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A study entitled “The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: A systematic review and meta-analysis,” published in eClinicalMedicine (part of Lancet Discovery Science) has shown that 12.9% of patients admitted to hospital in sub-Saharan Africa (SSA) contract deadly hospital-acquired infections.


Five of the authors of the article, including the lead author and principal investigator Dr Herbert Melariri (above), are from Nelson Mandela University’s Faculty of Health Sciences. Drs Melari, Robert Freercks and Elizabeth van der Merwe are from the Medical School (above), whereas Dr Wilma Ten Ham-Baloyi is with the Department of Nursing Science and Dr Paula Melariri is Research Director for the Faculty of Health Sciences.

Hospital-acquired infections are a leading cause of morbidity and mortality globally. These infections, which patient did not have at the time of hospitalisation are diverse, but the majority are lower respiratory tract infection, surgical site infection, bloodstream infection, and urinary tract infection.

The escalation of these infections, coupled with poor disease surveillance in sub-Saharan Africa, led Dr Herbert Melariri and the fellow researchers to quantify the burden of these infections in the region.

The researchers found a high mortality rate of 22.2% among patients with these infections. The highest burden burden was found in East Africa (19.7%) followed by West Africa (15.5%). Central Africa and Southern Africa were found to have 10.3% and 6.5% prevalence rates respectively. The researchers showed that intensive care units were the most risky hospital units for these infections, Dr Melariri said.

Preterm birth, indwelling medical devices, use of antibiotics, and overcrowiding were shown to be major risk factors for these infections among neonates. Risks factors for children included indwelling medical device, prolonged hospitalisation, and antibiotic use, while those for adults included surgery in addition to those found in children.

The study, which was a systematic review and meta-analysis, was conducted via a literature search of six databases to identify studies assessing the prevalence of hospital-acquired infections in sub-Saharan African countries in the past 10 years.

There were limited available studies on the prevalence of these infections in sub-Saharan Africa. For example, although Southern Africa recorded a lower prevalence, all the included studies in this subregion were from South Africa and Botswana, both of which are upper-middle income countries.

The high overall burden of these infections shows the urgent need to improve infection prevention and control, and to improve patient safety. The findings suggest that there is a particular need to target these efforts on West Africa and East Africa.

Enhanced data generation from sub-Saharan Africa will allow healthcare decisionmakers and donors to move ahead with new policy implementation and target enhanced responses towards the highest risk contexts.

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