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

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 parts per thousand (95% CI: 81.4-121.2). The prevalence was 49.8 parts per thousand (95% CI: 32.3-70.7) for gestational hypertension, 14.7 parts per thousand (95% CI: 11.6-18.2) for chronic hypertension, 9.2 parts per thousand (95% CI: 4.2-16.0) for superimposed preeclampsia, 44.0 parts per thousand (95% CI: 36.7-52.0) for preeclampsia, 22.1 parts per thousand (95% CI: 14.8-30.8) for severe preeclampsia, 14.7 parts per thousand (95% CI: 8.1-23.2) for eclampsia and 2.2 parts per thousand (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.