Prevalence and Factors Associated with Working Equid Lameness in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

ABSTRACT

Lameness is an important concern in working equids of low- and middle-income communities (LMICs) with significant One Welfare implications. This study aims to determine the prevalence and influencing factors of lameness in working equids of LMICs. A systematic review and meta-analysis were performed to investigate pooled outcome prevalence using a random intercept regression model. Subgroup and sensitivity analysis were performed through meta-regression. A meta-analysis of study factors for lameness prevalence was performed. Sixty-four studies were included in the review. The pooled prevalence of lameness was 29.9% (n = 42, 95% CI 17-47%), while the pooled prevalence of gait abnormality was 62.9% (n = 12; 95% CI 31-87%). When considering both outcomes together, the pooled prevalence was 38.4% (n = 46; 95% CI 23-57%) with a significant (p = 0.02) difference between lameness (29.5%; 95% CI 16-48%) and gait abnormality (78.8%; 95% CI 40-95%). Species, country income level, gait assessed, and risk of bias did not significantly affect the pooled prevalence. Lower body condition scores, unresponsive attitudes, and old age were the most frequently reported factors positively associated with lameness-related outcomes. Working 7 days per week was positively associated with lameness. The standardization of outcome terminology, grading systems, and study factor categorization is recommended to enable more accurate interpretation and comparison between studies.