Systematic review and meta-analysis of seroprevalence of human immunodeficiency virus serological markers among pregnant women in Africa, 1984-2020

BACKGROUND Human immunodeficiency virus(HIV)is a major public health concern,particularly in Africa where HIV rates remain substantial.Pregnant women are at an increased risk of acquiring HIV,which has a significant impact on both maternal and child health.AIM To review summarizes HIV seroprevalence among pregnant women in Africa.It also identifies regional and clinical characteristics that contribute to study-specific estimates variation.METHODS The study included pregnant women from any African country or region,irrespective of their symptoms,and any study design conducted in any setting.Using electronic literature searches,articles published until February 2023 were reviewed.The quality of the included studies was evaluated.The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa.Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity.Heterogeneity was assessed with Cochran's Q test and I2 statistics,and publication bias was assessed with Egger's test.RESULTS A total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis(meta-analysis).Out of the total studies,146(58.9%)had a low risk of bias and 102(41.1%)had a moderate risk of bias.No HIV-positive pregnant women died in the included studies.The overall HIV seroprevalence in pregnant women was estimated to be 9.3%[95%confidence interval(CI):8.3-10.3].The subgroup analysis showed statistically significant heterogeneity across subgroups(P<0.001),with the highest seroprevalence observed in Southern Africa(29.4%,95%CI:26.5-32.4)and the lowest seroprevalence observed in Northern Africa(0.7%,95%CI:0.3-1.3).CONCLUSION The review found that HIV seroprevalence among pregnant women in African countries remains significant,particularly in Southern African countries.This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.

Association between early viral lower respiratory tract infections and subsequent asthma development

BACKGROUND The association between hospitalization for human respiratory syncytial virus(HRSV)bronchiolitis in early childhood and subsequent asthma is well established.The long-term prognosis for non-bronchiolitis lower respiratory tract infections(LRTI)caused by viruses different from HRSV and rhinovirus,on the other hand,has received less interest.AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review.We included cohort studies comparing the incidence of asthma between patients with and without LRTI at≤2 years regardless of the virus responsible.The meta-analysis was performed using the random effects model.Sources of heterogeneity were assessed by stratified analyses.RESULTS This review included 15 articles(18 unique studies)that met the inclusion criteria.LRTIs at≤2 years were associated with an increased risk of subsequent asthma up to 20 years[odds ratio(OR)=5.0,95%CI:3.3-7.5],with doctor-diagnosed asthma(OR=5.3,95%CI:3.3-8.6),current asthma(OR=5.4,95%CI:2.7-10.6),and current medication for asthma(OR=1.2,95%CI:0.7-3.9).Our overall estimates were not affected by publication bias(P=0.671),but there was significant heterogeneity[I 2=58.8%(30.6-75.5)].Compared to studies with hospitalized controls without LRTI,those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma.The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview.The sensitivity analyses including only studies with similar proportions of confounding factors(gender,age at LRTI development,age at interview,gestational age,birth weight,weight,height,smoking exposure,crowding,family history of atopy,and family history of asthma)between cases and controls did not alter the overall estimates.CONCLUSION Regardless of the causative virus and confounding factors,viral LRTIs in children<2 years are associated with an increased risk of developing a subsequent asthma.Parents and pediatricians should be informed of this risk.

Global prevalence of hepatitis B virus serological markers among healthcare workers:A systematic review and meta-analysis

BACKGROUND The hepatitis B virus(HBV)infection is a global public health concern that affects about 2 billion people and causes 1 million people deaths yearly.HBV is a bloodborne disease and healthcare workers(HCWs)are a high-risk group because of occupational hazard to patients’blood.Different regions of the world show a highly variable proportion of HCWs infected and/or immunized against HBV.Global data on serologic markers of HBV infection and immunization in HCWs are very important to improve strategies for HBV control.AIM To determine the worldwide prevalence of HBV serological markers among HCWs.METHODS In this systematic review and meta–analyses,we searched PubMed and Excerpta Medica Database(Embase)to identify studies published between 1970 and 2019 on the prevalence of HBV serological markers in HCWs worldwide.We also manually searched for references of relevant articles.Four independent investigators selected studies and included those on the prevalence of each of the HBV serological markers including hepatitis B surface antigen(HBsAg),hepatitis e antigen(HBeAg),immunoglobulin M anti-HBc,and anti-HBs.Methodological quality of eligible studies was assessed and random-effect model meta-analysis resulted in the pooled prevalence of HBV serological markers HBV infection in HCWs.Heterogeneity(I²)was assessed using theχ²test on Cochran’s Q statistic and H parameters.Heterogeneity’sources were explored through subgroup and metaregression analyses.This study is registered with PROSPERO,number CRD42019137144.RESULTS We reviewed 14059 references,out of which 227 studies corresponding to 448 prevalence data among HCWs(224936 HCWs recruited from 1964 to 2019 in 71 countries)were included in this meta-analysis.The pooled seroprevalences of current HBsAg,current HBeAg,and acute HBV infection among HCWs were 2.3%[95% confidence interval(CI):1.9-2.7],0.2%(95%CI:0.0-1.7),and 5.3%(95%CI:1.4-11.2),respectively.The pooled seroprevalences of total immunity against HBV and immunity acquired by natural HBV infection in HCWs were 56.6%(95%CI:48.7-63.4)and 9.2%(95%CI:6.8-11.8),respectively.HBV infection was more prevalent in HCWs in low-income countries,particularly in Africa.The highest immunization rates against HBV in HCWs were recorded in urban areas and in high-income countries including Europe,the Eastern Mediterranean and the Western Pacific.CONCLUSION New strategies are needed to improve awareness,training,screening,vaccination,post-exposure management and treatment of HBV infection in HCWs,and particularly in low-income regions.

Global prevalence of occult hepatitis C virus: A systematic review and meta-analysis

BACKGROUND Occult hepatitis C infection(OCI)is characterized by the presence of hepatitis C virus(HCV)RNA in the liver,peripheral blood mononuclear cells(PBMC)and/or ultracentrifuged serum in the absence of detectable HCV-RNA in serum.OCI has been described in several categories of populations including hemodialysis patients,patients with a sustained virological response,immunocompromised individuals,patients with abnormal hepatic function,and apparently healthy subjects.AIM To highlight the global prevalence of OCI.METHODS We performed a systematic and comprehensive literature search in the following 4 electronic databases PubMed,EMBASE,Global Index Medicus,and Web of Science up to 6th May 2021 to retrieve relevant studies published in the field.Included studies were unrestricted population categories with known RNA status in serum,PBMC,liver tissue and/or ultracentrifuged serum.Data were extracted independently by each author and the Hoy et al tool was used to assess the quality of the included studies.We used the random-effect meta-analysis model to estimate the proportions of OCI and their 95%confidence intervals(95%CI).The Cochran's Q-test and the I2 test statistics were used to assess heterogeneity between studies.Funnel plot and Egger test were used to examine publication bias.R software version 4.1.0 was used for all analyses.RESULTS The electronic search resulted in 3950 articles.We obtained 102 prevalence data from 85 included studies.The pooled prevalence of seronegative OCI was estimated to be 9.61%(95%CI:6.84-12.73)with substantial heterogeneity[I^(2)=94.7%(95%CI:93.8%-95.4%),P<0.0001].Seropositive OCI prevalence was estimated to be 13.39%(95%CI:7.85-19.99)with substantial heterogeneity[I^(2)=93.0%(90.8%-94.7%)].Higher seronegative OCI prevalence was found in Southern Europe and Northern Africa,and in patients with abnormal liver function,hematological disorders,and kidney diseases.Higher seropositive OCI prevalence was found in Southern Europe,Northern America,and Northern Africa.CONCLUSION In conclusion,in the present study,it appears that the burden of OCI is high and variable across the different regions and population categories.Further studies on OCI are needed to assess the transmissibility,clinical significance,long-term outcome,and need for treatment.