Geographical patterns of bacterial enteropathogens in diarrheal cases: a meta-analysis and systematic review (1999-2024)

Bacterial enteropathogens are a leading cause of diarrheal diseases worldwide, with varying geographical trends. Understanding their distribution over time is critical for public health interventions. This meta-analysis and systematic review synthesizes evidence on the prevalence and geographical patterns of bacterial enteropathogens in diarrheal cases from 1999 to 2024. A comprehensive search was conducted through PubMed, Science Direct, Web of Science, Google Scholar and Scopus for studies reporting bacterial pathogen detection in diarrheal cases. Data was extracted on pathogen prevalence, geographic region, and temporal trends. Random-effects meta-analysis was performed to estimate pooled prevalence, and subgroup analyses assessed regional and year variations. Of the 100 included studies n = 790,141 samples, 72,354 pathogens isolates and 24,276 bacterial isolates, global bacterial isolates show high prevalence (59.2%) with marked regional variation. Africa reports the highest rate (69.6%), followed by America (58.1%), Europe (50.5%), and Asia (45.5%). Our studies also revealed high prevalence of Salmonella (11.0%) in Asia, Enteropathogenic E. coli (EPEC, 17.6%) and Enteroaggregative E. coli (EAEC, 12.3%) in America, similarly, Campylobacter's dominance (27.5%) in Europe, while in Africa Shigella has recorded the highest prevalence (10.0%). Bacterial enteropathogen prevalence exhibits significant geographical and temporal heterogeneity, influenced by socioeconomic and environmental factors. Targeted surveillance and region-specific interventions are needed to mitigate diarrheal disease burdens globally.