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Environmental contamination of vegetables and fruits with intestinal protozoan trophozoites, cysts and oocysts is a means of transmitting parasitic agents of public health importance. The purpose of this systematic review and meta-analysis was to determine the global prevalence of intestinal protozoan parasite contamination in vegetables and fruits. Several databases (Web of Science, PubMed, Scopus, ProQuest and Google Scholar) were searched for literature published up to August 2021. Pooled prevalence was determined using the meta-package in R (version 3.6.1). Out of 90,404 publications, 189 articles (202 datasets) met the inclusion criteria. Among these, 183 investigations documented protozoan contamination in vegetables and 20 in fruits. The pooled prevalence (95% confidence interval) was 20% (16%–24%) for vegetables and 13% (7%–21%) for fruits. The highest pooled prevalence was found in South-East Asian WHO region 37% (6%–76%). The most prevalent protozoan parasite in vegetables was Cryptosporidium spp. (11%, 7%–15%). As well, Entamoeba histolytica was the most common agent found in fruits (9%, 4%–14%). Furthermore, the unwashed samples had the highest pooled prevalence of contamination (22%, 3%–49%). Our data suggest a possible risk of protozoan infection in humans via unwashed vegetables and fruits. Accidental ingestion of protozoa occurs through consumption of contaminated vegetables and fruits that have been improperly washed and prepared under poor sanitation. Using sanitary irrigation water, consuming properly cleaned and cooked vegetables, and practicing good hygiene can all assist to reduce the risk of protozoa infection. [ABSTRACT FROM AUTHOR]

Accidental ingestion of infective stages of helminths through consumption of contaminated vegetables and fruits causes a wide range of food-borne diseases in humans. This systematic review and meta-analysis evaluated the global incidence of helminthic contamination of vegetables, cucurbits and fruits. Several databases (Science Direct, Web of Science, PubMed, Scopus, and Google Scholar) were searched for literature published prior to November 2020. Overally, 184 articles (32 countries) met the inclusion criteria. Among these, 137 studies documented helminthic contamination in vegetables, 46 in cucurbits and 9 were in fruits. The pooled incidence (95% confidence interval) was 31% (26%–37%) for vegetables, 20% (14%–27%) for cucurbits and 20% (8%–37%) for fruits. The highest incidence rate was found in the Western Pacific WHO region (54%; 9%–95%). The most prevalent parasitic agents were Ascaris lumbricoides eggs (12%; 9%–15%) and Strongyloides stercoralis larvae (12%; 8%–16%) in vegetables, S. stercoralis larvae (10%; 5%–15%) and Toxocara spp. eggs (10%; 3%–21%) in cucurbits, and Trichuris trichiura eggs (9%; 1%–22%) in fruits. The highest incidence rate was found to be associated with lower-middle income countries (34%, 28%–41%) and regions with a tropical rainforest climate (50%, 10%–91%). The potential role of vegetables, cucurbits, and fruits in the spread of helminthic parasites was revealed. Utilizing clean water for irrigation, proper washing and cooking of vegetables and improved sanitary practices can decrease the public health hazard regarding the consumption of vegetables, cucurbits, and fruits. • We estimated the global incidence of helminthic contaminated vegetables, cucurbits, and fruits. • The prevalence was 31%, 20%, and 20% for vegetables, cucurbits and fruits, respectively. • The highest prevalence rate was in Western Pacific WHO region 54%. • The highest helminthic contamination was related to tropical rainforest climate 50%. [ABSTRACT FROM AUTHOR]