Prevalence and genotype distribution of human norovirus infections in Ghana: A systematic review and meta-analysis

Introduction: Noroviruses are significant contributors to acute gastroenteritis (AGE), accounting for 16% to 18% of AGE cases globally and resulting in an estimated 685 million illnesses and 210 000 deaths annually. Most fatalities occur in low-resource countries, particularly among young children and the elderly. Despite bearing the highest burden, low-resource countries often have limited data due to underreporting and inadequate surveillance systems. This systematic review aimed to assess the prevalence and genotype distribution of norovirus in Ghana, synthesising existing research to identify gaps and inform effective prevention strategies. Understanding the impact of norovirus in Ghana is vital for targeted interventions and enhancing public health responses, especially with advancing vaccine development. Method: This systematic review was conducted following PRISMA guidelines. The literature search was conducted in PubMed, Web of Science, Scopus, and the Google Scholar search engine using predefined search terms. Descriptive statistics and proportional meta-analysis utilising a random-effects model with a 95% confidence interval were employed in the data analysis. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool was used to evaluate the quality of reporting in the eligible studies. Result: This study analysed data from 7 articles, comprising a total of 3562 samples, with 722 confirmed norovirus-positive cases. Meta-analysis using a random-effects model revealed an overall prevalence of 14.8% (95% CI: 7.0%-22.6%). Genotype II was identified as the predominant genotype. Conclusion: This review and meta-analysis confirms that human norovirus is a significant public health burden in Ghana, particularly among children under five. However, the true burden is likely underestimated due to limited and geographically constrained surveillance. These findings emphasise the need for strengthened, systematic national surveillance and further research to fully define the epidemiology of norovirus in Ghana, which is essential for guiding effective evidence-based control interventions. It is also important to implement robust hygiene promotion measures to curb the transmission of norovirus in Ghana.