{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:22:10Z","timestamp":1789042930560,"version":"build-2803163510"},"reference-count":51,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Environ\ufffdHealth\ufffdInsights"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Salmonella<\/jats:italic>\n                      outbreaks persist as a public health burden in low- and middle-income countries (LMICs), yet comprehensive synthesis of their epidemiology over the past decade remains limited.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar for laboratory-confirmed\n                      <jats:italic toggle=\"yes\">Salmonella<\/jats:italic>\n                      outbreaks in LMICs (1 January 2016\u20131 January 2026). Random-effects meta-analysis estimated pooled prevalence rates, with statistical heterogeneity quantified using I\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Given extreme heterogeneity across most outcomes (I\n                      <jats:sup>2<\/jats:sup>\n                      &gt; 90%), we present individual study ranges alongside pooled estimates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-four studies from 14 LMICs met inclusion criteria.\n                      <jats:italic toggle=\"yes\">Salmonella<\/jats:italic>\n                      Typhi was the predominant pathogen (70.8% of outbreaks). Waterborne transmission was most frequent (37.5%), predominating in Africa (83.3%), whereas foodborne and fecal-oral routes were common in Asia. Pooled laboratory confirmation rate was 28.02% (95% CI: 12.2\u201352.1; observed range: 1.5\u2013100%), varying by region: Southeast Asia 54.2% (95% CI: 4.3\u201396.9), Western Pacific 27.6% (95% CI: 8.0\u201356.9), and Africa 6.1% (95% CI: 5.3\u20136.9). The pooled case fatality rate was 7.0% (95% CI: 3.4\u201313.7; range: 3.6\u201310.0%). Fever (93.0%), abdominal pain (53.6%), and headache (52.0%) were most common symptoms. Pooled antimicrobial resistance reached 59.3% (95% CI: 26.6\u201385.4%), highest for trimethoprim\u2013sulfamethoxazole (94.2%) and ciprofloxacin (61.3%). Extreme heterogeneity and wide confidence intervals were observed across some pooled estimates and should be interpreted with caution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Salmonella<\/jats:italic>\n                      outbreaks in LMICs are characterized by high\n                      <jats:italic toggle=\"yes\">S.<\/jats:italic>\n                      Typhi prevalence and predominant waterborne transmission. Elevated mortality and widespread first-line antibiotic resistance show the need for improved WASH infrastructure, enhanced real-time outbreak surveillance, and revised empiric treatment protocols.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11786302261487799","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:55:40Z","timestamp":1788886540000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Salmonella<\/i>\n                    Outbreaks in Low- and Middle-Income Countries over the Last Decade: A Systematic Review and Meta-Analysis of Transmission Dynamics, Clinical Outcomes, and Antimicrobial Resistance"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4906-5522","authenticated-orcid":false,"given":"Peter Ofori","family":"Appiah","sequence":"first","affiliation":[{"name":"University of Ghana Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2536-6567","authenticated-orcid":false,"given":"Akuffo","family":"Anita","sequence":"additional","affiliation":[{"name":"Accra Technical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wisdom Boateng","family":"Owusu","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafizu","family":"Muntala","sequence":"additional","affiliation":[{"name":"University for Development Studies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyantseng Vivian","family":"Ekua","sequence":"additional","affiliation":[{"name":"Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Omoniyi","sequence":"additional","affiliation":[{"name":"University of Ghana Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0100-1201","authenticated-orcid":false,"given":"Kwarteng Randy","family":"Ankrah","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70301-8"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32154-2"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30685-6"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","unstructured":"Kabwama SN Bulage L Nsubuga F et al. 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