The Burden of Hypertensive Disorders of Pregnancy in Africa: A Systematic Review and Meta-Analysis

Background: Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource-limited settings. Although Africa has the highest burden of hypertension in the general adult population worldwide and exhibits a high rate of risk factors for HDP, little is known about the magnitude of HDP in the region. We conducted the first systematic review and meta-analysis to summarize available data on the prevalence of HDP in Africa. Methods: We did a comprehensive literature search to identify articles published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the overall and type-specific prevalence of HDP in Africa. Heterogeneity (I²) was assessed via the χ² test on Cochran's Q statistic. Findings: 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). Specifically, we found a prevalence of 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 pre-eclampsia, 44.0‰ (95%CI: 36.7-52.0) for pre-eclampsia, 22.1‰ (95%CI: 14.8-30.8) for severe pre-eclampsia, 14.7‰ (95%CI: 8.123.2) 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; and there was a consistent tendency of increasing HDP prevalence with income at the country level. Interpretation: The burden of HDP in Africa is high, with about one in ten 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. These findings call for a rapid implementation of culturally appropriate strategies for primary prevention, early detection and adequate management of women with HDP in Africa. Such interventions would contribute to curb the alarming maternal and perinatal mortality rates in this region. Funding Statement: There was no funding source for this study. Declaration of Interests: The authors declare no competing interests.