{
  "abstract": "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, 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 Joanna Briggs Institute tools, while the AACODS (Authority, Accuracy, Coverage, Objectivity, Date and Significance) checklist was used for grey literature. Estimates were pooled using random-effects meta-analysis where possible or synthesised narratively.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% CI 0.9% to 11.3%, I²=99%), 1.8% for Trichuris trichiura (95% CI 0.3% to 4.3%, I²=98%), 1.75% for Ascaris lumbricoides (95% CI 0.6% to 3.5%, I²=96%) and 1.8% for taeniasis (95% CI 0.3% to 4.4%, I²=98%). 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 with 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: 6.8/1000; refugees: 2.72/1000; refugees <5 years old: 7.3/1000). While hospitalisation and intensive care unit rates for malaria were 25.8% and 1.3%, respectively, severe malaria was higher in non-migrants compared with migrants in Qatar (50% vs 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 subregion of North Africa. We generally found that migrants were disproportionately affected by both NTDs and malaria, especially in the Middle East. PROSPERO registration number CRD42023407748",
  "authors": [
    {
      "affiliations": [
        "Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Madani, Sudan",
        "Migrant Health Research group, Barcelona Institute for Global Health (ISGlobal, Hospital Clinic—University of Barcelona), Barcelona, Spain",
        "Faculty of Medicine, University of Barcelona, Barcelona, Spain"
      ],
      "name": "Eman Elafef"
    },
    {
      "affiliations": [
        "Migrant Health Research group, Barcelona Institute for Global Health (ISGlobal, Hospital Clinic—University of Barcelona), Barcelona, Spain",
        "Faculty of Medicine, University of Barcelona, Barcelona, Spain",
        "University of Sousse, Faculty of Medicine of Sousse, Research Laboratory Quality of Care and Management of Maternal Health Services, LR12ES03, Sousse, Tunisia"
      ],
      "name": "Taha Maatoug"
    },
    {
      "affiliations": [
        "Migrant Health Research group, Barcelona Institute for Global Health (ISGlobal, Hospital Clinic—University of Barcelona), Barcelona, Spain"
      ],
      "name": "Stella Evangelidou"
    },
    {
      "affiliations": [
        "Migrant Health Research group, Barcelona Institute for Global Health (ISGlobal, Hospital Clinic—University of Barcelona), Barcelona, Spain"
      ],
      "name": "Helena Marti-Soler"
    },
    {
      "affiliations": [
        "Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Madani, Sudan"
      ],
      "name": "Asad Adam"
    },
    {
      "affiliations": [
        "Faculty of Veterinary Medicine, Badr University in Cairo, Cairo, Egypt"
      ],
      "name": "Ahmed Hamed Arisha"
    },
    {
      "affiliations": [
        "Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Madani, Sudan"
      ],
      "name": "Mahmoud Hilali"
    },
    {
      "affiliations": [
        "The Migrant Health Research Group, Institute for Infection and Immunity, School of Health & Medical Sciences, City St George's University of London, London, Spain"
      ],
      "name": "Sally Hargreaves"
    },
    {
      "affiliations": [
        "Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven, Connecticut, USA"
      ],
      "name": "Ibrahim Bani"
    },
    {
      "affiliations": [
        "The Migrant Health Research Group, Institute for Infection and Immunity, School of Health & Medical Sciences, City St George's University of London, London, Spain"
      ],
      "name": "Farah Seedat"
    },
    {
      "affiliations": [
        "Migrant Health Research group, Barcelona Institute for Global Health (ISGlobal, Hospital Clinic—University of Barcelona), Barcelona, Spain",
        "Department of Infectious Diseases, Karolinska University Hospital Department of Infectious Diseases, Stockholm, Sweden",
        "CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain"
      ],
      "name": "Ana Requena-Méndez"
    }
  ],
  "title": "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",
  "uid": "81d8f318-8ba6-5e06-b58e-08408a8f1502"
}