Epidemiologic trends, diagnostic limitations, and public health challenges of enteric fever in sub-Saharan Africa: A narrative review

Abstract

Objectives: This paper reviews existing literature on the prevalence and epidemiologic trends of enteric fever in sub-Saharan Africa. It also evaluates diagnostic limitations and explores the region's public health challenges related to disease control. Methods: A comprehensive search across six major databases initially identified 1831 articles. Of these, 40 peer-reviewed articles published between 2000 and 2024 met the inclusion criteria. Data were extracted on country, sample size, diagnostics, and prevalence. Risk of bias was assessed using the Newcastle-Ottawa Scale, whereas the Joanna Briggs Institute checklist was used for quality assessment. Results: Among the 40 included studies, the highest prevalence of enteric fever was observed in children under 15 years of age (65%). Despite its well-known limitations as a diagnostic test, the Widal test was used in approximately 75% of studies. Only 30% of patients received blood cultures, and fewer than 10% received advanced diagnostics such as polymerase chain reaction or Typhidot. Multidrug-resistant Salmonella Typhi strains were reported in 60% of the studies. Conclusion: Enteric fever remains a significant public health issue in sub-Saharan Africa, particularly affecting children and vulnerable groups. Barriers, including inadequate diagnostics, fragile health care systems, and low vaccine coverage, hinder efforts to control the disease.