Malaria prevalence in Mauritania: a systematic review and meta-analysis

Abstract

Background: Understanding malaria epidemiology is a critical step toward efficient malaria control and elimination. The objective of this meta-analysis was to derive robust estimates of malaria prevalence and Plasmodium species from studies conducted in Mauritania and published since 2000.

Methods: The present review followed the PRISMA guidelines. Searches were conducted in various electronic databases such as PubMed, Web of Science, and Scopus. To obtain pooled prevalence of malaria, meta-analysis was performed using the DerSimonian-Laird random-effects model. Methodological quality of eligible prevalence studies was assessed using Joanna Briggs Institute tool. Inconsistency and heterogeneity between studies were quantified by the I² index and Cochran's Q test. Publication bias was assessed with funnel plots and Egger's regression tests.

Results: A total of 16 studies with a good individual methodological quality were included and analysed in this study. The overall random effects pooled prevalence of malaria infection (symptomatic and asymptomatic) across all included studies was 14.9% (95% confidence interval [95% CI]: 6.64, 25.80, I² = 99.8%, P < 0.0001) by microscopy, 25.6% (95% CI: 8.74, 47.62, I² = 99.6%, P < 0.0001) by PCR and 24.3% (95% CI: 12.05 to 39.14, I² = 99.7%, P < 0.0001) by rapid diagnostic test. Using microscopy, the prevalence of asymptomatic malaria was 1.0% (95% CI: 0.00, 3.48) against 21.46% (95% CI: 11.03, 34.21) in symptomatic malaria. The overall prevalence of Plasmodium falciparum and Plasmodium vivax was 51.14% and 37.55%, respectively. Subgroup analysis showed significant variation (P = 0.039) in the prevalence of malaria between asymptomatic and symptomatic cases.

Conclusion: Plasmodium falciparum and P. vivax are widespread in Mauritania. Results of this meta-analysis implies that distinct intervention measures including accurate parasite-based diagnosis and appropriate treatment of confirmed malaria cases are critical for a successful malaria control and elimination programme in Mauritania.

Keywords: Malaria; Mauritania; Meta-analysis; Plasmodium falciparum; Plasmodium vivax; Prevalence; Systematic review.

Fig. 1

Map of Mauritania and study sites. Geographical distribution of locations from which malaria prevalence was reported is shown. Red circles, sites in the Sahelian zone; blue circles, sites in the Saharan zone

Fig. 2

Flow chart of the literature search and selection process

Fig. 3

Forest plots showing random effects of individual and pooled estimates of malaria prevalence in Mauritania by diagnostic method

Fig. 4

Forest plots showing individual and pooled estimates of P. falciparum and P. vivax prevalence using microscopy in Mauritania

Fig. 5

Subgroup analysis of the possible source of heterogeneity among individual studies using microscopy in Mauritania

Fig. 6

Begg’s funnel plot to assess publication bias among the included malaria prevalence studies