Abstract
BACKGROUND: Staphylococcal foodborne illness is a prevalent global foodborne disease caused by the ingestion of food contaminated with Staphylococcus aureus enterotoxins. Food handlers can contain these dangerous bacteria, which can contaminate food and cause staphylococcal food poisoning. Thus, study aimed to determine the pooled prevalence of Staphylococcus aureus among food handlers in Ethiopia. METHODS: This systematic review and meta-analysis followed the PRISMA guidelines. The articles were thoroughly searched in electronic databases such as PubMed, Scopus, Epistemonikos, and Google Scholar and grey literatures for relevant entry terms or phrases. Studies published between 2000 and 2024 were included. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Studies with a JBI quality score of ≥ 50% were included after critical appraisal. Stata version 17 software was used for statistical analysis. A random-effects model was used to calculate the overall pooled prevalence of Staphylococcus aureus among food handlers. Heterogeneity was assessed using the Cochrane Q test and I(2) statistics, along with their corresponding p-value of < 0.05. To check for publication bias, we used a funnel plot and Egger’s test, and then performed a trim and fill analysis. Finally, sensitivity analysis was performed to see the impact of individual studies on the pooled effect size. RESULT: The meta-analysis included 11 studies with 7,880 study participants who met the eligibility criteria. The overall pooled prevalence of Staphylococcus aureus among food handlers was 20.46% (95% CI: 12.26, 28.66). A high level of heterogeneity was observed among the studies (I² = 99.99%, p < 0.001). The publication year-based subgroup analysis showed the highest pooled prevalence of 20.8% (95% CI: 9.70, 31.9) in studies published 2019. The regional subgroup analysis revealed a significantly higher pooled prevalence of 27.7% (95% CI: 23.64, 32) in the Oromia region. The total number of Staphylococcus aureus isolates was identified as the variable responsible for the heterogeneity among the studies (p < 0.001). CONCLUSION: Staphylococcus aureus remains a significant concern among food handlers in Ethiopia, yet comprehensive, methodologically robust studies are still lacking. Knowledge gaps persist regarding the burden and impact of related foodborne diseases. Strengthened investment in food safety, coordinated research efforts, and targeted interventions are urgently needed to improve food handling practices and reduce associated health risks. TRIAL REGISTRATION: PROSPERO registration identification number: CRD42024601688. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-025-12260-z.