A recent study by Debash et al. (2025) titled “Burden of intestinal parasites among diabetic patients in Africa: a systematic review and meta-analysis,” published in BMC Infectious Diseases by Springer Nature, reveals that diabetic patients are at a higher risk of intestinal parasitic infections.
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Diabetic patients in Africa face a 31% prevalence of intestinal parasitic infections, with higher risks linked to poor hygiene and sanitation.– Debash et al. 2025
Intestinal parasite infections (IPIs) pose a significant public health concern, particularly in regions with poor sanitation. Diabetic patients, due to their compromised immune systems, may be more vulnerable to these infections. This systematic review and meta-analysis assess the overall burden of IPIs among diabetic individuals across Africa. A comprehensive search of studies published between January 1, 2000, and August 13, 2024, was conducted, focusing on the prevalence of IPIs in diabetic patients. Sixteen studies were included in the final analysis, with data analyzed using STATA software. Subgroup analysis was performed to address variations across studies. The findings revealed that 31% of diabetic patients in Africa were affected by intestinal parasites, with the highest prevalence reported in Egypt (39%) and in case-control studies (40%). Key factors contributing to higher infection rates included poor hygiene, inadequate sanitation, and diabetes status. Given the increased risk among diabetic individuals, the study highlights the urgent need for regular screening, improved hygiene practices, and better sanitation measures to reduce the burden of IPIs. Implementing preventive strategies and raising awareness among diabetic patients is crucial in mitigating this public health challenge.
How the Study was Conducted
The study systematically reviewed research published between January 1, 2000, and August 13, 2024, using institutional repositories and online databases such as PubMed, ScienceDirect, Scopus, and Google Scholar. Search terms included “prevalence,” “incidence,” “intestinal parasites,” “helminths,” “protozoa,” and “Diabetes Mellitus (type I & II DM).”
Inclusion Criteria: Original research, brief reports, case-control, cross-sectional, and hospital-based studies focusing on diabetic patients with intestinal parasites.
Exclusion Criteria: Duplicate studies, research conducted outside Africa, studies without diabetic participants, case reports, review articles, studies with sample sizes below 30, and letters.
Study Selection and Quality Assessment
The search results were managed using Endnote X7, with duplicates removed systematically. Two independent reviewers screened articles based on titles and abstracts, while another set of reviewers assessed full-text publications. Quality assessment followed the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) criteria, categorizing studies as high quality (≥7 stars) or intermediate quality (5–7 stars).
Data Extraction and Statistical Analysis
Key data points—including author details, publication year, study design, sample size, country, number of cases, and parasite prevalence among diabetic patients—were extracted and recorded in an Excel file. The analysis was conducted using STATA version 17, employing:
Random-effects model for significant heterogeneity (I² > 50%).
Subgroup analysis by country and study design to refine findings.
Egger’s test and trim-and-fill analysis to evaluate and adjust for publication bias.
Sensitivity analysis to validate pooled prevalence estimates.
What the Authors Found
The study found that the overall prevalence of intestinal parasites among diabetic patients in Africa is 31% (CI: 23-38%). Geographical variation was observed, with Egypt recording the highest prevalence at 39% (CI: 26-52%) and Nigeria showing a significant prevalence of 33% (CI: 18-49%). Study design impacted the findings, as case-control studies reported a higher prevalence of 40% (CI: 28-52%), while cross-sectional studies showed a prevalence of 22% (CI: 17-27%).
Several factors were associated with increased infection risk. Poor hygiene and sanitation significantly raised the odds of infection by 8.1 times, while diabetes mellitus itself increased the odds by 5.62 times. The most commonly reported parasites included protozoa such as Cryptosporidium species, Giardia species, and Entamoeba histolytica, as well as helminths like Ascaris lumbricoides, Trichuris trichiura, and hookworm. The study identified high heterogeneity among the included studies (I²=95.94%), indicating variability beyond random chance. While Egger’s test suggested potential publication bias, a trim-and-fill analysis showed no significant differences.
Why is this important?
Higher Risk for Diabetic Patients: The study reveals that diabetic patients in Africa are significantly more likely to be infected with intestinal parasites compared to non-diabetic individuals. These infections can exacerbate existing health issues and lead to severe complications.
Impact on Immune System: Diabetic patients often have compromised immune systems, making them more susceptible to infections. Intestinal parasites can further weaken their immune response, leading to prolonged illness and more severe symptoms.
Prevalence in Africa: With a pooled prevalence of 31%, the study highlights a considerable burden of intestinal parasites among diabetic patients in Africa. This calls for targeted public health interventions in the region.
Preventive Measures: Emphasizing the need for better hygiene and sanitation practices can help reduce the transmission of these parasites. Public health campaigns and education programs can play a crucial role in achieving this.
Screening and Treatment: The study underscores the importance of prioritizing diabetic patients for regular screening and early treatment of intestinal parasitic infections. This can help prevent complications and improve the overall health outcomes for these patients.
Guidance for Healthcare Providers: The findings provide valuable insights for healthcare providers, enabling them to develop and implement effective strategies for managing and preventing intestinal parasites in diabetic patients.
Highlighting Knowledge Gaps: The study identifies areas where further research is needed, such as the specific types of intestinal parasites affecting diabetic patients and the mechanisms underlying their increased susceptibility.
Basis for Future Studies: The systematic review and meta-analysis serve as a foundation for future research, helping to better understand the relationship between diabetes and intestinal parasitic infections.
What the Authors Recommended
- The authors recommend that diabetic patients should be prioritized for regular screening of intestinal parasitic infections to facilitate early detection and treatment. This is crucial given their higher susceptibility to these infections.
- Public health interventions should focus on improving hygiene and sanitation, particularly in areas with inadequate facilities. This can significantly reduce the transmission of intestinal parasites.
- Develop and implement health education programs aimed at increasing awareness among diabetic patients about the transmission routes and prevention strategies for intestinal parasitic infections. Knowledge about proper hygiene practices, safe food handling, and the importance of clean water can help reduce infection rates.
- Encourage diabetic patients to practice good personal hygiene, such as regular handwashing, especially before meals and after using the toilet. Ensure proper disposal of human excreta and solid waste to minimize environmental contamination and advise diabetic patients to avoid consuming raw or undercooked vegetables and foods that may be contaminated with parasites.
- The authors suggest conducting more well-designed case-control and experimental studies to better understand the relationship between diabetes and intestinal parasitic infections. This can help in developing targeted interventions and improving the overall management of diabetic patients.
- In addition, governments and health authorities should incorporate these findings into national health policies, ensuring that diabetic patients are included in public health plans for controlling intestinal parasitic infections.
In conclusion, this study highlights the significant burden of intestinal parasitic infections among diabetic patients in Africa, with a prevalence rate of 31%. The findings underscore the urgent need for regular screening, improved hygiene, and enhanced public health interventions to mitigate infection risks. Given the vulnerability of diabetic individuals due to their compromised immune systems, targeted awareness campaigns and preventive measures are essential in reducing disease transmission. Policymakers, healthcare providers, and researchers must work collaboratively to integrate these findings into national health strategies, ensuring better health outcomes for diabetic patients. Addressing this dual burden of diabetes and parasitic infections is crucial for improving overall public health and quality of life in affected regions.
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