Tinea capitis among children under eighteen years of age in Sub Saharan Africa a systematic review and meta analysis

Abstract

Tinea capitis is a prevalent superficial fungal infection of the scalp and hair that causes significant morbidity and social stigma among children. Sub-Saharan Africa (SSA) bears a high burden due to climatic and socioeconomic factors. This review aimed to estimate the pooled prevalence of tinea capitis among children under 18 years in SSA and evaluate epidemiological drivers. A systematic search was conducted following PRISMA 2020 guidelines across PubMed, EMBASE, Web of Science, and African databases through March 15, 2024. Peer-reviewed studies reporting prevalence in pediatric populations within SSA were selected. A random-effects model using back-transformed estimates was employed to calculate pooled prevalence. Heterogeneity was quantified using the I² statistic. Subgroup analyses were performed by diagnostic methodology and geographic region. Twenty-seven studies met the inclusion criteria. The meta-analysis revealed a pooled prevalence of 34% (95% CI: 24%–44%). Significant heterogeneity was observed (Cochran’s Q = 76.76, df = 26, p < 0.0001; I² = 69.5%). Subgroup analysis indicated that clinical-only diagnosis resulted in higher prevalence estimates (42.0%) compared to laboratory-confirmed cases (26.4%). Regional analysis showed the highest burden in West Africa (38.2%). No evidence of publication bias was found (Egger’s test p = 0.19). Tinea capitis is hyperendemic in Sub-Saharan Africa, affecting approximately one in three children. The high heterogeneity suggests complex local epidemiological drivers. Urgent measures including school-based surveillance and improved access to diagnostics are required to mitigate this burden.