Postpartum hemorrhage and associated risk factors in Africa: a systematic review and meta-analysis

Abstract

Postpartum hemorrhage (PPH) is a major public health problem and remains one of the leading causes of maternal morbidity and mortality, with sub-Saharan Africa carrying the highest burden. This study aimed to determine the prevalence and risk factors of postpartum hemorrhage in Africa. A systematic review and meta -analysis of observational studies estimating PPH was undertaken through literature searches in biomedical databases. The protocol has been registered at PROSPERO and is available at https://www.crd.york.ac.uk/ , under the registration number (CRD42020206087). All statistical analyses were conducted using STATA-Version 13 software. To assess heterogeneity, the I 2 test was used across the studies. A random-effect model was used to estimate the pooled prevalence of PPH. Odds ratios (OR) with 95% confidence intervals (CI) were also used to determine the association of variables with PPH. Twenty-nine articles were included in this meta -analysis with a total sample size of 179,730 from countries in Africa. The pooled prevalence of PPH in Africa from 2003 to 2023 was 4.2% (95% CI; 3–4). The regional distribution was 1% (95% CI: 1–1) in Eastern Africa, 3% (95% CI: 3–4) in Southern Africa, 4% (95% CI: 3–5) in Northern Africa, 5% (95% CI: 4–5) in Western Africa, and 5% (95% CI: 4–5) in Central Africa. Macrosomia and cesarean section were shown to be risk factors for PPH. This analysis demonstrated that the prevalence of PPH was low. This result will inform risk factor-based prevention, cause-based treatment, and the planning and implementation of applicable public health strategies.