Prevalence of infertility and its risk factors in Sub-Saharan Africa: a systematic review and meta-analysis

Abstract

BACKGROUND: Infertility is a significant public health concern affecting millions of couples globally, with a particularly high prevalence in Sub-Saharan Africa, where its social and psychological impacts are profound. Despite advances in reproductive health research, comprehensive data on infertility in the region remain limited, and existing studies often yield inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis conducted to estimate the prevalence of infertility and identify its risk factors in Sub-Saharan Africa. METHODS: We conducted a systematic search of electronic databases and grey literature using predefined search terms. Original articles published in English between January 1, 2000, and May 30, 2024, reporting the prevalence and/or associated factors of infertility in Sub-Saharan Africa were included. The review followed PRISMA guidelines and was registered in PROSPERO (CRD42023428778). Data were extracted using the Joanna Briggs Institute tool. A random-effects meta-analysis using STATA version 14 generated pooled prevalence estimates with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran's Q and I² statistics; publication bias was evaluated using funnel plots and Egger's test. RESULT: Sixteen primary studies from ten Sub-Saharan African countries, comprising a total of 22,303 participants were included in the review. The pooled prevalence of infertility in the region was 16.98% (95% CI: 11.62, 22.33%). Factors such as obstetric complications (OR = 7.94, 95% CI: 4.74, 13.30), STIs / PID (OR = 3.24; 95% CI: 2.33, 4.52), substance use (OR = 3.84, 95% CI: 1.71, 8.63), and women's age (OR = 2.19, CI: 1.48, 3.22) were identified as significant risk factors of infertility. CONCLUSIONS: Nearly one in six couples in Sub-Saharan Africa experience infertility. Key contributing factors include STIs/PID, substance use, and obstetric complications. These findings highlight the need for targeted, context-specific reproductive health interventions and policies to mitigate the burden of infertility in the region.