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Home / Equine Research Bank / Equine Vet J / Equine trypanosomiasis, a systematic review and meta-analyse...
Equine veterinary journal2025; 58(2); 291-319; doi: 10.1111/evj.70101

Equine trypanosomiasis, a systematic review and meta-analyses: Prevalence, morbidity and mortality.

Abstract: Equine trypanosomiasis is a neglected protozoal disease. Objective: To perform a systematic search of literature to explore: (1) In equines what is the global geographical distribution and prevalence of trypanosomiasis? In low and middle-income countries (LMICs) is trypanosomiasis more prevalent than in higher-income countries (HICs)? (2) Is trypanosomiasis infection a significant contributor to global morbidity and mortality? Methods: Systematic review and meta-analyses. Methods: Studies were identified that described naturally occurring equine trypanosomiasis worldwide following 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' using eight international databases (1980-2022). Equine population data for each country were extracted. Meta-analyses were used to estimate point prevalence and disease characteristics. Country exposure risk to equines (negligible/low/medium/high) and clinical data (Trypanosoma sp.; outbreak (O) vs. endemic (E) disease) were categorised. Results: Study quality was assessed (Question 1 prevalence: n = 147 manuscripts, median grade 'medium' (4/8 (range 2-6)); Question 2 morbidity and mortality: n = 46 'moderate' (n = 1), 'low' (n = 20) or 'very low' (n = 25)). Heterogeneity was high. LMICs were more likely to report disease (41/125; 33% vs. 7/80, 9%; (p < 0.001; OR 5.1 (2.1-14.2))). Fifty-six percent of the world's equines reside in a 'medium'/'high' risk country (61,507,601). Disease characteristics were summated. For Trypanosoma evansi: (O) Infection rate (IR) (42%; 95% CI 14-76), morbidity (47%; (13-85)), mortality (23%; 7-54) and death to case ratio (DCR) (45%; 20-73). Trypanosoma equiperdum: (O) IR 12% (7-18), morbidity 25% (9-49). Tsetse transmitted trypanosomiasis (O): IR 46% (29-63), morbidity 46% (29%-63%), mortality 6% (1-19), DCR 12% (2-38). (E) IR 50% (20-60), morbidity (no data), mortality 11% (7-14), DCR 9% (5-16). Trypanosoma vivax (O) IR 43% (10-83), morbidity 43% (10-83), mortality 15% (0-100), DCR 32% (0-100). Conclusions: Publication bias, heterogeneity, descriptive data, missing data. Conclusions: Equine trypanosomiasis predominates in LMICs. Conservatively, globally more than eight million equines are estimated to be affected, with substantial morbidity and mortality.
© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2025-10-23 PubMed ID: 41131780PubMed Central: PMC12892385DOI: 10.1111/evj.70101Google Scholar: Lookup
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  • Journal Article
  • Systematic Review
  • Meta-Analysis
  • Review

Summary

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Overview

  • This research systematically reviews and analyzes the global prevalence, morbidity, and mortality of equine trypanosomiasis, a neglected protozoal disease affecting horses and related animals.
  • The study compares disease prevalence between low and middle-income countries (LMICs) and higher-income countries (HICs) and evaluates the impact of infection on animal health worldwide.

Introduction and Objectives

  • Equine trypanosomiasis is a protozoal infection that affects equines (horses, donkeys, mules) and is often overlooked in veterinary and epidemiological research.
  • The study aims to:
    • Map the global geographical distribution and prevalence of equine trypanosomiasis.
    • Compare prevalence rates between LMICs and HICs.
    • Determine the extent to which trypanosomiasis contributes to morbidity (disease symptoms/impact) and mortality in equines globally.

Methods

  • A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
  • Eight international databases were searched for studies on naturally occurring equine trypanosomiasis from 1980 to 2022.
  • Data were extracted on:
    • Country-level equine population sizes.
    • Prevalence and clinical characteristics of disease.
    • Exposure risk to trypanosomiasis categorized as negligible, low, medium, or high.
    • Disease pattern classified as outbreak (O) versus endemic (E).
  • Meta-analyses were performed to estimate point prevalence, morbidity, mortality, and death-to-case ratio (DCR).
  • Quality assessments:
    • 147 manuscripts evaluated for prevalence data with medium quality on average.
    • 46 manuscripts evaluated for morbidity and mortality, mostly low or very low quality.
    • High heterogeneity was noted among studies, indicating variations in study designs, populations, and outcomes.

Key Findings: Prevalence and Geography

  • LMICs reported a significantly higher prevalence of equine trypanosomiasis compared to HICs:
    • 33% of LMICs reported disease versus 9% of HICs.
    • Odds ratio (OR) for reporting disease in LMICs vs. HICs was 5.1, indicating LMICs are over five times more likely to report disease.
  • More than half (56%) of the global equine population (~61.5 million animals) resides in countries with medium to high risk for trypanosomiasis exposure.

Key Findings: Disease Characteristics by Trypanosoma Species and Disease Patterns

  • Trypanosoma evansi (Outbreaks):
    • Infection Rate (IR): 42% (wide confidence interval 14-76%)
    • Morbidity: 47% (13-85%)
    • Mortality: 23% (7-54%)
    • Death to Case Ratio (DCR): 45% (20-73%)
  • Trypanosoma equiperdum (Outbreaks):
    • IR: 12% (7-18%)
    • Morbidity: 25% (9-49%)
  • Tsetse-transmitted Trypanosomiasis (Outbreaks):
    • IR: 46% (29-63%)
    • Morbidity: 46% (29-63%)
    • Mortality: 6% (1-19%)
    • DCR: 12% (2-38%)
  • Tsetse-transmitted Trypanosomiasis (Endemic):
    • IR: 50% (20-60%)
    • No morbidity data available in endemic settings
    • Mortality: 11% (7-14%)
    • DCR: 9% (5-16%)
  • Trypanosoma vivax (Outbreaks):
    • IR: 43% (10-83%)
    • Morbidity: 43% (10-83%)
    • Mortality: 15% (0-100%) (very wide range)
    • DCR: 32% (0-100%) (very wide range)

Limitations

  • Publication bias:
    • Possible overrepresentation of studies from certain regions or outbreaks.
  • Heterogeneity:
    • High variation between studies in methodology, sample size, diagnostic criteria, and locations.
  • Descriptive and missing data:
    • Limited standardized data reporting on morbidity and mortality in many studies.
    • Some categories, e.g., morbidity in endemic tsetse-transmitted disease, lacked sufficient data.

Conclusions and Implications

  • Equine trypanosomiasis predominately affects LMICs with higher reported rates in these countries compared to wealthier nations.
  • Globally, a conservative estimate suggests that over eight million equines suffer from trypanosomiasis, underscoring a significant animal health burden.
  • The disease leads to considerable morbidity and mortality, with substantial death-to-case ratios for some Trypanosoma species, highlighting the impact on equine populations.
  • These findings emphasize the need for:
    • Improved surveillance, diagnosis, and control strategies, particularly in medium and high-risk countries.
    • Better quality research with standardized reporting to reduce heterogeneity and fill gaps on morbidity and mortality data.
    • Increased awareness and resource allocation to address this neglected disease, which threatens livelihoods dependent on working equines, especially in LMICs.

Cite This Article

APA
Raftery AG, Gummery L, Garcia K, Mohite D, Capewell P, Sutton DGM. (2025). Equine trypanosomiasis, a systematic review and meta-analyses: Prevalence, morbidity and mortality. Equine Vet J, 58(2), 291-319. https://doi.org/10.1111/evj.70101

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 58
Issue: 2
Pages: 291-319

Researcher Affiliations

Raftery, Alexandra G
  • School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Gummery, Lauren
  • Three Counties Equine Hospital, Stratford Bridge, Gloucestershire, UK.
Garcia, Karelhia
  • Faculty of Veterinary Medicine, Veterinary Medical Sciences, University of Calgary, Calgary, Canada.
Mohite, Dinesh
  • Federation of Indian Animal Protection Organisations, New Dehli, India.
Capewell, Paul
  • School of Molecular Biosciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Sutton, David G M
  • School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

MeSH Terms

  • Animals
  • Horse Diseases / epidemiology
  • Horse Diseases / parasitology
  • Horse Diseases / mortality
  • Horses
  • Prevalence
  • Trypanosomiasis / veterinary
  • Trypanosomiasis / epidemiology
  • Trypanosomiasis / mortality
  • Trypanosomiasis / parasitology
  • Trypanosoma

Grant Funding

  • Vet Fund (University of Glasgow)

Conflict of Interest Statement

The authors declare no conflicts of interest.

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Citations

This article has been cited 1 times.
  1. Raftery AG, Gummery L, Garcia K, Mohite D, Capewell P, Sutton D. Equine trypanosomiasis, a systematic review: Disease management. Equine Vet J 2026 Mar;58(2):320-332.
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