Abstract

Scientific evidence from public health findings can enhance the management, treatment, and prevention policies 
for bacterial meningitis (BM) infections. However, comprehensive epidemiological data on BM prevalence in South 
Africa is limited. We aimed to assess the prevalence and characteristics of laboratory-confirmed BM cases at the 
national population level. Using PRISMA standards, we retrieved data from electronic databases and selected 
reference articles. Out of 115,626 participants, 57,964 (50.13%) were infected with BM, with the highest prevalence 
(7.67%) in the age group 6–17 years. Our meta-analysis of 19 studies revealed an overall pooled prevalence 
of 38.01%, 95% confidence interval (CI: 0.26–0.50), with significant heterogeneity (I² = 99.86%, Q = 13117.45, 
p < 0.0001). The Egger test indicated publication bias (z = 3.4977, p = 0.0005). Subgroup analyses showed a higher 
prevalence in studies with sample sizes over 1000 (60.22%, 95% CI: 0.3899–0.7819, I² = 99.92%), over long study 
years (37.50%, 95% CI: 0.2642–0.5005, I² = 99.84%), cross-sectional study design (58.69%, 95%CI: 0.4906–0.6770, 
I2 = 99.72%), and particularly in Gauteng province (60.42%, 95% CI: 0.4539–0.7371, I² = 98.45%). The infectious 
types included Listeria (83.33%, 95% CI: 0.1936–0.9905, I² = 0.00%) and Neisseria (62.64%, 95% CI: 0.6126-0.6400, I² 
= 0.00%). Significant heterogeneity was noted in study design (R² = 52.93%, p < 0.0001), sample size (R² = 0.00%, 
p = 0.0117), and province (R² = 0.0%, p < 0.0001). These findings underscore a high prevalence of BM infections 
in South Africa’s epidemiological landscape, highlighting the urgent need for targeted surveillance for effective 
prevention and treatment strategies.