Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis.

BACKGROUND: Hepatitis E virus (HEV) is a major cause of acute hepatitis in humans worldwide and have high burden in the resource-limited countries. Better knowledge of the epidemiology of hepatitis in animals in Africa can help to understand the epidemiology among humans. The objective of this study was to summarize the prevalence of HEV infection and distribution of HEV genotypes among animals in Africa. METHODS: In this systematic review and meta-analysis, we comprehensively searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to March 22th, 2020 without any language restriction. We considered cross-sectional studies of HEV infection in animals in Africa. Study selection, data extraction, and methodological quality of included studies were done independently by two investigators. Prevalence data were pooled using the random-effects meta-analysis. This review was registered in PROSPERO, CRD42018087684. RESULTS: Twenty-five studies (13 species and 6983 animals) were included. The prevalence (antibodies or ribonucleic acid [RNA]) of HEV infection in animals varied widely depending on biological markers of HEV infection measured: 23.4% (95% confidence interval; 12.0-37.2) for anti-HEV immunoglobulins G, 13.1% (3.1-28.3) for anti-HEV immunoglobulins M, and 1.8% (0.2-4.3) for RNA; with substantial heterogeneity. In subgroup analysis, the immunoglobulins G seroprevalence was higher among pigs 37.8% (13.9-65.4). The following HEV genotypes were reported in animals: Rat-HEV genotype 1 (rats and horses), HEV-3 (pigs), HEV-7 (dromedaries), and Bat hepeviruses (bats). CONCLUSIONS: We found a high prevalence of HEV infection in animals in Africa and HEV genotypes close to that of humans. Some animals in Africa could be the reservoir of HEV, highlighting the need of molecular epidemiological studies for investigating zoonotic transmission.

Dengue virus infection in people residing in Africa: a systematic review and meta-analysis of prevalence studies.

Better knowledge of the face of the current dengue virus (DENV) epidemiology in Africa can help to implement efficient strategies to curb the burden of dengue fever. We conducted this systematic review and meta-analysis to determine the prevalence of DENV infection in Africa. We searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to June 10th, 2019 without any language restriction. We used a random-effects model to pool studies. A total of 76 studies (80,977 participants; 24 countries) were included. No study had high risk of bias. Twenty-two (29%) had moderate and 54 (71%) had low risk of bias. In apparently healthy individuals, the pooled prevalence of DENV was 15.6% (95% confidence interval 9.9-22.2), 3.5% (0.8-7.8), and 0.0% (0.0-0.5) respectively for immunoglobulins (Ig) G, IgM, and for ribonucleic acid (RNA) in apparently healthy populations. In populations presenting with fever, the prevalence was 24.8% (13.8-37.8), 10.8% (3.8-20.6k) and 8.4% (3.7-14.4) for IgG, IgM, and for RNA respectively. There was heterogeneity in the distribution between different regions of Africa. The prevalence of DENV infection is high in the African continent. Dengue fever therefore deserves more attention from healthcare workers, researchers, and health policy makers.

Case fatality rate and viral aetiologies of acute respiratory tract infections in HIV positive and negative people in Africa: The VARIAFRICA-HIV systematic review and meta-analysis.

BACKGROUND: To set priorities for efficient control of acute respiratory tract infection (ARTI) in Africa, it is necessary to have accurate estimate of its burden, especially among HIV-infected populations. OBJECTIVES: To compare case fatality rate (CFR) and viral aetiologies of ARTI between HIV-positive and HIV-negative populations in Africa. STUDY DESIGN: We searched PubMed, EMBASE, Web of Knowledge, Africa Journal Online, and Global Index Medicus to identify studies published from January 2000 to April 2018. Random-effect meta-analysis method was used to assess association (pooled weighted odds ratios (OR) with 95% confidence interval (CI)). RESULTS: A total of 36 studies (126,526 participants) were included. CFR was significantly higher in patients with HIV than in HIV-negative controls (OR 4.10, 95%CI: 2.63-6.27, I²: 93.7%). The risk was significantly higher among children ≤5 years (OR 5.51, 95%CI 2.83-10.74) compared to people aged >5 years (OR 1.48, 95%CI 1.17-1.89); p = 0.0002. There was no difference between children (15 years) and adults and between regions of Africa. There was no difference for viral respiratory aetiologies (Enterovirus, Adenovirus, Bocavirus, Coronavirus, Metapneumovirus, Parainfluenza, Influenza, and Respiratory Syncytial Virus) of ARTI between HIV-positive and HIV-negative people, except for Rhinovirus where being HIV-negative was associated with Rhinovirus (OR 0.70; 95%CI 0.51-0.97, I²: 63.4%). CONCLUSIONS: This study shows an increased risk of deaths among HIV-infected individuals with ARTI, however with no difference in viral aetiologies compared to HIV-negative individuals in Africa. ARTI deserves more attention from HIV health-care providers for efficient control. Specific strategies are needed for HIV-positive children under 5.

Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis protocol.

BACKGROUND: Hepatitis E virus (HEV) is one of the major causes of acute hepatitis in humans worldwide with a case-fatality rate of 1-4% in the general population that might reach 30% in pregnant women. In the past decade in Africa, studies have shown that HEV infects not only humans but also animals. A systematic review summarizing the epidemiological data of HEV has been only performed in humans residing in Africa. We will perform this systematic review and meta-analysis to assess the prevalence of HEV infection in animal species in Africa. METHODS: This review will include cross-sectional studies among different animal species that reported the prevalence of HEV in Africa. We will consider published and unpublished studies from January 1, 2000 to present. A comprehensive search of PubMed, Excerpta Medica, African Journals Online, and Africa Index Medicus will be conducted to identify all relevant articles. Reference lists of eligible items and relevant articles will be reviewed. The funnel plots and the Egger test will be used to assess the publication bias. Study-specific estimates will be aggregated using a DerSimonian and Laird random-effects meta-analysis model to obtain an overall summary estimate of HEV prevalence across studies. The heterogeneity of the studies will be evaluated by the χ2 test on the Cochran's Q test. The results will be presented by animal species. DISCUSSION: HEV-infected animals are likely to transmit this virus to humans in Africa, as studies have already shown in developed countries. This systematic review and meta-analysis will provide a clear picture of the epidemiology of HEV in animals in Africa, to better understand this infection and to respond adequately to the epidemic challenges that often afflict Africa. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018087684 .

Gender development and hepatitis B and C infections among pregnant women in Africa: a systematic review and meta-analysis.

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.

Epidemiology of depressive disorders in people living with HIV in Africa: a systematic review and meta-analysis: Burden of depression in HIV in Africa.

OBJECTIVE: The burden of HIV infection is higher in Africa where 70% of people living with HIV (PLHIV) resides. Since depression can negatively impact the course of HIV infection, it is therefore important to accurately estimate its burden among PLHIV in the continent. METHODS: We searched multiple databases to identify articles published between January 2000 and February 2018, reporting the prevalence of (major) depressive disorders in PLHIV residing in Africa. We used a random-effects meta-analysis model to pool studies. RESULTS: Overall, 118 studies (60,476 participants, 19 countries) were included. There was no publication bias. The overall prevalence estimates of depressive disorders and probable major depressive disorders were 36.5% (95% CI 32.3-41.0; 101 studies) and 14.9% (12.1-17.9; 55 studies) respectively. The heterogeneity of the overall prevalence of depressive disorders was significantly explained by screening tool used, period (higher prevalence in recent studies) and distribution in sub-regions. The study setting, site, CD4 cell counts, age, sex, proportion of people with undetectable viral load were not sources of heterogeneity. CONCLUSIONS: This study shows that more than one third of PLHIV face depressive disorders and half of them having major form, with heterogeneous distribution in the continent. As such, depressive disorders deserve more attention from HIV healthcare providers for improved detection and overall proper management.

Prevalence of respiratory bacterial infections in people with lower respiratory tract infections in Africa: the BARIAFRICA systematic review and meta-analysis protocol.

INTRODUCTION: The burden of lower respiratory tract infections (LRTIs) is a substantial public health concern. However, the epidemiology of LRTI and its bacterial aetiologies are poorly characterised, particularly in the African continent. Providing accurate data can help design cost-effective interventions to curb the burden of respiratory infections in Africa. Therefore, the aim of this systematic review and meta-analysis will be to determine the prevalence of respiratory Bacterial Aetiologies in people with low Respiratory tract Infections in Africa (BARIAFRICA) and associated factors. METHODS AND ANALYSIS: We will search PubMed, EMBASE, Web of Science, African Journals Online, Cumulative Index to Nursing and Allied Health Literature, and Global Index Medicus to identify studies that reported the prevalence (of enough data to compute this estimate) of respiratory bacterial infections in people with LRTIs in Africa from 1 January 2000 to 31 March 2018, without any linguistic restrictions. Study selection, data extraction and risk of bias assessment will be conducted independently by two investigators. Heterogeneity will be evaluated using the χ² test on Cochran's Q statistic and quantified with H and I² statistics. Prevalence will be pooled using a random-effect meta-analysis model. Subgroup and meta-regression analyses will be used to identify sources of heterogeneity of prevalence estimates. This study will be reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. ETHICS AND DISSEMINATION: Since this study will be based on published data, it does not require ethical approval. This systematic review and meta-analysis is intended to serve as a basis for determining the burden of LRTIs, for identifying data gaps and for guiding future investigations in Africa. The final report will be published in peer-reviewed journals, presented in conferences and submitted to relevant health policy makers. PROSPERO REGISTRATION NUMBER: CRD42018092359.