Trends and progress toward SDG targets for soil-transmitted helminthiasis among pediatric population in Sub-Saharan Africa: A systematic review and meta-analysis

Title: Trends and Progress Toward SDG Targets for Soil-Transmitted Helminthiasis Among Pediatric Population in Sub-Saharan Africa: A Systematic Review and Meta-Analysis Background: Soil-transmitted helminthiasis (STH) remains one of the most common neglected tropical diseases affecting children in Sub-Saharan Africa. The major causative parasites, including Ascaris lumbricoides, Trichuris trichiura, and hookworms (Necator americanus and Ancylostoma duodenale), are associated with malnutrition, anemia, impaired cognitive development, reduced educational attainment, and poor overall health outcomes. School-aged children are particularly vulnerable due to increased exposure to contaminated environments and inadequate water, sanitation, and hygiene (WASH) conditions. Over the past decade, substantial efforts have been made to control STH through preventive chemotherapy, school-based deworming programs, and improvements in sanitation and hygiene. These efforts have been further reinforced by the World Health Organization's Neglected Tropical Diseases Roadmap 2021–2030 and the Sustainable Development Goals (SDGs), particularly those related to health, education, poverty reduction, and access to clean water and sanitation. Despite these interventions, the burden of STH remains heterogeneous across countries and regions of Sub-Saharan Africa, and the extent of progress toward global targets remains unclear. An updated synthesis of epidemiological evidence is therefore necessary to evaluate trends in STH prevalence among children, identify geographical and temporal variations, and assess whether current control strategies are sufficient to achieve the goals outlined in international health frameworks. Purpose: The purpose of this systematic review and meta-analysis is to synthesize available epidemiological evidence on soil-transmitted helminth infections among school-aged children in Sub-Saharan Africa and to evaluate progress toward the elimination and control targets outlined in the WHO Neglected Tropical Diseases Roadmap 2021–2030 and relevant Sustainable Development Goals. The review aims to provide robust pooled estimates of STH prevalence and to examine temporal trends and regional disparities in infection burden across Sub-Saharan Africa. Objectives: Primary Objective: To estimate the pooled prevalence of soil-transmitted helminth infections among school-aged children (5–15 years) in Sub-Saharan Africa using studies published between January 2015 and March 2026. Secondary Objectives: To assess temporal trends in STH prevalence during the study period. To estimate pooled prevalence separately for: Ascaris lumbricoides Trichuris trichiura Hookworm infections To evaluate geographical variation in STH prevalence across countries and subregions of Sub-Saharan Africa. To investigate sources of heterogeneity through subgroup analyses and meta-regression. To assess the extent to which observed trends align with the targets established under the WHO NTD Roadmap 2021–2030 and related SDG indicators. To identify evidence gaps and priority areas for future research and intervention. Research Questions: What is the pooled prevalence of soil-transmitted helminth infections among school-aged children in Sub-Saharan Africa? How has STH prevalence changed between 2015 and 2026? Are there significant differences in prevalence between countries, regions, diagnostic methods, and study settings? Is the observed epidemiological trend consistent with progress toward WHO NTD Roadmap 2021–2030 objectives and broader SDG targets? What evidence gaps remain that may hinder progress toward STH control and elimination? Methods Overview: This study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search will be conducted in multiple electronic databases, including PubMed, Embase, Scopus, Web of Science Core Collection, and CINAHL. Additional sources may include reference list screening and grey literature searches where appropriate. Eligible studies will include observational epidemiological studies and clinical trials reporting baseline prevalence data among school-aged children (5–15 years) residing in Sub-Saharan Africa and published between January 2015 and March 2026. Two reviewers will independently screen titles, abstracts, and full texts, extract relevant data, and assess methodological quality using an appropriate risk-of-bias assessment tool for prevalence studies. Random-effects meta-analysis will be used to estimate pooled prevalence and corresponding 95% confidence intervals. Statistical heterogeneity will be evaluated using Cochran's Q and the I² statistic. Planned subgroup analyses may include country, geographic region, publication year, diagnostic method, study setting, and parasite species. Meta-regression will be conducted where sufficient data are available. Publication bias will be assessed using funnel plots and appropriate statistical tests when the number of included studies permits. Expected Outcomes: This review is expected to provide: Comprehensive pooled prevalence estimates of soil-transmitted helminth infections among school-aged children in Sub-Saharan Africa. An updated assessment of epidemiological trends since 2015. Evidence on geographical inequalities and high-burden settings. Insights into progress toward WHO NTD Roadmap 2021–2030 targets and related Sustainable Development Goals. Identification of populations and regions that may require intensified intervention strategies. Evidence to support policymakers, public health practitioners, researchers, and international organizations involved in neglected tropical disease control. Significance: The findings of this review will contribute to understanding the current burden of soil-transmitted helminthiasis among children in Sub-Saharan Africa and provide evidence on whether the region is progressing toward internationally agreed disease-control targets. The results will inform future deworming programs, WASH interventions, surveillance activities, and policy decisions aimed at reducing the health and socioeconomic impacts of STH and improving child health outcomes throughout the region.