Chagas Disease Prevalence in Colombia: A Meta-Analysis and Systematic Review.

ABSTRACT

BACKGROUND AND OBJECTIVES: Chagas disease is a major public health problem in Latin America. A neglected disease of poor and rural Latin American populations, it has now emerged in other regions and urban areas due to international migration. In Colombia, systematic data pertaining to the disease's magnitude in the general population and its distribution within regions are lacking. Our objective is to describe the prevalence of Chagas disease in Colombia through a meta-analysis and systematic review. MATERIALS AND METHODS: A comprehensive search using several electronic databases, gray literature, and reference lists of selected articles for population-based studies on Chagas disease prevalence in Colombia was performed between 1990 and 2017. Articles published in either English or Spanish were included. Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated for Chagas disease in the general population using a meta-analysis random-effects model. Subgroup analyses were performed to investigate potential sources of heterogeneity among studies. A sensitivity analysis was conducted to determine whether publication bias existed. RESULTS: Seventeen articles with relevant prevalence data were identified from a total of 1213 references. The initial pooled estimate of Chagas disease prevalence across studies for the entire period was 4.10% (95% CI 2.23-7.41). After removing studies with large effect and small sample sizes, the pooled estimate was 1.67% (95% CI 0.95-2.92). A high degree of heterogeneity in most pooled estimates was observed, even after subgroup analysis. The Orinoquía region, rural areas, males, and persons aged ≥15 years yielded the highest pooled prevalence. INTERPRETATION AND CONCLUSION: Higher prevalence was observed in select regions, rural areas, and older teenagers and adults. Additional population-based studies within Colombia are recommended to provide more stable and reliable estimates and identify high-risk areas and groups.