Prevalence of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis

Abstract Background: Severe indirect hyperbilirubinemia is a silent cause of newborn disease and death worldwide. However, studies of the disease in sub-Saharan Africa are highly variable with respect to its prevalence. Hence, this study aimed to estimate the overall magnitude of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase (GP6D) deficiency and blood type incompatibility in sub-Saharan Africa. Methods : PubMed, Scopus, Google Scholar, and the Cochrane Review were systematically searched online to retrieve hyperbilirubinemia-related articles. All observational studies reported the prevalence of hyperbilirubinemia in sub-Saharan Africa were included for analysis and excluded if the study failed to determine the desired outcome. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. Heterogeneity across the included studies was evaluated using the inconsistency index (I 2 ). Publication bias was examined by funnel plot and the Egger’s regression test. The random-effect model was fitted to estimate the pooled prevalence of neonatal hyperbilirubinemia among patients in Sub Saharan Africa. The meta-analysis was performed using the STATA™ version 14 software. Results : A total of 30,486 studies were collected from the different databases and 10 articles were included for the final analysis. The overall magnitude of neonatal hyperbilirubinemia was 28.08 % (95% CI: (20.23, 35.94)) in sub-Saharan Africa. Neonates with G6PD deficiency were 2.42 times (95% CI: 1.64, 3.56) more likely to develop hyperbilirubinemia as compared to infants with normal G6PD levels. Moreover, the risk of developing hyperbilirubinemia was 3.3 times (95% CI: 1.96, 5.72) higher among neonates that had a blood type that was incompatible with their mother’s. Conclusion : The failure to prevent and screen G6PD deficiency and blood type incompatibility with their mother’s results in high burden of neonatal hyperbilirubinemia in sub-Saharan Africa. Therefore, early identification and care strategies should be developed to the affected neonates with G6PD deficiency and blood type incompatibility with their mother’s to address long-term medical and scholastic damages among those exposed to severe hyperbilirubinemia