Bovine tuberculosis in the Middle East and North Africa: a systematic review and meta-analysis on prevalence and Mycobacterium bovis clonal complexes

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Introduction Bovine tuberculosis (bTB) is endemic in the Middle East and North Africa (MENA) region causing major threat to dairy production and milk consumers. This paper presents a comprehensive systematic review and meta-analysis of bTB prevalence and Mycobacterium bovis clonal complexes in the MENA region based on studies published between 2000 and 2025. Methods A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Embase, and relevant regional databases. Thirty-eight studies met the criteria and included in the meta-analysis. Random-effects meta-analysis was used to estimate pooled prevalence. Additional analyses were done on sensitivity, meta-regression, and publication bias. Results A total of 38 studies comprising 100,094 animals and 2,830 confirmed bTB cases were included in the meta-analysis. Screening test-based pooled prevalence was 5.3% (95% CI: 2.5–10.7%) while confirmatory test-based pooled prevalence was 2.3% (95% CI: 1.4–3.7%). Based on confirmatory test, higher pooled prevalence was recorded in the Middle East (5%) than in the North Africa (2%) while the pooled prevalence in Egypt (1%) was lower than the pooled prevalence (5%) of the other MENA countries. High heterogeneity ( I 2 > 99%) was observed among prevalence reported by the confirmatory test and the sources of heterogeneity were identified to be country’s prevalence report and sample size based on meta-regression analysis. Confirmatory test-based sensitivity analysis demonstrated robustness the pooled prevalence while Egger’s regression test showed the presence of publication bias ( p = 0.001) that was confirmed by Trim and Fill analysis which suggested the presence of missing studies that lead to underestimation of pooled prevalence. Molecular analysis of 590 M. bovis isolates showed that the European 2 (Eu2) clonal complex was predominant (63.6%), followed by Eu1 (9.7%) and Eu3 (6.6%), while 20.2% of isolates could not be assigned to known clonal complexes. The most reported spoligotypes were SB0120, SB0121, and SB0134. Conclusion Low pooled prevalence with high heterogeneity was recorded in the MENA region. The dominance of European clonal complexes of M. bovis could suggest historical its introduction with cattle importation. Substantial gaps in prevalence warrants for more surveillance studies in order to establish the national prevalence in each country. Systematic review registration Epidemiology and Genetic Diversity of Mycobacterium bovis in Animals in the Middle East and North Africa: A Systematic Review and Meta-Analysis [CRD420261326357].

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