Prevalence rates of six selected infectious diseases among African migrants and refugees: a systematic review and meta-analysis

  • A. Chernet
  • J. Utzinger
  • V. Sydow
  • N. Probst-Hensch
  • D. H. Paris
  • N. D. Labhardt
  • A. NeumayrEmail author


The objective of this paper was to systematically review the literature on the prevalence of selected infectious diseases among migrants/refugees of African origin and to provide policy makers and health care professionals with evidence-based information. We pursued a systematic review and meta-analysis to determine the prevalence of six selected infectious diseases (i.e., syphilis, helminthiasis, schistosomiasis, intestinal protozoa infections, hepatitis B, and hepatitis C) among migrants/refugees of African origin. Three electronic databases (i.e., PubMed, EMBASE, and ISI Web of Science) were searched without language restrictions. Relevant data were extracted and random-effects meta-analyses conducted. Only adjusted estimates were analyzed to help account for heterogeneity and potential confounding. We assessed the quality of evidence using the GRADE approach. The results were stratified by geographical region. Ninety-six studies were included. The evidence was of low quality due to the small numbers of countries, infectious diseases, and participants included. African migrants/refugees had median (with 95% confidence interval [95% CI]) prevalence for syphilis, helminthiasis, schistosomiasis, intestinal protozoa infection, hepatitis B, and hepatitis C of 6.0% [95% CI: 2.0–7.0%], 13.0% [95% CI: 9.5–14.5%], 14.0% [95% CI: 13.0–17.0%], 15.0% [95% CI: 10.5–21.0%], 10.0% [95% CI: 6.0–14.0%], and 3.0% [95% CI: 1.0–4.0%], respectively. We found high heterogeneity regardless of the disease (I 2; minimum 97.5%, maximum 99.7%). The relatively high prevalence of some infectious diseases among African migrants/refugees warrants for systematic screening. The large heterogeneity of the available published data does not allow for stratifying such screening programs according to the geographical origin of African migrants/refugees.



This study did not receive funds from any funding agents.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Swiss Tropical and Public Health Institute institutional research commission.

Informed consent

As this research pertained to a systematic review and meta-analysis of published articles, there was no need to collect informed consent.

Supplementary material

10096_2017_3126_MOESM1_ESM.docx (105 kb)
ESM 1 (DOCX 105 kb)
10096_2017_3126_MOESM2_ESM.docx (108 kb)
ESM 2 (DOCX 107 kb)


  1. 1.
    United Nations (2016) International Migration Report 2015. Available online at: Accessed 31 May 2017
  2. 2.
    United Nations High Commissioner for Refugees (UNHCR) (2017) Global Trends. Forced displacement in 2016. Available online at: Accessed 26 Jun 2017
  3. 3.
    Theuring S, Friedrich-Jänicke B, Pörtner K, Trebesch I, Durst A, Dieckmann S et al (2016) Screening for infectious diseases among unaccompanied minor refugees in Berlin, 2014–2015. Eur J Epidemiol 31(7):707–710CrossRefPubMedGoogle Scholar
  4. 4.
    Chernet A, Kling K, Sydow V, Kuenzli E, Hatz C, Utzinger J et al (2017) Accuracy of diagnostic tests for Schistosoma mansoni infection in asymptomatic Eritrean refugees: serology and point-of-care circulating cathodic antigen against stool microscopy. Clin Infect Dis 65(4):568–574CrossRefPubMedGoogle Scholar
  5. 5.
    Goldenberger D, Claas GJ, Bloch-Infanger C, Breidthardt T, Suter B, Martínez M et al (2015) Louse-borne relapsing fever (Borrelia recurrentis) in an Eritrean refugee arriving in Switzerland, August 2015. Euro Surveill 20(32):2–5CrossRefPubMedGoogle Scholar
  6. 6.
    Roggelin L, Tappe D, Noack B, Addo MM, Tannich E, Rothe C (2016) Sharp increase of imported Plasmodium vivax malaria seen in migrants from Eritrea in Hamburg, Germany. Malar J 15:325CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Jaton L, Pillonel T, Jaton K, Dory E, Prod’hom G, Blanc DS et al (2016) Common skin infection due to Panton–Valentine leucocidin-producing Staphylococcus aureus strains in asylum seekers from Eritrea: a genome-based investigation of a suspected outbreak. Clin Microbiol Infect 22(8):739.e5–739.e8CrossRefGoogle Scholar
  8. 8.
    Daw MA, El-Bouzedi A, Ahmed MO, Dau AA, Agnan MM, Drah AM et al (2016) Prevalence of human immune deficiency virus in immigrants crossing to Europe from north and Sub-Saharan Africa. Travel Med Infect Dis 14(6):637–638CrossRefPubMedGoogle Scholar
  9. 9.
    Kramer MA, van Veen MG, Op de Coul ELM, Coutinho RA, Prins M (2014) Do sexual risk behaviour, risk perception and testing behaviour differ across generations of migrants? Eur J Public Health 24(1):134–138CrossRefPubMedGoogle Scholar
  10. 10.
    Tanser F, Bärnighausen T, Vandormael A, Dobra A (2015) HIV treatment cascade in migrants and mobile populations. Curr Opin HIV AIDS 10(6):430–438CrossRefPubMedGoogle Scholar
  11. 11.
    Fu SS, McFall M, Saxon AJ, Beckham JC, Carmody TP, Baker DG et al (2007) Post-traumatic stress disorder and smoking: a systematic review. Nicotine Tob Res 9(11):1071–1084CrossRefPubMedGoogle Scholar
  12. 12.
    Buhmann CB (2014) Traumatized refugees: morbidity, treatment and predictors of outcome. Dan Med J 61(8):B4871PubMedGoogle Scholar
  13. 13.
    Slobodin O, de Jong JTVM (2015) Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy? Int J Soc Psychiatry 61(1):17–26CrossRefPubMedGoogle Scholar
  14. 14.
    Alpak G, Unal A, Bulbul F, Sagaltici E, Bez Y, Altindag A et al (2015) Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. Int J Psychiatry Clin Pract 19(1):45–50CrossRefPubMedGoogle Scholar
  15. 15.
    Schouler-Ocak M, Aichberger MC, Penka S, Kluge U, Heinz A (2015) Mental disorders of immigrants in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 58(6):527–532CrossRefPubMedGoogle Scholar
  16. 16.
    Bogic M, Njoku A, Priebe S (2015) Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights 15:29CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lolk M, Byberg S, Carlsson J, Norredam M (2016) Somatic comorbidity among migrants with posttraumatic stress disorder and depression—a prospective cohort study. BMC Psychiatry 16(1):447CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Utzinger J, Becker SL, Knopp S, Blum J, Neumayr AL, Keiser J et al (2012) Neglected tropical diseases: diagnosis, clinical management, treatment and control. Swiss Med Wkly 142:w13727PubMedGoogle Scholar
  19. 19.
    Cuenca-Gómez JA, Salas-Coronas J, Soriano-Pérez MJ, Vázquez-Villegas J, Lozano-Serrano AB, Cabezas-Fernández MT (2016) Viral hepatitis and immigration: a challenge for the healthcare system. Rev Clin Esp 216(5):248–252CrossRefPubMedGoogle Scholar
  20. 20.
    Kärki T, Napoli C, Riccardo F, Fabiani M, Dente MG, Carballo M et al (2014) Screening for infectious diseases among newly arrived migrants in EU/EEA countries—varying practices but consensus on the utility of screening. Int J Environ Res Public Health 11(10):11004–11014CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Israel H, Richter RR (2011) A guide to understanding meta-analysis. J Orthop Sports Phys Ther 41(7):496–504CrossRefPubMedGoogle Scholar
  22. 22.
    Sedgwick P (2015) How to read a forest plot in a meta-analysis. BMJ 351:h4028CrossRefPubMedGoogle Scholar
  23. 23.
    BMJ (2017) What is GRADE? Available online at: Accessed 2 Oct 2017
  24. 24.
    Pullan RL, Brooker SJ (2012) The global limits and population at risk of soil-transmitted helminth infections in 2010. Parasit Vectors 5:81CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC (2014) Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 11(3):e1001620CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lai Y-S, Biedermann P, Ekpo UF, Garba A, Mathieu E, Midzi N et al (2015) Spatial distribution of schistosomiasis and treatment needs in sub-Saharan Africa: a systematic review and geostatistical analysis. Lancet Infect Dis 15(8):927–940CrossRefPubMedGoogle Scholar
  27. 27.
    Colley DG, Bustinduy AL, Secor WE, King CH (2014) Human schistosomiasis. Lancet 383(9936):2253–2264CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Knopp S, Mgeni AF, Khamis IS, Steinmann P, Stothard JR, Rollinson D et al (2008) Diagnosis of soil-transmitted helminths in the era of preventive chemotherapy: effect of multiple stool sampling and use of different diagnostic techniques. PLoS Negl Trop Dis 2(11):e331CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gartlehner G, West SL, Mansfield AJ, Poole C, Tant E, Lux LJ et al (2012) Clinical heterogeneity in systematic reviews and health technology assessments: synthesis of guidance documents and the literature. Int J Technol Assess Health Care 28(1):36–43CrossRefPubMedGoogle Scholar
  30. 30.
    Melsen WG, Bootsma MCJ, Rovers MM, Bonten MJM (2014) The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses. Clin Microbiol Infect 20(2):123–129CrossRefPubMedGoogle Scholar
  31. 31.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ziegelbauer K, Speich B, Mäusezahl D, Bos R, Keiser J, Utzinger J (2012) Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med 9(1):e1001162CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    World Health Organization (WHO). Country maps: schistosomiasis. Available online at: Accessed 2 Jun 2017
  34. 34.
    Khyatti M, Trimbitas R-D, Zouheir Y, Benani A, El Messaoudi M-D, Hemminki K (2014) Infectious diseases in North Africa and north African immigrants to Europe. Eur J Public Health 24(Suppl 1):47–56CrossRefPubMedGoogle Scholar
  35. 35.
    Rossi C, Shrier I, Marshall L, Cnossen S, Schwartzman K, Klein MB et al (2012) Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: a systematic review and meta-analysis. PLoS One 7(9):e44611CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Greenaway C, Thu Ma A, Kloda LA, Klein M, Cnossen S, Schwarzer G et al (2015) The seroprevalence of hepatitis C antibodies in immigrants and refugees from intermediate and high endemic countries: a systematic review and meta-analysis. PLoS One 10(11):e0141715CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Napoli C, Dente MG, Kärki T, Riccardo F, Rossi P, Declich S et al (2015) Screening for infectious diseases among newly arrived migrants: experiences and practices in non-EU countries of the Mediterranean Basin and Black Sea. Int J Environ Res Public Health 12(12):15550–15558CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Minodier P, Lamarre V, Carle M-E, Blais D, Ovetchkine P, Tapiero B (2010) Evaluation of a school-based program for diagnosis and treatment of latent tuberculosis infection in immigrant children. J Infect Public Health 3(2):67–75CrossRefPubMedGoogle Scholar
  39. 39.
    Veldhuijzen IK, Toy M, Hahné SJM, De Wit GA, Schalm SW, de Man RA et al (2010) Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology 138(2):522–530CrossRefPubMedGoogle Scholar
  40. 40.
    Alvarez GG, Gushulak B, Abu Rumman K, Altpeter E, Chemtob D, Douglas P et al (2011) A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Infect Dis 11:3CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Urbanus AT, van Keep M, Matser AA, Rozenbaum MH, Weegink CJ, van den Hoek A et al (2013) Is adding HCV screening to the antenatal national screening program in Amsterdam, the Netherlands, cost-effective? PLoS One 8(8):e70319CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Coker R, Bell A, Pitman R, Zellweger J-P, Heldal E, Hayward A et al (2006) Tuberculosis screening in migrants in selected European countries shows wide disparities. Eur Respir J 27(4):801–807CrossRefPubMedGoogle Scholar
  43. 43.
    Zammarchi L, Casadei G, Strohmeyer M, Bartalesi F, Liendo C, Matteelli A et al (2015) A scoping review of cost-effectiveness of screening and treatment for latent tubercolosis infection in migrants from high-incidence countries. BMC Health Serv Res 15:412CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • A. Chernet
    • 1
    • 2
  • J. Utzinger
    • 1
    • 2
  • V. Sydow
    • 1
    • 2
  • N. Probst-Hensch
    • 1
    • 2
  • D. H. Paris
    • 1
    • 2
  • N. D. Labhardt
    • 1
    • 2
    • 3
  • A. Neumayr
    • 1
    • 2
    Email author
  1. 1.Swiss Tropical and Public Health InstituteBaselSwitzerland
  2. 2.University of BaselBaselSwitzerland
  3. 3.Division of Infectious Disease and Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland

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