Prevalence and Historical Trends of Trachoma in Egypt: A Systematic Review and Meta-Analysis.

Rationale: Trachoma remains a leading cause of preventable blindness that has long persisted in Egypt. Global estimates tend to undervalue the actual national prevalence, and no previous analysis has comprehensively mapped the temporal and regional trends within the country. The present study addresses these gaps to guide elimination efforts and policy planning. Objective: To estimate the prevalence of active and chronic trachoma and associated visual impairment and blindness in Egypt through a comprehensive systematic review and meta analysis. Methods: We prospectively registered with PROSPERO (CRD420251070078) and adhered to PRISMA 2020 and Cochrane standards. Three independent reviewers searched 10 databases without language restrictions for population-based, cross-sectional surveys that reported WHO-graded trachoma outcomes. Two reviewers independently screened records, extracted data, and assessed bias using the Joanna Briggs Institute (JBI) checklist; Grading of Recommendations, Assessment, Development and Evaluations (GRADE) appraised evidence certainty. We transformed proportions using the Freeman-Tukey double arcsine transformation, pooled estimates using random-effects meta-analysis and directly age-standardized them to Egypt's 2000-2020 population structure. We performed sensitivity, subgroup, and meta-regression analyses to explore heterogeneity. Results: From 16 cross sectional surveys (n = 45 934), the pooled age standardized prevalence estimates were as follows: active trachoma in children (1-9 years) 10.8% (95% CI; 7.0-14.6), visual impairment in those cases 5.3% (95% CI; 3.2-7.5), chronic trachoma in adults (≥ 15 years) 7.2% (95% CI; 4.0-10.4), associated visual impairment 1.6% (95% CI; 1.0-2.2), and blindness 0.7% (95% CI; 0.1-1.9). Sensitivity, subgroup, and meta regression analyses demonstrated consistent estimates and no evidence of small study effects. Conclusion: Despite substantial declines, active and chronic trachoma remain well above elimination thresholds in Egypt. These findings underscore the need for sustained implementation of the SAFE strategy-particularly enhanced water, sanitation, and hygiene (WASH) infrastructure, ongoing surveillance, and targeted surgical outreach-and call for harmonized survey methods to guide and evaluate future control efforts.