Abstract
BACKGROUND: Preventing healthcare-associated infections (HAIs) depends largely on healthcare workers knowledge and consistent application of infection prevention and control measures. However, despite the availability of global and regional guidelines, significant gaps remain, especially in low-resource settings. In East Africa, existing studies show wide variation in healthcare workers knowledge and practice levels, highlighting inconsistencies in the evidence base. Therefore, this study aimed to assess the knowledge and practice of healthcare workers towards healthcare-associated infection prevention in East Africa through a systematic review and meta-analysis. METHOD: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was conducted across databases including PubMed, Embase, Scopus, ScienceDirect, AJOL, and institutional repositories to identify studies assessing healthcare workers' knowledge and practice regarding HAI prevention in East Africa. Meta-analysis was conducted using a random-effects model due to significant heterogeneity, and pooled prevalence estimates with 95% confidence intervals were reported. Subgroup and sensitivity analyses were performed to explore heterogeneity, and publication bias was assessed using funnel plots and Egger's test. RESULTS: Out of 6,023 identified records, 41 studies met the inclusion criteria and were included in the meta-analysis. These studies, encompassing 11,974 healthcare workers across East African countries, revealed that the pooled prevalence of adequate knowledge regarding HAI prevention was 64.71% (95% CI: 56-72), while the overall prevalence of good infection prevention practices was 55% (95% CI: 50-60). Subgroup analysis indicated that the highest knowledge level was reported in Eritrea (91%), and the lowest in Madagascar (37%). For practice, the highest adherence was observed in Zambia (80%) and the lowest in Sudan (33%). Substantial heterogeneity was noted across studies, prompting further subgroup and sensitivity analyses. CONCLUSIONS: This review found that healthcare workers in East Africa have moderate knowledge and practice levels regarding HAI prevention, with notable variation across countries. To address these gaps, infection prevention and control programs should be strengthened through regular training, adequate resources, and institutional support. Enhanced policy enforcement and further research on country-specific challenges are also recommended.