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Meta-Analysis
. 2025 Apr 2;44(1):98.
doi: 10.1186/s41043-025-00767-9.

Dominance of antimicrobial resistance bacteria and risk factors of bacteriuria infection among pregnant women in East Africa: implications for public health

Molla Getie Mehari #  1 , Almaw Genet Yeshiwas  2 , Dereje Esubalew  3 , Yehzibalem Azmeraw  4 , Amare Mebrat Delie  5 , Liknaw Workie Limenh  6 , Nigus Kassie Worku  7 , Mickiale Hailu  8 , Mihret Melese  9 , Alemwork Abie  10 , Tenagnework Eseyneh Dagnaw  5 , Eneyew Talie Fenta  5 , Abraham Teym  11 , Rahel Mulatie Anteneh  12 , Chalachew Yenew #  13
Affiliations
Meta-Analysis

Dominance of antimicrobial resistance bacteria and risk factors of bacteriuria infection among pregnant women in East Africa: implications for public health

Molla Getie Mehari et al. J Health Popul Nutr. .

Abstract

Background: Bacterial infections in pregnancy pose significant health risks in East Africa. This study estimates pooled prevalence and identifies key risk factors, addressing limited data to improve maternal health outcomes in the region.

Methods: This study employed a systematic review and meta-analysis, analyzing data from eight East African studies (2016-2021). Searches spanned PubMed, Embase, Scopus, and more, with manual reference checks. Data quality was assessed via the Newcastle-Ottawa Scale. RevMan software with a random-effects model estimated pooled prevalence and hazard ratios for risk factors.

Results: A pooled analysis of antimicrobial resistance (AMR) bacterial isolates from pregnant women in East Africa highlights concerning prevalence rates of various pathogens. Escherichia coli emerged as the most common pathogen, present in 43% (95% CI: 37-48%) of cases, followed by Staphylococcus aureus at 20% (95% CI: 0.12, 0.29) and Corynebacterium, Enterococcus, and Nocardia species (CONs) in 16% (95% CI: 10-23%) and 16% (95% CI: 12-21%) (Prevalence of K. pneumoniae). A very small proportion 6% (95% CI: 2 - 11%) was found to be infected with Pseudomonas aeruginosa. The forest plot highlights risk factors for infections in pregnant women in East Africa: antibiotic use (HR: 2.0, 95% CI: 1.5-2.6), smoking (HR: 1.3, 95% CI: 1.0-1.6), poor sanitation (HR: 1.8, 95% CI: 1.2-2.4), diabetes (HR: 2.1, 95% CI: 1.5-2.8), and age > 30 years (HR: 1.5, 95% CI: 1.1-2.0).

Conclusions: This analysis reveals a significant prevalence of bacterial infections, particularly Escherichia coli, among pregnant women in East Africa, with antimicrobial resistance (AMR) complicating treatment. The study identified several key risk factors, including antibiotic use, smoking, poor sanitation, diabetes, and age over 30, which are associated with higher rates of infection. While these findings emphasize the need for further research, the results suggest that routine bacterial screening, AMR surveillance, improved sanitation, and antibiotic stewardship are important steps in mitigating the impact of these infections. Public health strategies should prioritize high-risk groups, encourage hygiene practices, and continue to guide policy and interventions through ongoing studies.

Keywords: Escherichia coli; Antimicrobial Resistance (AMR); Bacterial infections; Pregnant women; Public Health interventions.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The analysis used publicly available data from published studies. As no new data collection was performed, ethical approval was not required. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot showing the prevalence of E. coli among pregnant women in East Africa, 2024
Fig. 2
Fig. 2
Forest plot showing the prevalence of S. aureus among pregnant women in East Africa, 2024
Fig. 3
Fig. 3
Forest plot showing the prevalence of CONs among pregnant women in East Africa, 2024
Fig. 4
Fig. 4
Forest plot showing the prevalence of K. pneumoniae among pregnant women in East Africa, 2024
Fig. 5
Fig. 5
Forest plot showing the prevalence of P. aeruginosa among pregnant women in East Africa, 2024
Fig. 6
Fig. 6
Forest Plot of Risk Factors Associated with Infections among Pregnant Women in East Africa, Showing Hazard Ratios (HRs) with 95% Confidence Intervals
See this image and copyright information in PMC

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