Estimates of the prevalence of autism spectrum disorder in the Middle East and North Africa region: A systematic review and Meta-Analysis.

This study looked at how common autism is across Middle Eastern and North African countries. Researchers found that autism affects about 0.14% of people in this region - much lower than rates seen in other parts of the world. The numbers varied greatly between countries and studies, ranging from very low (0.01%) to much higher (6.50%). More recent studies found higher rates than older ones, suggesting autism recognition may be improving over time.

This systematic review and meta-analysis examined autism spectrum disorder (ASD) prevalence across the Middle East and North Africa (MENA) region by analyzing 19 studies from 2007-2025 across 10 countries. The overall ASD prevalence was 0.14% (95%CI 0.02-0.36%), significantly lower than global estimates. Prevalence varied dramatically by country (0.01% to 6.50%), diagnostic method, and time period, with post-2015 studies showing higher rates (0.45%) than pre-2015 studies (0.04%). Studies using M-CHAT screening showed higher prevalence (1.66%) compared to those using DSM-IV criteria (0.14%).

The findings suggest possible underdiagnosis in the region, influenced by methodological differences, cultural factors, and evolving diagnostic practices.

The low prevalence estimates suggest significant underdiagnosis of ASD in the MENA region, highlighting need for improved diagnostic capacity, training, and awareness. Standardized diagnostic protocols and screening tools are needed. The temporal increase in prevalence indicates progress but suggests substantial unmet diagnostic need remains across the region.

Extremely high heterogeneity between studies limits confidence in pooled estimates. Methodological variability in diagnostic approaches, sampling methods, and study populations across different countries and time periods. Potential publication bias and limited representation from some MENA countries may affect generalizability.

Prevalence estimates for autism spectrum disorder (ASD) in the Middle East and North Africa (MENA) region are not readily available, amid a lack of recent evidence. In this study, we estimated the prevalence of ASD in the MENA region by synthesising evidence from published studies. We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, Scopus, and CINAHL for studies assessing ASD prevalence in the MENA region. Risk of bias was assessed using the Newcastle Ottawa scale.

A bias-adjusted inverse variance heterogeneity meta-analysis model was used to synthesize prevalence estimates from included studies. Cochran's Q statistic and the Istatistic were used to assess heterogeneity, and publication bias assessed using funnel and Doi plots. Of 3,739 studies identified, 19 met the inclusion criteria, published during the period 2007-2025, from Iran, Oman, Libya, Egypt, Saudi Arabia, Lebanon, United Arab Emirates, Bahrain, and Qatar, Iraq. Country specific prevalence estimates ranged from 0.01% in Oman in 2009 to 6.50% in one study from Iraq in 2024.

The overall prevalence of ASD in the MENA region was 0.14% (95%CI 0.02- 0.36%), with significant heterogeneity (I = 99.8%). Overall ASD prevalence was 0.04% (95%CI 0.00-0.13, I = 99.4%) for studies done before 2015 and 0.45% (95%CI 0.17-0.87, I = 99.4%) for studies after 2015. Overall ASD prevalence was high in studies that used the Modified Checklist for Autism in Toddlers (M-CHAT) only [1.66% (95%CI 0.15-4.33, I = 97.5%)] while the overall ASD prevalence was 0.14% (95%CI 0.00-0.46, I = 99.9%) for studies that used the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for diagnosis. Estimates of the prevalence of ASD vary widely across the MENA region, with variability in ASD prevalence estimates by diagnostic methods and sampling approaches.

While the data suggest a possible increase in prevalence during the study period, this observation warrants further investigation through more robust, longitudinal, and methodologically consistent studies. PROSPERO registration ID CRD42024499837.