Abstract
BACKGROUND: Vegetables and fruits are essential parts of a healthy diet; however, the consumption of unclean, uncooked, and improperly prepared vegetables and fruits is a major cause of parasitic and bacterial infections. These vegetables and fruits are contaminated during pre- and post-harvest stages. Therefore, this systematic review and meta-analysis provides evidence-based scientific information about the level of both parasitic and bacterial contamination of vegetables and fruits and its associated factors in Ethiopia. METHODS: A systematic search was conducted in the PubMed, Scopus, Web of Science, ScienceDirect, and African Journals Online (AJOL) databases for studies published between March 2010 and January 2025. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-2020 guidelines. Microsoft Excel 2016 sheet template was employed to extract the data. The Joanna Briggs Institute (JBI) checklist was used to evaluate the quality of the included studies. A random effects model was selected for analysis. Heterogeneity was quantified using the I² statistic, and sources of heterogeneity were explored via subgroup analyses and Galbraith plot. Publication bias was evaluated using funnel plots and Egger’s test. Risk factors were summarized as adjusted odds ratios (aOR) with 95% confidence intervals (CI). All analysis was performed via STATA version 14 with metan command. RESULTS: Twenty-nine studies with 6659 vegetables and fruits were included. The overall prevalence of contaminated fresh produce was 48.76% (95% CI: 40.78–56.74). The meta-analysis yielded a pooled prevalence of 52.85% (95% CI: 32.10–73.60) for bacterial contamination and 46.40% (95% CI: 40.04–52.75) for parasitic contamination. Gram-positive bacteria were more common (28.97%) than gram-negative bacteria (23.88%). Similarly, helminths were more prevalent (29.07%) than protozoans (17.30%). Among bacteria, the predominant family/genera were Enterobacteriaceae (14.78%), Bacillus spp. (10.27%), Staphylococcus spp. (8.86%), and Micrococcus spp. (5.20%). The most prevalent parasites identified were Ascaris spp. (8.34%), Entamoeba spp. (6.92%), Strongylida (6.51%), and Giardia spp. (5.67%). Lettuce (61.0%), salad (57.4%), spinach (54.2%), and cabbage (52.9%), were the vegetables most contaminated by parasites, while salad (73.8%), green pepper (35.3%), lettuce (26.0%), and cabbage (20.0%), were the most contaminated by bacteria. The contamination rates of fruits by bacteria and parasites were 0.55% and 5.4%, respectively, while those of vegetables were 52.30% and 41.00%, respectively. The mode of produce display (adjusted odds ratio [aOR]: 2.15, 95% CI: 1.17–3.13), type of produce (aOR: 2.10, 95% CI: 1.13–3.08), vendors’ fingernail hygiene (aOR: 2.02, 95% CI: 1.10–2.93), source of produce (aOR: 2.46, 95% CI: 1.45–3.47), education status of vendors (aOR: 11.43, 95% CI: 6.18–29.05), handwashing habits of vendors (aOR: 3.10, 95% CI: 1.53–4.67) and washing before display (aOR: 2.41, 95% CI: 1.52–3.30) were the significantly associated factors. CONCLUSION: This meta-analysis found a high prevalence of bacterial and parasitic contamination in vegetables and fruits. Therefore, food and drug authorities and public health institutions should increase awareness among vendors and consumers about safe practices for the handling and consumption of vegetables and fruits, and region/city administrators should prepare safe farms and marketplaces. Furthermore, the agricultural industry should increase awareness among farmers about the cultivation and transportation of vegetables and fruits. PROTOCOL REGISTRATION: This systematic review and meta-analysis study is registered in International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42025640154. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-025-12045-4.