This protocol outlines the methodology for a comprehensive systematic review and meta-analysis assessing the zinc status of the Iraqi population over a 36-year period (1990–2026). Zinc is an essential micronutrient critical for immune function, growth, and development, with deficiency posing a significant public health burden. Primary Aim: To synthesize existing English-language evidence and estimate the pooled prevalence of zinc deficiency and mean serum/plasma zinc levels across all Iraqi demographic groups, including analysis of trends before and during the COVID-19 pandemic. Secondary & Comparative Aim: To contextualize the findings from Iraq by comparing the pooled estimates with published data from the broader Middle East and North Africa (MENA) region and global figures. This comparison will help determine if the burden of zinc deficiency in Iraq is disproportionate and identify potential regional or global disparities. Methodology: The review will adhere to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. We will conduct extensive searches across multiple databases (PubMed/MEDLINE, Scopus, Web of Science, etc.). Two independent reviewers will screen studies, extract data, and assess the risk of bias using standardized tools (Newcastle-Ottawa Scale, Cochrane RoB 2.0, AMSTAR-2). A random-effects meta-analysis will be performed for Iraqi data. Findings will be compared narratively and statistically with existing systematic reviews on MENA and global zinc status. Expected Impact: This work will provide the first consolidated evidence on the magnitude and trends of zinc deficiency in Iraq, inform national nutrition policy and interventions, and offer a comparative perspective to understand Iraq's position within regional and global health contexts.
Al-Timimi et al. (2026) studied this question.