Epidemiology and genetic variation of acute viral gastroenteritis in children under five years in the Middle East (2020–2025): a systematic review and meta-analysis
Abstract
Acute viral gastroenteritis remains a major cause of morbidity and hospitalization among children under five years worldwide. In the Middle East, epidemiological and molecular evidence remains fragmented, particularly in the post-COVID-19 period. This systematic review and meta-analysis aimed to synthesize recent data (2020–2025) on the prevalence, genetic diversity, and co-infection patterns of enteric viruses among children aged 0–59 months in the region. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and the WHO Global Index Medicus identified eligible observational and molecular studies published between 1 January 2020 and 31 May 2025. Study selection, data extraction, and risk-of-bias assessment were independently conducted by two reviewers according to PRISMA 2020 guidelines. The protocol was prospectively registered in PROSPERO (CRD420251064184). Pooled prevalence estimates were calculated using a random-effects model with Freeman–Tukey double arcsine transformation. Forty-three studies, including 22,021 children tested for acute gastroenteritis (AGE) from nine Middle Eastern countries, met the inclusion criteria. Rotavirus (28 studies) was the most prevalent pathogen, with a pooled prevalence of 30.4% (95% CI: 24.3–35.8; I² = 96%, p < 0.001), followed by norovirus (12 studies) at 23.5% (95% CI: 11.4–29), adenovirus (13 studies) at 11.3% (95% CI: 8.6–17.6), and astrovirus (10 studies) at 6.0% (95% CI: 1.3–12.7). Predominant rotavirus…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 22,021 participants or records.
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