The Prevalence, Risk Factors, and Antimicrobial Resistance of Campylobacter in African Children: A Systematic Review and Meta-Analysis

BackgroundCampylobacter is a major cause of childhood diarrhoea across Africa and asymptomatic carriage is frequently reported, however risk factors for Campylobacter presence remain poorly defined. This meta-analysis aimed to calculate the pooled prevalence of Campylobacter in diarrhoeic and non-diarrhoeic stool, assess its association with diarrhoea, identify risk factors for Campylobacter presence and antimicrobial resistance (AMR) patterns. MethodEnglish language studies on Campylobacter in children (<18 years) in Africa were searched. Prevalence of Campylobacter and AMR, Odds Ratios (OR) for Campylobacter presence in diarrhoeic stool and risk factors for Campylobacter were estimated. Heterogeneity was assessed using I2 and bias assessed via funnel plots and Eggers test. ResultsA total of 168 studies were included in the meta-analysis. The pooled prevalence of Campylobacter in diarrhoeic stool was 11.25% (9.41-13.23%), in non-diarrhoeic stool 12.56% (7.79-18.27%), and mixed stool types 33.47% (20.53-47.81%). The OR for Campylobacter presence in diarrhoeic stool versus non-diarrhoeic stool was 1.95 (95% CI: 1.62-2.33). Age affected the OR with children 0-6 months old having an OR 2.57 (1.74-3.81), 7-12 months old an OR 1.60 (1.07-2.40), 13-24 months old an OR 1.02 (0.68-1.52) and 25-60 months old an OR 1.76 (0.77-4.05). Risk factors for Campylobacter presence in stool were children living in rural areas (pooled Adjusted Odds Ratio (pAOR) = 2.59 95% CI 1.43-4.69) and having contact with animals (pAOR 4.28 95% CI: 2.40-7.61). AMR prevalence ranged from 54.85% for ampicillin to 9.85% for chloramphenicol. Heterogeneity was high across all analyses. ConclusionCampylobacter prevalence is high in symptomatic and asymptomatic children across Africa. Contact with animals and living in an urban environment are risk factors for Campylobacter presence. Risk factor identification in the African context would be strengthened with standardized risk factors. Further research is needed to clarify the public health significance of asymptomatic carriage. What is already known on this topic - Campylobacter is a significant cause of diarrhoea in children and asymptomatic carriage is common. However, the burden of asymptomatic carriage and risk factors are not well understood in Africa. What this study adds - This meta-analysis highlights the high burden of asymptomatic Campylobacter carriage, its relation to age, and identified risk factors for Campylobacter in children in Africa. How this study might affect research, practice or policy - Standardising risk factor assessments can guide future control strategies. Further research into the impact of asymptomatic carriage is warranted.