Waterborne <i>Cryptosporidium</i> species and <i>Giardia duodenalis</i> in resources of MENA: A systematic review and meta-analysis

Abstract

This review explores our understanding of <i>Cryptosporidium</i> species and <i>Giardia duodenalis</i> distribution in Middle East and North African (MENA) water resources. Results emphasize that <i>Cryptosporidium</i> species (sp.) and <i>G. duodenalis</i> (oo)cysts are present in distinct categories of water in ten MENA countries. <i>Cryptosporidium</i> sp. proportional prevalence in the MENA region was 24.5% (95% CI 16.3-33.8), while <i>G</i>. <i>duodenalis</i> prevalence was 37.7% (95% CI 21.9-55.1). Raw wastewater and surface water were the water categories most significantly impacted. Both parasites were reported in the various types of MENA drinking waters. The most frequent species/genotypes reported were <i>C. hominis</i>, <i>C. parvum</i>, and <i>G. duodenalis</i> assemblage A. Despite the high prevalence of (oo)cysts reported, we should consider the absence of waterborne outbreaks. This indicates significant underestimation and underreporting of both parasites in MENA. Stakeholders should apply water contamination legislation to eradicate <i>Cryptosporidium</i> sp. and <i>G. duodenalis</i> (oo)cysts from water resources/categories.