Abstract
BACKGROUND: Although Africa is a region of hyper endemicity to viral hepatitis B (HBV) and C (HCV) infections, there is limited data on their related burden among pregnant women. The present systematic review and meta-analysis aimed to determine the magnitude of these infections among pregnant women living in Africa and investigate its association with gender-related human development indicators. MAIN TEXT: We searched PubMed, Embase, Web of Science, Africa Journal Online, and Global Index Medicus, with no language restriction, to identify observational studies on HBV and HCV infections in pregnant women residing in Africa published from January 1, 2000 until December 31, 2017. Eligible studies reported the prevalence of HBV and/or HCV infection(s) (HBs antigen and HCV antibodies) and/or infectivity (HBe antigen or detectable HCV viral load). Each study was independently reviewed for methodological quality. We used a random-effects model meta-analysis to pool studies. In total, 145 studies (258 251 participants, 30 countries) were included, of which 120 (82.8%) had a low, 24 (16.5%) a moderate, and one (0.7%) had a high risk of bias. The prevalence of HBV and HCV infections was 6.8% (95% confidence interval [CI]: 6.1-7.6, 113 studies) and 3.4% (95% CI: 2.6-4.2, 58 studies), respectively. The prevalence of HBe antigen and HCV detectable viral load was 18.9% (95% CI: 14.4-23.9) and 62.3% (95% CI: 51.6-72.5) in HBV positive and HCV positive pregnant women, respectively. The multivariable meta-regression analysis showed that the prevalence of HBV infection increased with decreasing gender development index, males' level of education and females' expected years of schooling. Furthermore, this prevalence was higher in rural areas and in western and central Africa. The prevalence of HCV infection increased with decreasing proportion of seats held by women in parliament. CONCLUSIONS: To address the burden of HBV and HCV infections, beyond well-known risk factors at the individual-level, macro-level factors including gender-related human development indicators and dwelling in rural areas should be considered. In Africa, HBV or HCV infected mothers seems to have high potential of transmission to their children.