational grazing and the control of arthropod intermediate hosts will reduce the economic losses due to these parasites and curtail possible transmission to humans.

Toxoplasma gondii infections in birds, companion, food and recreational animals in Nigeria: A systematic review and meta-analysis.

Toxoplasma gondii is a protozoan pathogen of zoonotic and economic importance with a global distribution. The pathogen is associated with abortion, stillbirth, neonatal mortalities and mummification in sheep and goats which may also serve as sources of human infections. In pregnant women, the parasite undergoes intrauterine transmission to cause neonatal complications like miscarriage, chorioretinitis, hydrocephalus, cerebral calcification and foetal death. Here, we determine the prevalence and geographical distribution of T. gondii infections in Nigeria using the PRISMA protocol. Prevalence estimates (PE) and heterogeneity were determined by the random-effects model and the Cochran's Q-test respectively. Twenty-eight articles identified, reported 2311 positive cases of Toxoplasma gondii from a total of 9847 animals examined across 15 Nigerian States. Overall PE was 20.70% (95% CI: 15.05-27.78) with a range of 10.18% (95% CI: 2.66-31.98) to 94.00% (95% CI: 89.73-96.56) across sub-groups. PEs varied significantly (p < .05) across host species, with a range of 4.06% (95% CI: 2.47-6.87) to 40.65% (95% CI: 19.88-65.40). PEs in females (22.65%, 95% CI: 15.78-31.72) was significantly higher (p < .05) than that in males (18.97%, 95% CI: 12.78-27.22), while those for adult and young animals were 20.23% (95% CI: 13.42-29.33) and 18.96% (95% CI: 11.11-30.45) respectively. The majority of the studies were published from the south-western region. Toxoplasma gondii infection is prevalent among birds, companion, food and recreational animals from Nigeria. Integrated control strategies including adequate sanitation, cat movement restrictions, public enlightenment are recommended to curtail the menace of T. gondii in animals and its public health consequences in humans.

Human Toxoplasma gondii infection in Nigeria: a systematic review and meta-analysis of data published between 1960 and 2019.

BACKGROUND: Over 70% of the worlds' population is infected by Toxoplasma gondii; a pathogen capable of causing cerebral toxoplasmosis in HIV patients and neonatal complications like miscarriage, chorioretinitis, hydrocephalus, cerebral calcification and foetal death in the third trimester of pregnancy. In spite of this, the burden of this zoonotic pathogen is poorly understood in Nigeria. The aim of the present study therefore, is to determine the burden of T. gondii among normal individuals, HIV patients and pregnant women as well as the distribution of the infection across Nigeria. METHODS: Using the PRISMA guidelines, we conducted a systematic review and meta-analysis of data retrieved from six electronic databases (AJOL, Google Scholar, PubMed, Scopus, Science Direct and Web of Science). Pooled prevalence (PP) and heterogeneity were determined by the random-effects model and the Cochran's Q-test respectively. The quality of each study and publication bias were assessed by the 9 point Joanna Briggs Institute Critical Appraisal Instrument and the Egger's regression asymmetry test respectively, while the robustness of a pooled estimate was tested by the single study omission analysis. RESULTS: Exactly 5834 of the 16,230 individuals examined for T. gondii infection by 50 studies across 17 Nigerian States were positive for the infection. Overall PP was 32.92% (95% CI: 27.89, 38.37), with a range of 14.41% (95% CI: 5.32, 33.54) to 86.82% (95% CI: 66.13, 95.69) across sub-groups. Pooled prevalence was significantly higher (p < 0.001) among pregnant women (40.25%; 95% CI: 33.19, 47.73) and HIV patients (31.68, 95% CI: 20.53, 45.41) than normal individuals (23.32, 95% CI: 17.25, 30.75). T. gondii prevalence declined by over 58% during the 59 years reviewed. CONCLUSION: Toxoplasma gondii infection is moderately prevalent in Nigeria. Highest prevalence estimates were observed among pregnant women and in the south-south region. For effective control of the disease in Nigeria, a holistic approach involving on-farm, environmental, public health and animal components are suggested.