Awareness and associated factors of pregnancy-induced hypertension among pregnant women in Africa: A systematic review and meta-analysis

Introductionthrombocytopenia is a common hematological disorder during pregnancy next to anemia. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, cesarean section incision site oozing, stillbirth and neonatal thrombocytopenia. Findings on the magnitude of thrombocytopenia among pregnant women were inconsistent. Therefore, this review aimed to estimate the pooled prevalence of thrombocytopenia among pregnant women in Africa.Methodsthis systematic review and meta-analysis were performed based on PRISMA guidelines. The databases (PubMed, PubMed Central, Hinari, Science Direct, Pop line, Google Scholar, and African Journals Online) were searched to identify relevant studies. Data were analyzed using STATA 11 statistical software. A random-effect model was fitted to estimate the pooled prevalence of thrombocytopenia. I2 test statistics were done to test the heterogeneity of included studies. Funnel plots analysis and Egger weighted regression tests were done to detect publication bias.Resultsof the total 1,517 articles retrieved, 15 articles which involved 8,380 pregnant women were eligible for meta-analysis. The overall pooled prevalence of thrombocytopenia among pregnant women in Africa was 10.23% (95% confidence interval (CI): 7.44, 13.02%). Its level of severity showed that, 77.95% (I2=43.1%), 15.62% (I2=53.4%), and 5.60 (I2=0.0%) of pregnant women had mild, moderate and severe thrombocytopenia, respectively. The highest prevalence of thrombocytopenia was occurred in the third trimester of pregnancy (54.05% (95% CI: 29.48, 78.61)).Conclusionthis systematic review and meta-analysis showed that the pooled prevalence of thrombocytopenia among pregnant women in Africa was found to be relatively higher compared with the globe. Therefore, routine screening and follow-up programs are needed to identify pregnant women with thrombocytopenia and provide them with the necessary interventions.

Introduction: One way to find and stop HIV transmission through healthcare is to investigate unexplained infections. Because pregnant women in Africa get a lot of healthcare and HIV tests, public health officials should be alert to recognize and investigate new infections in pregnant and early postpartum women with no sexual risks. Methods: For all identified published reports of HIV incidence (new infections) in pregnant and early postpartum women in Africa, I look for evidence of nosocomial (from healthcare) infections in two ways: reported incidence higher than estimated incidence from sex (calculated from estimates of partners’ HIV prevalence, coital frequency, and transmission per coital act); and reported incidence so high that women with incidence at that rate for several years would reach observed prevalence in the population from which the sample or cohort was selected. Results: In 46 samples or cohorts, HIV incidence in pregnant and early postpartum women ranges from 0 to 19 per 100 person-years (PYs). After subtracting estimated incidence from sex, unexplained incidence in 14 samples or cohorts ranges from 5.8 to 14.9 per 100 PYs. For 10 of the 14 reports of unexplained incidence ≥5.8 per 100 years, studies report HIV prevalence in the population of women from which the sample or cohort was selected; in all 10 studies, women acquiring HIV at the observed rate would reach observed HIV prevalence in 0.9-3.9 years. Discussion: Unexplained high incidence in pregnant and early postpartum women in some sites and years suggests many may have gotten HIV from pregnancy-related healthcare. Initiatives to protect women (e.g., reporting infection control practices in pregnancy-related healthcare, acknowledging unexplained infections, and investigating suspected outbreaks) are indicated.

BackgroundThere have been a number of studies about seroprevalence of HEV among pregnant women in Africa. However, the finding of seroprevalence of HEV infection among pregnant women is variable and inconsistent. Therefore; this systematic review intended to provide the pooled seroprevalence of HEV among pregnant women in Africa.MethodsWe searched, Pub Med, Science direct, African online journals and Google scholar electronic data bases and all available references until August 30, 2018. We included cross sectional studies and cohort studies. The search was further limited studies done in African pregnant women. Statistical analysis done by using Stata (version 11) software. The overall pooled prevalence of HEV presented by using the forest plot with 95% CI. The methodological qualities of included studies were assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments.ResultThe pooled seroprevalence of HEV among pregnant women in Africa was 29.13% (95% CI 14.63–43.63). The highest seroprevalence was 84.3% in Egypt and the lowest 6.6% reported in Gabon. There was highest heterogeneity level where I2 = 99.7%; P < 0.0001.The observed heterogeneity attributed to geographic location/ region, country, assay method used in each study and year of study published. Moreover, HEV seroprevalence varies between countries and within countries. The HEV infection among African pregnant women seems to have a decreasing trend over time.ConclusionThe seroprevalence of HEV among pregnant women in Africa is high. The seroprevalence of HEV among pregnant women differ with geographic location and assay method. Therefore, it is recommended to conduct further research on commercial ELISA kit sensitivity and specificity, molecular tests, incidence, morbidity and mortality and vertical transmission of HEV from mother to infant in Africa.Trial registrationCRD42018084963.

Alcohol consumption is a major global risk factor for poor health, contributing to a wide range of physical, mental, and social problems. Among vulnerable populations, alcohol use during pregnancy is a particularly critical concern due to its harmful effects on both maternal and fetal health. This issue is especially pressing in low- and middle-income countries (LMICs), where alcohol consumption is increasing and healthcare systems often lack the capacity to address related consequences. In Africa, characterized by diverse cultural norms and socioeconomic disparities, the burden of alcohol use during pregnancy remains inadequately understood. While several studies have explored this issue across various African settings, their findings have been inconsistent. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of alcohol consumption during pregnancy and identify associated factors among pregnant women in Africa. This study followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024557559). A comprehensive search was conducted across PubMed, MEDLINE, EMBASE, Scopus, and the Cochrane Library. Eligible cross-sectional studies reporting alcohol consumption among pregnant women in Africa were included. The methodological quality of each study was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Only studies scoring five or higher were included. Data extraction was done using a structured Excel sheet. Publication bias was assessed using funnel plots and Egger's test. A total of 21 studies from various African countries involving 11,726 pregnant women were included. The pooled prevalence of alcohol consumption during pregnancy was 28.33% (95% CI: 22.68-33.99%). Subgroup analysis showed prevalence estimates of 34.09% in Ghana, 29.19% in Ethiopia, and 19.80% in Uganda. Significant associated factors included rural residence, lack of formal education, poor social support, family history of mental illness, history of abortion, lack of awareness, pre-pregnancy alcohol use, partner alcohol use, and unplanned pregnancy. This systematic review and meta-analysis found that the pooled prevalence of alcohol consumption among pregnant women was high. This study provides valuable insights that can inform future public health initiatives and research on this critical topic.

BackgroundAlthough hepatitis B infection is highly endemic in Africa, information on its epidemiology among pregnant women in the region is limited. Therefore, this systematic review provided up-to-date information on the epidemiology of hepatitis B virus (HBsAg) infection among pregnant women in Africa.MethodsA systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews. The Web of Science, Scopus, PubMed, Google Scholar, and African journals online were searched to identify relevant studies published between January 1, 2015, and May 21, 2024, on hepatitis B virus infection in pregnant women living in Africa. The Joanna Briggs Institute tool was used to assess the methodological qualities of the included studies. The random effects model was used to estimate the pooled prevalence of HBV infection. I2 assessed the amount of heterogeneity. Publication bias was assessed using Egger’s test and a funnel plot.ResultsWe included 91 studies from 28 African countries. The pooled prevalence of hepatitis B infection among pregnant women in Africa was 5.89% (95% CI: 5.26–6.51%), with significant heterogeneity between studies (I2 = 97.71%, p < 0.001). Family history of hepatitis B virus infection (AOR = 2.72, 95%CI: 1.53–3.9), multiple sexual partners (AOR = 2.17, 95%CI: 1.3–3.04), and sharing sharp materials were risk factors for hepatitis B infection.ConclusionAn intermediate endemic level of hepatitis B virus infection (2–7%) was observed among pregnant women in Africa. To prevent disease transmission, interventions should focus on pregnant women with a family history of hepatitis B infection, multiple sexual partners, and sharing sharp materials.

BACKGROUNDHuman immunodeficiency virus (HIV) is a major public health concern, particularly in Africa where HIV rates remain substantial. Pregnant women are at an increased risk of acquiring HIV, which has a significant impact on both maternal and child health.AIMTo review summarizes HIV seroprevalence among pregnant women in Africa. It also identifies regional and clinical characteristics that contribute to study-specific estimates variation.METHODSThe study included pregnant women from any African country or region, irrespective of their symptoms, and any study design conducted in any setting. Using electronic literature searches, articles published until February 2023 were reviewed. The quality of the included studies was evaluated. The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa. Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity. Heterogeneity was assessed with Cochran's Q test and I2 statistics, and publication bias was assessed with Egger's test.RESULTSA total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis (meta-analysis). Out of the total studies, 146 (58.9%) had a low risk of bias and 102 (41.1%) had a moderate risk of bias. No HIV-positive pregnant women died in the included studies. The overall HIV seroprevalence in pregnant women was estimated to be 9.3% [95% confidence interval (CI): 8.3-10.3]. The subgroup analysis showed statistically significant heterogeneity across subgroups (P < 0.001), with the highest seroprevalence observed in Southern Africa (29.4%, 95%CI: 26.5-32.4) and the lowest seroprevalence observed in Northern Africa (0.7%, 95%CI: 0.3-1.3).CONCLUSIONThe review found that HIV seroprevalence among pregnant women in African countries remains significant, particularly in Southern African countries. This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.

Background Different physiologic changes that occur during pregnancy, such as Hydroureter, dilatation of the renal pelvis, glycosuria and aminoaciduria, and low urine production predispose pregnant women for ascending urinary tract infection. Globally, 2% to 15% of the pregnant women have urinary tract infection without specific symptoms. Therefore, this study aimed to estimate the prevalence of asymptomatic bacteriuria (ABU) in pregnant women in Africa. Methods Systematic search of published studies done on PubMed, EMBASE, Web of Science, SCOPUS, PsychInfo, CINAHL, and google scholar for gray literature. All published observational studies until October 30, 2020 were included. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality of studies was assessed by modified Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using a random-effects method with the double arcsine transformation approach using the STATA™ Version 14 software. Trim and fill analysis was done to correct presence of significant publication bias. The study protocol is prospectively registered on PROSPERO, registration number CRD42020212601. Findings From 3393 obtained studies, 48 studies from 12 African countries involving 15, 664 pregnant women included in this Meta-analysis. The overall pooled prevalence of asymptomatic bacteriuria among pregnant women in Africa after correction for publication bias by trim and fill analysis was found to be 11.1% (95% CI: 7.8, 14.4). The most common bacterial isolates involved in the etiology of ABU was Escherichia coli with pooled prevalence 33.4% (95% CI: 27.3 - 39.4) Interpretation Asymptomatic bacteriuria is substantial among pregnant women in Africa. Therefore, all pregnant women should be tested for the presence of asymptomatic bacteriuria. A screening program must be based not only on the incidence but also on a cost-efficacy evaluation and a microbiological evaluation. Funding There was no funding source for this study.

IntroductionAfrica exhibits a considerably high prevalence of the hepatitis B virus among pregnant women. Furthermore, there is a discernible lack of a well-established surveillance system to adequately monitor and comprehend the epidemiology of the hepatitis B virus, particularly among pregnant women. The eradication efforts of the virus in Africa have been impeded by the significant disease burden in the region, and there is a lack of evidence regarding the pooled prevalence of the hepatitis B virus in Africa. Consequently, this systematic review and meta-analysis aims to determine the prevalence of hepatitis B virus infection among pregnant women in Africa.MethodsWe conducted a systematic literature search using reputable databases such as PubMed, Advanced Google Scholar, Scopus, and the Cochrane Library. The search spanned from July 2013 to July 2023 and included all relevant articles published within this period. To identify potentially eligible articles, we conducted a comprehensive manual review of the reference lists of the identified studies. Our review encompassed articles from the African Journal Online. The analysis focused on observational studies published in peer-reviewed journals that reported the prevalence of hepatitis B surface antigen-positive testing among pregnant women. We utilized the Newcastle-Ottawa critical appraisal checklist to assess the methodological quality of each paper. Finally, a meta-analysis was conducted using a random-effects model.ResultsOut of the 774 studies identified, 31 studies involving 33,967 pregnant women were selected for the meta-analysis. According to the random-effects model, the combined prevalence of hepatitis B virus among pregnant women was 6.77% [95% CI: 5.72, 7.83]. The I2 statistic was calculated to be 95.57% (p = 0.00), indicating significant heterogeneity among the studies. The high I2 value of 95.57% suggests a substantial degree of heterogeneity. A subgroup meta-analysis revealed that factors such as time-dependent bias, sample size dependence, or individual variation among study participants contributed to this heterogeneity (p-difference < 0.05).ConclusionAccording to the findings of this study, the pooled prevalence of hepatitis B infection among pregnant women in Africa was found to be intermediate-high. It is recommended that policymakers implement hepatitis B virus immunization programs targeting pregnant women and their new-born babies at higher risk of exposure.

BackgroundObstetric ultrasound (US) is a non-invasive imaging method that employs sound waves to explore the abdominal and pelvic areas of a pregnant woman. It is recommended to have at least two ultrasound scans during pregnancy, one in the first trimester and another in the second trimester, to identify potential complications and improve perinatal outcomes. While this practice is widely implemented in developed nations, its utilization in many African countries remains suboptimal. This systematic review and meta-analysis aims to examine the level of knowledge and utilization of obstetric ultrasound among pregnant women in Africa, providing insights into its awareness and utilization across the continent.MethodA systematic review and meta-analysis were conducted following PRISMA guidelines. Extensive literature searches were carried out across various databases, including PubMed, Google Scholar, ScienceDirect, Web of Science, Scopus, and African Online Journal databases. The pooled prevalence was estimated using a weighted inverse variance random-effects model. Heterogeneity among studies was assessed using the Cochrane Q-test and I2 statistics, while publication bias was evaluated through a funnel plot and Egger's test. Stata v17 software was employed to analyze factors associated with the utilization of obstetric ultrasound among pregnant women in Africa.ResultA total of 622 articles were initially identified, with 23 ultimately meeting the inclusion criteria for this review, including five studies that addressed both knowledge and utilization of obstetric ultrasound. The overall knowledge level among pregnant women in Africa regarding obstetric ultrasound was estimated at 74.33% (95% CI 63.27–85.38%), while the pooled proportion of utilization was 63.3% (95% CI 51.59–75.02%). Subgroup analysis revealed that both knowledge and utilization levels were highest in Western Africa, whereas knowledge was lowest among pregnant women in Eastern Africa. Pregnant women with good knowledge of obstetric ultrasound were significantly more likely to utilize the service, with a pooled odds ratio (POR) of 8.41 (95% CI 4.66–12.16).ConclusionThis systematic review and meta-analysis revealed a moderate utilization of obstetric ultrasound among pregnant mothers in Africa, with an increasing trend over time, particularly after 2020. The overall level of knowledge about obstetric ultrasound among mothers was 74.33%, and knowledge was identified as the key factor significantly associated with ultrasound utilization.

BackgroundThis systematic review aimed to assess pregnant women’s knowledge, perceptions, and attitudes toward oral health changes in sub-Saharan Africa (SSA) and examine their oral health-seeking behavior during pregnancy.MethodsA comprehensive search was conducted across PubMed, Google Scholar, African Journals Online (AJOL), the Directory of Open Access Journals (DOAJ), and the Cochrane Library. Both Medical Subject Headings (MeSH) and free-text terms related to oral health, knowledge, attitudes, perceptions, antenatal care, pregnancy, and Africa were used. Boolean operators (“AND,” “NOT,” and “OR”) refined the search strategy. Two independent reviewers screened studies and extracted data using Rayyan software, with a third reviewer resolving conflicts. The Robins-E tool assessed the risk of bias.ResultsFifteen of seventy-five studies initially identified met the inclusion criteria after full-text screening. Most employed a cross-sectional design. Findings revealed low oral health-seeking behavior among pregnant women in Africa, attributed to factors such as negative dental experiences, concerns about harm to the unborn child, and the belief that dental care is unnecessary. Many women visited dental clinics only when they noticed significant oral health changes.ConclusionsThe reviewed studies demonstrated a low risk of bias and consistent findings. Pregnancy is a critical period, and poor oral health can adversely affect birth outcomes. Insufficient knowledge and misconceptions deter women from seeking dental care during pregnancy. To address this, targeted oral health education must improve awareness and overcome barriers to seeking care.

The epidemiology of toxoplasmosis in pregnancy is a major issue in public health. Toxoplasmosis is caused by the protozoan parasite. Toxoplasma parasite is at high risk for life-threatening diseases during pregnancy. Congenital toxoplasmosis results from a maternal infection acquired during gestation. Therefore, this systematic review and meta-analysis was aimed to determine the seropositive prevalence of toxoplasmosis infection among pregnant women who attended antenatal care in a health facility in Africa. A systematic review and meta-analysis of published and unpublished studies were included. Databases such as MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, African Journals Online were used with relevant search terms. The quality of the articles was critically evaluated using the tool of the Joanna Briggs Institute. Data were extracted on Microsoft word 2016. Meta-analysis was conducted using STATA 14 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test, respectively. Forest plots were used to present the pooled prevalence and odds ratio with a 95% confidence interval of meta-analysis using the random effect model. In total, 23 studies comprising 7,579 pregnant women across ten countries in Africa were included in this meta-analysis. The overall prevalence of seropositive toxoplasmosis among pregnant women in Africa was 51.01% (95% CI; 37.66, 64.34). The heterogeneity test showed that heterogeneity was high, I2 = 99.6%, P-value < 0.001. The variables responsible for the source of heterogeneity were included from Cameroon, the Democratic Republic of Congo, and Ethiopia. Overall prevalence of toxoplasmosis in Africa showed that more than one-half of pregnant women were infected. The risk of acquiring toxoplasmosis infection during pregnancy is high; hence, preventive measures to avoid exposure of pregnant women to Toxoplasma infection should be strictly applied.

The epidemiology of toxoplasmosis in pregnancy is a major issue in public health. Toxoplasmosis is caused by the protozoan parasite. Toxoplasma parasite is at high risk for life-threatening diseases during pregnancy. Congenital toxoplasmosis results from a maternal infection acquired during gestation. Therefore, this systematic review and meta-analysis was aimed to determine the seropositive prevalence of toxoplasmosis infection among pregnant women who attended antenatal care in a health facility in Africa. A systematic review and meta-analysis of published and unpublished studies were included. Databases such as MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, African Journals Online were used with relevant search terms. The quality of the articles was critically evaluated using the tool of the Joanna Briggs Institute. Data were extracted on Microsoft word 2016. Meta-analysis was conducted using STATA 14 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test, respectively. Forest plots were used to present the pooled prevalence and odds ratio with a 95% confidence interval of meta-analysis using the random effect model. In total, 23 studies comprising 7,579 pregnant women across ten countries in Africa were included in this meta-analysis. The overall prevalence of seropositive toxoplasmosis among pregnant women in Africa was 51.01% (95% CI; 37.66, 64.34). The heterogeneity test showed that heterogeneity was high, I2 = 99.6%, P-value < 0.001. The variables responsible for the source of heterogeneity were included from Cameroon, the Democratic Republic of Congo, and Ethiopia. Overall prevalence of toxoplasmosis in Africa showed that more than one-half of pregnant women were infected. The risk of acquiring toxoplasmosis infection during pregnancy is high; hence, preventive measures to avoid exposure of pregnant women to Toxoplasma infection should be strictly applied.

Bacterial Profile and asymptomatic bacteriuria among pregnant women in Africa: A systematic review and meta analysis.

Toxoplasmosis is a serious endemic zoonotic disease caused by the protozoan parasite Toxoplasma gondii. Toxoplasma infection during pregnancy can result in congenital transmission and serious fetal and neonatal complications. This systematic review and meta-analysis aimed to assess the pooled seroprevalence of T. gondii infection and its determinants among pregnant women in African countries. All articles reporting the seroprevalence of toxoplasmosis among pregnant women in African countries and published from 2010 to 2023 were searched using various databases. The pooled prevalence of toxoplasmosis was calculated using a random-effect model. The variation between the included studies was assessed using a funnel plot and I2 heterogeneity statistics. To identify the sources of heterogeneity, sub-group analysis was further conducted by country, diagnostic method, and sub-African region. The association of prevalence rates with the socio-economic level and geoclimatic parameters was also explored. In total, 29,383 pregnant women from 60 articles were included for analysis. The pooled T. gondii seroprevalence was 42.89% with high heterogeneity (I2 = 99.4%, P < 0.001). Sub-group analysis revealed variation by country (ranging from 2.62% in Namibia to 80.28% in Congo), diagnostic method used (from 8.66% in studies using a rapid diagnostic test to 55.69% in those using an agglutination test), and sub-African region (from 4.14% in regions of Southern Africa to 53.96 in Central Africa). Cat ownership (OR = 1.58) and the consumption of raw meat (OR = 1.50) and raw vegetables (OR = 1.48) had a statistically significant combined effect on T. gondii seroprevalence. No association was found between T. gondii prevalence and the level of income of the country or geoclimatic parameters. The prevalence of toxoplasmosis infection among pregnant women in Africa is high, particularly in Central and Eastern Africa. The determinants of prevalence are multifactorial. Therefore, efforts should be made to increase the awareness of women concerning the risk factors for toxoplasmosis.

Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva, which is caused by Candida species and affects women worldwide. Pregnant women are more vulnerable to VVC due to certain risks. Moreover, their offspring are also exposed to the risk of preterm birth. In this context, ascertaining the burden of VVC is of paramount importance and this meta-analysis was conducted to estimate the occurrence of VVC among pregnant women in Africa. Database search was carried out through PubMed, Scopus, Science-Direct, and Google Scholar from the date of inception until December 2020. All the studies on the prevalence of VVC among African pregnant women were included in the analysis. The pooled prevalence was estimated based on the Random-effect model DerSimonian-Laird approach with Freeman- Tukey double arcsine transformed proportion. Heterogeneity was assessed using I2 test and subsequently explored using subgroup and meta-regression analysis. A total of Sixteen records having a sample size 4,185 were included in this study. The overall prevalence of VVC was pooled at 29.2% (CI 95%: 23.4 - 33.0). Subgroup analysis revealed a higher prevalence in Eastern Africa, followed by Western Africa and North Africa (35%, 28%, and 15% respectively). Moderator analysis indicated that the studies that used advanced methods of detection had a higher prevalence (p = 0.048). In addition, the large sample size was associated with higher prevalence (p ≤ 0.001). No other moderators were found to be statistically significant. The overall prevalence of VVC among African pregnant women is comparable to other studies worldwide. However, appropriate identification techniques and larger sample size could likely be associated with an increased prevalence. Our findings necessitate the need for further investigations to determine the geographical distribution of VVC across African regions.