Hepatitis C virus among blood donors and general population in Middle East and North Africa: Meta-analyses and meta-regressions

Table 1 Results of meta-analyses on studies reporting HCV Ab prevalence among blood donors and in the general population in Middle East and North Africa

Population	Studies	Samples	HCV Ab prevalence		Pooled HCV Ab prevalence		Heterogeneity measures
	Total (n)	Total (n)	Range (%)	Median (%)	Mean (%)	95%CI	Q (P value)1	I² (confidence limits)2	Prediction interval (%)3
Blood donors
Afghanistan	40	737407	0.00-7.19	0.60	0.75	0.57-0.96	3046.03 (P < 0.01)	98.7% (98.6%-98.9%)	0.02-2.41
Egypt	116	1566669	0.00-38.20	10.97	10.40	9.59-11.23	24513.7 (P < 0.01)	99.5% (99.5%-99.6%)	3.64-19.96
Fertile Crescent4	157	3488952	0.00-3.95	0.27	0.21	0.18-0.25	3674.2 (P < 0.01)	95.8% (95.4%-96.1%)	0.00-0.67
Gulf5	156	20891379	0.00-27.19	0.89	0.78	0.71-0.86	29882.0 (P < 0.01)	99.5% (99.5%-99.5%)	0.20-1.69
Horn of Africa6	22	48076	0.0-6.03	1.0	0.97	0.57-1.45	327.8 (P < 0.01)	93.6% (91.5%-95.2%)	0.00-3.78
Iran	73	15971802	0.00-3.13	0.24	0.31	0.22-0.40	55740.9 (P < 0.01)	99.9% (99.9%-99.9%)	0.00-1.43
Maghreb7	49	2145044	0.11-6.58	0.65	0.68	0.49-0.91	13475.9 (P < 0.01)	99.6% (99.6%-99.7%)	0.00-2.82
Pakistan	73	1797644	0.01-20.79	3.00	3.47	2.96-4.02	24753.7 (P < 0.01)	99.7% (99.7%-99.7%)	0.38-9.32
All countries/subregions	686	46646973	0.00-38.2	0.86	1.58	1.48-1.69	481819.0 (P < 0.01)	99.9% (99.9%-99.9%)	0.01-5.18
General population
Afghanistan	6	12048	0.00-4.03	0.88	0.61	0.20-1.18	21.7 (P < 0.01)	76.9% (48.5%-89.6%)	0.00-2.68
Egypt	147	110603	0.00-54.10	11.82	13.08	11.51-14.73	8457.0 (P < 0.01)	98.3% (98.1-98.4%)	0.62-36.45
Fertile Crescent4	64	189456	0.00-8.87	0.19	0.42	0.24-0.64	1117.8 (P < 0.01)	94.4% (93.4%-95.2%)	0.00-2.39
Gulf5	85	222829	0.00-22.54	0.83	1.41	1.0-1.88	5343.3 (P < 0.01)	98.4% (98.3%-98.6%)	0.00-7.66
Horn of Africa6	27	29552	0.00-8.50	1.53	1.86	1.26-2.57	262.0 (P < 0.01)	90.1% (86.8%-92.6%)	0.00-6.13
Iran	50	101677	0.00-2.35	0.45	0.33	0.21-0.47	206.9 (P < 0.01)	76.3% (69.0%-81.9%)	0.00-1.25
Maghreb7	42	1378206	0.00-6.16	0.62	0.87	0.55-1.26	7595.3 (P < 0.01)	99.5% (99.5%-99.5%)	0.00-4.38
Pakistan	106	301814	0.44-73.38	6.82	8.81	7.62-10.06	13619.0 (P < 0.01)	99.2% (99.2%-99.3%)	0.60-24.62
All countries/subregions	527	2346185	0.00-73.38	3.14	4.49	4.10-4.90	83750.3 (P < 0.01)	99.4% (99.4%-99.4%)	0.00-16.88

¹Q: the Cochran’s Q statistic is a measure assessing the existence of heterogeneity in effect size (here, HCV Ab prevalence) across studies.

²I²: A measure assessing the magnitude of between-study variation that is due to true differences in effect size (here, HCV Ab prevalence) across studies rather than chance.

³Prediction interval: a measure estimating the 95% interval of the distribution of true effect sizes (here, HCV Ab prevalence).

⁴Countries include Iraq, Jordan, Lebanon, Palestine, and Syria.

⁵Countries include Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates.

⁶Countries include Djibouti, Somalia, Sudan, and Yemen.

⁷Countries include Algeria, Libya, Mauritania, Morocco, and Tunisia. Ab: Antibody; CI: Confidence interval; HCV: Hepatitis C virus.

Table 2 Results of meta-analyses on studies reporting HCV Ab prevalence among blood donors and in the general population in Europe

Subpopulation	Studies	Samples	HCV Ab prevalence		Pooled HCV Ab prevalence		Heterogeneity measures
	Total (n)	Total (n)	Range (%)	Median (%)	Mean (%)	95%CI	Q (P value)1	I² (confidence limits)2	Prediction interval (%)3
Blood donors	257	25232790	0.0-3.28	0.06	0.11	0.10-0.13	35657.5 (P < 0.01)	99.3 (99.3-99.3)	0.00-0.51
The general population	120	410444	0.0-16.83	1.11	1.59	1.25-1.97	9176.9 (P < 0.01)	98.7 (98.6-98.8)	0.0-7.57

¹Q: the Cochran’s Q statistic is a measure assessing the existence of heterogeneity in effect size (here, HCV Ab prevalence) across studies.

²I²: a measure assessing the magnitude of between-study variation that is due to true differences in effect size (here, HCV Ab prevalence) across studies rather than chance.

³Prediction interval: a measure estimating the 95% interval of the distribution of true effect sizes (here, HCV Ab prevalence). Ab: Antibody; CI: Confidence interval; HCV: Hepatitis C virus.

Table 3 Univariable and multivariable meta-regression models for HCV Ab prevalence among blood donors and the general population in Middle East and North Africa

	Studies	Samples		Univariable analysis				Multivariable analysisb
	Total (n)	Total (n)	RR (95%CI)		P value	F P valuea	Variance explained R2 (%)	ARR (95%CI)	P value
Subpopulations
Blood donors	686	46646973	1		-			1	-
The general population	527	2346185	2.92 (2.41-3.55)		< 0.001	< 0.001	10.73	1.72 (1.50-1.97)	< 0.001
Country/subregion
Afghanistan	46	749455	1		-			1	-
Egypt	263	1677272	14.89 (10.2-21.8)		< 0.001			9.48 (6.54-13.75)	< 0.001
Fertile Crescent1	221	3678408	0.52 (0.35-0.77)		< 0.001			0.49 (0.34-0.72)	< 0.001
Gulf2	241	21114208	1.24 (0.84-1.82)		0.280			0.82 (0.56-1.19)	0.398
Horn of Africa3	49	77628	2.05 (1.25-3.37)		0.005			1.33 (0.82-2.15)	0.244
Iran	123	16073479	0.50 (0.33-0.77)		< 0.001			0.42 (0.28-0.63)	< 0.001
Maghreb4	91	3523250	1.02 (0.66-1.56)		0.936			0.77 (0.51-1.16)	0.207
Pakistan	179	2099458	6.96 (4.71-10.29)		< 0.001	< 0.001	58.39	5.44 (3.73-7.93)	< 0.001
Year of data collection	1213	48993158	0.95 (0.94-0.97)		< 0.001	< 0.001	3.71	0.96 (0.95-0.97)	< 0.001

¹Countries include Iraq, Jordan, Lebanon, Palestine, and Syria.

²Countries include Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates.

³Countries include Djibouti, Somalia, Sudan, and Yemen.

⁴Countries include Algeria, Libya, Mauritania, Morocco, and Tunisia.

^aVariables with P ≤ 0.2 were eligible for inclusion in the multivariable analysis.

^bThe adjusted R-squared for the full model was 62.65%.

Ab: Antibody; ARR: Adjusted relative risk; CI: Confidence interval; RR: Relative risk.

Table 4 Subgroup analyses: Univariable and multivariable meta-regression models for HCV Ab prevalence among blood donors and the general population in Egypt, Pakistan, and rest of Middle East and North Africa countries

	Studies	Samples		Univariable analysis			Multivariable analysisb
	Total (n)	Total (n)	RR (95%CI)	P value	F P valuea	Variance explained R2 (%)	ARR (95%CI)	P value
Egypt
Subpopulations
Blood donors	116	1566669	1	-			1	-
The general population	147	110603	1.25 (1.00-1.57)	0.049	0.087	2.05	1.30 (1.07-1.59)	0.008
Year of data collection	263	1677272	0.94 (0.93-0.95)	< 0.001	< 0.001	24.48	0.94 (0.93-0.95)	< 0.001
Pakistan
Subpopulations
Blood donors	73	1797644	1	-			-	-
The general population	106	301814	2.52 (1.89-3.36)	< 0.001	< 0.001	19.03	-	-
Year of data collection	179	2099458	1.00 (0.98-1.03)	0.648	0.648	0.00	-	-
Rest of MENA countries
Subpopulations
Blood donors	497	43282660	1	-	-		1	-
The general population	274	1933768	1.80 (1.47-2.21)	< 0.001	< 0.001	5.44	1.73 (1.42-2.11)	< 0.001
Country/subregion
Afghanistan	46	749455	1	-	-		1	-
Fertile Crescent1	221	3678408	0.53 (0.35-0.81)	0.003			0.50 (0.33-0.75)	0.001
Gulf2	241	21114208	1.26 (0.83-1.91)	0.273			0.86 (0.56-1.30)	0.462
Horn of Africa3	49	77628	2.08 (1.22-3.54)	0.007			1.37 (0.81-2.32)	0.247
Iran	123	16073479	0.51 (0.33-0.81)	0.004			0.43 (0.28-0.67)	< 0.001
Maghreb4	91	3523250	1.04 (0.65-1.64)	0.883	< 0.001	11.48	0.79 (0.50-1.24)	0.298
Year of data collection	771	45216428	0.95 (0.94-0.96)	< 0.001	< 0.001	6.22	0.96 (0.95-0.98)	< 0.001

¹Countries include Iraq, Jordan, Lebanon, Palestine, and Syria.

²Countries include Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates.

³Countries include Djibouti, Somalia, Sudan, and Yemen.

⁴Countries include Algeria, Libya, Mauritania, Morocco, and Tunisia.

^aVariables with a P value ≤ 0.2 were eligible for inclusion in the multivariable analysis. No multivariable analysis was conducted for Pakistan, as only one variable qualified for inclusion in the model.

^bThe adjusted R-squared was 27.35% for the multivariable model for Egypt and 17.92% for the multivariable model for rest of MENA countries. Ab: Antibody; ARR: Adjusted relative risk; CI: Confidence interval; RR: Relative risk.

Table 5 Univariable and multivariable meta-regression models for HCV Ab prevalence among blood donors and the general population in Europe

	Studies	Samples		Univariable analysis			Multivariable analysisb
	Total (n)	Total (n)	RR (95%CI)	P value	F P valuea	Variance explained R2 (%)	ARR (95%CI)	P value
Subpopulations
Blood donors	257	25232790	1				1
The general population	120	410444	15.57 (11.83-20.49)	< 0.001	< 0.001	53.62	15.10 (11.48-19.86)	< 0.001
Year of data collection	377	25643234	0.93 (0.88-0.98)	0.004	0.005	2.17	0.96 (0.92-0.99)	0.020

^aVariables with P ≤ 0.2 were eligible for inclusion in the multivariable analysis.

^bThe adjusted R² for the full model was 54.27%.

Ab: Antibody; ARR: Adjusted relative risk; CI: Confidence interval; RR: Relative risk.