Antimicrobial Resistance in Selected Foodborne Pathogens in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

<b>Background/Objectives:</b> The increasing trend of foodborne zoonotic pathogens exhibiting antimicrobial resistance (AMR) represents a growing threat to food safety and public health in sub-Saharan Africa (SSA). Resistant strains of foodborne zoonotic pathogens compromise treatment efficacy, raise illness, and threaten sustainable food systems in human and animal health. However, regional understanding and policy response are limited due to the fragmentation of data and the inadequacy of surveillance. This systematic review and meta-analysis aimed to achieve the following: (1) estimate the pooled prevalence of AMR, including multidrug resistance (MDR) in selected foodborne pathogens; (2) compare subgroup variations across countries, pathogen species, and antibiotic classes; and (3) evaluate temporal trends. <b>Methods:</b> Following PRISMA 2020 guidelines, studies published between 2010 and June 2025 reporting AMR and MDR in <i>Salmonella</i>, <i>Campylobacter</i>, or <i>E. coli</i> from food or animal sources in SSA were systematically reviewed. Data on pathogen prevalence, AMR profile, and MDR were extracted. Random-effects meta-analysis using R software was implemented to estimate the pooled prevalence and the 95% confidence intervals (95% CI). Subgroup analyses were performed to explore heterogeneity across countries, antibiotic class, and bacterial species. <b>Results:</b> Ninety studies from 16 sub-Saharan African countries were included, encompassing 104,086 positive isolates. The pooled foodborne pathogen prevalence was 53.1% (95% CI: 51.5-54.7), AMR prevalence was 61.6% (95% CI: 59.4-63.9), and MDR prevalence was 9.1% (95% CI: 8.3-10.0). The highest resistance was reported in <i>Campylobacter</i> spp. (43.6%), followed by <i>Salmonella</i> spp. (29.1%) and <i>E. coli</i> (22.8%). High heterogeneity was observed across studies (<i>I</i>² = 95-99%, <i>p</i> < 0.001). <b>Conclusions:</b> It is concluded that substantial AMR burden exists in food systems, highlighting an urgent need for integrated One Health surveillance, antimicrobial stewardship, and policy harmonization in SSA. Strengthening laboratory capacity, enforcing prudent antimicrobial use, and promoting regional data sharing are critical for the management of antimicrobial resistance in sub-Saharan Africa.