Molecular Diagnosis of Bacterial Meningitis in Ethiopia: A Narrative Review of Current Evidence and Implementation Gaps.

Background: Bacterial meningitis (BM) remains a significant public health concern in Ethiopia, particularly due to diagnostic challenges posed by limited laboratory infrastructure, late patient presentation, and technical skills required for cerebrospinal fluid (CSF) sampling. Molecular diagnostic methods offer rapid, sensitive, and specific alternatives to conventional culture. Objective: This narrative review synthesizes available evidence on molecular diagnostics for BM in Ethiopia, evaluates their performance compared to conventional methods, and identifies barriers to implementation. Methods: A structured literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science (August 1977-September 2024) using the terms: Meningitis OR Bacterial meningitis AND Diagnostics OR Molecular diagnostics, including PCR, CRISPR, next-generation sequencing (NGS), and MALDI-TOF. The review used a repeatable research selection procedure, well-defined inclusion/exclusion criteria, and PRISMA reporting requirements. Studies from Ethiopia and other low-resource settings were included. After screening titles/abstracts and full texts, 66 articles were selected. Results: In Ethiopia, multiplex PCR detected bacterial DNA in 10%-22% of the CSF samples, whereas culture was positive in only 0.5%-1% of the cases, primarily due to pre-admission antibiotic use. Globally, molecular panels (e.g., BioFire FilmArray ME) show > 90% sensitivity and specificity. Advanced techniques (CRISPR-Cas, NGS, and MALDI-TOF) have not yet been implemented in Ethiopian routine diagnostics. Conclusion: Molecular methods vastly improve the detection of BM in Ethiopia, but high costs, infrastructure gaps, and shortage of trained personnel prevent widespread adoption. Molecular assays have outstanding analytical sensitivity, but culture remains the gold standard for confirmation of the viability of live pathogens. Implementation gaps require urgent targeted investment in point-of-care diagnostics and specialized transport networks.