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Traoré FB, Sidibé CS, Diallo EHM, Camara BS, Sidibé S, Diallo A, Diarra NH, Ly BA, Ag Ahmed MA, Kayentao K, Touré A, Camara A, Delamou A, Sangho H, Terera I. Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis. Front Public Health 2024; 12:1272193. [PMID: 38327574 PMCID: PMC10847291 DOI: 10.3389/fpubh.2024.1272193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa. Methods This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias. Results A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis. Conclusion The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).
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Affiliation(s)
- Fatoumata Bintou Traoré
- National Institute of Public Health, Bamako, Mali
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Cheick Sidya Sidibé
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU Amsterdam, Amsterdam, Netherlands
| | - El Hadj Marouf Diallo
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bienvenu Salim Camara
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Sidikiba Sidibé
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alhassane Diallo
- Université de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nielé Hawa Diarra
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Birama Apho Ly
- Faculté de Pharmacie, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali
| | - Mohamed Ali Ag Ahmed
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Kassoum Kayentao
- Malaria Research and Training Center, Mali International Center for Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Abdoulaye Touré
- Center of Research and Training in Infectious Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alioune Camara
- National Malaria Control Programme Conakry, Conakry, Guinea
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Hamadoun Sangho
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
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Amouzou A, Maïga A, Faye CM, Chakwera S, Melesse DY, Mutua MK, Thiam S, Abdoulaye IB, Afagbedzi SK, Ag Iknane A, Ake-Tano OS, Akinyemi JO, Alegana V, Alhassan Y, Sam AE, Atweam DK, Bajaria S, Bawo L, Berthé M, Blanchard AK, Bouhari HA, Boulhassane OMA, Bulawayo M, Chooye O, Coulibaly A, Diabate M, Diawara F, Esleman O, Gajaa M, Garba KHA, Getachew T, Jacobs C, Jacobs GP, James F, Jegede AS, Joachim C, Kananura RM, Karimi J, Kiarie H, Kpebo D, Lankoandé B, Lawanson AO, Mahamadou Y, Mahundi M, Manaye T, Masanja H, Millogo MR, Mohamed AK, Musukuma M, Muthee R, Nabié D, Nyamhagata M, Ogwal J, Orimadegun A, Ovuoraye A, Pongathie AS, Sable SP, Saydee GS, Shabini J, Sikapande BM, Simba D, Tadele A, Tadlle T, Tarway-Twalla AK, Tassembedo M, Tehoungue BZ, Terera I, Traoré S, Twalla MP, Waiswa P, Wondirad N, Boerma T. Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services. BMJ Glob Health 2022; 7:bmjgh-2021-008069. [PMID: 35501068 PMCID: PMC9062456 DOI: 10.1136/bmjgh-2021-008069] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/04/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.
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Affiliation(s)
- Agbessi Amouzou
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cheikh Mbacké Faye
- African Population Health Research Centre, Dakar, Senegal.,School of Public Health, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | - Dessalegn Y Melesse
- Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sokhna Thiam
- African Population Health Research Centre, Dakar, Senegal
| | | | | | | | | | | | - Victor Alegana
- School of Geography and Environmental Sciences, University of Southampton, Southampton, UK.,Kenya Medical Research Institute, Nairobi, Kenya
| | - Yakubu Alhassan
- University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | | | | | - Shraddha Bajaria
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | - Luke Bawo
- Ministry of Health, Monrovia, Montserrado, Liberia
| | | | | | | | | | - Maio Bulawayo
- Department of Health Policy and Management, University of Zambia, Lusaka, Zambia
| | | | - Amed Coulibaly
- Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Mamatou Diabate
- Ministère de la Santé et de l'Hygiène Publique du Mali, Bamako, Mali
| | | | | | - Mulugeta Gajaa
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia
| | | | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia.,College of Medicine and Health Science, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Choolwe Jacobs
- Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | | | | | | | | | | | | | | | - Denise Kpebo
- Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Bruno Lankoandé
- Institut Superieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | | | | | - Masoud Mahundi
- University of Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | | | - Honorati Masanja
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | | | | | - Mwiche Musukuma
- University of Zambia School of Public Health, Lusaka, Zambia
| | | | - Douba Nabié
- Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | | | - Adebola Orimadegun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | | | | | | | - Josephine Shabini
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamayo, Tanzania, United Republic of
| | | | - Daudi Simba
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Ashenif Tadele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia
| | - Tefera Tadlle
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia
| | | | | | | | | | | | - Musu P Twalla
- University of Liberia, Monrovia, Montserrado, Liberia
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Naod Wondirad
- Federal Ministry of Health, Addis Ababa, Ethiopia.,Clinical Services Directorate, Ethiopia Ministry of Health, Addis Ababa, Lideta, Ethiopia
| | - Ties Boerma
- Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
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