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Meta-Analysis
. 2019 Apr;21(4):479-488.
doi: 10.1111/jch.13514. Epub 2019 Mar 7.

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta-analysis

Jean Jacques Noubiap  1 , Jean Joel Bigna  2 , Ulrich Flore Nyaga  3 , Ahmadou M Jingi  3 , Arnaud D Kaze  4 , Jobert Richie Nansseu  5   6 , Joël Fokom Domgue  7   8
Affiliations
Meta-Analysis

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta-analysis

Jean Jacques Noubiap et al. J Clin Hypertens (Greenwich). 2019 Apr.

Abstract

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource-limited settings. Little is known about the magnitude of HDP in Africa. We conducted the first systematic review and meta-analysis to summarize available data on the prevalence of HDP in Africa. We did a comprehensive literature search to identify review paper published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved review paper. We used a random-effects model to estimate the overall and type-specific prevalence of HDP in Africa. We included 82 studies published between 1997 and 2017 reporting data on a pooled sample of 854 304 women during pregnancy or puerperium. Most studies were hospital-based, conducted in urban settings across 24 countries. In this population, the overall prevalence of HDP was 100.4‰ (95% CI: 81.4-121.2). The prevalence was 49.8‰ (95% CI: 32.3-70.7) for gestational hypertension, 14.7‰ (95% CI: 11.6-18.2) for chronic hypertension, 9.2‰ (95% CI: 4.2-16.0) for superimposed preeclampsia, 44.0‰ (95% CI: 36.7-52.0) for preeclampsia, 22.1‰ (95% CI: 14.8-30.8) for severe preeclampsia, 14.7‰ (95% CI: 8.1-23.2) for eclampsia and 2.2‰ (95% CI: 1.2-3.4) for HELLP syndrome. Prevalence of HDP was significantly higher in Central and Western Africa; there was a consistent tendency of increasing HDP prevalence with income at the country level. In conclusion, the burden of HDP in Africa is high, with about one in 10 pregnancies affected. The higher rate of severe forms of HDP that are associated with significant maternal and perinatal mortality is a major concern in the region.

Keywords: Africa; HELLP syndrome; eclampsia; gestational hypertension; hypertension; preeclampsia; pregnancy; pregnancy-induced hypertension.

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Conflict of interest statement

We declare no competing interests.

Figures

Figure 1
Figure 1
Meta‐analysis of the prevalence of overall hypertensive disorders of pregnancy
Figure 2
Figure 2
Meta‐analysis of the prevalence of gestational hypertension
Figure 3
Figure 3
A, Meta‐analysis of the prevalence of preeclampsia. B, Meta‐analysis of the prevalence of severe preeclampsia
Figure 4
Figure 4
Meta‐analysis of the prevalence of eclampsia
Figure 5
Figure 5
Meta‐analysis of the prevalence of chronic hypertension
See this image and copyright information in PMC

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