Prevalence of hookworm infection and its proportion among pregnant women with intestinal helminth infection in Ethiopia: A systematic review and meta-analysis

Background: Hookworms are the most common soil-transmitted helminths in tropical and subtropical regions. Although infection with hookworms is a principal cause of maternal anemia, there is limited consolidated evidence on pooled prevalence and its proportion among intestinal helminths infections in pregnant women in Ethiopia. This study aimed to estimate the pooled prevalence of infection with hookworms and its proportion among intestinal helminths in pregnant women in Ethiopia. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. Articles published between 2010 and 2024 were retrieved from databases including PubMed, Google Scholar, ScienceDirect, and African Journals Online using relevant search terms related to Ethiopia. Data extraction was performed using a standardized Excel spreadsheet after assessing the quality of the studies with the Newcastle-Ottawa Scale. Data were analyzed using STATA version 17. A random-effects model using the DerSimonian–Laird method was employed to account for heterogeneity, which was assessed using the I² statistic and the p-value of Cochrane’s Q test. Publication bias was evaluated using funnel plots, Begg’s, and Egger’s tests. Results were presented using forest plots with 95% confidence intervals (CIs). Results: A total of 33 studies, including 13367 pregnant women were analysed. Among these 4161 women infected with intestinal Helminthiases, including 1853 cases of infection with hookworms. The pooled prevalence of infection with hookworms among pregnant women in Ethiopia was 12.21% (95% CI: 9.46%–14.95%), while the pooled proportion of hookworms among intestinal helminths was 44.0% (95% CI: 33.24%–55.75%). Regionally, prevalence was highest in Amhara (13.11%, 95% CI: 9.17%–17.05%) and the lowest in Gambella (4.44%, 95% CI: 2.32%–6.57%). The proportion was highest in Amhara (67.86%, 95% CI: 57.87%–77.84%) and lowest in Harerge (16.67%, 95% CI: 9.21%–24.12%). By diagnostic method, the concentration technique yielded the highest prevalence (16.11%, 95% CI: 9.31%–22.90%), while combined methods showed the lowest (9.48%, 95% CI: 6.14%–12.83%). Conclusion: Infection with hookworms remains a public health concern among pregnant women in Ethiopia (pooled prevalence: 12.21%), accounting for 44.0% of intestinal helminths. Marked regional variation exists, highest in Amhara and lowest in Gambella. Prevalence estimates varied by diagnostic method, with higher values from concentration techniques. Targeted interventions, improved sanitation, deworming, and standardized diagnostics are needed. Author summary: Hookworms are common soil-transmitted helminthic disease in tropical and subtropical regions, including Ethiopia. While low-intensity infections are often asymptomatic, moderate-to-heavy infections can contribute substantially to anemia and adverse maternal health outcomes, particularly among pregnant women. Despite its public health importance, national-level evidence on the overall burden of infection with hookworms in this population has been limited and fragmented. In this study, we systematically reviewed and analyzed data from multiple studies conducted across Ethiopia to estimate both the overall prevalence of infection with hookworms among pregnant women and its proportion among intestinal helminth infections.