Background Tens of millions of agricultural workers are directly exposed to pesticides through handling pesticide products, mostly in developing countries. Systematic data synthesis on the genotoxic consequences of such occupational exposures and their human health risks in agricultural settings is required in Arab countries. We aim to conduct a systematic review and, if possible, a meta-analysis to review published literature about the genotoxicity of occupational pesticide exposures in Arab countries, with the objectives of characterising the (1) prevalence rates of genotoxic pesticide exposures, (2) extent of genotoxic insult, (3) attributed risk factors, and (4) preventive measures against pesticide-induced genotoxic effects detectable by biomonitoring. Methods The research will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. A comprehensive search will be conducted in November 2022 in the electronic databases PubMed (NLM), EMBASE (Elsevier), Web of Science (Clarivate), Scopus (Elsevier), and Agricola in addition to WHO Index Medicus for the Eastern Mediterranean (IMEMR). The search will be performed without any restrictions for publication years. A filter for English and Arabic language will be applied. The systematic search will include agricultural workers over the age of 18 years, located in Arabic speaking countries of the Middle East and North Africa (MENA) region, occupationally exposed to pesticides inducing genotoxic insult detectable by biomonitoring. Records identified in the search will be imported into the systematic review tool Covidence for blinded screening and selection by two reviewers independently. The reviewers will then extract data and conduct risk of bias assessment using the Navigation Guide RoB tool and the RoB-SPEO tool. The results will be synthetized narratively in summary tables, and, if findings allow, meta-analysis, including subgroup and sensitivity analysis, will be conducted on the prevalence of genotoxic pesticide exposures, and on the effect size of risk factors. The systematic review methodology does not require ethics approval. Discussion The systematic review will consider various types of pesticide exposures and genotoxicity biomarker assays to determine prevalence and extent of such occupational genotoxic insults, the correlation between genetic damage and various risk factors, e.g. work conditions, types of pesticides, environmental exposure routes, and the applied preventive measures. The review will provide gap-filling information about genotoxic pesticide exposures of agricultural workers in the local context, as well as it will contribute to our general knowledge on pesticide genotoxicity. Systematic review registration PROSPERO registration number: CRD42022314453 .

The authors have declared no competing interest.

This work will be supported by the College of Medicine and Health Sciences (CMHS) of the United Arab Emirates University (UAEU) research grant [grant number G00003625]. The contribution of MS and KRM was supported by the United Arab Emirates University PhD grant and the Stipendium Hungaricum Scholarship Programme, respectively. The funders had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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