Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa: a systematic review and meta-analysis.

"Declarations Ethics approval and consent to participateNot applicable. Consent for publicationNot applicable. Competing interestsThe authors declare no competing interests. Competing interests The authors declare no competing interests."

"Funding NF and GKB were funded by the NIHR Global Health Professorship (NIHR301627), and PM by a Wellcome International Training Fellowship (223012/Z/21/Z). GKB was also funded by the Else Kröner-Fresenius-Stiftung through the BEBUC Excellence Scholarship."

"We included observational studies (case-control, longitudinal, cohort, and cross-sectional) that prospectively or retrospectively explored the outcomes of interest (prevalence, risk factors, aetiologic agent and the antimicrobial resistance profile of bacteria isolated from HCAI) in all age groups in inpatient settings. We excluded the following types of studies due to the lack of relevance to our research question, or due to their limitations in allowing us to identify risk factors for HCAI or assess AMR: those reporting only the prevalence of HCAI without including at least one of the other outcomes of interest, those reporting on specific microorganisms causing HCAI, those reporting risk factors associated with HCAI but not reporting the effect size measures of these factors, or those reporting on HCAI outbreaks. Case series, case reports, editorials, commentaries, conference proceedings, preprints, reviews, previous systematic reviews and meta-analyses, and unpublished articles were excluded. Research letters to the editor containing data that met these criteria were included. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines [] ( pp5-6) while conducting this systematic review and meta-analysis. The protocol was registered and published in PROSPERO (CRD42022374559). Methods: MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. Availability of data and materials: All the data presented in this systematic review were obtained from published studies and are cited in the references. The protocol of this study was registered and available in PROSPERO (CRD42022374559). The manuscript of this paper is also available as Preprint at SSRN: https://ssrn.com/abstract=4499690 or 10.2139/ssrn.4499690."