Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis

Melese Yeshambaw Teferi, Ziad El-Khatib, Endawoke Amsalu Alemayehu, Hawult Taye Adane, Azeb Tarekegn Andualem, Yonas Abebe Hailesilassie, Abraham Sahilemichael Kebede, Benedict Oppong Asamoah, Minyahil Tadesse Boltena, Mulatu Biru Shargie

Research output: Contribution to journalArticlepeer-review


Typhoid fever continues to be a health challenge in low-and middle-income countries where access to clean water and sanitation infrastructure is scarce. The non-confirmatory diagnostic method continues to hinder effective diagnosis and treatment, ensuring in a high antimicrobial resistance. This systematic review and -analysis aimed to estimate the pooled prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia. The review was designed based on the condition-context-population review approach. Fifteen eligible articles were identified from PubMed, Google Scholar, and Science Direct databases. Risk of bias and quality of studies were assessed using the Joanna Briggs Institute's appraisal criteria. Heterogeneity was assessed using Cochran's Q test and statistics. The review protocol was registered in PROSPERO (registration number CRD42021224478). The estimated pooled prevalence of typhoid fever from blood and stool culture diagnosis was 3% (95% CI: 2%-4%, ) ( = 82.25) and Widal test examination 33% (95% CI: 22%-44%) ( = 99.14). The sub-group analyses identified a lower detection of typhoid fever of 2% (95% CI: 1%-3%) among febrile patients compared to typhoid suspected cases of 6% (95% CI: 2%-9%). The stool culture test identified was twofold higher, value of 4% (95% CI: 2%-7%) S. Typhi infection than blood culture test of 2% (95% CI: 1%-4%). The antimicrobial susceptibility of S. Typhi for antibiotics was 94%, 80% and 65% for ceftriaxone, ciprofloxacin, and gentamycin respectively. Low susceptibility of S. Typhi isolates against nalidixic acid 22% (95% CI: 2%-46%) and chloramphenicol 11% (95% CI: 2%-20%) were observed. The diagnosis of typhoid fever was under or overestimated depending on the diagnostic modality. The Widal test which identified as nonreliable has long been used in Ethiopia for the diagnosis of S. Typhi causing high diagnosis uncertainties. Antimicrobial susceptibility of S. Typhi was low for most nationally recommended antibiotics. Ethiopian Food and Drug Authority must strengthen its continued monitoring and enhanced national antimicrobial surveillance system using the best available state-of-the-art technology and or tools to inform the rising resistance of S. Typhi towards the prescription of standard antibiotics. Finally, it is crucial to develop an evidence-based clinical decision-making support system for the diagnosis, empiric treatment and prevention of antimicrobial resistance. [Abstract copyright: © 2021 The Author(s).]
Original languageEnglish
Pages (from-to)101670
JournalPreventive medicine reports
Publication statusPublished - 13 Dec 2021


  • PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses
  • Antimicrobial resistance
  • AMR, Antimicrobial Resistance
  • AMS, Antimicrobial Susceptibility
  • JBI, The Joanna Briggs Institute
  • Systematic review and Meta-analysis
  • Antimicrobial susceptibility
  • LMICs, Low- and Middle-Income Countries
  • XDR, Extensive Drug Resistance
  • Ethiopia
  • WHO, The World Health Organization
  • Typhoid fever
  • SSA, Sub-Saharan Africa
  • PROSPERO, International Prospective Registry of Systematic Reviews
  • AHRI, Armauer Hansen Research Institute


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