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

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 (I2). 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

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