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Prevalence of Intestinal Protozoan Parasites Among Food Handlers in Iran: A Systematic Review and Meta‑Analysis
<p><strong>Background:</strong> Intestinal protozoa are significant causes of foodborne diseases in food handlers who may also act as carriers of no signs of infection. Food handling is an important occupation in Iran; although a national estimate of intestinal protozoan prevalence has been previously reported, it is now outdated and more recent data is required. Therefore, we aimed to determine the pooled prevalence of intestinal protozoan parasites and examine geographic variation among food handlers in Iran.</p>
<p><strong>Methods:</strong> A systematic literature search was conducted using PubMed, Scopus, Embase, Web of Science, and Google Scholar up to 2025. Cross‑sectional studies reporting the prevalence of intestinal protozoa among Iranian food handlers were included. Pooled prevalence with 95% confidence intervals (CIs) was calculated using a random‑effects model.</p>
<p><strong>Results:</strong> Twenty‑four studies with 110,404 food handlers were included. The overall pooled prevalence of intestinal protozoan infection was 14.1% (95% CI: 9.2% – 21.0%). <em>Blastocystis hominis</em> was the most common parasite (11.2%), followed by <em>Entamoeba coli</em> (8.2%), <em>Giardia lamblia </em>(5.4%), and <em>Chilomastix mesnili </em>(5.4%).</p>
<p><strong>Conclusion:</strong> Approximately one in seven food handlers in Iran harbors intestinal protozoan parasites, with profound geographic disparities. Targeted interventions, including periodic stool screening and hygiene training, are urgently needed, particularly in high‑prevalence provinces.</p>
<p><strong> </strong></p>
https://creativecommons.org/licenses/by/4.0
Sayed Hussain Mosawi, Ahmad Wali Ataye, Ahmad Jamshid Mehrpoor, Zahra Ramezani, Fatemeh Ghasemi, Ioannis Adamopoulos, Milad Badri
2026
Intestinal protozoa
Food handlers
Iran
Systematic review
Meta analysis
Prevalence
Sayed Hussain
Mosawi
Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
AF
sayedhussain.mosawi@ghalib.edu.af
Ahmad
Wali Ataye
Department of Public Health, Faculty of Medicine, Afghan Islamic International University, Kabul, Afghanistan.
AF
prof.atayekakar@kums.edu.af
Ahmad Jamshid
Mehrpoor
Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
AF
jamshid.mehrpoor@ghalib.edu.af
Zahra
Ramezani
Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
IR
Ram.faeze@gmail.com
Fatemeh
Ghasemi
Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
IR
M.ghasemei64@gmail.com
Ioannis
Adamopoulos
Department of Public Health Policy, Sector of Occupational and Environmental Health, School of Public Health, University of West Attica, Athens, Greece.
GR
iadamopoulos@uniwa.gr
Milad
Badri
Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
IR
Badri22.milad@gmail.com
195
PDF
0
Grace D. Food safety in low and middle income countries. Int J Environ Res Public Health. 2015;12(9):10490–507.
La Hoz RM, Morris MI, of Practice ASTIDC. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13618.
Candela E, Goizueta C, Periago MV, Muñoz-Antoli C. Prevalence of intestinal parasites and molecular characterization of Giardia intestinalis, Blastocystis spp. and Entamoeba histolytica in the village of Fortn Mbororé (Puerto Iguazú, Misiones, Argentina). Parasit Vectors. 2021;14(1):510.
Khan W, Arshad S, Khatoon N, Khan I, Ahmad N, Kamal M, et al. Food handlers: an important reservoir of protozoans and helminth parasites of public health importance. Brazilian J Biol. 2022;82:e238891.
Yimam Y, Woreta A, Mohebali M. Intestinal parasites among food handlers of food service establishments in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2020;20(1):73.
Amegah KE, Addo HO, Ashinyo ME, Fiagbe L, Akpanya S, Akoriyea SK, et al. Determinants of hand hygiene practice at critical times among food handlers in educational institutions of the Sagnarigu municipality of Ghana: a cross-sectional study. Environ Health Insights. 2020;14:1178630220960418.
Abera W, Gintamo B, Shitemaw T, Mekuria ZN, Gizaw Z. Prevalence of intestinal parasites and associated factors among food handlers in food establishments in the Lideta subcity of Addis Ababa, Ethiopia: an institution-based, cross-sectional study. BMJ Open. 2022;12(7):e061688.
Eslahi AV, Olfatifar M, Zaki L, Saryazdi AK, Barikbin F, Maleki A, et al. Global prevalence of intestinal protozoan parasites among food handlers: A systematic review and meta-analysis. Food Control. 2022;109466.
Gebretsadik D, Tesfaye M, Adamu A, Zewde G. Prevalence of intestinal parasitic infection and its associated factors among school children in two primary schools in Harbu Town, North East Ethiopia: cross-sectional study. Pediatr Heal Med Ther. 2020;179–88.
Sharifi-Sarasiabi K, Heydari-Hengami M, Shokri A, HosseyniTeshnizi S. Prevalence of intestinal parasitic infection in food handlers of Iran: A systematic review and meta-analysis. Vet Med Sci. 2021;7(6):2450–62.
Speich B, Croll D, Fuerst T, Utzinger J, Keiser J. Effect of sanitation and water treatment on intestinal protozoa infection: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(1):87–99.
Gutiérrez L, Bartelt L. Current understanding of Giardia lamblia and pathogenesis of stunting and cognitive deficits in children from low-and middle-income countries. Curr Trop Med reports. 2024;11(1):28–39.
Shirley DA, Hung CC, Moonah S. Entamoeba histolytica (amebiasis). In: Hunter’s tropical medicine and emerging infectious diseases. Elsevier; 2020. p. 699–706.
Amoak S, Soldera J. Blastocystis hominis as a cause of chronic diarrhea in low-resource settings: A systematic review. World J Meta-Analysis. 2024;12(3).
Balendran T, Iddawela D, Lenadora S. Cryptosporidiosis in a zoonotic gastrointestinal disorder perspective: present status, risk factors, pathophysiology, and treatment, particularly in immunocompromised patients. J Trop Med. 2024;2024(1):6439375.
Korpe PS, Haque R, Gilchrist C, Valencia C, Niu F, Lu M, et al. Natural history of cryptosporidiosis in a longitudinal study of slum-dwelling Bangladeshi children: association with severe malnutrition. PLoS Negl Trop Dis. 2016;10(5):e0004564.
Ahmed Ak, Sanadeki Mm, Abd Rabou Ram, Kamal Am, Abdel-Ghany Wm, Abdelrehim Mg. Prevalence and associated risk factors of Cyclospora cayetanensis and Cystoisospora belli infections among adult immune-competent patients with diarrhea attending Minia University Hospitals, Egypt. J Egypt Soc Parasitol. 2021;51(1):17–22.
Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One. 2016;11(1):e0147601.
Rouhani S, Kochesfahani Reshad M, Athari A. Surveying the Prevalence of Intestinal Parasites' Infection in Food Handlers in Nowshahr and Chalous. Research in Medicine. 2000;24(1):15-20.
Ketabi P, Shadzi SH, Samarian H, Mohammad ZZ. Intestinal parasitic infection in foodhandlers: in the hospitals affiliated to Isfahan University of Medical Sciences–1997. J Res Med Sci. 2001: 140-142.
Neghab M, Moosavi S, Moemenbellah-Fard MD. Prevalence of Intestinal Parasitic Infections among Catering Staff of Students”. Pak J Biol Sci. 2006;9(14):2699-703.
Kheirandish F, Tarahi MJ, Haghighi A, Nazemalhosseini-Mojarad E, Kheirandish M. Prevalence of intestinal parasites in bakery workers in Khorramabad, Lorestan Iran. Iran J Parasitol. 2011;6(4):76-83.
Fallah M, Sadeghian S, Taherkhani H, Habibi F, Barghi ZH. Study of parasitic and bacterial infections in the food-handling personnel, Ramadan, Iran. J Res Health Sci . 2011; ;4(1):3-10.
Garedaghi Y, Mashaei SS. Parasitic infections among restaurant workers in Tabriz (East-Azerbaijan province) Iran. Res J Med Sci. 2011;5(2):.116-118.
Saki J, Khademvatan S, Masoumi K, Chafghani M. Prevalence of intestinal parasitic infections among food handlers in Khuzestan, Southwest of Iran: A 10-year retrospective study. Afr J Microbiol Res. 2012;6(10):2475-80.
Koohsar F, Amini A, Ayatollahi AA, Noshak GH, HedayatMofidi HS, Namjoo M. The prevalence of intestinal parasitic infections in food handlers in Gorgan, Iran. Med Lab J.. 2012; 6(1): 27-34
Safi M, Tavalla M, Mardani M, Afrisham R. Prevalence of intestinal parasitic infections among applicants for health cards attending Ahvaz East Health Center during 2012–2013. Asian Pac J Trop Dis. 2016; 1;6(2):151-4.
Salary S, Safizadeh H. Prevalence of intestinal parasite infestation in the food suppliers of Kerman City, Iran, in 2010. Health dev. j. . 2013; 1;1(4):315-22.
Garedaghi Y, Firouzivand Y. Protozoan infections of restaurant workers in Tabriz, Iran. Crescent J Med Biol Sci. 2014; 1 (2):46-48
Kheirandish F, Tarahi MJ, Ezatpour B. Prevalence of intestinal parasites among food handlers in Western Iran. Rev Inst Med Trop Sao Paulo . 2014;56(2):111-4.
Motazedian MH, Najjari M, Ebrahimipour M, Asgari Q, Mojtabavi S, Mansouri M. Prevalence of intestinal parasites among food-handlers in Shiraz, Iran. Iran J Parasitol. 2015;10(4): 652–657
Sharif M, Daryani A, Kia E, Rezaei F, Nasiri M, Nasrolahei M. Prevalence of intestinal parasites among food handlers of Sari, Northern Iran. Rev Inst Med Trop Sao Paulo. 2015;57(2):139-44.
Balarak D, Modrek MJ, Bazrafshan E, Ansari H, Kord Mostafapour F. Prevalence of intestinal parasitic infection among food handlers in northwest Iran. J Parasitol Res. 2016;2016(1):8461965.
Balarak D, Ansari H. Prevalence of intestinal parasites among the food handlers in the city of Qom, 2014. J Community Health.. 2017;8(4):20-8.
Hooshyar H, Ghafarinasab S, Arbabi M, Delavari M, Rasti S. Genetic variation of Giardia lamblia isolates from food-handlers in Kashan, Central Iran. Iran J Parasitol 2017;12(1):83-89.
Beiromvand M, Mirrezaie E, Mirzavand S. Foodborne Giardiasis: is there any relationship between food handlers and transmission of Giardia duodenalis?. Infect Disord Drug Targets (Formerly Curr Drug Targets Infect Disord.). 2017;17(2):72-6.
Heydari-Hengami M, Hamedi Y, Najafi-Asl M, Sharifi-Sarasiabi K. Prevalence of intestinal parasites in food handlers of Bandar Abbas, Southern Iran. Iran J Public Health. 2018;47(1):111-118.
Khodabakhsh Arbat S, Hooshyar H, Arbabi M, Eslami M, Abani B, Poor Movayed R. Prevalence of intestinal parasites among food handlers in Kashan, central Iran, 2017–2018. J Parasit Dis. 2018;42(4):577-81.
Mohammadzadeh A, Spotin A, Galeh TM, Fadaee M. The prevalence of intestinal parasites in staff working at the restaurants of Tabriz city. Med J Tabriz Univ Med Sci. 2018;40(4):60-6.
Hatami H, Azarbarzin V. The prevalence of intestinal parasitic infections in food handlers health applicants in areas covered by Shomal Health Center in Tehran in 2016. J Community Health 2018;5(1):22-9.
Shahnazi M, Sadeghi M, Saraei M, Alipour M, Hajialilo E. Prevalence of parasitic intestinal infections among food handlers in Qazvin, Iran. Turkiye Parazitol Derg. 2019; 43(1):16-20.
Shahnazi M, Abdollahpour H, Alipour M, Sadeghi M, Saraei M, Hajialilo E, Heydarian P. Prevalence of intestinal parasites in food handlers of the city of Saqqez in 2016. J Parasit Dis. 2019;43(1):113-9.
Teimouri A, Keshavarz H, Mohtasebi S, Goudarzi F, Mikaeili F, Borjian A, Allahmoradi M, Yimam Y, Afshar MJ. Intestinal parasites among food handlers in Iran: a systematic review and meta-analysis. Food Microbiol. 2021;95:103703.
Sinclair JB. Blastocystis hominis: the fascinating enigma. Aust J Med Sci. 2016;37(1):2–12.
Jafari A, Bahrami F, Nasiri-Kalmarzi R, Abdoli A. Chronic urticaria associated with Blastocystis hominis infection. Arch Dermatol Res. 2024;316(7):413.
Eltayeb LB, Al-Zahrani SA, Al-Hoechel LH, Ali H. Bacteriological and parasitological assessment of apparently healthy food handlers at Al-Kharj province/KSA: a cross-sectional prospective study. Int J Pharm Phytopharm Res. 2020;10(4):103–11.
Rossi F, Amadoro C, Santonicola S, Marino L, Colavita G. Protozoan Infections Acquired from Food or Drinking Water: An Update. Appl Sci. 2024;14(12): 5339
Jiang C, Lacante SA, Mizuno T, Syafruddin D, Tokoro M. Genetic diversity of genus Chilomastix: molecular classification of C. mesnili and other potential species variations in humans and animals. Trop Med Health. 2025;53(1):40.
Njambi E, Magu D, Masaku J, Okoyo C, Njenga SM. Prevalence of intestinal parasitic infections and associated water, sanitation, and hygiene risk factors among school children in Mwea Irrigation Scheme, Kirinyaga County, Kenya. J Trop Med. 2020;2020(1):3974156.
Zhou XN, editor. Surveillance and Management of Parasitic Diseases in China. Singapore: Springer Nature; 2024. 315.
Mbewe Z. Demonstration of presence of human helminthes and protozoa in faecal matter from pit latrines of selected residential compounds in Lusaka, Zambia [thesis]. Lusaka, Zambia: The University of Zambia; 2020 [cited 2026 Jul 22]. Available from: http://dspace.unza.zm/handle/123456789/6867
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