Prevalence and multidrug resistance patterns of bacterial pathogens in wastewater and drinking water systems from hospital and non-hospital environments in Ethiopia: a systematic review and meta-analysis.

BACKGROUND

Wastewater systems worldwide can transport bacterial pathogens alongside antimicrobial resistance genes and pharmaceutical residues. The presence of these pathogens and resistance genes in wastewater systems poses significant public health risks, especially in regions like Ethiopia, where limited wastewater treatment and sanitation infrastructure exist. The spread of infectious diseases and the exacerbation of antimicrobial resistance through wastewater can contribute to the growing global health challenge, with specific implications for local healthcare systems.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the prevalence of bacterial pathogens and their multidrug resistance patterns within wastewater and drinking water systems in Ethiopia, focusing on both hospital and non-hospital environments.

METHODS

A comprehensive search was conducted across electronic databases and grey literature using relevant terms and phrases. Studies meeting the eligibility criteria were extracted into MS Excel and analyzed using STATA version 17 software. A random-effects model was employed to estimate the pooled prevalence of bacterial pathogens in hospital and non-hospital wastewater. Heterogeneity was evaluated using the Cochrane Q test and I² statistics, with a significance threshold of p < 0.05. Publication bias was assessed using a funnel plot and Egger's test. A sensitivity analysis was also performed to determine the influence of individual studies on the overall effect size. Studies included in the meta-analysis reported the prevalence of bacterial species and their corresponding multidrug resistance phenotypes.

RESULT

Out of 472 studies initially identified, 80 met the eligibility criteria for full-text review. Of these, 17 studies were included in the meta-analysis, comprising a total of 848 wastewater and 325 drinking water samples and 2,961 bacterial strains. The most frequently identified bacterium was Pseudomonas aeruginosa (or related species), with an overall prevalence of 41.25% (95% CI: 10.04-81.46%). The pooled prevalence of bacterial pathogens in hospital and non-hospital wastewater systems in Ethiopia was 70.02% (95% CI: 59.90-80.13%), exhibiting substantial heterogeneity (I² = 99.1%, p < 0.001) and the data provides environmental measurements across different categories: wastewater 82.57% (CI: 72.88-92.25%), drinking water 42.18% (CL:10.33, 88.83%). Additionally, the overall prevalence of multidrug-resistant bacterial strains in wastewater was 65.26% (95% CI: 57.23-75.30%), with high heterogeneity (I² = 98.6%, p < 0.001) across different bacterial species and study settings.

CONCLUSION

This systematic review and meta-analysis reveal high levels of bacterial contamination and multidrug resistance within Ethiopian wastewater systems, with significant variability across studies. The findings highlight the urgent need for enhanced wastewater management and monitoring to tackle these public health issues. Future research should focus on standardizing methodologies and investigating the sources of variability to effectively manage and mitigate the risks associated with wastewater systems.