Schistosoma-Salmonella co-infection in Africa: Epidemiology, biological mechanisms, and antimicrobial resistance: A systematic review and meta analysis

Schistosomiasis and salmonellosis are major public health problems in Africa, contribute substantially to morbidity. Schistosoma-Salmonella co-infection is a neglected and overlooked health condition with important clinical and public health implications. Therefore, we conducted a systematic review and meta-analysis to synthesize evidence on the epidemiology, biological mechanisms, and antimicrobial resistance of Schistosoma-Salmonella co-infection in Africa. A systematic review and Meta-analysis were conducted following the PRISMA framework. The pooled prevalence of co-infection was estimated using a random effects model, with at 95% confidence intervals. Between studies heterogeneity was assessed using Cochran’s Q test and the I ² statistic. Subgroup analyses were performed according to Schistosoma species and country to explore potential source of heterogeneity. This systematic review found that the pooled prevalence of Schistosoma-Salmonella co-infection in Africa was 9%. Species specific pooled prevalence was 4% for Schistosoma mansoni -Salmonella co-infection and 12% for Schistosoma hematobium -Salmonella co-infection. Country based subgroup analysis showed prevalence of Schistosoma mansoni -Salmonella co-infection of 2% in Ethiopia, 9% in Sudan, 2% in Democratic republic of Congo and 4% in Nigeria, while Schistosoma hematobium -Salmonella co-infection prevalence were 0%, 25%, and 8% in Ethiopia, Sudan, and Nigeria respectively. Schistosoma-Salmonella co-infection is driven by immune modulation, tissue pathology, and parasite bacterium interactions that support persistent infection and compromise therapeutic efficacy, thereby contributing to treatment failure and the emergence of antimicrobial resistance. Schistosoma-Salmonella co-infection represents an important and under-recognized public health concern in Africa, with a pooled prevalence of 9%. The findings demonstrate notable variation in co-infection prevalence across Schistosoma species and geographical settings, with higher rates observed among Schistosoma haematobium compared with Schistosoma mansoni . Strengthened surveillance systems, improving early diagnosis, and implementing integrated control strategies are essential to reduce the burden and enhance clinical management of this neglected co-infection in Africa.