Global Prevalence, Regional Distribution, and Demographic Patterns of Schistosomal Appendicitis: A Systematic Review and Meta-Analysis.

The prevalence of schistosomal appendicitis (SA) remains uncertain due to its infrequent occurrence in medical practice. This systematic review and meta-analysis aimed to determine the global prevalence and distribution patterns of SA. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five databases were searched up to June 2025. Eligible studies were observational cohorts reporting histologically confirmed cases of SA from appendectomy specimens. Two independent reviewers conducted data extraction, and study quality was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies. A random-effects meta-analysis was performed to estimate pooled prevalence, with subgroup analyses by endemicity, region, income level, and study period. Twenty-four studies comprising 41,301 appendectomy specimens were included. The global pooled prevalence of SA was 1.84% (95% CI: 1.13%-2.71%). Prevalence was higher in endemic regions (2.67%, 95% CI: 1.81%-3.69%) than in non-endemic regions (0.16%, 95% CI: 0.10%-0.24%). Lower-middle-income countries had the highest prevalence (2.66%, 95% CI: 1.94%-3.47%), followed by upper-middle-income (2.10%, 95% CI: 0.55%-4.58%) and high-income countries (0.59%, 95% CI: 0.24%-1.08%). Regionally, Africa had the highest pooled prevalence (3.22%, 95% CI: 1.69%-5.18%), followed by Asia (1.01%, 95% CI: 0.39%-1.91%). Among 247 histologically confirmed cases, 91.92% (95% CI: 76.22%-100.00%) showed appendiceal inflammation. A temporal trend indicated rising SA prevalence after 2015, and a male predominance was noted, with a male-to-female ratio of 2.78:1. Heterogeneity among studies was high (I² = 96.7%), and funnel plot analysis suggested potential publication bias. Despite declining global incidence, SA remains a significant cause of appendicitis in endemic areas. Routine histopathological examination of appendectomy specimens is recommended, alongside sustained control and elimination efforts to reduce disease burden.