Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

Fatoumata Bintou Traoré; Cheick Sidya Sidibé; El Hadj Marouf Diallo; Bienvenu Salim Camara; Sidikiba Sidibé; Alhassane Diallo; Nielé Hawa Diarra; Birama Apho Ly; Mohamed Ali Ag Ahmed; Kassoum Kayentao; Abdoulaye Touré; Alioune Camara; Alexandre Delamou; Hamadoun Sangho; Ibrahim Terera

doi:10.3389/fpubh.2024.1272193

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

Front Public Health. 2024 Jan 24:12:1272193. doi: 10.3389/fpubh.2024.1272193. eCollection 2024.

Authors

Fatoumata Bintou Traoré^{1

2}, Cheick Sidya Sidibé³, El Hadj Marouf Diallo², Bienvenu Salim Camara^{2

4}, Sidikiba Sidibé^{2

4}, Alhassane Diallo⁵, Nielé Hawa Diarra⁶, Birama Apho Ly⁷, Mohamed Ali Ag Ahmed⁶, Kassoum Kayentao⁸, Abdoulaye Touré⁹, Alioune Camara¹⁰, Alexandre Delamou², Hamadoun Sangho⁶, Ibrahim Terera¹

Affiliations

¹ National Institute of Public Health, Bamako, Mali.
² African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.
³ Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU Amsterdam, Amsterdam, Netherlands.
⁴ Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.
⁵ Université de Montpellier, Montpellier, Languedoc-Roussillon, France.
⁶ Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.
⁷ Faculté de Pharmacie, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali.
⁸ Malaria Research and Training Center, Mali International Center for Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali.
⁹ Center of Research and Training in Infectious Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.
¹⁰ National Malaria Control Programme Conakry, Conakry, Guinea.

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).

Keywords: associated factors; maternal sepsis; neonatal sepsis; prevalence; sub-Saharan Africa.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Africa South of the Sahara / epidemiology
Female
Humans
Infant, Newborn
Male
Mothers
Neonatal Sepsis* / epidemiology
Pregnancy
Pregnancy Complications, Infectious*
Prevalence

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the West African Network of African Center of Excellence on Infectious Diseases (WANIDA); however, the institution played no role in the study design, data collection, data analysis, or writing of the article. The corresponding author was responsible for the data and submission of the article for publication.