Prevalence, risk factors, and clinical outcomes of hepatitis E infection in pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis

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Although the well-documented epidemiological importance of the hepatitis E virus (HEV) and its adverse impacts during pregnancy are well recognized in Sub-Saharan Africa (SSA), the data remain fragmented and heterogeneous. This systematic review and meta-analysis aims to estimate the prevalence of HEV among pregnant women, to identify key associated risk factors and to assess its impact on maternal and fetal outcomes. A literature review was conducted using the PubMed, Embase, Scopus, and Web of Science (WoS) databases. Observational studies on HEV among pregnant women in SSA published between 2015 and 2025 were selected according to predefined search strategies. HEV prevalence was defined by the detection of IgG or IgM antibodies in serum or plasma using ELISA, PCR or rapid diagnostic tests (RDTs). Pooled prevalence estimates were calculated using a random effects model. A narrative synthesis was performed to identify the factors associated with the risk of HEV infection and its consequences during pregnancy. All data were analysed using Stata version 17 software. This review was registered with PROSPERO, CRD420251065899. A total of 30 studies from SSA were included in this systematic review and meta-analysis. The pooled prevalence was 17% (95% CI 13–21) and 4% (95% CI 3–5) for IgG and IgM, respectively. Sub-regional analysis of IgG anti-HEV prevalence showed significant heterogeneity among pregnant women in SSA. Sociodemographic, economic, behavioural, and environmental factors were associated with having a HEV infection. Regarding maternal outcomes, both mild symptomatic cases and severe forms with mortality rates of up to 20% were observed. Neonatal outcomes included jaundice, hypotrophy, and fetal mortality. The reported risk of miscarriage and prematurity varied between studies, ranging from 0% to 8.4%. This research showed that HEV infection in pregnant women remains a public health concern in SSA, with significant maternal and neonatal consequences.

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