title: Prevalence of Nasopharyngeal Carriage of Streptococcus pneumonia in Iran: A Meta-Analysis.
abstract: BACKGROUND
  Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide. Several studies have explored the nasopharyngeal carriage of S. pneumonia in Iran. This meta-analysis is aimed at exploring the overall prevalence of nasopharyngeal carriage of S. pneumoniae among healthy children and its resistance to antibiotics.
  
  
  METHODS
  We have systematically reviewed published studies from international databases (PubMed, Web of Science, and Scopus) and national databases (Iranmedex, Magiran, Medlib, SID and Irandoc) and reference lists of articles published up to May 2015. Only cross-sectional studies supported with sensitivity test on samples collected from nasopharyngeal area were included and heterogeneity was assessed using Q-test and I2 test statistic. Publication bias was explored using the Egger's and Begg's tests and the funnel plot. The overall prevalence of analyzed data were reported with 95% confidence intervals (CI) using the random-effects model.
  
  
  RESULTS
  A total of 16 studies were included in the final analysis. The pooled prevalence of S. pneumoniae nasopharyngeal carriage was 18% (95% CI: 14% - 23%). Antibiotic resistance rates were 26% (95% CI: 15% - 37%) to penicillin, 30% (95% CI: 10% - 49%) to erythromycin and 34% (95% CI: 10% - 57%) to tetracycline respectively.
  
  
  CONCLUSIONS
  This study could be able effectively estimate the overall prevalence of nasopharyngeal carriage of S. pneumoniae and its antibiotics resistance rate among healthy children in Iran. In addition, the findings evidenced the role of pneumococcal vaccination in reducing the prevalence of S. pneumoniae carriage among healthy children in Iran.
authors.affiliation: Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Seyed Mehdi
authors.initials: SM
authors.lastname: Hosseini
authors.affiliation: Research Center for Health Sciences and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Jalal
authors.initials: J
authors.lastname: Poorolajal
authors.affiliation: Social Determinants of Health Research Center (SDHRC) and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. ma.karami@umsha.ac.ir.
authors.forename: Manoochehr
authors.initials: M
authors.lastname: Karami
authors.affiliation: Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Pegah
authors.initials: P
authors.lastname: Ameri
mesh_terms: D000293:Adolescent; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
keywords: Antibiotic Resistance; Meta-Analysis; Nasopharyngeal Carriage; Streptococcus Pneumonia