Incidence, trends and risk factors of preeclampsia in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

INTRODUCTION: Maternal health remains one of the major public health problems for low- and middle-income countries. Of these, preeclampsia is one of the major public health issues in sub-Saharan African countries. This high burden of preeclampsia has been a major concern in sub-Saharan Africa; but there is lack of published studies on the incidence and risk factors of preeclampsia. Therefore, the aim of this systematic review and meta-analysis was to determine the incidence, trends and risk factors of preeclampsia in sub-Saharan Africa. METHODS: we searched databases of PubMed/Medline, Scopus, Cochran Library, Science Direct, Embase, and gray literature from Google and Google Scholar in the year from January 1, 2009, to March 15, 2019. The reason for limiting the year of publication was to generate up-to-date evidence on the pooled incidence of preeclampsia. We looked for articles written in English. Language was limited to reduce bias in the interpretation of meta-results. Data extraction and quality assessment were performed independently by four reviewers. We used the Newcastle-Ottawa Assessment Tool for quality assessment. A PRISMA flow diagram was used to summarize the study selection. We used a random effect model to account for within- and between study variations. We assessed heterogeneity by using the Galbraith plot, subgroup analysis, and egger test. RESULTS: a total of 4,250 studies were found, with 1,345 duplicates removed. Of the 61 studies eligible for full text review, 12 studies were excluded after reading the full-text article. A total of 49 studies were eligible for systematic review, and 11 studies were included in the meta-analysis. In sub-Saharan Africa, the overall pooled incidence of preeclampsia was 13% [95% CI: 0.12´>95% CI: 0.12-0.14]. Women who had multigravida had 89% (aRR = 1.89; 95% CI: 1.65 to 2.17) higher risks for preeclampsia compared to women who did not have multigravida. The result of the trend analysis found that the incidence of preeclampsia had increased from 2.22% in 2010 to 2.67% in 2018. CONCLUSION: incidence of preeclampsia affected a significant proportion of pregnant women in sub-Saharan Africa. The incidence of preeclampsia varies from country to country in sub-Saharan Africa. Women who had multigravida had 89% higher risks for preeclampsia compared to women who did not have multigravida. Preeclampsia awareness, early detection and pharmacological therapy, and health promotion during routine antenatal care services and communities, with a focus on preeclampsia risk factors, could improve maternal and perinatal outcomes in these settings.

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