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

Introduction: This 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. Methods: We 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) Results: We 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), 1.8% for Trichuris trichiura (0.3-4.3), 1.75% for Ascaris lumbricoides (0.6-3.5), and 1.8% for taeniasis (0.3-4.4). 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). Conclusions: Despite 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.