Prevalence, pattern and predictors of clinically important parasites contaminating raw vegetables and fruits in Ethiopia: a systematic review and meta-analysis

Abstract

Background: There is a growing concern regarding food safety, with the potential presence of parasitic pathogens in raw produce globally. Contaminated fruits and vegetables can be sources of various parasitic infections imposing significant health consequences for general population, particularly, vulnerable populations such as pregnant women, young children, and immunocompromised individuals. Therefore, the aim of this meta-analysis is to systematically assess and synthesize the available evidence on the magnitude of parasitic contamination in raw fruits and vegetables obtained from local markets in Ethiopia.

Methods: Thoroughly search of published and unpublished studies was conducted in the databases of MEDLINE/PubMed, EMBASE, Google Scholar, CINAHL, Cochrane library and Science Direct. PRISMA checklist was strictly followed to select potential studies. Microsoft Excel 2016 sheet template was employed to extract the data. Quality of included studies was assessed by using the Newcastle - Ottawa Scale. STATA software version 14.0 was used to compute the estimated pooled prevalence. Heterogeneity among included studies was assessed using percentage of variance (I²) and P-value.

Results: Thirteen studies with a total sample size of 3769 fruits and vegetables were included. The pooled prevalence of parasitic contamination in raw fruits and vegetables with at least one parasite in Ethiopia is 43.38% (95% CI: [36.64, 50.12]). The highest pooled prevalence of contamination with at least one parasite is reported from Oromia region, 51.95% (95% CI: [40.53, 63.37]). The most prevalent parasite is strongyloides stercoralis, followed by Toxocara spp., G. lamblia and A. lumbricoides. The most contaminated vegetables with at least one parasites is spinach followed by cabbage and lettuce. Banana has emerged to be the most frequently contaminated fruit with a contamination prevalence of 38.34% (95% CI: [1.84, 56.83]). Being unwashed fruits and vegetables, placement of the products and literacy status of the sellers are significantly associated with the occurrence of parasitic contamination.

Conclusions: The result of this study showed that contamination of raw fruits and vegetables with clinical important parasites is high. Therefore, adequate public awareness on hygienic harvest, storage, placement and consumption shall be created in order to mitigate such a significant public health concern.

Keywords: Contamination; Meta-analysis; Parasite; Raw fruits; Raw vegetables.

Fig. 1

PRISMA chart flow showing article selection process

Fig. 2

Forest plot showing meta-analysis of parasitic contamination among raw vegetables and fruits in Ethiopia

Fig. 3

Forest plot showing subgroup analysis by region of parasitic contamination among raw vegetables and fruits in Ethiopia

Fig. 4

Forest plot showing subgroup analysis by diagnostic techniques of parasitic contamination among raw vegetables and fruits in Ethiopia

Fig. 5

Forest plot showing subgroup analysis of parasitic contamination among raw vegetables and fruits in Ethiopia local market based on the utilization of modified Ziehl Neelson technique

Fig. 6

Pooled prevalence of parasitic contamination among raw vegetables (A) and fruits (B) in Ethiopia

Fig. 7

Number of parasites found in contaminated raw vegetables and fruits

Fig. 8

Predictors associated with parasitic contamination in raw vegetables and fruits in Ethiopia. A: washing status, B: Vendor’s educational status and C: place of display

Fig. 9

funnel plot depicting publication bias for meta-analysis of parasitic contamination among raw vegetables and fruits in Ethiopia