A systematic review and meta-analysis on the prevalence of vulvovaginal candidiasis in Southeast Asian countries

Vulvovaginal candidiasis (VVC) is a disease caused by pathogenic Candida species. This disease typically affects women of reproductive age with high sexual activity (i.e., sex workers), poor educational attainment and economic status, and infrequent hygiene practices. VVC remains a major public health concern. VVC prevalence across Southeast Asian countries remains poorly understood. To address this concern, the current study estimated the current prevalence of VVC infections among women in Southeast Asian countries by conducting a systematic review and meta-analyses. All studies reporting the prevalence of VVC in Southeast Asia were obtained from Ovid Medline, Scopus, and CINAHL. A review of titles and abstracts was done independently by three reviewers. The quality of the studies was assessed using the Newcastle-Ottawa scale. Meta-analysis was performed in R v.4.1,1 using the ‘meta’ package (version 4.19-0). Based on the results of the current study, the pooled estimated prevalence of VVC among Southeast Asian women is 23.0% (95% CI: 18.0% to 28.0%). Across countries, Laos had the highest estimated prevalence at 33.0% (95% CI: 22.0% to 46.0%). Subgroup analysis based on pregnancy status and occupation revealed a higher estimated prevalence among non-pregnant women (32.0%, 95% CI: 25.0% to 40.0%) and non-sex workers (33.0%, 95% CI: 20.0% to 48.0%). Based on the diagnostic method, the prevalence was higher for the combinatorial approach using microscopy, a culture-based approach, and molecular techniques (51.0%) and lowest when solely based on clinical diagnosis (9.0%, 95% CI: 1.0% to 22.0%) or an exclusively culture-based approach (11%, 95% CI: 6.0% to 18.0%). Overall, further study is necessary to accurately characterize the current distribution of VVC across Southeast Asian countries. Developing more effective diagnostic and management strategies is to improve the health of affected women.