Prevalence of Strongyloides stercoralis infection among African children: A systematic review and meta-analysis

Strongyloides stercoralis is a neglected parasite that causes strongyloidiasis. However, the true prevalence of strongyloidiasis is underreported due to low-sensitivity diagnostic methods. This systematic review assessed the prevalence of S. stercoralis among African children and its variation by diagnostic methods, countries, and study settings. All studies published in African countries on S. stercoralis prevalence up to the year 2025 in the PubMed, Google Scholar, Scopus, and ScienceDirect databases were included. Identification, screening, checking the eligibility, and including the relevant studies were done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Out of 651 articles screened, 27 studies involving 16,358 children were included in the systematic review. The pooled prevalence of S. stercoralis among African children was 14% using a random-effect model. The highest pooled prevalence of S. stercoralis was recorded at 27% in Côte d’Ivoire, followed by 26% in Ethiopia. A high prevalence (36%) of S. stercoralis was obtained by a combination of PCR, culture, and microscopic diagnostic methods. This review indicated that S. stercoralis prevalence in African children is considerable and likely underestimated due to low-sensitivity diagnostics. Therefore, further studies using sensitive diagnostic approaches are urgently needed to determine the true burden of strongyloidiasis.Author summary: Strongyloides stercoralis remains a neglected soil-transmitted helminth with limited data on its burden among children in Africa. This systematic review and meta-analysis aimed to estimate the pooled prevalence and assess diagnostic approaches across the continent. A comprehensive search of PubMed, Scopus, Google Scholar, and ScienceDirect identified 651 records, of which 27 studies met the inclusion criteria. Using a random-effects model, the pooled prevalence of S. stercoralis infection was high with substantial heterogeneity across studies. Lower estimates were reported in studies using less sensitive diagnostic methods such as direct microscopy and formol-ether concentration. In contrast, studies employing combined techniques, including PCR and culture methods, reported markedly higher detection rates. These findings highlight the underestimation of infection due to diagnostic limitations and emphasize the need for improved surveillance, sensitive diagnostic tools, and targeted control strategies for children in endemic settings.