Pooled prevalence of multidrug-resistant uropathogens causing urinary tract infections in East Africa: a systematic review and meta-analysis

Background Multidrug-resistant (MDR) uropathogens are an increasing public health concern in East Africa, compromising the effective management of urinary tract infections (UTIs). This study aimed to estimate the pooled prevalence of MDR uropathogens causing UTIs in East Africa. Methods A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guideline and registered in PROSPERO (CRD420251249266). Electronic databases (PubMed/MEDLINE, Scopus, ScienceDirect, Embase, African Journals Online [AJOL], and Google Scholar) were searched for observational studies published between 1 January 2005 and 11 December 2025. Eligible studies reporting the prevalence of MDR among culture-confirmed UTI isolates in East Africa were included. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies. A random-effects meta-analysis was performed using STATA version 14.0. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using funnel plots and Egger’s test. Results Sixteen studies involving 7,625 participants met the inclusion criteria. Of these, 11 were conducted in Ethiopia, three in Uganda, and one each in Kenya and Tanzania. The pooled prevalence of MDR uropathogens causing UTI in East Africa was 61.4% (95% CI: 47.5–75.3), with very substantial between-study heterogeneity (I² = 98.3%, p < 0.001). Given this heterogeneity and the wide confidence interval, the pooled estimate should be interpreted cautiously and should not be regarded as a stable or uniformly applicable regional prevalence estimate. The predominance of studies from Ethiopia should also be considered when interpreting the pooled estimate. Sensitivity analysis indicated that no single study substantially influenced the pooled estimate. Conclusion This systematic review and meta-analysis found that MDR uropathogens causing UTI are highly prevalent in East Africa. However, the very high between-study heterogeneity and the disproportionate representation of Ethiopian studies mean that the pooled estimate is imprecise and should be interpreted cautiously. These results underscore the need for continued antimicrobial resistance surveillance, standardized reporting of MDR, and well-designed epidemiological studies to better characterize the regional burden and inform evidence-based policies and interventions.