Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines

Lancet Infect Dis. 2019 Nov;19(11):1219-1234. doi: 10.1016/S1473-3099(19)30414-1. Epub 2019 Sep 12.


Background: Aetiological data for neonatal infections are essential to inform policies and programme strategies, but such data are scarce from sub-Saharan Africa. We therefore completed a systematic review and meta-analysis of available data from the African continent since 1980, with a focus on regional differences in aetiology and antimicrobial resistance (AMR) in the past decade (2008-18).

Methods: We included data for microbiologically confirmed invasive bacterial infection including meningitis and AMR among neonates in sub-Saharan Africa and assessed the quality of scientific reporting according to Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI) checklist. We calculated pooled proportions for reported bacterial isolates and AMR.

Findings: We included 151 studies comprising data from 84 534 neonates from 26 countries, almost all of which were hospital-based. Of the 82 studies published between 2008 and 2018, insufficient details were reported regarding most STROBE-NI items. Regarding culture positive bacteraemia or sepsis, Staphylococcus aureus, Klebsiella spp, and Escherichia coli accounted for 25% (95% CI 21-29), 21% (16-27), and 10% (8-10) respectively. For meningitis, the predominant identified causes were group B streptococcus 25% (16-33), Streptococcus pneumoniae 17% (9-6), and S aureus 12% (3-25). Resistance to WHO recommended β-lactams was reported in 614 (68%) of 904 cases and resistance to aminoglycosides in 317 (27%) of 1176 cases.

Interpretation: Hospital-acquired neonatal infections and AMR are a major burden in Africa. More population-based neonatal infection studies and improved routine surveillance are needed to improve clinical care, plan health systems approaches, and address AMR. Future studies should be reported according to standardised reporting guidelines, such as STROBE-NI, to aid comparability and reduce research waste.

Funding: Uduak Okomo was supported by a Medical Research Council PhD Studentship.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Anti-Bacterial Agents / pharmacology
  • Bacteremia / epidemiology*
  • Bacteremia / etiology*
  • Bacteria / classification*
  • Bacteria / drug effects*
  • Bacteria / isolation & purification
  • Drug Resistance, Bacterial*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / etiology*
  • Prevalence


  • Anti-Bacterial Agents