One Health drivers of zoonotic Taenia solium in rural districts of low and middle-income countries: A systematic review and meta-analysis.

Background Infection with Taenia solium in humans and pigs continues to be a public health problem in rural districts of low and middle-income countries (LMICs). This is attributed to weak collaboration in surveillance, prevention, control and diagnosis among different sectors. Free-ranging pigs act as reservoirs of T. solium , increasing human infection risk through close contact, poor sanitation, and consumption of undercooked pork. This systematic and meta-analysis was aimed at estimating pooled prevalence of T. solium in human, porcine cysticercosis and identify their One health drivers in LMICs. Methods A systematic search of Medline/PubMed, Embase, CINAHL, Web of Science, Cochrane database, Global Health online, Scopus and African Journals Online. ClinicalTrials.gov, Google Scholar. Open Grey database, WHO reports, FAO/WHO/WOA, and government or NGO technical reports were searched for studies published in January 2015 onwards. The systematic review was registered under PROSPERO CRD 420251023448. Random effects meta-analysis using the Der Simonian–Laird method estimated pooled prevalence. Publication bias was assessed using funnel plots and Egger’s regression test while subgroup and sensitivity analysis was used to explore heterogeneity. Results Fifty-nine studies meet the inclusion criteria for systematic review and 29 studies for meta-analysis. The pooled prevalence of porcine cysticercosis was 10.9% (95% CI: 5.1%-21.8%) based on 14 of fourteen studies involving 8,904 pigs. The pooled prevalence of human T. solium was 13% (95%CL 8.00%-20%) based on 15 studies including 25,184 participants. Most frequently studies reporting risk factors were poor sanitation and free-range pigs with each (41; 69.5%) follow by open defecation with (36; 61%), poor hygiene (26; 44.1%), poor knowledge (23; 39%), lack of meat inspection (20; 33.9%) and backyard slaughtering (17; 28.8%). Human, animal and environmental risk factors were consistently associated with transmission and highlighting the need for One health integrated interventions. Conclusion T. solium remains highly prevalent in endemic areas of LMICs. Strengthening One health surveillance, prevention, diagnosis and control strategies in human, animal and environmental sector is essential to reduce disease transmission and burden.