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Review
. 2025 Jun 2:20:101090.
doi: 10.1016/j.onehlt.2025.101090. eCollection 2025 Jun.

Prevalence of ESBL-producing Escherichia coli in sub-Saharan Africa: A meta-analysis using a One Health approach

Morufat Oluwatosin Olaitan  1 , Oluwatosin Qawiyy Orababa  2 , Rukayya Bushola Shittu  3 , Gift Maureen Obunukwu  4 , Ayomikun Emmanuel Kade  2   5 , Margaret Toluwalayo Arowolo  5 , Adams Alabi Oyediran  4 , Rildwan Alaba Yusuff  6
Affiliations
Review

Prevalence of ESBL-producing Escherichia coli in sub-Saharan Africa: A meta-analysis using a One Health approach

Morufat Oluwatosin Olaitan et al. One Health. .

Abstract

The rise in the prevalence of antimicrobial-resistant (AMR) pathogens globally has been a major concern, especially due to the increasing mortality associated with AMR. One of these pathogens -classified as a WHO priority pathogen- is extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. In this study, we aim to determine the prevalence of ESBL-producing E. coli in sub-Saharan Africa (SSA) as well as the genes responsible for its spread in the region. Based on the PRISMA guideline, we screened 6521 articles published between 2013 and 2023 from PubMed, AJOL, Google Scholar, Scopus, and Web of Science using pre-set eligibility criteria. The final meta-analysis included one hundred and ninety-six of these articles. In this study, we reported an overall ESBL-producing E. coli prevalence of 20.76 % in SSA. Subregion analysis showed that West Africa had the highest prevalence of 22.80 % while Southern Africa (13.76 %) has the lowest ESBL-producing E. coli prevalence in SSA. Among the countries in SSA, Burkina Faso (33.37 %) had the highest prevalence of ESBL-producing E. coli. Additionally, sample source subgroup analysis revealed animals as the highest source of ESBL-producing E. coli in SSA with a prevalence of 29.15 %. We also found that bla CTX-M-15 is the most reported ESBL gene in E. coli in SSA. Our study shows a high prevalence of ESBL-producing E. coli in SSA countries, with animals significantly contributing to the spread of ESBL resistance in the region compared to humans, the environment and food. This study further emphasizes the importance of an interdisciplinary and intergovernmental approach to reducing AMR spread in SSA. Additionally, we implore policymakers to implement policies that will encourage responsible use of antimicrobials in both the clinic and agriculture to prevent the widespread of AMR genes.

Keywords: AMR; E. coli; ESBL; ESBL-Ec; One health; Public health; Sub-Saharan Africa.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Selection of studies following the PRISMA flowchart protocol.
Fig. 2
Fig. 2
Distribution of Included Studies. (A) Regional Distribution in sub-Saharan Africa: number of studies by region. Note: Two studies spanned multiple regions, affecting total count. (B) Publication Year: number of studies by year. (C) Sample Source: type of sample source. (D) Identification Method. Low: Phenotype only (41.84 %); Medium: Molecular only (3.06 %); High: Phenotype and molecular (55.10 %).
Fig. 3
Fig. 3
Geographical Distribution and Prevalence of ESBL-producing E. coli in sub-Saharan Africa. (A) Map of sub-Saharan Africa: countries with eligible studies. (B) Country-specific Prevalence of ESBL-producing E. coli: estimated prevalence rates.
Fig. 4
Fig. 4
(A) Forest Plot of Pooled Prevalence of ESBL-producing E. coli in sub-Saharan Africa. (B) Forest Plot of Subgroup Analysis of ESBL-producing E. coli in sub-Saharan Africa by Year of Publication.
Fig. 4
Fig. 4
(A) Forest Plot of Pooled Prevalence of ESBL-producing E. coli in sub-Saharan Africa. (B) Forest Plot of Subgroup Analysis of ESBL-producing E. coli in sub-Saharan Africa by Year of Publication.
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