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Prevalence of curable STIs and bacterial vaginosis during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis
  1. Dorothy Chiwoniso Nyemba1,2,
  2. Eposi C Haddison3,
  3. Colin Wang4,
  4. Leigh Francis Johnson2,
  5. Landon Myer1,
  6. Dvora Joseph Davey1,5
  1. 1 Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
  2. 2 Centre for Infectious Disease Epidemiology, University of Cape Town, Rondebosch, South Africa
  3. 3 Saa Health District, Centre Regional Delegation of Public Health, Buea, Cameroon
  4. 4 David Geffen School of Medicine, UCLA, Los Angeles, California, USA
  5. 5 Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Mrs Dorothy Chiwoniso Nyemba, UCT Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Province, South Africa; dorothy.nyemba{at}


Objective STIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries, syndromic management is used for screening and treatment of STIs. We aimed to update and summarise pooled prevalence of curable STIs and bacterial vaginosis (BV) among pregnant women in sub-Saharan Africa.

Methods Electronic databases and reference lists of relevant published and unpublished studies were searched from March 2015 to October 2020. Studies were included if they estimated prevalence of Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Mycoplasma genitalium (MG) and BV among pregnant women in sub-Saharan Africa. Meta-analyses were performed with observed prevalences corrected for diagnostic errors to estimate the pooled prevalence of diagnosed infections by region.

Results A total of 48 studies met the inclusion criteria, providing 85-point prevalence estimates for curable STIs and BV. Pooled prevalence estimates (with 95% CI and number of women tested) were as follows: MG: 13.5% (4.0–27.2, n=1076); CT: 10.8% (6.9–15.5, n=6700); TV: 13.8% (10.0–18.0, n=9264); NG: 3.3% (2.1–4.7, n=6019); syphilis: 2.9% (2.0–4.0, n=95 308) and BV: 36.6% (27.1–46.6, n=5042). By region, BV was the most prevalent and ranged from 28.5% (24.5–32.8, n=1030) in Eastern Africa to 52.4% (33.5–70.9, n=2305) in Southern Africa; NG had the lowest prevalence, ranging from 1.4% (95% CI 0.1 to 3.1, n=367) in Central Africa to 4.4% (95% CI 2.6 to 6.4, n=4042) in Southern Africa.

Conclusion The prevalence of curable STIs and BV in sub-Saharan Africa is substantial in pregnant women but most prevalent in Southern Africa where HIV prevalence is highest. It is crucial to integrate screening of curable STIs into antenatal care programmes that have previously focused on diagnosis and treatment of syphilis and HIV.

  • Africa
  • sexual health
  • reproductive tract Infections
  • disease transmission
  • infectious

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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  • Handling editor Nicola Low

  • Twitter @DorothyNyemba, @LeighJohnson9

  • Contributors DCN, DJD, LFJ and LM designed the study. DCN and ECH searched for literature, reviewed titles and abstracts for inclusion in the review. DCN and CW performed risk of bias assessment and data extraction; DCN conducted the analysis and wrote the first draft of the manuscript. All authors contributed to data interpretation, reviewed successive drafts and approved the final version of the manuscript. DCN is responsible for the overall content as guarantor.

  • Funding This research is part of PhD project for DCN; DJD received funding from Fogarty International Centre/NIH (K01TW011187).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.