Recreational exposure to polluted open water and infection: A systematic review and meta-analysis protocol

We present a peer-reviewed protocol for a systematic review and meta-analysis of exposure to wastewater and runoff pollution and infection in recreational open water users in the Global North. Eligible studies must contain at least two groups of recreational water users known or suspected to have been exposed to distinct levels of pollution, with some estimate of cases of infection in each group. These studies will be obtained via searches of bibliographic databases (MEDLINE, Web of Science Core Collection, Environment Complete, and Global Health), grey literature sources, and supplementary search methods. Risk of bias in these studies will be assessed using Cochrane's ROBINS-E and RoB 2 tools. Studies' results will be qualitatively and quantitatively synthesised, following and reporting to contemporary standards and guidelines (e.g. PRISMA, SWiM). The results of the review will be summarised with a GRADE certainty assessment of the evidence for different types of infections, presented in a Summary of Findings table.