Leptospirosis in humans and selected animals in Sub-Saharan Africa, 2014–2022: a systematic review and meta-analysis

Abstract

Background Leptospirosis is an emerging neglected tropical zoonotic disease of public health importance causing substantial morbidities and mortalities among humans. The infection is maintained within the population through interactions between humans, animals, and the environment. Understanding the burden of disease in both humans and animals is necessary for effective prevention and control in Sub-Saharan Africa (SSA). Therefore, we aimed to determine the seroprevalence of leptospirosis in humans, selected domestic animals, and rodents in SSA. Methods A comprehensive search was done in six databases: Scopus, PubMed, Google Scholar, CINAHL, Web of Science, and African Journals Online databases for articles published between 01 January 2014 and 30 August 2022. Thirty-seven articles distributed across 14 out of 46 countries in SSA were included. The random effects meta-analysis model was used to pool the extracted seroprevalence data. Results The overall pooled seroprevalence of leptospirosis among humans was 12.7% (95% CI: 7.5,20.8), 15.1% (95% CI: 9.4,23.5), and 4.5% (95% CI: 0.4, 35.6) based on results obtained using ELISA, MAT, and PCR diagnostic methods respectively. The pooled seroprevalence estimates among cattle were 29.2%, 30.1%, and 9.7% based on ELISA, MAT, and PCR respectively. Further, the pooled seroprevalence in goats was 30.0% for studies that used MAT, and among rodents, the pooled seroprevalence estimates were 21.0% for MAT and 9.6% for PCR diagnostic criteria. The seroprevalence of leptospirosis varied extensively between studies, across SSA regions and study setting (rural or urban). Conclusion Leptospirosis is widespread in SSA in both humans and animals based on the current results of the pooled seroprevalence in the limited studies available. The burden is high in animals and humans and underestimated due to limited studies and challenges with limited diagnostic capacity in most healthcare settings in SSA. Hence, we recommend that leptospirosis should be listed as a disease of concern and be included on the list of routine diagnostics among patients presenting with febrile illness in healthcare settings. Further, we recommend the enhancement of surveillance of leptospirosis in all countries in SSA and the development of strategies with a One Health perspective to effectively prevent and control leptospirosis.

Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana

“…Baseline screening of PWH in our study revealed HTN prevalence of 37.2%. Our finding was higher than the 17% reported in Nigeria [ 9 ] and 27% from a meta-analysis from South Africa [ 11 ], but was lower than the prevalence of 43% reported in Tanzania [ 10 ]. The higher prevalence from our study compared to the one from Nigeria may be due to our patients being mostly ART experienced compared to ART-naive patients from the Nigerian study as ART has been linked to development of CVDs [ 19–21 ].…”

“…HTN prevalence in PWH in SSA has varied widely in literature, with crude prevalence of 17% among ART-naive PWH in Nigeria [ 9 ] to 43% in PWH on ART in Tanzania [ 10 ]. A meta-analysis from South Africa also reported a prevalence of 25.5% among 123 951 PWH from 22 studies [ 11 ]. The prevalence of HTN, both in the general population and among PWH, is likely to be underrated in SSA due to complex factors such as diverse diagnostic criteria, poor surveillance, poor health-seeking behavior, and inadequate resources for screening for HTN, among others [ 11–13 ].…”

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study

“…On the other hand, almost half of our cohort had GWG above the NAM recommended range, including one-third of WHIV. These results are concerning considering that PHIV already have a higher risk of adverse birth outcomes [37,38] and metabolic health outcomes associated with HIV-induced chronic inflammation [39][40][41]. In addition, unwanted GWG in PHIV could exacerbate their poor mental health and negatively affect ART adherence [42].…”

Domestic dogs in indigenous Amazonian communities: Key players in Leptospira cycling and transmission?

“…A diverse array of domestic and wild animals likely serve as reservoirs by excreting Leptospira in their urine [14][15][16]. Rats are thought to be important in transmission of Leptospira to humans, however in some settings, prevalence is higher in livestock suggesting that other animals also play significant roles [16][17][18][19][20][21][22][23]. Unfortunately reports of seroprevalence in wild animals are scarce [24][25][26][27][28][29][30][31], leaving gaps in our understanding of how interactions between domestic animals and wildlife influence prevalence in domestic animals and ultimately, transmission to humans.…”