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

Table 1 Summary of meta-analysis results for human immunodeficiency virus seroprevalence among pregnant African women from 1984 to 2020

	Prevalence (95%CI, %)	95% prediction interval	N Studies	N Participants	H (95%CI)	I² (95%CI)	P heterogeneity	P difference subtypes
Study design								< 0.001
Cohort	21.6 (15.5-28.4)	(2.6-51.8)	12	95334	19.6 (18.4-21)	99.7 (99.7-99.8)	< 0.001
Cross-sectional	8.8 (7.7-9.8)	(0-30.6)	236	1276343	20.7 (20.4-21)	99.8 (99.8-99.8)	< 0.001
Sampling								0.554
Non probabilistic	9.1 (8.1-10.2)	(0.1-29.9)	225	1228039	19.7 (19.5-20)	99.7 (99.7-99.8)	< 0.001
Probabilistic	10.5 (6.4-15.5)	(0-45.1)	26	146353	24.4 (23.5-25.4)	99.8 (99.8-99.8)	< 0.001
Timing of samples collection								0.936
Prospectively	9.2 (8.1-10.5)	(0-32.1)	205	942978	19.3 (19-19.6)	99.7 (99.7-99.7)	< 0.001
Retrospectively	9.2 (6.9-11.8)	(0-31.2)	43	428329	26.6 (25.9-27.3)	99.9 (99.9-99.9)	< 0.001
Countries								< 0.001
Angola	4.9 (0.6-13.2)	(0-100)	3	3008	7.8 (5.8-10.4)	98.3 (97-99.1)	< 0.001
Burkina Faso	7.6 (5.6-9.9)	(1.6-17.5)	10	55644	6 (5.1-7.1)	97.2 (96.2-98)	< 0.001
Cameroon	6.6 (5.4-7.9)	(2.5-12.3)	13	55429	5.5 (4.7-6.4)	96.7 (95.5-97.5)	< 0.001
Democratic Republic of the Congo	3 (2-4)	(0.5-7.3)	6	21268	3.8 (2.9-5.1)	93.2 (87.9-96.2)	< 0.001
Ethiopia	5.6 (3.1-8.8)	(0-25.1)	18	25412	9.2 (8.4-10.1)	98.8 (98.6-99)	< 0.001
Ghana	3.4 (0.4-9)	(0-46.7)	4	4736	6.7 (5.2-8.8)	97.8 (96.3-98.7)	< 0.001
Ivory Coast	13 (12.1-13.8)	(10.2-16)	9	74677	2.9 (2.2-3.8)	88.3 (80-93.2)	< 0.001
Kenya	14.4 (10.4-18.8)	(1.8-36)	14	51495	13.2 (12.2-14.3)	99.4 (99.3-99.5)	< 0.001
Malawi	18.7 (14.2-23.8)	(3.9-41.2)	12	130923	17.6 (16.4-18.9)	99.7 (99.6-99.7)	< 0.001
Nigeria	6.1 (5-7.3)	(0.4-17.2)	57	84396	6.6 (6.2-7)	97.7 (97.4-98)	< 0.001
Republic of the Congo	5 (4.1-6)	(2.3-8.7)	7	12841	2.4 (1.7-3.4)	82.8 (66-91.3)	< 0.001
Rwanda	14.5 (6.9-24.2)	(0-70.4)	4	28796	18.4 (16.1-21)	99.7 (99.6-99.8)	< 0.001
Senegal	0.7 (0.5-0.9)	(0-4.5)	3	23529	1.6 (1-3.1)	62.9 (0-89.4)	0.068
South Africa	29.9 (26.7-33.2)	(16.7-45.1)	18	134840	10 (9.2-10.9)	99 (98.8-99.2)	< 0.001
Sudan	1 (0.4-1.7)	(0-3.2)	4	1296	1.1 (1-2.7)	12.2 (0-86.6)	0.332
Tanzania	7.3 (5.9-8.8)	(1.9-15.8)	21	157211	10 (9.3-10.9)	99 (98.8-99.2)	< 0.001
Uganda	11.4 (6.9-16.8)	(0.2-35)	8	50585	14.6 (13.2-16.2)	99.5 (99.4-99.6)	< 0.001
Zambia	18.6 (14.7-22.8)	(6.3-35.3)	8	326966	20.3 (18.7-22)	99.8 (99.7-99.8)	< 0.001
Zimbabwe	25.7 (16.4-36.3)	(0.7-68.5)	10	33198	17.6 (16.3-19.1)	99.7 (99.6-99.7)	< 0.001
WHO Region								< 0.001
Africa	9.5 (8.4-10.6)	(0-31.3)	244	1366377	20.8 (20.5-21.1)	99.8 (99.8-99.8)	< 0.001
Eastern Mediterranean	1.4 (0.6-2.4)	(0-5.7)	6	7651	2.1 (1.4-3.2)	78.3 (52.3-90.2)	< 0.001
UN Regions								< 0.001
Eastern Africa	11.7 (10.2-13.2)	(1.2-30.3)	99	813901	20.1 (19.7-20.5)	99.8 (99.7-99.8)	< 0.001
Middle Africa	4.8 (4-5.8)	(0.9-11.5)	33	101346	6.6 (6-7.1)	97.7 (97.3-98)	< 0.001
Northern Africa	0.7 (0.3-1.3)	(0-2.8)	5	4328	1.4 (1-2.3)	46.4 (0-80.4)	0.113
Southern Africa	29.4 (26.5-32.4)	(16.5-44.2)	21	136338	9.3 (8.6-10.1)	98.8 (98.6-99)	< 0.001
Western Africa	6.2 (5.2-7.3)	(0.2-19.2)	92	317532	11.5 (11.2-11.9)	99.3 (99.2-99.3)	< 0.001
Sustainable Development Goal regions								< 0.001
Northern Africa and Western Asia	0.7 (0.3-1.3)	(0-2.8)	5	4328	1.4 (1-2.3)	46.4 (0-80.4)	0.113
Sub-Saharan Africa	9.5 (8.5-10.6)	(0-31.4)	246	1370064	20.7 (20.4-21)	99.8 (99.8-99.8)	< 0.001
World Bank Income Groups								< 0.001
Low-income countries	8.4 (6.9-10.1)	(0-28.5)	81	712218	23.3 (22.8-23.9)	99.8 (99.8-99.8)	< 0.001
Lower-middle-income countries	8.1 (7.2-9.1)	(0.5-23.2)	147	521930	12.7 (12.4-13)	99.4 (99.3-99.4)	< 0.001
Upper-middle-income countries	24 (19.9-28.3)	(6.9-47.2)	22	139297	14.8 (13.9-15.7)	99.5 (99.5-99.6)	< 0.001
Study period								0.255
(1987-2001)	9.9 (8.1-11.8)	(0.4-29)	62	238301	14.7 (14.2-15.3)	99.5 (99.5-99.6)	< 0.001
(2001-2016)	8 (6.8-9.4)	(0-27.7)	128	919743	21.7 (21.3-22.1)	99.8 (99.8-99.8)	< 0.001
(2016-2020)	9.5 (5.9-13.8)	(0-41.9)	30	189325	26.6 (25.8-27.5)	99.9 (99.8-99.9)	< 0.001
Parity								0.69
Multiparous	6.5 (4.5-8.8)	(0.9-16.1)	10	18015	4.6 (3.8-5.5)	95.2 (92.9-96.8)	< 0.001
Nulliparous	6.7 (4-10)	(0.1-21.1)	9	14035	5.3 (4.4-6.4)	96.5 (94.9-97.6)	< 0.001
Primiparous	5 (2.8-7.8)	(0-16.6)	9	8581	4 (3.2-5)	93.8 (90.3-96)	< 0.001
Gravidity								0.276
Multigravidae	9.2 (5.5-13.7)	(0-35.1)	17	53860	14.2 (13.2-15.2)	99.5 (99.4-99.6)	< 0.001
Primigravidae	6.5 (4.2-9.2)	(0-21)	16	22946	6.6 (5.9-7.5)	97.7 (97.1-98.2)	< 0.001
Gestational age								0.902
First trimester	7.3 (3.5-12.2)	(0-32.7)	17	6164	4.1 (3.5-4.8)	94 (91.8-95.6)	< 0.001
Second trimester	9.6 (5.2-15)	(0-40.7)	18	15874	7.8 (7.1-8.6)	98.4 (98-98.7)	< 0.001
Third trimester	8.7 (5.2-13.1)	(0-39.4)	27	16897	8.5 (7.8-9.2)	98.6 (98.4-98.8)	< 0.001
Residence								0.789
Rural	8.1 (5.8-10.6)	(0-29.9)	43	103272	13.5 (12.9-14.1)	99.5 (99.4-99.5)	< 0.001
Urban	8.5 (7-10.2)	(1.6-20.2)	32	92657	8.5 (7.9-9.1)	98.6 (98.4-98.8)	< 0.001
Education								0.804
None	5.8 (3.8-8.2)	(0-18)	18	29175	6 (5.3-6.8)	97.2 (96.5-97.8)	< 0.001
Primary	6.6 (4.1-9.6)	(0-24.6)	21	26835	7.9 (7.2-8.7)	98.4 (98.1-98.7)	< 0.001
Secondary	7.3 (5.4-9.6)	(0.8-19.1)	20	13337	4.1 (3.5-4.7)	94 (92-95.5)	< 0.001
Tertiary	6.2 (4.3-8.5)	(0.3-17.6)	18	4744	2.8 (2.3-3.3)	86.8 (80.6-91)	< 0.001
Type of HIV								< 0.001
HIV-1	8.2 (6.6-10)	(0.2-25.7)	58	279778	15.9 (15.4-16.5)	99.6 (99.6-99.6)	< 0.001
HIV-2	1.2 (0.7-1.9)	(0-5.2)	16	143453	9.7 (8.8-10.6)	98.9 (98.7-99.1)	< 0.001
Sample size								0.097
< 100	19.5 (7-36.1)	(0-82.2)	6	425	3.8 (2.9-5.1)	93.2 (87.9-96.2)	< 0.001
≥ 100	9.1 (8.1-10.2)	(0-30.8)	242	1371252	21 (20.7-21.3)	99.8 (99.8-99.8)	< 0.001
Risk of bias								0.205
Low risk of bias	8.8 (7.5-10.2)	(0-31)	146	1159206	25.3 (24.9-25.6)	99.8 (99.8-99.8)	< 0.001
Moderate risk of bias	10 (8.6-11.5)	(0.6-28.5)	102	212471	10.6 (10.3-11)	99.1 (99.1-99.2)	< 0.001

HIV: Human immunodeficiency virus.