Uncovering the burden of hookworm and co-infections in Southeast Asia: a systematic review on human and small animal populations

Purpose: Hookworm infection remains a major public health concern, particularly in tropical regions such as Southeast Asia (SEA), where environmental and socio-economic conditions favour transmission. Despite the substantial burden, current knowledge of hookworm epidemiology in SEA remains fragmented as limited efforts have been made to synthesis findings across human and small animal populations. Methods: This systematic review aimed to summarize existing literature from January 1, 2015 through March 7, 2025 on the prevalence and risk factors of hookworm infection in both human and small animal populations across SEA. Results: Pooled hookworm prevalence was 9.1% (95% CI: 6.6%–12.3%) among 10 2064 humans and 34.3% (95% CI: 21.6%–49.8%) among 4 219 small animals. In humans, the most prevalent combination was hookworm, Trichuris spp., and Ascaris spp. (15.6%, 95% CI:14.7%–16.5%), followed by hookworm and Strongyloides spp. (14.0%, 95% CI: 13.2%–14.8%). Animal hookworm coinfection was frequently associated with Toxocara spp. (57.7%, 95% CI: 52.4%–62.9%). Conclusion: These findings highlight the complex nature of hookworm transmission in SEA, imply the need for integrated One Health based control strategies. Future research is recommended to focus on urban settings and investigate host-parasites interactions underlying coinfections to support the development of more effective and context specific intervention strategies.

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