Epidemiology of Chlamydia trachomatis in the Middle East and north Africa

a systematic review, meta-analysis, and meta-regression

Alex Smolak, Hiam Chemaitelly, Joumana G. Hermez, Nicola Low, Laith Aburaddad

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods: We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. Findings: We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3–3·8) in general populations, 2·8% (1·0–5·2) in intermediate-risk populations, 13·2% (7·2–20·7) in female sex workers, 11·3% (9·0–13·7) in infertility clinic attendees, 12·4% (7·9–17·7) in women with miscarriage, 12·4% (9·4–15·7) in symptomatic women, and 17·4% (12·5–22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2–12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation: C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. Funding: National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).

Original languageEnglish
Pages (from-to)e1197-e1225
JournalThe Lancet Global Health
Volume7
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

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Northern Africa
Eastern Africa
Middle East
Chlamydia trachomatis
Meta-Analysis
Epidemiology
Qatar
Infection
Spontaneous Abortion
Infertility
Population
Sex Workers
Incidence
Reproductive Health
Research
PubMed
Sample Size
Language
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa : a systematic review, meta-analysis, and meta-regression. / Smolak, Alex; Chemaitelly, Hiam; Hermez, Joumana G.; Low, Nicola; Aburaddad, Laith.

In: The Lancet Global Health, Vol. 7, No. 9, 01.09.2019, p. e1197-e1225.

Research output: Contribution to journalArticle

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title = "Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression",
abstract = "Background: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods: We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. Findings: We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0{\%} (95{\%} CI 2·3–3·8) in general populations, 2·8{\%} (1·0–5·2) in intermediate-risk populations, 13·2{\%} (7·2–20·7) in female sex workers, 11·3{\%} (9·0–13·7) in infertility clinic attendees, 12·4{\%} (7·9–17·7) in women with miscarriage, 12·4{\%} (9·4–15·7) in symptomatic women, and 17·4{\%} (12·5–22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7{\%} (4·2–12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0{\%} of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90{\%} of studies used convenience sampling and >75{\%} had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation: C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. Funding: National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).",
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AU - Chemaitelly, Hiam

AU - Hermez, Joumana G.

AU - Low, Nicola

AU - Aburaddad, Laith

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AB - Background: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods: We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. Findings: We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3–3·8) in general populations, 2·8% (1·0–5·2) in intermediate-risk populations, 13·2% (7·2–20·7) in female sex workers, 11·3% (9·0–13·7) in infertility clinic attendees, 12·4% (7·9–17·7) in women with miscarriage, 12·4% (9·4–15·7) in symptomatic women, and 17·4% (12·5–22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2–12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation: C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. Funding: National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).

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