Prevalence of vulvovaginal candidiasis among pregnant women in Africa: A systematic review and meta-analysis

Introduction: Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva, which is caused by Candida species and affects women worldwide. Pregnant women are more vulnerable to VVC due to certain risks. Moreover, their offspring are also exposed to the risk of preterm birth. In this context, ascertaining the burden of VVC is of paramount importance and this meta-analysis was conducted to estimate the occurrence of VVC among pregnant women in Africa. Methodology: Database search was carried out through PubMed, Scopus, Science-Direct, and Google Scholar from the date of inception until December 2020. All the studies on the prevalence of VVC among African pregnant women were included in the analysis. The pooled prevalence was estimated based on the Random-effect model DerSimonian-Laird approach with Freeman- Tukey double arcsine transformed proportion. Heterogeneity was assessed using I2 test and subsequently explored using subgroup and meta-regression analysis. Results: A total of Sixteen records having a sample size 4,185 were included in this study. The overall prevalence of VVC was pooled at 29.2% (CI 95%: 23.4 – 33.0). Subgroup analysis revealed a higher prevalence in Eastern Africa, followed by Western Africa and North Africa (35%, 28%, and 15% respectively). Moderator analysis indicated that the studies that used advanced methods of detection had a higher prevalence (p = 0.048). In addition, the large sample size was associated with higher prevalence (p ≤ 0.001). No other moderators were found to be statistically significant. Conclusions: The overall prevalence of VVC among African pregnant women is comparable to other studies worldwide. However, appropriate identification techniques and larger sample size could likely be associated with an increased prevalence. Our findings necessitate the need for further investigations to determine the geographical distribution of VVC across African regions.