The Global Prevalence of Tuberculosis Infection in Buffaloes: A Systematic Review and Meta-Analysis.

Bovine tuberculosis (bTB), caused by Mycobacterium bovis (M. bovis), is a chronic zoonotic disease with buffaloes as maintenance hosts, yet global pooled prevalence of bTB in buffaloes has not been systematically quantified. This systematic review and meta-analysis estimated the global prevalence, distribution, and risk factors (spatio-temporal, geographical and socioeconomic, host characteristics, and research design and methodology) of bTB in buffaloes. Six electronic databases (PubMed, ScienceDirect, Web of Science, CNKI, VIP, and WanFang) were systematically searched for studies published between 1963 and 2025. Of 1731 records, 104 studies (385,616 buffaloes, 17 countries) were included. Estimates a global pooled prevalence of 7.4% for buffaloes, which is higher than recent global estimates for cattle (reported at 3.98% and, in a 2024 meta-analysis, 3.27% at the animal level); this cross-species comparison should be interpreted cautiously given differences in diagnostics, regions and time periods. Key risk factors identified were advanced age (15-20 years, 34.2%), draught use (28.0%), free-ranging management (12.0%), large herd size (9.9%), low-income economies (13.7%), and tropical savanna climate (10.1%). Publication bias was detected but did not substantially alter the overall pooled prevalence estimate. The persistently high burden in Africa and developing countries highlights the urgent need for integrated One Health surveillance and targeted control strategies.