Declining Trends in Gastrointestinal Parasitic Infections Among Nepalese School Children: A Systematic Review and...

Gastrointestinal parasitic infections (GIPs) remain a major health concern in low-income countries, particularly among school-aged children. Nepal's national deworming program, launched in 2004, has significantly improved in controlling GIPs, yet they persist in many areas. This review synthesizes evidence on the prevalence and temporal trends of GIPs among schoolchildren in Nepal.

PubMed, Google Scholar, and regional databases were searched for studies published between 2004 and 2022, reporting the prevalence of GIPs among children aged 5-17 years. Studies providing information on sample size, location, and clear diagnostic methods were considered eligible for analysis. Pooled prevalence estimates were calculated using a random-effects model (DerSimonian-Laird) with logit transformation. Heterogeneity (I ², τ ²) and temporal trends (meta-regression) were assessed.

Twenty-five studies comprising 17,628 stool samples were included, of which 7091 (40.2%) tested positive for GIPs. The pooled prevalence was 28.6% (95% CI: 21.7%-36.7%), with substantial heterogeneity. Prevalence declined significantly over time (OR = 0.58, 95% CI: 0.41-0.81), from 43.4% (2004-2010) to 24.2% (2010-2016), followed by a slight increase to 28.4% (2016-2022). Prevalence was similar by sex, with approximately 12.7%, and urban areas had a slightly higher prevalence (29.0%) than did rural areas (27.9%). Helminth infections (20.0%) were more common than protozoans (9.9%), and in 7.7% (95% CI: 5.6%-9.7%) of the children, polyparasitism was recorded.

GIPs among Nepalese schoolchildren have declined notably over the past two decades but remain a persistent concern. Continued disparities highlight the need for sustained deworming, sanitation, and region-specific monitoring.