A systematic review and meta-analysis on the global prevalence of helminthic parasites among schoolchildren: a public health concern

Abstract

Background

Neglected tropical diseases (NTDs) are responsible for substantial illness and death worldwide. Helminthic infections among school-aged children pose a serious public health challenge due to their detrimental effects on health and development.

Methods

A wide-ranging search conducted across five databases, including Scopus, EMBASE, PubMed, Web of Science, and Google Scholar to retrieve papers published between 1998 and 2024. To evaluate the combined prevalence, a random-effects model with a 95% confidence interval (CI) was applied, and the statistical analysis was performed using meta-analysis packages in R version (3.6.1).

Results

There were 190 eligible studies documented in 42 countries, and 199,988 schoolchildren included in this review. The global prevalence of helminthic parasites was 20.6% (17.2– 24.3%). Among the countries studied, Tanzania and Vietnam showed the highest levels of prevalence at 67.41% and 65.04%, respectively, with Toxocara spp. and Ascaris lumbricoides being the most prevalent helminthic parasites at 10.36% and 9.47%, respectively.

Conclusion

In conclusion, this study underscores the pressing public health concern of helminthic infections among schoolchildren, largely driven by inadequate sanitation and poor water quality. Prompt action, such as improving sanitation, expanding school-based deworming programs, and enhancing access to safe water, is crucial to control these infections and enhance overall health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-23958-9.

Background

Neglected tropical diseases (NTDs) are primarily chronic infections that cause significant illness and death, particularly among the world’s poorest populations. These diseases not only impact health but also contribute to the cycle of poverty [1].

Socioeconomic disadvantage is a well-established and significant factor influencing the spread of these diseases. Factors such as poverty and inadequate sanitation play a key role in facilitating parasite transmission [2]. In terms of disability-adjusted life years (DALYs), the greatest burden of NTDs is still attributed to soil-transmitted helminth (STHs) infections, schistosomiasis, lymphatic filariasis, and dengue fever [3].

Intestinal helminth infections are regarded as highly significant socio-economic and public health concerns globally [4]. Their prevalence is higher in tropical and subtropical zones, notably among populations in developing countries facing poverty and poor sanitary conditions [5]. It is approximated that nearly 300 million people suffer from heavy morbidity of intestinal helminths with annual deaths ranging from 10,000 to 135,000 [5, 6]. According to the World Health Organization (WHO) statistics, many people worldwide are infected with these infections. Globally, nearly 2 billion people primarily children are infected with common parasitic diseases such as STHs, which include hookworms (Necator americanus, Ancylostoma duodenale), Ascaris lumbricoides, and Trichuris trichiura [7].

Preschoolers and school-aged children, including adolescents, are disproportionately affected by intestinal helminths and schistosomes for reasons that are not yet well understood. These infections can result in stunted growth, weakened physical health, and impaired cognitive function particularly memory and learning which together negatively impact their educational achievement and school participation [8].

Transmission of intestinal parasites commonly occurs via exposure to contaminated feces, ingestion of raw or undercooked meat, contaminated water or soil, or through transdermal penetration [9]. In children, infection commonly occurs through soil-transmitted routes and behaviors such as nail biting. In high-prevalence regions, approximately 870 million children are estimated to be at risk of soil‑transmitted helminth infections globally, according to WHO [10]. A prevalence rate of high intestinal parasite has been reported in children compared to people of other ages. Intestinal helminths infection in children can lead to severe complications such as malabsorption, malnutrition, disorders of growth and development, anemia and retardation, intestinal obstruction, hemorrhagic diarrhea, fever, dehydration, vomiting and nutritional complications such as iron deficiency anemia. Up to date, numerous studies have been conducted on intestinal parasites prevalence in school-aged children in different countries [11].

According to the geographical and health status of the studied area, statistics have been designed in a wide range, indicating helminth infection as a leading cause of health problem in the world. However, differences in the rate of prevalence of helminth parasites may be related to diverse factors such as climate, geography, socio-economic, and cultural factors [12, 13].

Helminth infections in fecal samples are primarily diagnosed using direct smear microscopy, concentration methods, and the Kato-Katz technique for quantifying helminth eggs, including Schistosoma species [14–16]. Today, more accurate DNA-based methods are used to more accurately diagnose infections of this type [10, 14]. Preschool and schoolchildren are particularly vulnerable to helminth infections and associated complications like malnutrition and anemia. Due to their higher exposure to contaminated sources such as soil, growing evidence over recent years highlights the importance of prioritizing infection risk in this population. These findings are critical in creating proper and effective interventions [17–19].

This systematic review and meta-analysis focused on estimating the global prevalence of helminthic parasite in school-age children via synthesizing data across studies in distinct geographic locations. The findings of this review are expected to support evidence-based interventions aimed at reducing the burden of soil-transmitted helminthic infections among school-aged children.

Methods

Search approach

This study adhered to the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Fig. 1) [20]. We systematically searched several databases, including Scopus, EMBASE, PubMed, Web of Science, and Google Scholar, to collect relevant papers published between 1998 and 2024, applying no date restrictions (Supplementary Table 1).

Fig. 1.

Flow diagram of the study design process

We used search terms associated with the prevalence, epidemiology, incidence, parasites, parasitic diseases, parasitic infections, helminthiasis, parasitic helminth, helminth parasites, helminthic infections, helminth diseases, pathogenic helminth, intestinal helminth, preschool and/or school-age children, global, and worldwide, using both AND and/or Boolean operators.

Duplicates were removed using EndNote X9 software library and manual verification, followed by manual screening of reference lists to capture relevant studies potentially missed by the database search. After automatic and manual duplicate removal (21,350 duplicates), 2,906 unique records were screened.

Two reviewers (ZG and HS) independently screened titles and abstracts and assessed full-text articles for eligibility. Disagreements were resolved through discussion with a third reviewer (MB). Data extraction and quality assessment were also independently conducted by ZG and HS, with supervision by AVE and MB.

Inclusion and exclusion criteria

Articles were included if they were cross-sectional studies documenting helminthic infections in schoolchildren, published as original research in peer-reviewed journals, available in English with both abstracts and full texts accessible, and reporting the total sample size and the number of positive cases.

Studies classified as case series, case reports, letters, editorials, publications lacking original data, review articles, those with inconclusive findings, non-English publications, and studies reporting parasitic helminths from non-human samples were excluded from this analysis.

Microsoft Excel® version 2016 was employed to systematically extract the following data from the included articles: author names, publication year, climate, annual rainfall, average temperature, humidity, gender, age, mean age, educational level, Global Burden of Disease (GBD) regions, WHO region, countries, district/city/province, Human Development Index (HDI), income level, type of samples, diagnostic method, and type of helminth parasites (Tables 1, 2 and 3).

Table 1.

Main characteristics of the included studies reporting the prevalence of helminth parasites among schoolchildren

Study No	Author	Study Year	Country	District/City/Province	Diagnostic method	Sample size	Infected	Age of selected population	Mean age	Species of helminths
2	Khan W et al	2020	Pakistan	Dir	Direct smear & Concentration (Sedimentation)	324	266	4_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis
3	Chien Wei Liao et al	2016	West Africa	Democratic Republic of Sao Tome	Concentration (Sedimentation)	252	108	8_9	9.8	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
4	Okyay et al	2004	Turkey		Direct smear	456	83	7_14	––	Enterobius vermicularis
5	Habtu Debash et al	2023	Ethiopia	Sekota	Direct smear & Concentration (Sedimentation) & staining	402	38	6_14	––	Hymenolepis nana
6	Hussein Sharif Siddig et al	2017	Sudan	Khartoum	Direct smear & Concentration (Sedimentation)	120	20	5_7	––	Ascaris lombricidas, Hymenolepis nana, Schistosoma spp., Enterobius vermicularis
7	Ashok et al	2013	India		Direct smear & Concentration (Sedimentation)	208	14	6_14	8.8	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm, Enterobius vermicularis
8	Ranjit Gupta et al	2020	Nepal	Saptari	Concentration (Sedimentation)	285	8	11_15	––	Ascaris lumbricoides, Hymenolepis nana
9	Tamiru Getnet et al	2020	Ethiopia	Amber	Direct smear	384	55	9_12	––	Ascaris lombricidas, Hymenolepis nana, Hookworm, Enterobius vermicularis
10	Khadime sylla et al	2020	Senegal	Dakar	Direct smear & Concentration (Sedimentation) & staining	1603	18	5_10	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp.
11	Chien Wei Liao et al	2017	The Republic Of Marshall Island	Democratic Republic of Sao Tome	Concentration (Sedimentation)	400	22	6_13	9.73	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
12	Napharanh Nanthavong et al	2017	Democratic Republic	Huaphan	Direct smear & Concentration (Sedimentation)	74	18	up to 5	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
13	Wafaa FA.Ahmad et al	2011	Egypt	Tanta	Direct smear & Concentration (Sedimentation)	1520	112	6_12	––	Ascaris lumbricoides, Schistosoma spp., Enterobius vermicularis
14	Talal Alharazi et al	2020	Yemen	Taiz	Direct smear & Concentration (Sedimentation)	385	36	7_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Hookworm, Enterobius vermicularis
15	Taheri et al	2011	Iran	South Khorasan	Direct smear & Concentration (Sedimentation)	2169	171	6_11	––	Ascaris lombricidas, Hymenolepis nana, Enterobius vermicularis
16	Ikram Ullah et al	2009	Pakistan	Peshawar	Direct smear	200	140	5_10	––	Ascaris lombricidas, Hymenolepis nana, Taenia spp., Enterobius vermicularis
17	Abdelsafi Gabbad and Mohammed A Elawad	2014	Sudan	Khartoum	Direct smear & Concentration (Flotation & Sedimentation)	500	228	5_10	––	Hymenolepis nana, Taenia spp., Schistosoma spp., Enterobius vermicularis
18	Berhanu Feleke	2016	Ethiopia	Bahir Dar	Direct smear	2372	1463	5_19	12.75	Ascaris lumbricoides
19	Dires Tegen et al	2020	Ethiopia	Dera	Direct smear & Concentration (Sedimentation)	382	211	6_21	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Schistosoma spp., Hookworm, Enterobius vermicularis
20	Baba Krishna Sharma et al	2004	Nepal	Kathmandu	Concentration (Sedimentation)	533	485	4_19	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
21	Olawumi Edward et al	2017	Malaysia	Tapah	Direct smear & Concentration (Sedimentation) & kato-katz method	508	308	6_13	10.1	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Hookworm
22	Afridi et al	2017	Pakistan	Skardu	Direct smear	300	95	up to 5	––	Ascaris lumbricoides, Hymenolepis nana
23	Ika Puspa Sari et al	2016	Indonesia	Jakarta	Direct smear	157	2	6_11	––	Trichuris trichiura, Hookworm
24	Eman H.Radwan et al	2019	Egypt	Damanhur	Direct smear & Concentration (Sedimentation)	810	47	6_18	11.2	Ascaris lombricidas, Hymenolepis nana, Schistosoma spp., Enterobius vermicularis
25	Msab Nou Raldein et al	2019	Sudan	Berber	Direct smear & Concentration (Sedimentation)	100	87	6_11	––	Ascaris lombricidas, Hymenolepis nana, Hookworm
26	LK Khanal et al	2011	Nepal	Kathmandu	Concentration (Sedimentation)	142	19	6_16	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
27	Zeynep Gokalp	2015	Turkey	Eskisehir	Concentration (Sedimentation)	132	10	7_12	7.96	Enterobius vermicularis
28	Daniel Gebretasdik et al	2018	Ethiopia	Harbu	Direct smear & Concentration (Sedimentation)	400	38	5_15	––	Hymenolepis nana
29	Ismail et al	2018	Egypt	Taifg	Direct smear & Concentration (Sedimentation)	150	18	4_14	––	Ascaris lumbricoides
30	Hayatham Mahmoud Ahmad and Gamal Ali Abu-Sheishaa	2022	Egypt	Aga	Direct smear & Concentration (Sedimentation)	726	154	6_18	––	Ascaris lombricidas, Hymenolepis nana, Schistosoma spp., Hookworm, Enterobius vermicularis
31	Ayalew Sisay and Brook Lemma	2016	Ethiopia	Bochesa	Direct smear & Concentration (Sedimentation)	384	84	7_14	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Strongyloides stercoralis
32	Abuobieda Sirelkhatem et al	2019	Sudan	Ombda	Direct smear & Concentration (Flotation)	210	29	6_14	––	Ascaris lombricidas, Hymenolepis nana, Taenia spp.
33	R Canete et al	2013	Cuba	Matanzas	Direct smear & Concentration (Sedimentation) & staining	107	46	8_9	––	Ascaris lumbricoides, Trichuris trichiura
34	Niyizuragero Emile et al	2013	South Africa	Rwanda	Direct smear	109	23	6_12	––	Ascaris lumbricoides, Hookworm
35	R Devera et al	1998	Venezuela		Direct smear & Scotch Tape Test	282	53	––	––	Enterobius vermicularis
36	Z Astal	2004	Palestine	Khan Younis	Direct smear & Concentration (Flotation & Sedimentation)	1370	209	6_11	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura
37	Vicente Y.Belizurio et al	2011	Philippines	Davao del Norte	Direct smear & Concentration (Sedimentation)	572	248	6_12	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
38	Latha Ragunathan et al	2010	India	Puducherry	Direct smear & staining	1172	660	5_10	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis
39	Kuang Yao Chen et al	2018	Taiwan		Direct smear & Scotch Tape Test	44,163	93	4_6	––	Enterobius vermicularis
40	Abraham Degarege et al	2013	Ethiopia	Wonji Shoa Sugar	Direct smear & Concentration (Sedimentation) & kato-katz method	403	312	4_6	3.3	Ascaris. Lumbricoides, Trichuris trichiura, Schistosoma spp., Hookworm
41	Alexandwe Rosewell et al	2010	Nicaragua		kato-katz method	880	238	6_14	––	Ascaris lumbricoides, Trichuris trichiura,
42	Abolfazl Iranikhah et al	2017	Iran	Qom	Direct smear & Concentration (Sedimentation)	2410	119	7_14	––	Hymenolepis nana, Enterobius vermicularis
43	Moradali Fouladvand et al	2018	Iran	Bushehr	Direct smear & Scotch Tape Test	203	23	7_12	––	Enterobius vermicularis
44	Warunee Ngrenngarmlert et al	2007	Thailand	Nakhon Prathom	Concentration (Sedimentation)	1920	14	7_12	––	Trichuris trichiura, Taenia spp., Hookworm, Strongyloides stercoralis, Opisthorchis spp.
45	Huong Thi Le et al	2007	Vietnam	Tam Nong	Direct smear	400	368	5_8	––	Ascaris lumbricoides, Trichuris trichiura
46	Mustafa Ulukanligil and Adnan Seyrek	2003	Turkey	Sanliurfa	Direct smear & Scotch Tape Test	1820	1759	7_14	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp.
47	Sarmila Tandukar et al	2013	Nepal	Lalitpur	Direct smear & Concentration (Sedimentation) & staining	1392	40	5_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
48	Rostami Masoumeh et al	2012	Iran	Golestan	Direct smear & Concentration (Sedimentation)	800	31	8_12	––	Ascaris lombricidas, Hymenolepis nana, Hookworm, Enterobius vermicularis
49	Ayodhia Pitaloka Pasaribu et al	2019	Indonesia	Suka	Direct smear & Concentration (Sedimentation) & kato-katz method	468	360	6_12	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
50	Jitendra Shrestha et al	2019	Nepal	Kathmandu	Concentration (Sedimentation)	508	141	4_19	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura
51	Jannatbi Iti	2018	India	Bijapur	Direct smear	58	6	8_13	––	Ascaris lumbricoides, Hymenolepis nana
52	Hassan Rezanezhad et al	2017	Iran	Jahrom	Direct smear & Concentration (Sedimentation)	431	1	––-	––	Enterobius vermicularis
53	Kamal Singh Khadka et al	2013	Nepal	Pokhara	Concentration (Sedimentation)	100	6	3_15	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
54	Elahe Atashnafas et al	2006	Iran	Damghan	Direct smear & Concentration (Sedimentation)	764	70	7_12	––	Enterobius vermicularis
55	Z.Astal et al	2004	Palestine	Khan Younis	Direct smear & Concentration (Sedimentation) & staining	1370	496	6_11	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Enterobius vermicularis
56	A.Dudlova et al	2018	Slovakia		Direct smear & Scotch Tape Test	390	14	2_15	––	Enterobius vermicularis
57	Tsegaw Fentie et al	2013	Ethiopia	Tana	Direct smear & Concentration (Sedimentation) & kato-katz method	520	458	6_15	11.6	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Fasciola spp., Schistosoma spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
58	D L Lee et al	1999	Malaysia	Sarawak	Concentration (Sedimentation)	264	117	7_16	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
59	David M.Cook et al	2009	Guatemala	Palajunoj	Direct smear	5228	1207	5_15	––	Ascaris lumbricoides, Hymenolepis nana
60	Laukaji Rai et al	2017	Nepal	Lokhim	Direct smear	359	31	4_16	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Enterobius vermicularis
61	Manisha Shurma et al	2020	Nepal	Bhaktapur	Direct smear	194	4	6_14	––	Hymenolepis nana
62	Bijay Kumar Shrestha et al	2021	Nepal	Dharan Submetropolitan	Direct smear & Concentration (Sedimentation)	400	43	6_11	––	Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis
63	Melaku Wale and Solomon Gedefaw	2022	Ethiopia	Jaragedo	Concentration (Sedimentation)	396	72	7_16	––	Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis
64	Olufemi MOSES Agbolade et al	2007	Nigeria	Ogun State	Direct smear & Concentration (Sedimentation)	1059	1006	3_18	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Schistosoma spp., Enterobius vermicularis, Strongyloides stercoralis
65	Hossein Mahmoudvand et al	2020	Iran	Lorestan	Direct smear & Concentration (Sedimentation)	366	36	2_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Enterobius vermicularis
66	Nan Linh Njuyen et al	2012	Ethiopia	Angolela	Concentration (Sedimentation)	664	75	6_19	––	Ascaris lombricidas, Hymenolepis nana, Enterobius vermicularis
67	Rosa Elena Mejia Torres et al	2014	Honduras	Tegucigalpa	kato-katz method	2554	1493	8_11	––	Ascaris Lumbricoides, Hymenolepis nana, Trichuris trichiura , Enterobius vermicularis, Strongyloides stercoralis
68	David Jose Gonzalez et al	2019	colombia	Antioquia	Direct smear & Concentration (Sedimentation) & kato-katz method	6045	2182	7_10	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
69	Collins Okoyo et al	2020	Kenya	Kenya	Direct smear & Concentration (Sedimentation) & kato-katz method	9801	1646	5_14	––	Ascaris lumbricoides, Trichuris trichiura, Schistosoma spp., Hookworm
70	Rajabu Hussein et al	2020	Tanzania	Nyamikoma	kato-katz method	830	752	––	––	Schistosoma spp.
71	Teshome Bekana et al	2021	Ethiopia	Amhara	Direct smear & Concentration (Sedimentation) & kato-katz method	798	248	6_15	––	Fasciola spp., Schistosoma spp.
72	A Escobedol Andel et al	2008	Cuba	Pinar del Río	Direct smear & Concentration (Sedimentation) & kato-katz method	200	163	5_15	––	Ascaris Lumbricoides, Trichuris trichiura, Hookworm
73	Nahya Salim et al	2014	Tanzania	rural coastal Tanzania	Duplicate Urine filtration & Dipstick & Baerman method & Concentration (Flotation & Sedimentation)	1033	396	––	––	Ascaris Lumbricoides, Trichuris trichiura, Schistosoma spp., Hookworm Enterobius vermicularis, Strongyloides stercoralis, Wuchereria bancrofti,
74	Daniel Getacher Feleke et al	2022	Ethiopia	Ambara	Direct smear & Concentration (Sedimentation)	375	95	6_11	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Schistosoma spp., Hookworm, Enterobius.vermicularis, Strongyloides stercoralis
75	Fikru Gashaw et al	2015	Ethiopia	Maksegnit and Enfranz	Direct smear & Concentration (Sedimentation) & kato-katz method	550	352	5_17	––	Ascaris Lumbricoides, Schistosoma spp.
76	Angus Hughes et al	2023	Vietnam	Dak Lak	Multiplex PCR	7710	2328	––	––	Ascaris Lumbricoides, Trichuris trichiura, Hookworm, Strongyloides stercoralis
77	Privat Agniwo et al	2023	Mali	Fangouné Bamanan and Diakalèl	Duplicate Urine filtration & Dipstick & Baerman method & Concentration (Flotation & Sedimentation)	971	487	6_14	––	Schistosoma spp.
78	Sangeeta Deka et al	2021	India	North-eastern India	Direct smear & Concentration (Sedimentation) & kato-katz method	435	50	––	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
79	A.Daryani et al	2012	Iran	Sari	Direct smear & Concentration (Sedimentation) & staining	1100	56	7_14	––	Enterobius.vermicularis, Strongyloides stercoralis, Trichostrongylus spp.
80	Orabi	2000	Palestine	Nablus	Direct smear & Concentration (Sedimentation)	220	8	1_6	––	Hymenolepis nana, Enterobius vermicularis
81	LEE et al	2000	Philippines	Roxas	Concentration (Sedimentation)	301	262	1_16	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Opisthorchis spp., Echinostoma spp., Rhabditis spp.
82	LEE et al	2000	Philippines	Legaspi	Concentration (Sedimentation)	64	30	3_20	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Opisthorchis spp., Echinostoma spp., Rhabditis spp.
83	Salahi et al	2019	Iran	Khodabandeh	Direct smear & Concentration (Sedimentation)	520	17	3_7	––	Taenia spp., Enterobius vermicularis
84	Yong et al	2000	Nepal	Baharatpur	Direct smear & Concentration (Sedimentation)	300	62	––	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Fasciola spp., Hookworm
85	Shahabi et al	2000	Iran	Shahriar	Direct smear & Concentration (Sedimentation)	1902	294	6_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Fasciola spp., Hookworm, Enterobius vermicularis, Trichostrongylus spp., Dicrocoelium dendriticum
86	Chandrasena et al	2004	Sri Lanka	Mahiyangana	Direct smear	145	28	6_15	––	Hookworm, Enterobius vermicularis
87	Saifi et al	2001	India	Budaun	Direct smear & Concentration (Flotation)	367	49	5_13	––	Ascaris lumbricoides, Hymenolepis nana
88	Waikagul et al	2002	Thailand	Nan	Concentration (Sedimentation)	1010	606	––	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Enterobius vermicularis, Strongyloides stercoralis, Opisthorchis spp.
89	LEE et al	2002	Cambodia	Kampongcham	Concentration (Sedimentation)	251	138	––	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Opisthorchis spp., Echinostoma spp., Rhabditis spp.
90	Sanprasert et al	2016	Thailand	––	Concentration (Sedimentation)	1909	131	1_23	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Fasciola spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
91	Piangiai et al	2003	Thailand	Chiang Mal	Concentration (Sedimentation)	403	120	––	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Opisthorchis spp.
92	Rita Khanal et al	2018	Nepal	Rupandehi	Direct smear & Concentration (Flotation & Sedimentation)	217	114	4_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp.
93	Bakarman et al	2019	Saudi Arabia	Jeddah	Concentration (Sedimentation)	581	1	6_16	11.6	Hymenolepis nana
94	Nematian et al	2004	Iran	Tehran	Direct smear & Concentration (Sedimentation)	19,209	826	––	8.5	Ascaris lumbricoides, Hymenolepis nana, Taenia spp., Enterobius vermicularis
95	Jintana Yanola et al	2018	Thailand	Omkoi	Concentration (Sedimentation)	375	33	6_14	––	Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis
96	Saksirisampant et al	2004	Thailand	Chiang Mai	Concentration (Sedimentation)	781	146	6_19	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Enterobius vermicularis, Strongyloides stercoralis
97	Daryani et al	2005	Iran	Ardabil	Direct smear & Concentration (Sedimentation)	1070	16	7_13	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Enterobius vermicularis
98	Chandrashekhar et al	2005	Nepal	Kaski	Direct smear	2091	117	6_10	8.8	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm, Enterobius vermicularis, Strongyloides stercoralis
99	Sadjjadi and N Tanideh	2005	Iran	Marvdasht	Direct smear & Concentration (Sedimentation)	337	6	3_6	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Enterobius vermicularis
100	Shoji Uga et al	2005	Vietnam	Hanoi	Direct smear & Concentration (Sedimentation)	217	144	14_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Fasciola spp., Hookworm, Enterobius vermicularis
101	Wongiindanon et al	2005	Thailand	Samut Sakhon	Direct smear	4014	152	5_7	––	Taenia spp., Hookworm, Strongyloides stercoralis, Opisthorchis spp.
102	Chhakda et al	2005	Cambodia	––	Direct smear & Concentration (Sedimentation) & kato-katz method	1616	546	––	11.3	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
103	Kanoa et al	2006	Palestine	Gaza	Direct smear & staining	432	53	6_11	––	Ascaris lumbricoides, Hymenolepis nana, Enterobius vermicularis
104	K. Patel and R. Khandekar	2006	Oman	Dahahira	Direct smear	436	41	9_10	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Enterobius vermicularis, Strongyloides stercoralis
105	Saksirisampant et al	2006	Thailand	––	Concentration (Sedimentation)	1037	7	3_12	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Enterobius vermicularis, Strongyloides stercoralis
106	Yaicharoen et al	2006	Thailand	Nakhon Pathom	Direct smear	814	29	7_13	––	Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Strongyloides stercoralis, Opisthorchis spp.
107	Aksoy et al	2007	Turkey	Izmir	Direct smear & Concentration (Sedimentation) & staining	1127	128	7_14	––	Hymenolepis nana, Enterobius vermicularis
108	Aminzadeh et al	2007	Iran	Varamin	Direct smear & Concentration (Sedimentation) & staining	293	16	––	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Enterobius vermicularis, Strongyloides stercoralis
109	Almerie et al	2008	Syria	Damascus	Direct smear	1469	5	6_12	––	Ascaris lumbricoides, Hymenolepis nana, Enterobius vermicularis
110	Gyawali et al	2009	Nepal	Dharan	Direct smear & Concentration (Sedimentation)	182	10	4_10	––	Ascaris lumbricoides, Hymenolepis nana, Enterobius vermicularis
111	Nagwa Aly and Magda M.M. Mostafa	2010	Saudi Arabia	Tabuk	Direct smear & Concentration (Sedimentation) & staining	812	10	2_12	––	Ascaris lumbricoides, Hymenolepis nana, Enterobius vermicularis
112	Sehgal et al	2010	India	Chandigarh	Direct smear	360	22	––	––	Hymenolepis nana
113	Shwkat Ahmad Wani et al	2010	India	Kashmir	Direct smear & Concentration (Sedimentation) & kato-katz method	352	265	1_15	9.1	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Enterobius vermicularis
114	Singh et al	2010	India	Srinagar	Direct smear	514	191	5_14	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp.
115	Samal et al	2016	India	Khurda	Direct smear & Concentration (Sedimentation) & staining	250	20	1_15	––	Ascaris lumbricoides, Hymenolepis nana, Hookworm
116	Rayan et al	2010	India	––	Direct smear	195	61	5_11	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
117	Matthys et al	2011	Tajikistan	––	Concentration (Sedimentation)	594	208	7_11	9.1	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
118	S. Hussein	2011	Palestine	Nablus	Direct smear & Concentration (Sedimentation) & staining & PCR	735	40	7_13	9.5	Ascaris lumbricoides, Enterobius vermicularis
119	Bhandari et al	2011	Nepal	Kavrepalanchowk	Direct smear & Concentration (Sedimentation)	360	81	––	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Strongyloides stercoralis
120	D.Chandi and J.Lakhani	2018	India	Bhaili	Direct smear & Concentration (Sedimentation)	250	27	6_15	––	Ascaris lumbricoides, Taenia spp., Hookworm
121	A Aher and S Kulkarni	2011	India	Ahmednagar	Direct smear	624	54	6_12	––	Ascaris lumbricoides, Hymenolepis nana, Taenia spp., Hookworm, Strongyloides stercoralis
122	Nithyamathi et al	2016	Malaysia	Peninsular	Direct smear & Concentration (Sedimentation)	1760	108	7_12	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Hookworm
123	Abdulsalam et al	2012	Malaysia	Pahang	Direct smear	300	208	6_13	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
124	Bhattachan et al	2015	Nepal	Chitwan	Concentration (Sedimentation)	296	23	5_18	––	Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm
125	Panda et al	2012	India	Nellimarla Mandal	Direct smear	124	17	6_9	––	Hymenolepis nana, Hookworm, Strongyloides stercoralis
126	Shrestha et al	2012	Nepal	Baglung	Direct smear & Concentration (Sedimentation)	260	26	≤ 4 −10	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm
127	Al-Delaimy et al	2014	Malaysia	Lipis	Direct smear & Concentration (Sedimentation) & staining	498	261	6_12	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
128	Al-Mekhlafi et al	2019	Malaysia	Peninsular	Direct smear & Concentration (Sedimentation) & staining & PCR	1142	180	6_19	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Enterobius vermicularis, Strongyloides stercoralis
129	Bilakshan sah et al	2013	Nepal	Itahari	Direct smear	200	26	12_15	––-	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Hookworm
130	J.lakhani et al	2013	India	Vadodara	Direct smear & Concentration (Sedimentation)	140	16	6_12	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm
131	Kitvatanachai et al	2013	India	Muang Pathum Thani	Direct smear & Concentration (Sedimentation)	202	1	7_12	––	Hookworm
132	Raj Tiwari et al	2013	Nepal	Dadeldhura	Direct smear	530	161	4_12	–-	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
133	Ullah et al	2014	Pakistan	Khyber Pakhtunkhwa	Direct smear & staining	222	222	4_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis, Toxocara spp.
134	Pradhan et al	2014	Nepal	Kathmandu	Direct smear	194	9	6_10	––	Hymenolepis nana, Trichuris trichiura, Hookworm
135	Hajare et al	2022	Ethiopia	Ofa	Direct smear	391	357	5_15	––	Ascaris lumbricoides, Trichuris trichiura, Schistosoma spp., Strongyloides stercoralis
136	Muharram	2023	Yemen	Sana'a	Direct smear & Concentration (Sedimentation)	500	9	6_16	––	Ascaris lumbricoides, Hymenolepis nana, Taenia spp.
137	Jada et al	2016	Malaysia	Kancheepuram	Direct smear & Concentration (Flotation)	335	133	6_12	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
138	Oladejo So et al	2018	Nigeria	Imo	Direct smear & Concentration (Sedimentation)	132	26	1_45	––	Ascaris Lumbricoides, Fasciola spp., Schistosoma spp., Hookworm
139	Kiran et al	2014	India	Bhopal	Direct smear	300	45	6_12	––	Ascaris lumbricoides, Hookworm
140	Jaiswal et al	2014	Nepal	Kaski	Direct smear	163	6	3_15	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
141	Pandey et al	2015	Nepal	Kathmandu	Direct smear & Concentration (Sedimentation)	300	6	7_15	––	Ascaris lumbricoides, Hymenolepis nana
142	R Polseela and A Vitta	2015	Thailand	Phitsanulok	Direct smear & Concentration (Sedimentation)	352	12	7_15	––	Hookworm, Enterobius vermicularis, Strongyloides stercoralis
143	Altinoz Aytar et al	2015	Turkey	Yıgılca	Direct smear & staining	523	89	6_19	––	Ascaris lumbricoides, Hymenolepis nana, Enterobius vermicularis
144	Punsawad et al	2018	Thailand	Nopphitam	Direct smear & Concentration (Sedimentation) & kato-katz method	299	34	7_12	––-	Trichuris trichiura, Hookworm, Enterobius vermicularis
145	Aschalew Gelaw et al	2013	Ethiopia	Gondar	Direct smear & Concentration (Sedimentation)	304	82	9_13	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Hookworm, Strongyloides stercoralis
146	Bhandari et al	2015	Nepal	Kathmandu	Direct smear & Concentration (Sedimentation) & staining	507	18	3_14	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Strongyloides stercoralis
147	K Yadav and S Prakash	2016	Nepal	Kathmandu	Direct smear & staining	507	129	6_10	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura
148	Dahal et al	2022	Nepal	Kathmandu	Direct smear	409	39	5_18	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
149	Bansal et al	2018	India	Rishikesh	Direct smear & Concentration (Flotation) & staining	461	26	< 10	7.26	Ascaris lumbricoides, Hymenolepis nana, Hookworm, Enterobius vermicularis
150	Limbu et al	2021	Nepal	Dharan	Direct smear & Concentration (Sedimentation)	116	4	––	––	Ascaris lumbricoides, Hymenolepis nana, Hookworm
151	Shrestha et al	2016	Nepal	Bhaktapur	Direct smear & Concentration (Sedimentation)	184	34	3_14	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm
152	Dhital et al	2016	Nepal	Kathmandu	Direct smear & Concentration (Sedimentation) & staining	600	11	3_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp.
153	Doi et al	2016	Thailand	Sakon Nakhon	Concentration (Sedimentation)	417	121	4_12	––-	Trichuris trichiura, Taenia spp., Hookworm, Opisthorchis spp., Heterophyes Heterophyes, Gongylonema spp.,
154	Ankan et al	2016	Turkey	Kutahya	Direct smear & Concentration (Sedimentation) & staining	471	57	5_11	7.91	Enterobius vermicularis
155	Safi et al	2019	Afghanistan	––	kato-katz method	2263	602	8_10	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
156	Korzeniewski	2016	Afghanistan	––	Direct smear & Concentration (Sedimentation)	500	189	7_18	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Fasciola spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis, Trichostrongylus spp., Dicrocoelium dendriticum
157	Al-Mekhlafi et al	2016	Yemen	Sana'a	Direct smear & Concentration (Sedimentation)	1218	209	5_15	9.3	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Enterobius vermicularis, Strongyloides stercoralis
158	AL-Fakih et al	2022	Yemen	––	Direct smear & Concentration (Sedimentation)	600	60	7_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Schistosoma spp., Enterobius vermicularis
159	Alsubaie et al	2016	Yemen	Ibb	Direct smear & Concentration (Sedimentation)	258	92	8_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Hookworm, Enterobius vermicularis, Strongyloides stercoralis
160	Ghani et al	2016	Pakistan	Lahore	Direct smear	300	36	< 10	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Enterobius vermicularis
161	Turki et al	2017	Iran	Bandar Abbas	Direct smear & Concentration (Sedimentation) & staining	1456	4	6_14	9.2	Hymenolepis nana, Enterobius vermicularis
162	Bahmani et al	2017	Iran	Sanandaj	Direct smear & Concentration (Sedimentation)	400	15	7_15	––	Hymenolepis nana
163	Jameel et al	2017	Iraq	Zakho	Direct smear	103	18	6_12	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Enterobius vermicularis
164	Jaiswal et al	2017	Nepal	Damauli	Direct smear & Concentration (Flotation & Sedimentation)	150	27	7_13	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
165	Tenali et al	2018	India	––	Direct smear & staining	1246	208	5_18	12.6	Ascaris lumbricoides, Trichuris trichiura, Hookworm, Enterobius vermicularis
166	Kyaw et al	2018	Thailand	Ratchaburi	Direct smear & Concentration (Sedimentation)	252	12	9_17	11.86	Ascaris lumbricoides, Hookworm
167	Tandukar et al	2018	Nepal	Kathmandu	Direct smear & Concentration (Sedimentation) & staining & PCR	333	9	5_15	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
168	Gopalakrishnan et al	2018	India	Anakaputhur	Direct smear	250	19	13_18	––	Ascaris lumbricoides, Hookworm
169	Assavapongpaiboon et al	2018	Thailand	Saraburi	Direct smear & Concentration (Sedimentation)	263	5	4_15	7.9	Strongyloides stercoralis, Opisthorchis spp.
170	Upama et al	2019	Nepal	Kathmandu	Direct smear & Concentration (Sedimentation)	330	21	––	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Hookworm
171	Rather et al	2019	India	Kashmir	Concentration (Sedimentation)	130	41	5_16	––	Ascaris lumbricoides, Trichuris trichiura,.Taenia spp
172	Gurung et al	2019	Nepal	Kathmandu	Direct smear & Concentration (Flotation & Sedimentation)	160	42	< 10	––	Ascaris lumbricoides, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis
173	Qasem et al	2020	Yemen	Ibb	Direct smear & Concentration (Sedimentation)	300	27	6_16	––	Ascaris lumbricoides, Hymenolepis nana, Enterobius vermicularis
174	Sah et al	2021	Nepal	Janakpurdham	Direct smear & Concentration (Sedimentation)	155	14	5_17	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis
175	T Alharrazi	2022	Yemen	Taiz	Direct smear & Concentration (Sedimentation)	478	100	6_15	––	Ascaris lumbricoides, Trichuris trichiura, Schistosoma spp., Enterobius vermicularis
176	Edrees et al	2022	Yemen	Amran	Direct smear & Concentration (Sedimentation)	360	33	6_15	––	Ascaris lumbricoides, Hymenolepis nana, Taenia spp., Schistosoma spp., Enterobius vermicularis
177	Edrees et al	2022	Yemen	Sana’a	Direct smear	173	29	9_13	––	Ascaris lumbricoides, Hymenolepis nana, Taenia spp., Schistosoma spp., Enterobius vermicularis
178	Khan et al	2022	Pakistan	Lower Dir	Direct smear & Concentration (Sedimentation)	184	58	10_17	14	Ascaris lumbricoides, Hymenolepis nana, Taenia spp., Hookworm
179	Salih et al	2022	Iraq	Duhok	Direct smear & Concentration (Sedimentation)	1172	158	6_12	––	Enterobius vermicularis
180	Al-Mekhlafi et al	2023	Yemen	Sana'a	Direct smear & Concentration (Sedimentation) & staining	400	133	7_12	9.52	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Schistosoma spp., Enterobius vermicularis, Strongyloides stercoralis
181	Karmacharya et al	2023	Nepal	Bhaktapur	Direct smear & Concentration (Sedimentation)	190	7	––	––	Ascaris lumbricoides, Taenia spp., Schistosoma spp., Hookworm, Enterobius vermicularis
182	Subhan et al	2023	Pakistan	Bajawar	Direct smear	402	243	4_12	––	Ascaris lumbricoides, Hymenolepis nana, Trichuris trichiura, Taenia spp., Hookworm, Enterobius vermicularis
183	Njenga et al	2022	Kenya	Nairobi	Direct smear & Concentration (Sedimentation) & staining	406	63	––	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
184	Mekonnen et al	2024	Ethiopia	Hakim	Direct smear & Concentration (Sedimentation)	333	34	5_17	––	Ascaris lumbricoides, Trichuris trichiura, Hookworm
185	Erismann et al	2016	Burkina faso	––-	Direct smear & Concentration (Sedimentation) & kato-katz method	385	25	8_14	––	Hymenolepis nana, Schistosoma spp., Hookworm
186	Ikponmwosa Owen Evbuomwan et al	2022	Nigeria	Benin	Direct smear & Concentration (Sedimentation)	249	164	––	––	Strongyloides stercoralis
187	Z Khudrui	2000	Palestine	Qalqilia	Direct smear & Concentration (Flotation)	1329	153	––	––	Hymenolepis nana, Taenia spp., Enterobius vermicularis
188	Padmaja et al	2014	India	Amalapuram	Direct smear & Concentration (Sedimentation)	200	13	––	––	Ascaris lumbricoides, Hookworm, Enterobius vermicularis
189	Richert et al	2024	Madagascar	Ambatoboeny	Direct smear	241	14	0_17	11.8	Hymenolepis nana, Taenia spp., Hookworm, Enterobius vermicularis, Trichuris trichiura, Ascaris lumbricoides
190	Shaddel et al	2024	Iran	Tehran	Direct smear & Concentration (Sedimentation) & staining	250	9	7_14	10.17	Ascaris lumbricoides, Hookworm, Hymenolepis nana

Table 2.

Sub–group analysis based on HDI, Educational level, Source of sample, Diagnostic method, Average temperature, Annual rainfall, Climate, GBD Geographies regions, WHO region, Countries, Humidity, Age, Mean age, Gender and District/City/province in included studies

Variables	No studies	Sample size	Infected	Pooled prevalence (95% CI)	Heterogeneity
					I2 τ2 p-value
HDI
Very High human development	31	25,401	4929	16.94 (9.5–25.98)	99 9.76 P <.001
High human development	44	104,595	7876	17.39 (10.86–25.07)	99 10.02 P <.001
Medium human development	68	45,167	9477	15.69 (11.91–19.87)	99 5.14 P <.001
Low human development	47	24,825	9409	35.35 (25.97–45.34)	99 12.58 P <.001
Total	190
Income level
High income level	4	2219	66	2.67 (0.00–11.52)	96 1.22 P <.001
Upper middle income level	57	115,458	10,965	15.46 (10.22–21.55)	99 8.63 P <.001
Lower middle income level	91	61,616	16,112	22.78 (17.41–23.63)	99 10.16 P <.001
Low income level	38	20,695	6432	26.95 (18.74–36.03)	99 8.75 P <.001
Total	190
Educational level
Secondary school	7	1788	212	12.65 (7.42–19.01)	91 1.26 P <.001
Primary school	154	175,407	29,356	21.86 (17.96–26.03)	99 9.42 P <.001
Primary & Secondary school	29	22,793	4007	0.1675 (0.0829–0.2739)	99 12.44 P <.001
Total	190
Type of sample
Stool & Urine	4	12,310	3169	47.27 (18.72–76.83)	99 12.50 P <.001
Stool	180	185,382	29,698	20.24 (16.71–24.01)	99 9.53 P <.001
Stool & Blood	5	1325	221	13.93 (4.46–27.40)	97 3.54 P <.001
Total	190
Diagnostic method
Direct smear	37	24,959	5404	19.85 (12.63–28.22)	99 9.10 P <.001
Concentration (Sedimentation)	26	13,745	2944	22.73 (13.3–33.8)	99 10.14 P <.001
Direct smear & Concentration (Sedimentation)	64	51,350	6016	15.18 (10.76–20.18)	99 7.04 P <.001
Direct smear & Concentration (Sedimentation) & staining	18	13,044	1424	10.35 (4.9–17.5)	99 4.97 P <.001
Direct smear & Concentration (Flotation & Sedimentation)	5	2397	620	30.59 (17.08–46.04)	98 3.19 P <.001
Direct smear & Concentration (Sedimentation) & kato-katz method	14	22,380	6949	47.04 (30.19–64.25)	99 10.95 P <.001
Direct smear & Concentration (Flotation)	4	2241	364	18.56 (8.21–31.86)	97 2.39 P <.001
Direct smear & Scotch Tape Test	5	46,858	1942	21.63 (0.00–65.87)	99 27.72 P <.001
Direct smear & staining	6	4102	1361	40.15 (10.15–75.07)	99 20.29 P <.001
Kato-katz method	4	6527	3085	51.90 (20.65–80.34)	99 11.48 P <.001
Direct smear & Concentration (Flotation) & staining	1	461	26	5.64 (3.84–8.10)	-—-
Duplicate Urine filtration & Dipstick & Baerman method & Concentration (Flotation & Sedimentation)	2	2004	883	44.20 (33.02–55.68)	96 0.66 P <.001
Multiplex PCR	1	7710	2328	30.19 (29.13–31.18)	-—-
Direct smear & Concentration (Sedimentation) & staining & PCR	3	2210	229	7.19 (1.70–15.96)	97 1.46 P <.001
Total	190
Average temperature
0–10	2	984	222	16.10 (0.00–55.82)	99 9.56 P <.001
10–20	61	55,359	6493	11.38 (7.77–15.57)	99 5.83 P <.001
> 20	127	143,645	26,860	25.94 (21.15–31.04)	99 10.39 P <.001
Total	190
Humidity
< 40	33	40,847	3497	12.20 (7.40–17.99)	99 5.54 P <.001
40–75	134	89,849	22,803	21.42 (17.10–26.07)	99 10.14 P <.001
> 75	23	69,673	6978	14.85 (8.75–22.20)	99 12.23 P <.001
Total	190
Annual rainfall
< 400	43	49,326	4639	11.63 (7.73–16.20)	99 4.79 P <.001
400–1000	48	40,710	11,581	30.85 (21.77–40.73)	99 13.21 P <.001
1001–1500	59	22,907	5043	16.63(11.79–22.11)	99 7.20 P <.001
> 1500	41	90,421	12,511	25.89 (17.68–35.05)	99 10.48 P <.001
Total	190
Climate
Desert climate	48	25,097	6986	28.28 (20.04–37.33)	99 11.50 P <.001
Hot-summer Mediterranean climate	8	7292	2917	27.81 (9.16–51.78)	99 12.66 P <.001
Humid subtropical climates	1	390	14	3.59 (2.15–5.93)	-—-
Semi-desert climate	26	39,792	2782	7.60 (4.78–11)	98 2.25 P <.001
Tropical monsoon climate	45	76,352	9916	20.82 (13.38–29.39)	99 11.31 P <.001
Tropical rainforest climate	18	15,817	5219	35.44 (22.47–49.61)	99 9.54 P <.001
Tropical savanna climate	20	25,613	3880	16.57 (8.43–26.74)	99 7.92 P <.001
Tropical wet-dry climate	24	9635	1861	15.39 (9.56–22.29)	99 4.70 P <.001
Total	190
GBD Geographies regions
Caribbean	2	307	209	63.52 (24.94–94.03)	97 8 P <.001
Central Asia	1	594	208	35.02 (31.25–38.91)	-—-
Central Europe	1	390	14	3.59 (2.17–5.95)	-—-
Central Latin America	5	14,989	5173	32.19 (19.54–46.34)	99 2.72 P <.001
Central sub-Saharan Africa	1	74	18	24.32 (16.40–35.39)	-—-
East Asia	1	44,163	93	0.21 (0.07–0.15)	-—-
Eastern sub-Saharan Africa	25	22,299	7209	36.63 (24.48–49.71)	99 11.27 P <.001
North Africa and Middle East	49	56,116	6087	9.98 (6.71–13.82)	99 4.39 P <.001
Oceania	1	400	22	5.50 (3.62–8.15)	-—-
South Asia	72	29,770	5828	16.47 (11.92–21.59)	99 7.81 P <.001
Southeast Asia	23	25,964	6792	38.30 (25.52–51.96)	99 11.21 P <.001
Southern sub-Saharan Africa	2	271	88	30.39 (14.18–49.56)	91 1.80 P <.001
West Africa	1	252	108	42.86 (36.88–49.03)	-—-
Western sub-Saharan Africa	6	4399	1726	36.72 (7.58–72.83)	99 21.35 P <.001
Total	190
WHO region
African	30	26,291	8767	35.99 (24.72–48.09)	99 11.67 P <.001
Americas	7	15,296	5382	40.73 (24.38–58.21)	99 5.52 P <.001
Eastern Mediterranean	56	57,212	6176	15.33 (10.19–21.28)	99 8.55 P <.001
European	8	5513	2348	23.67 (5.88–48.51)	99 14.20 P <.001
South-East Asia	71	35,101	5390	13.24 (9.69–17.24)	99 5.57 P <.001
Western Pacific	18	60,575	5512	40.90 (26.74–55.88)	99 10.44 P <.001
Total	190
Countries
Afghanistan	2	2763	791	31.91 (21.68–43.11)	95 0.67 P <.001
Burkina Faso	1	385	25	6.49 (4.38–9.35)	-—-
Cambodia	2	1867	684	44.03 (24.44–64.65)	97 2.20 P <.001
Colombia	1	6945	2182	36.10 (34.77–37.21)	-—-
Cuba	2	307	209	63.52 (24.94–94.03)	97 0.0800 P <.001
Democratic Republic	1	74	18	24.32 (16.34–35.36)	-—-
Egypt	4	3206	331	10.92 (5.30–18.20)	97 1.06 P <.001
Ethiopia	16	9058	3974	37.30 (22.49–53.45)	99 10.95 P <.001
Guatemala	1	5228	1207	23.09 (21.93–24.22)	-—-
Honduras	1	2554	1493	58.46 (56.55–60.38)	-—-
India	21	7838	1805	16.02 (9.61–23.60)	98 4.90 P <.001
Indonesia	2	625	362	31.60 (0.0–99.92)	99 44.30 P <.001
Iran	17	33,680	1710	4.62 (2.89–6.72)	97 0.86 P <.001
Iraq	2	1275	176	14.25 (10.78–18.10)	24 0.07 P =.25
Kenya	2	10,207	1709	16.67 (15.70–17.66)	0 0.01 P =.52
Madagascar	1	241	14	5.81 (3.60–9.61)	-—-
Malaysia	7	4807	1315	39.38 (21.58–58.77)	99 6.86 P <.001
Mali	1	971	487	50.15 (46.97–53.34)	-—-
Nepal	33	12,647	1773	11.96 (7.35–17.48)	98 5.08 P <.001
Nicaragua	1	880	238	27.05 (24.11–30)	-—-
Nigeria	3	1440	1196	63.25 (16.50–97.87)	99 19.32 P <.001
Oman	1	436	41	9.40 (6.94–12.45)	-—-
Pakistan	7	1932	1060	58.61 (29.80–84.54)	99 15.58 P <.001
Palestine	6	5456	959	12.73 (5.54–22.28)	98 2.45 P <.001
Philippines	3	937	540	60.75 (30.74–86.91)	98 7.04 P <.001
Saudi Arabia	2	1393	11	0.62 (0.01–1.95)	81 0.0015 P =.02
Senegal	1	1603	18	1.12 (0.42–1.45)	-—-
Slovakia	1	390	14	3.59 (2.11–5.90)	-—-
South Africa	2	271	88	30.39 (14.18–49.56)	91 1.80 P <.001
Sri Lanka	1	145	28	19.31 (13.86–26.59)	-—-
Sudan	4	930	364	40.03 (9.58–76.61)	98 13.86 P <.001
Syria	1	1469	5	0.34 (0.09–0.73)	-—-
Taiwan	1	44,163	93	0.21 (0.07–0.15)	-—-
Tajikistan	1	594	208	35.02 (31.28–38.93)	-—-
Tanzania	2	1863	1148	67.41 (14.04–99.96)	99 17.39 P <.001
Thailand	14	13,846	1422	9.96 (4–18.17)	99 5.10 P <.001
The Republic Of Marshall Island	1	400	22	5.50 (3.59–8.13)	-—-
Turkey	6	4529	2126	26.41 (4.04–58.99)	99 17.47 P <.001
Venezuela	1	282	53	18.79 (14.67–23.77)	-—-
Vietnam	3	8327	2840	65.04 (26.48–94.62)	99 12.23 P <.001
West Africa	1	252	108	42.86 (36.88–49.03)	-—-
Yemen	10	4672	728	14.85 (8.75–22.20)	97 2.26 P <.001
Total	190
Age
5–10	85	102,795	12,330	19.25 (14.69–24.25)	99 8.01 P <.001
10–15	85	61,428	15,140	22.32 (16.56–28.68)	99 11.63 P <.001
Total	190
Gender
Male	108	54,944	10,029	33.15 (28.17–38.33)	99 7.95 P <.001
Female	108	49,297	8102	31.09 (26.04–36.37)	99 8.48 P <.001
Total	108
District/City/province
Aga	1	726	154	21.21 (18.24–24.21)	-—-
Ahmednagar	1	624	54	8.65 (6.63–11.06)	-—-
Amalapuram	1	200	13	6.50 (3.88–10.84)	-—-
Ambara	1	375	95	25.33 (21.20–29.97)	-—-
Ambatoboeny	1	241	14	5.81 (3.31–9.35)	-—-
Amber	1	384	55	14.32 (11.14–18.15)	-—-
Amhara	1	798	248	31.08 (27.93–34.35)	-—-
Amran	1	360	33	9.17 (6.69–12.67)	-—-
Anakaputhur	1	250	19	7.60 (4.51–11.21)	-—-
Angolela	1	664	75	11.30 (9.14–13.96)	-—-
Antioquia	1	6045	2182	36.10 (34.86–37.28)	-—-
Ardabil	1	1070	16	1.50 (0.95–2.44)	-—-
Baglung	1	260	26	10 (6.87–14.21)	-—-
Baharatpur	1	300	62	20.67 (16.51–25.64)	-—-
Bahir Dar	1	2372	1463	61.68 (59.70–63.61)	-—-
Bajawar	1	402	243	60.45 (55.59–65.11)	-—-
Bandar Abbas	1	1456	4	0.27 (0.06–0.65)	-—-
Benin	1	249	164	65.86 (59.75–71.343)	-—-
Berber	1	100	87	87 (78.83–91.97)	-—-
Bhaili	1	250	27	10.80 (7.43–15.18)	-—-
Bhaktapur	3	568	45	6.68 (0.55–18.20)	94 2.31 P <.001
Bhopal	1	300	45	15 (11.24–19.35)	-—-
Bijapur	1	58	6	10.34 (5.45–21.21)	-—-
Bochesa	1	384	84	21.88 (17.90–26.18)	-—-
Budaun	1	367	49	13.35 (10.30–17.26)	-—-
Bushehr	1	203	23	11.33 (7.77–16.50)	-—-
Chandigarh	1	360	22	6.11 (3.98–9)	-—-
Chiang Mai	1	781	146	18.69 (15.85–21.35)	-—-
Chiang Mal	1	403	120	29.78 (25.36–34.31)	-—-
Chitwan	1	296	23	7.77 (5.35–11.49)	-—-
Dadeldhura	1	530	161	30.38 (26.62–34.42)	-—-
Dahahira	1	436	41	9.40 (7.07–12.56)	-—-
Dak Lak	1	7710	2328	30.19 (29.18–31.23)	-—-
Dakar	1	1603	18	1.12 (0.62–1.68)	-—-
Damanhur	1	810	47	5.80 (4.27–7.51)	-—-
Damascus	1	1469	5	0.34 (0.16–0.81)	-—-
Damauli	1	150	27	18 (12.74–24.97)	-—-
Damghan	1	764	70	9.16 (7.35–11.45)	-—-
Davao del Norte	1	572	248	43.36 (39.35–47.45)	-—-
Democratic Republic of Sao Tome	1	252	108	42.86 (36.94–49.03)	-—-
Dera	1	382	211	55.24 (50.22–60.13)	-—-
Dharan	2	298	14	4.62 (2.32–7.57)	0 0.02 P =.45
Dharan Submetropolitan	1	400	43	10.75 (8.10–14.19)	-—-
Dir	1	324	266	82.10 (77.94–86.39)	-—-
Duhok	1	1172	158	13.48 (11.59–15.51)	-—-
Eskisehir	1	132	10	7.58 (4.06–13.30)	-—-
Fangouné Bamanan and Diakalèl	1	971	487	50.15 (47.01–53.29)	-—-
Gaza	1	432	53	12.27 (9.57–15.75)	-—-
Golestan	1	800	31	3.87 (2.71–5.42)	-—-
Gondar	1	304	82	26.97 (22.28–32.22)	-—-
Hakim	1	333	34	10.21 (7.52–14.03)	-—-
Hanoi	1	217	144	66.36 (59.82–72.27)	-—-
Harbu	1	400	38	9.50 (6.89–12.67)	-—-
Huaphan	1	74	18	24.32 (16.34–35.37)	-—-
Ibb	2	558	119	20.70 (2.04–51.25)	98 5.39 P <.001
Imo	1	132	26	19.70 (13.98–27.41)	-—-
Itahari	1	200	26	13 (9.17–18.48)	-—-
Izmir	1	1127	128	11.36 (9.65–13.36)	-—-
Jahrom	1	431	1	0.23 (0.12–1.40)	-—-
Jakarta	1	157	2	1.27 (0.62–4.80)	-—-
Janakpurdham	1	155	14	9.03 (5.68–14.77)	-—-
Jaragedo	1	396	72	18.18 (14.74–22.32)	-—-
Jeddah	1	581	1	0.17 (0–0.82)	-—-
Kampongcham	1	251	138	54.98 (48.80–60.98)	-—-
Kancheepuram	1	335	133	39.70 (34.61–45.03)	-—-
Kashmir	2	482	306	53.99 (13.92–91.16)	98 9.95 P <.001
Kaski	2	2254	123	5.17 (3.75–6.80)	0 0.02 P =.34
Kathmandu	12	4523	929	14.53 (4.36–29.18)	99 9.90 P <.001
Kavrepalanchowk	1	360	81	22.50 (18.50–27.10)	-—-
Kenya	1	9801	1646	16.79 (15.91–17.40)	-—-
Khan Younis	2	2740	705	24.99 (7.88–47.68)	99 2.94 P <.001
Khartoum	2	620	248	30.42 (7.32–60.69)	97 4.79 P <.001
Khodabandeh	1	250	17	3.27 (2.10–5.22)	-—-
Khurda	1	250	20	8 (5.39–12.17)	-—-
Khyber Pakhtunkhwa	1	222	222	0 (98.23–99.99)	-—-
Kutahya	1	471	51	12.10 (9.36–15.27)	-—-
Lahore	1	300	36	12 (8.92–16.27)	-—-
Lalitpur	1	1392	40	2.87 (2.04–3.82)	-—-
Legaspi	1	64	30	46.88 (35.35–58.81)	-—-
Lipis	1	498	261	52.41 (48.02–56.76)	-—-
Lokhim	1	359	31	8.64 (6.23–12.07)	-—-
Lorestan	1	366	36	9.84 (7.16–13.29)	-—-
Lower Dir	1	184	58	31.52 (25.36–38.61)	-—-
Mahiyangana	1	145	28	19.31 (13.76–26.53)	-—-
Maksegnit and Enfranz	1	520	352	64 (59.90–67.82)	-—-
Marvdasht	1	337	6	1.78 (0.83–3.84)	-—-
Matanzas	1	107	46	42.99 (34.12–52.44)	-—-
Mthatha	1	162	65	40.12 (32.96–47.82)	-—-
Muang Pathum Thani	1	202	1	0.5 (0.1–2.79)	-—-
Nablus	2	955	48	4.84 (3.23–6.74)	5.39 0 P =.30
Nairobi	1	406	63	15.52 (12.26–19.31)	-—-
Nakhon Pathom	1	814	29	3.56 (2.47–5.05)	-—-
Nan	1	1010	606	60 (56.96–63.01)	-—-
Nellimarla Mandal	1	124	17	13.71 (8.93–21)	-—-
Nopphitam	1	299	34	11.37 (8.06–15.31)	-—-
North‑eastern India	1	435	50	11.49 (8.77–14.78)	-—-
Nyamikoma	1	830	752	90.60 (88,46–92.44)	-—-
Ofa	1	391	357	91.30 (88.03–93.64)	-—-
Ogun State	1	1059	1006	95 (93.69–96.34)	-—-
Ombda	1	210	29	13.81 (9.70–19.06)	-—-
Omkoi	1	375	33	8.80 (6.24–12.02)	-—-
Pahang	1	300	208	69.33 (63.88–74.24)	-—-
Palajunoj	1	5228	1207	23.09 (21.84–24.14)	-—-
Peninsular	1	2902	288	10.44 (3.03–21.56)	98 1.21 P <.001
Peshawar	1	200	140	70 (63.29–75.86)	-—-
Phitsanulok	1	352	12	3.41 (2–5.9)	-—-
Pinar del Río	1	200	163	81.50 (75.49–86.20)	-—-
Pokhara	1	100	6	6 (2.88–12.57)	-—-
Puducherry	1	1172	660	56.31 (53.47–59.15)	-—-
Qalqilia	1	1329	153	11.51 (9.69–13.14)	-—-
Qom	1	2410	119	4.94 (4.01–5.75)	-—-
Ratchaburi	1	252	12	4.76 (2.80–8.18)	-—-
Rishikesh	1	461	26	5.64 (3.89–8.15)	-—-
Roxas	1	301	262	87.04 (82.78–90.38)	-—-
Rupandehi	1	217	114	52.53 (45.91–59.06)	-—-
Rural coastal Tanzania	1	1033	396	38.33 (35.40–41.33)	-—-
Rwanda	1	109	23	21.10 (14.74–29.82)	-—-
Sakon Nakhon	1	417	121	29.02 (24.87–33.55)	-—-
Samut Sakhon	1	4014	152	3.79 (3.15–4.34)	-—-
Sana’a	2	573	162	7.75 (0–28.70)	99 4.12 P <.001
Sanandaj	1	400	15	3.75 (2.30–6.11)	-—-
Sanliurfa	1	1820	1759	96.65 (95.73–97.39)	-—-
Saptari	1	285	8	2.81 (1.41–5.42)	-—-
Saraburi	1	263	5	1.90 (0.84–4.39)	-—-
Sarawak	1	264	117	44.32 (38.49–50.35)	-—-
Sari	1	1100	56	5.09 (3.87–6.48)	-—-
Sekota	1	402	38	9.45 (6.66–12.44)	-—-
Shahriar	1	1902	294	15.46 (13.68–16.95)	-—-
Skardu	1	300	95	31.67 (26.65–37.13)	-—-
South Khorasan	1	2169	171	7.88 (6.71–8.99)	-—-
Srinagar	1	514	191	37.16 (31.06–41.40)	-—-
Suka	1	468	360	76.92 (72.93–80.56)	-—-
Tabuk	1	812	10	1.23 (0.59–2.17)	-—-
Taifg	1	150	18	12 (7.68–18.14)	-—-
Taipei	1	44,163	93	0.21 (0–0.04)	-—-
Taiz	2	863	136	14.70 (5.44–27.41)	95 1.22 P <.001
Tam Nong	1	400	368	92 (88.91–94.26)	-—-
Tana	1	520	458	88.08 (85.04–90.62)	-—-
Tanta	1	1520	112	7.37 (5.94–8.58)	-—-
Tapah	1	508	308	60.63 (56.34–64.83)	-—-
Tegucigalpa	1	2554	1493	58.46 (56.54–60.36)	-—-
Tehran	2	19,459	835	4.20 (3.85–4.56)	0 0.01 P =.68
Vadodara	1	140	16	11.43 (7.35–17.91)	-—-
Varamin	1	293	16	5.46 (3.43–8.72)	-—-
Wonji Shoa Sugar	1	403	312	77.42 (73.13–81.28)	-—-
Yıgılca	1	523	89	17.02 (14–20.44)	-—-
Zakho	1	103	18	17.48 (11.56–26.08)	-—-
Total	147

Table 3.

Sub-group analysis based on type of helminth parasites

Type of helminth parasites	No studies	Sample size	Infected	Pooled prevalence (95% CI)	Heterogeneity
					I2 τ2 p-value
Toxocara spp.	1	222	23	10.36 (7.08–15.13)	-	-	-
Ascaris lumbricoides	139	123,449	12,011	9.47 (7.32–11.85)	97 5.26 P <.001
Heterophyes heterophyes	1	417	1	8.87 (6.34–11.85)	-	-	-
Schistosoma spp.	30	26,128	2472	7.82 (3.43–13.76)	99 0.0713 P <.001
Trichuris trichiura	105	85,018	6499	5.83 (3.86–8.16)	99 0.0554 P <.001
Hookworms	92	72,923	5421	4.57 (3.30–6.03)	97 0.0239 P <.001
Hymenolepis nana	98	80,871	2427	3.03 (2.35–3.78)	97 0.0099 P <.001
Enterobius vermicularis	86	112,682	3055	2.75 (1.97–3.65)	98 0.0135 P <.001
Rhabditis spp.	1	251	6	2.39 (1.16–5.18)	-	-	-
Taenia spp.	52	55,028	877	2.34 (1.45–3.42)	97 0.0129 P <.001
Fasciola spp.	9	6440	95	1.83 (0. 33–4.36)	95 0.0116 P <.001
Strongyloides stercoralis	33	31,326	576	1.65 (0.76–2.83)	96 0.0129 P <.001
Wuchereria bancrofti	1	1033	15	1.45 (0.81–2.32)	-	-	-
Opisthorchis spp.	8	9092	95	1.44 (0.23–3.55)	95 0.0091 P <.001
Dicrocoelium dendriticum	2	2402	12	0.62 (0.04–1.73)	79 0.11 P <.001
Trichostrongylus spp.	3	3502	23	0.58 (0.01–1.78)	92 0.0022 P <.001
Gongylonema spp.	1	417	1	0. 24 (0.04–1.33)	-	-	-

Quality assessment

The quality of the studies was assessed using the Newcastle–Ottawa Scale, as detailed in Supplementary Table 2 [21]. Scores were assigned across three domains: Selection (maximum 5 stars), Comparability (maximum 2 stars), and Outcome (maximum 3 stars).

Studies scoring 7–9 on the Newcastle–Ottawa Scale were classified as high quality and included. Studies scoring 4–6 were classified as moderate quality. Studies scoring < 4 or lacking sufficient methodological clarity were excluded due to high risk of bias or insufficient data.

Data synthesis and statistical analysis

Data were extracted independently by two reviewers (ZG and HS) using a standardized Excel form. The extracted data included study characteristics, sample size, diagnostic methods, and prevalence rates. Cross-verification was conducted by a third author (AVE) to ensure data accuracy.

A range of statistical techniques was applied to thoroughly assess the worldwide prevalence of helminthic infections in school-aged children. The overall pooled prevalence was calculated using a 95% confidence interval (CI).

A random-effects model incorporating the Freeman-Tukey double arcsine transformation was used to estimate the pooled prevalence. Publication bias was evaluated through Egger’s funnel plot, Begg’s rank test, the Luis Furuya-Kanamori (LFK) index, and the Doi plot [22].

An LFK index outside ± 2 was classified as major asymmetry, between ± 1 and ± 2 as minor asymmetry, and within ± 1 as symmetry, indicating no publication bias.

To evaluate heterogeneity across studies, Cochrane’s Q test and the inconsistency index (I²) were applied. I² values were interpreted as follows: 0–25% indicated low heterogeneity, 25–50% moderate heterogeneity, and 50–75% high heterogeneity. A p-value < 0.05 was considered statistically significant. All statistical analyses were carried out using the meta and metasens packages in R (version 3.6.1) [23].

Results

Characteristics of included studies

The systematic search conducted in this study initially identified 24,256 articles. We retrieved 20,900 records from Google Scholar, 1,879 from PubMed, 1,033 from Web of Science, 352 from Scopus, and 92 from EMBASE.

After screening, 228 full-text articles were reviewed for eligibility. Of these, two studies were excluded due to insufficient data, two for overlapping data, three for lacking participant information, and 31 for not containing original data (e.g., letters, reviews, workshop reports, and theses). Ultimately, 190 articles met the inclusion criteria and were included in the meta-analysis following critical appraisal (Fig. 1).

Data on the prevalence of helminthic parasites have been reported from 42 countries, and 199,988 schoolchildren, with Nepal (33 studies) and India (21 studies) being the most frequently represented (Table 2). The estimated global prevalence was 20.6% (17.2–24.3%) (Fig. 2).

Fig. 2.

Forest plots for random-effects meta-analysis of helminthic parasites among schoolchildren (The boxes indicate the effect size of the studies (prevalence) and the whiskers indicate its confidence interval for corresponding effect size. There is no specific difference between white and black bars, only studies with a very narrow confidence interval are shown in white. In the case of diamonds, their size indicates the size of the effect, and their length indicates confidence intervals)

According to the data collected in the included studies, a map was generated using QGIS3 software (https://qgis.org/en/site/) to illustrate the prevalence of helminthic parasites among schoolchildren in various regions of the world (Fig. 3a). A Sankey plot indicated that the largest number of studies in GBD regions was related to Nepal (Fig. 3b).

Fig. 3.

The global prevalence of helminthic parasites among schoolchildren in different geographical regions of the world based on included studies (https://qgis.org/en/site/) (a). Additionally, the Sankey plot presents data concerning the majority of studies related to countries and GBD Region based on the included studies (b)

Prevalence based on type of helminthic parasites, type of samples, and diagnostic techniques

The overall prevalence of helminthic parasites among schoolchildren was as detailed: 10.36% (7.08–15.13%) for Toxocara spp., 9.47% (7.32–11.85%) for A. lumbricoides, 8.87% (6.34–11.85%) for Heterophyes heterophyes, 7.82% (3.43–13.76%) for Schistosoma spp., 5.83% (3.86–8.16%) for T. trichiura, 4.57% (3.30–6.03%) for hookworms, 3.03% (2.35–3.78%) for Hymenolepis nana, 2.75% (1.97–3.65%) for Enterobius vermicularis, 2.39% (1.16–5.18%) for Rhabditis spp., 2.34% (1.45–3.42%) for Taenia spp., 1.83% (0.33–4.36%) for Fasciola spp., 1.65% (0.76–2.83%) for Strongyloides stercoralis, 1.45% (0.008–2.32%) for Wuchereria bancrofti, 1.44% (0.23–3.55%) for Opisthorchis spp., 0.62% (0.04–1.73%) for Dicrocoelium dendriticum, 0.58% (0.01–1.78%) for Trichostrongylus spp., 0.24% (0.04–1.33%) for Gongylonema spp. (Table 3).

The highest pooled prevalence based on type of sample was estimated at 47.27% (18.72–76.83%) for studies using both stool and urine samples (Table 2). Based on the diagnostic methods used, the highest prevalence was reported in studies employing the Kato-Katz technique, with an estimated rate of 51.9% (20.65–82.34%) (Table 2).

Prevalence based on WHO regions, country, socio-economic status, educational level, age, and gender

WHO regional estimates of prevalence spanned from 40.90% to 13.24%, with 40.90% (26.74–55.88%) in Western Pacific Region, 40.73% (24.38–58.21%) in Region of the Americas, 35.99% (24.72%– 48.09%) in African Region, 23.67% (5.88–48.51%) in European Region, 15.33% (10.19–21.28%) in Eastern Mediterranean Region, 13.24% (9.69–17.24%) in South-East Asian Region (Table 2). Findings from country-based analyses revealed that Tanzania had the highest prevalence (67.41%, 14.04–99.96%) followed by Vietnam (65.04%, 26.48–94.62%) (Table 2).

The estimated pooled prevalence based on countries income level ranged from 26.95% to 2.67%, with the highest rate observed in low income (26.95%, 18.74–36.03%) (Table 2). Based on the HDI, the highest prevalence was observed in countries with low human development, at 35.35% (25.97–45.34) (Table 2).

Analysis by education level revealed that primary school children had the greatest pooled prevalence, 21.86% (17.96–26.03%) (Table 2). Furthermore, schoolchildren aged 10–15 years showed the highest prevalence rate among all age groups, estimated at 22.32% (16.56–28.68%) (Table 2). Additionally, the highest pooled prevalence as indicated by gender was observed among male schoolchildren, at 33.15% (28.17–38.33%) (Table 2).

Prevalence in association with climatic factors

The analyses revealed that regions with average annual rainfall of 400–1000 mm 30.85% (21.77–40.73%) had the highest rate of pooled prevalence (Table 2). Furthermore, regions with average temperature of >20 °C (25.94%, 21.15–31.04%) had the highest rate of prevalence for helminthic parasites among schoolchildren (Table 2). Moreover, the highest pooled prevalence rate of 21.42% (17.10–26.07%) was observed at a humidity range of 40–75% (Table 2). In addition, we found that tropical rainforest climate had the highest prevalence rate (35.44%, 22.47–49.61%) (Table 2).

Meta regression

Significant heterogeneity was detected for annual rainfall and year of publication, though the association with annual rainfall was not statistically significant (slop = 13.167, p < 0.07), and year of publication for all studies included (slop = 0.411, p < 0.06) (Fig. 4a-b).

Fig. 4.

The global prevalence of helminthic parasites among schoolchildren in different geographical regions of the world based on annual rainfall and year of publication (the pink line is the regression line, which was plotted based on the intercept and the slope of the regression model). The different coloured bubbles represent the countries under study, and their sizes indicate the effect size of each study

Publication bias

A non-significant publication bias was detected using Egger’s test (t = 5.59, p < 0.001). Furthermore, there was a major asymmetry in the Doi plot (LFK index: 2.71) (Fig. 5 a-c).

Fig. 5.

Eggers funnel plot (a) and Beggs plot (b) used to evaluate publication bias related to the global prevalence of helminthic parasites among schoolchildren according to the studies included; colored circles represent individual studies. The central line indicates the effect size, while the other two lines outline the corresponding confidence intervals. The Doi plot (c), which also reflects the publication bias, reveals a Luis Furuya-Kanamori (LFK) index of 2.71, indicating major asymmetry

Quality assessment

According to the quality assessment, 120 of the 190 studies were rated as high quality (scores of 7–9), and 70 were rated as moderate quality (scores of 4–6) (Supplementary Table 2).

While Egger’s test detected some asymmetry (p < 0.001), this could reflect true heterogeneity due to variations in study design, location, or diagnostic sensitivity. The LFK index of 2.71 further indicated possible publication bias. However, the inclusion of studies with moderate-to-high quality scores (≥ 4) and clear eligibility criteria suggests a reliable evidence base. Still, the interpretation of the results should be with caution due to the inherent risk of reporting bias and study-level variability.

Discussion

This study emphasizes the substantial global impact of helminthic infections in schoolchildren, highlighting their continued role as a major public health concern, especially in low-income and tropical areas. The findings support earlier research showing that helminthiasis remains a significant health problem, predominantly in areas where sanitation is poor, clean water is scarce, and socioeconomic inequalities are noticeable [4, 5, 24, 25].

We observed the highest prevalence rates in the Western Pacific Region and the Region of the Americas, with Tanzania and Vietnam reporting the highest country-specific rates. These patterns reflect the impact of geographical and climatic factors on helminth transmission, as tropical and subtropical regions with warm temperatures and high rainfall offer the most favourable conditions for the survival and spread of STHs [5, 6].

The subgroup analyses in this study demonstrated notably high infection rates in low-income countries, where environmental and infrastructural conditions favour transmission. These findings are in line with studies from similar settings, and they point to socio-economic status as a primary risk determinant of helminth infection [4, 5, 10]. The elevated prevalence in low-income countries further focuses on the role played by poor medical facilities and poverty in perpetuating such infections [9].

Among the helminth species encountered, A. lumbricoides and Toxocara spp. were the most frequently isolated. This dominancy aligns with their widespread distribution and efficient transmission routes, e.g., ingestion of contaminated food or soil [10]. The high occurrence of A. lumbricoides supports its classification as major STHs by the WHO, affecting nearly two billion people globally [11]. These infections pose significant risks to children’s health, frequently causing iron-deficiency anaemia, delayed physical development, learning difficulties, and poor nutritional status [10, 17, 19].

Beyond STHs, our study revealed significant burdens from food-borne, water-borne, and vector-borne helminths, highlighting the need for targeted interventions. Schistosomiasis remains a major public health concern in endemic areas, particularly among school-aged children, who suffer from chronic morbidity including hepatic and urogenital inflammation, anemia, and cognitive impairments as a result of repeated exposure during water-contact activities [26]. Toxocariasis, primarily transmitted through contact with soil-contaminated hands or inadequately washed produce, poses significant health risks, including visceral and ocular larva migrans, exacerbation of asthma, and neurocognitive impairments [27]. The high pooled prevalence of H. heterophyes highlights the health risks associated with consuming raw or undercooked fish, which can lead to intestinal mucosal ulceration and abdominal pain that is often misdiagnosed [28].

A total of about 1.5 billion individuals globally are infected with STHs, with the highest burden residing in the tropics and subtropics most notably in sub-Saharan Africa, South America, and South Asia, where infection rates still persist higher than anywhere else. The environmental and soil conditions in such regions are conducive to survival of the STHs in the external environment. Inadequate personal and environmental hygiene, lack of access to safe water, and unsanitary facilities also promote transmission of STH infection [29]. Our study showed that climate poses a potent role in determining prevalence with high levels present in tropical rainforest and rainfall areas of 400–1000 mm per annum. These environments support survival of helminth eggs and larvae outside the host and hence transmission [13].

Variation in prevalence between species is also caused by variation in their diagnosis methods, with Kato-Katz technique having the highest rate of detection because of its sensitivity when counting STH eggs [12]. Although microscopy remains the global standard, DNA‑based diagnostics (e.g. conventional PCR, qPCR, multiplex PCR and LAMP) offer significantly higher sensitivity—especially in low-intensity infections—and the capacity to detect mixed-species helminth infections accurately, providing species-level identification and quantitative data beyond microscopy’s reach [12, 15, 16]. Differences in diagnostic methods across countries may lead to bias. Countries that use more sensitive methods such as Kato-Katz or molecular diagnostics will tend to report higher prevalence not necessarily due to higher infection rates, but due to improved detection. The difference may affect cross-country comparison and needs to be adjusted for while interpreting results.

High rates of helminthic infection in children demand stronger global commitment and intervention to eliminate these infectious diseases. Improved sanitation services, safe water accessibility, and mass drug administration (MDA) programs remain basis strategies [30]. Furthermore, integrating health education in schools to promote hygiene practices, such as handwashing and wearing shoes, would significantly reduce transmission [19].

The MDA holds significant promise for disease control, yet it also faces notable challenges and limitations. One of the major obstacles is the lack of adequate funding. Advancing research and development, conducting essential clinical trials to optimize treatment, and ensuring the procurement, distribution, and long-term maintenance of drug supplies all demand considerable financial and logistical resources that are currently insufficient. Moreover, the narrow range of available chemotherapeutic agents heightens the risk of drug resistance due to overuse.

Effective control of helminth infections requires more than only MDA. For schistosomiasis, key measures include minimizing snail breeding sites and promoting safe practices around recreational water use. To prevent fish- and food-borne helminths, raising community awareness about safe food handling, thorough cooking, and personal hygiene is vital for reducing transmission.

Effective pharmaco-epidemiological surveillance involves tracking drug efficacy, treatment coverage, and emerging resistance patterns, which requires investment in laboratory infrastructure, standardized monitoring protocols, and integration into national surveillance systems to detect and respond to resistance early [31]. While this strategy has shown some positive outcomes, the growing global threat of antimicrobial resistance, largely driven by excessive drug use, raises concerns that these short-term benefits may come at the cost of long-term consequences by promoting further drug resistance [32].

The study also revealed that children in primary schools were most affected, perhaps due to their increased exposure to infested soil and poor hygiene after playing or during daily activities [15]. The finding underscores the need for focused school-based deworming exercises and health education for preventing transmission among this vulnerable age group [16].

Although intestinal helminth infections rarely cause mortality, they are significant causes of disability among children and have long-term socioeconomic repercussions, including reduced earning capacity in adulthood. The parasitic infections most frequently pose significant challenges for children living in poverty especially in poor rural or urban areas with very limited access to clean water, sanitation, and hygiene (WASH) [7].

Enhancing socioeconomic conditions, along with implementing several key strategic interventions, is critical [33]. This approach involves the use of preventive chemotherapy for preschool and schoolchildren [29, 34]; ensuring availability of proper sanitation, waste management, improved hygiene, and safe water in both households and schools; advancing diagnostic and treatment services for individuals in STH-endemic regions; and promoting health awareness in at-risk populations to improve behavioural changes that lower transmission risk [35].

Limitations

This review has the listed limitations: 1) reliance on published data may have led to selection bias since studies from underrepresented regions or with non-significant results might have been excluded; 2) heterogeneity in diagnostic techniques among studies may affect the accuracy of prevalence estimates; 3) some subgroup analyses were based on a small number of studies, which may affect the stability and generalizability of the prevalence estimates. Therefore, caution is advised when interpreting these findings.

Conclusion

This meta-analysis provides a global overview of helminthic infections in schoolchildren and their disproportionate burden in tropical, resource-limited settings. The findings support the necessity for enhanced prevention and treatment measures to control the adverse health and developmental effects of helminthic infections. Future studies need to address longitudinal studies to evaluate the long-term effectiveness of interventions and study socioeconomic determinants of transmission of the helminths.

Recommendations

To make lasting progress in the fight against helminth infections among schoolchildren, several important steps are needed: 1) More long-term studies are essential to understand how well current interventions work over time. These studies should also explore how factors like poverty, living conditions, and the environment influence the spread of infections. This knowledge will help shape more effective and lasting solutions; 2) Expanding school-based deworming programs and improving access to WASH can make a meaningful difference in children's health. Making helminth control a national public health priority is crucial to reaching those most at risk; 3) Local education efforts that teach simple but powerful hygiene practices like handwashing and using safe toilets can greatly reduce the spread of infection. It's also vital to ensure that all children, especially those in underserved or remote areas, have fair access to preventive treatment.

Abbreviations

STHs

Soil-transmitted helminths

WHO

World Health Organization

NTDs

Neglected tropical diseases

DALYs

Disability-adjusted life years

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

GBD

Global Burden of Disease

CI

Confidence interval

LFK

Luis Furuya-Kanamori

MDA

Mass drug administration

WASH

Water, sanitation, and hygiene

Authors’ contributions

MB,AA, MP and AVE designed the study. ZG and HS searched for primary publications, screened, and appraised primary studies. ZG and HS extracted the data. MO was involved in data analysis. MB, KHN, GS, AA, AA and AVE were responsible for drafting the manuscript. MB and AVE corrected the final version of the manuscript. MB, MP, AA, and AVE supervised the project. All authors read and approved the final manuscript.

Funding

This study was supported by the Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran and Jahrom University of Medical Sciences, Jahrom, Iran (contract no. IR.QUMS.REC.1403.124).

Data availability

Data generated and analyzed in this study are included in the published article. Additional data are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was granted by our institutional review board, as documented (no. IR.QUMS.REC.1403.124).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.