# The magnitude of anemia among visceral leishmaniasis patients in Ethiopia: a systematic review and meta-analysis

## TL;DR

This study finds that nearly 90% of visceral leishmaniasis patients in Ethiopia suffer from anemia, highlighting the need for regular blood tests to monitor and manage this condition.

## Contribution

The study provides the first pooled prevalence estimate of anemia among visceral leishmaniasis patients in Ethiopia using a systematic review and meta-analysis.

## Key findings

- The overall pooled prevalence of anemia among visceral leishmaniasis patients in Ethiopia is 88.91%.
- The highest regional prevalence of anemia was observed in the Tigray region at 96.0%.
- Anemia prevalence varied slightly by study design, with the highest rate in cross-sectional studies at 93.6%.

## Abstract

Anemia is the most common hematological manifestation among visceral leishmaniasis patients. The cause of anemia is multifactorial: sequestration and destruction of red blood cells in an enlarged spleen, immune mechanisms, and alterations in RBC membrane permeability have been implicated. Studies on the magnitude of anemia among visceral leishmaniasis patients were inconsistent. Therefore, this review aimed to estimate the pooled prevalence of anemia among visceral leishmaniasis patients in Ethiopia.

This systematic review and meta-analysis followed the PRISMA guidelines. Comprehensive searches were conducted in PubMed/MEDLINE, Embase, Science Direct, African journals online, and grey literatures like Google Scholar and Google, of studies published from inception to January 2025, supplemented by manual searches to identify relevant studies. Three authors independently selected studies, extracted data, and assessed the critical appraisal of studies. The JBI critical appraisal tool was used for quality appraisal. Statistical analyses were performed using Stata 11.0 software. The I2 test statistic was used to test the heterogeneity of the included studies. Moreover, Funnel plots analysis and Egger-weighted regression tests were done to detect publication bias. The overall pooled prevalence was calculated using the random-effects model.

A total of 9 eligible studies with 2,075 study participants were included to estimate the pooled prevalence of anemia among visceral leishmaniasis patients. The combined prevalence of anemia among visceral leishmaniasis patients was 88.91% (95% CI: 84.45–93.37). Regionally, the highest prevalence of anemia among studies conducted in the Tigray region was 96.0% (95% CI; 92.0-99.9). Moreover, the prevalence of anemia among visceral leishmaniasis patients according to the study design was 88.0% (95% CI; 81.8–94.1), 93.6% (95% CI; 87.9–99.3), and 85.5% (95% CI; 82.0-88.9) in a retrospective cross-sectional study, cross-sectional study, and the retrospective cohort study respectively.

This systematic review and meta-analysis found a high prevalence of anemia among visceral leishmaniasis patients in Ethiopia. Red blood cell parameters should be assessed regularly to prevent and monitor anemia disorders in those study groups.

The online version contains supplementary material available at 10.1186/s12879-025-12237-y.