Prevalence of enteric non-typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta-analysis

Rami H. Al-Rifai, Karima Chaabna, Thomas Denagamage, Walid Q. Alali

Research output: Contribution to journalReview articlepeer-review

13 Citations (Scopus)


To enhance efforts related to controlling foodborne pathogens in the Middle East and North Africa (MENA), information on epidemiology of non-typhoidal Salmonella enterica (hereafter termed “Salmonella”) is limited. We quantified the overall regional and country-specific Salmonella prevalence in different human populations and identified the most common serotypes. Published literature of Salmonella prevalence was systematically reviewed and reported following the Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pooled Salmonella prevalence measures were estimated using a random-effects model. We identified 46 research reports that reported 84 Salmonella prevalence measures in 15 out of 24 countries in MENA. There were 252,831 tested humans with 6,356 Salmonella-positive cases. The pooled Salmonella prevalence in MENA was estimated at 6.6% (95% confidence interval (CI): 5.4%–7.9%). The highest pooled Salmonella prevalence measures were in Morocco (17.9%, 95% CI: 5.7%–34.8%, 1997–2012), Tunisia (10.2%, 95% CI: 4.3%–18.0%, 1988–2009) and Sudan (9.2%, 95% CI: 6.5%–12.2%, 2006–2008), while the lowest were in Jordan (1.1%, 95% CI: 0.1%–3.0%, 1993–2010), Oman (1.2%, 95% CI: 1.2%–1.3%, 1998–2002) and Palestine (1.2%, 95% CI: 0.4%–2.1%, 1999–2011). In MENA, Salmonella pooled prevalence in gastrointestinal symptomatic, gastrointestinal asymptomatic and food handlers population groups was 13.0% (95% CI: 7.6%–19.6%), 11.4% (95% CI: 2.2%–25.7%) and 3.8% (95% CI: 1.0%–8.0%), respectively. Salmonella prevalence was 14.5% (95% CI: 8.7%–26.1%) in studies tested <100 subjects, whereas 4.6% (95% CI: 3.6%–5.8%) in studies tested ≥100 subjects. Salmonella Enteritidis (29.8%) and Typhimurium (23.6%) were the most common serotypes. Salmonella was a common foodborne pathogen in MENA countries, particularly in North African countries. Findings inform the scientific community, the public and the decision-makers with Salmonella prevalence and gaps in evidence in MENA to support control and prevention strategies and could leverage more research studies.

Original languageEnglish
Pages (from-to)701-728
Number of pages28
JournalZoonoses and Public Health
Issue number7
Publication statusPublished - Nov 1 2019


  • MENA region
  • Middle East and North Africa
  • Salmonella
  • human
  • meta-analyses
  • non-typhoidal Salmonella
  • prevalence
  • systematic review

ASJC Scopus subject areas

  • Epidemiology
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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