A systematic review of the burden and risk factors of sudden infant death syndrome (SIDS) in Africa

Abstract

Background: While sudden infant death syndrome (SIDS) has long been recognized as a leading preventable cause of infant mortality in high-income countries, little is known about the burden of SIDS in Africa. To address this knowledge gap, we conducted the first systematic review of SIDS-related publications in Africa. Our objective was to assess the prevalence of SIDS and its risk factors in Africa.

Methods: We systematically searched PubMed, Embase, Web of Science, Cochrane, and Google Scholar to identify studies published until December 26, 2020. Review authors screened titles and abstracts, and selected articles independently for full-text review. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) or a modification. Data on the proportion of infants who died of SIDS and reported prevalence of any risk factors were extracted using customized data extraction forms in Covidence.

Results: Our analysis rested on 32 peer-reviewed articles. Nine studies presented prevalence estimates on bedsharing and prone sleeping, suggesting near-universal bedsharing of infants with parents (range, 60 to 91.8%) and frequent use of the prone sleeping position (range, 26.7 to 63.8%). Eleven studies reported on the prevalence of SIDS, suggesting high rates of SIDS in Africa. The prevalence of SIDS ranged from 3.7 per 1000 live births in South Africa, 2.5 per 1000 live births in Niger, and 0.2 per 1000 live births in Zimbabwe. SIDS and other sudden infant deaths accounted for between 2.5 to 21% of infant deaths in South Africa and 11.3% in Zambia.

Conclusions: Africa may have the highest global rate of SIDS with a high burden of associated risk factors. However, majority of the studies were from South Africa which limits generalizability of our findings to the entire continent. There is an urgent need for higher quality studies outside of South Africa to fill this knowledge gap.

Protocol registration: Prospero Registration Number: CRD42021257261.

Figure 1

PRISMA flow diagram of search strategy. The PRISMA diagram details our search and selection process during the review. Source: [24]. For more information, visit: http://www.prisma-statement.org/.

Figure 2

Distribution of included studies by year of publication. The figure shows the distribution of included studies by year of publication. Until recently, SIDS has been a low priority for researchers in Africa. More than half (52%) of the included studies were published between 2013 and 2021.

Figure 3

Distribution of included studies across the African continent. The figure shows the distribution of included studies across the African continent. Overall, the studies were skewed to southern Africa with the majority (72%) from South Africa. Slightly more than a quarter (28%) of the studies were conducted outside of South Africa.