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Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic review

Por: Aremu · B. A. · Afolabi · I. B. · Simeon · A. N. · Mujeeb · S.
Objective

Teenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. This calls for a concerted effort from different stakeholders involved in issues of teenagers’ sexual reproductive health to achieve the SDG target of 2030 on the reduction of maternal mortality. The objective of this systematic review was to estimate the prevalence of teenage pregnancy and its associated factors in Uganda.

Designs

We conducted a systematic review and random-effects meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-analysis standards.

Data sources

After prospective registration (PROSPERO CRD42023486460), a literature search was conducted in PubMed, African Journals Online and Google Scholar in December 2023.

Eligibility criteria for selecting studies

Observational studies that reported the prevalence of teenage pregnancy among teenagers were included.

Data extraction and synthesis

Articles were screened for relevance at the title, abstract and full-text levels by multiple reviewers. The quality of studies was independently appraised using the Joanna Briggs Institute Critical Appraisal Checklist and Newcastle-Ottawa Scale. Any discrepancies were resolved by reaching a consensus. The process of extracting data included study information, geographical categorisation, type of studies, population, sample size, results/outcomes and prevalence of teenage pregnancy. The risk of bias was determined by Egger’s test. The results were pooled using random-effects models to calculate the prevalence of teenage pregnancy with a CI of 95% and statistic.

Results

Of 918 records screened, 10 studies (4143 participants) were included. The pooled prevalence of teenage pregnancy was 25.5% (95% CI 13.7% to 39.5%; =98.9%), with individual study estimates ranging widely from 3.0% to 56.4%, reflecting substantial heterogeneity across study settings, populations and periods of data collection. Higher estimates were observed in the Central–Eastern region (31.7%, 95% CI 19.5% to 45.1%). The overall certainty of evidence was rated as very low using the Grading of Recommendations, Assessment, Development and Evaluation framework, primarily due to very serious inconsistency across included studies (=98.9%).

Conclusions

Pooling studies of mixed quality revealed a slightly higher prevalence of teenage pregnancy in Uganda. This review provides valuable insight for policymakers and healthcare providers in developing interventions and policies to reduce the burden of teenage pregnancy from disadvantaged backgrounds.

PROSPERO registration number

CRD42023486460.

Azithromycin use in labour to prevent sepsis among pregnant women undergoing vaginal delivery in Nigeria (AZIN-V): a study protocol for a hybrid type 2 effectiveness-implementation trial

Por: Afolabi · B. B. · Makwe · C. C. · Oluwole · E. O. · Obi-Jeff · C. · Mitchell · E. J. · Banke-Thomas · A. · Adeyemo · T. A. · Abioye · A. I. · Eboreime · E. A. · Saidu · A. D. · Okoro · U. A. · Akintan · P. · Osuagwu · C. S. · Chieme · C. F. · Lawanson · T. · Hossain · A. · Walker · K.
Introduction

Nigeria has the highest number of maternal deaths globally, and maternal peripartum sepsis is one of the leading causes of maternal mortality. A single oral dose of azithromycin (AZM; 2 g) is safe and effectively reduces 33%–60% of maternal sepsis during planned vaginal birth in low- and middle-income countries (LMICs). However, the clinical and cost-effectiveness of oral AZM during vaginal birth in Nigeria remains unknown in the context of poor antimicrobial stewardship practices, significant antimicrobial resistance and healthcare financing. Evidence is also lacking on the standard care for the prevention of maternal sepsis among pregnant women undergoing vaginal births in Nigeria. The AZIN-V trial is a hybrid type 2 effectiveness-implementation trial to determine the safety, clinical and cost-effectiveness of intrapartum oral AZM versus usual care in the prevention of peripartum maternal sepsis. The trial will also examine the impact of implementation strategies in enhancing adherence to the oral AZM protocol during planned vaginal births and identify effective strategies to improve adherence (fidelity) to the protocol in real-world LMIC settings.

Methods and analysis

This is a multicentre hybrid type 2 trial conducted in six Nigerian states: Ebonyi, Edo, Gombe, Kano, Kwara and Lagos. The study aims to simultaneously test the clinical and cost-effectiveness of AZM (clinical trial) and the impact of implementation strategies (implementation research) in Nigeria’s unique healthcare context. The clinical trial is a two-arm, cluster-randomised controlled trial conducted across 48 health facilities, randomly assigned (1:1) to either intrapartum administration of oral AZM (intervention group) or usual care—the current routine practice (control group). A total of 5040 study participants (2520 in each group) will be enrolled in the clinical trial. The implementation trial is a two-arm cluster non-randomised controlled trial conducted in 12 health facilities (1:1) allocated to either a bottom-up approach using the Plan-Do-Study-Act cycle or a usual top-down approach with a one-time training workshop and distribution of clinical guidelines, with both arms administering oral AZM during vaginal birth while assessing fidelity (primary outcome).

For the clinical trial, data will be analysed using intention-to-treat statistical methods. The cost-effectiveness outcome will be analysed using the Incremental Cost-Effectiveness Ratio. Implementation outcomes will be analysed using descriptive statistics and a thematic approach.

Ethics and dissemination

This study has been approved by the National Health Research Ethics Committee, Nigeria (NHREC/01/01/2007-30/09/2024), the ethics committees of the participating health institutions (Lagos University Teaching Hospital Research Ethics Committee: ADM/DSCST/HREC/APP/6325; University of Ilorin Teaching Hospital Health Research Ethics Committee: ERC/PAN/2025/03/0581; University of Benin Teaching Hospital Health Research Ethics Committee: ADM/E22/A/VOL. VII/483117141; Aminu Kano Teaching Hospital Research Ethics Committee: AKTH/MAC/SUB/12 A/P-3/VI/2509 and Irrua Specialist Teaching Hospital Research Ethics Committee: ISTH/HREC/20241507/605), the Ministries of Health of the six states and the National Agency for Food and Drug Administration and Control. Written informed consent will be obtained from all eligible study participants before enrolment. Results will be shared with communities and policy stakeholders and through peer-reviewed journals and will be presented at conferences.

Trial registration number

ISRCTN16415327.

Preventing vertical transmission of hepatitis B in sub-Saharan Africa: protocol for a systematic review and meta-analysis on vaccination uptake and determinants among pregnant women

Por: Afolabi · I. B. · Phillips · J. C. · El-Chaar · D. · Bainbridge · S. A. · Phillips · K. P.
Background

Effective prevention of maternal-fetal transmission of hepatitis B virus (HBV) in highly endemic settings depends on targeting vaccination efforts to key priority groups, including pregnant women. However, the extent of HBV vaccination and determinants of uptake in sub-Saharan Africa (SSA) have not been systematically examined. This systematic review aims to estimate HBV vaccination among pregnant women in SSA and identify the broader factors influencing uptake.

Methods and analysis

This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. A comprehensive literature search will be conducted in MEDLINE, Embase, Web of Science, Scopus, African Journals Online and Google Scholar in November 2025. We will include published observational studies that assess HBV vaccination among pregnant women in SSA countries from database inception to October 2025. A meta-analysis will be conducted using random-effects models to pool estimates of HBV vaccination and multivariable-adjusted ORs for vaccination-associated factors. Statistical heterogeneity will be assessed using the I² statistic.

Ethics and dissemination

Ethical approval is not required as this review will not involve primary data collection. Findings will be published in a peer-reviewed journal, presented at regional and international public health conferences, and, where applicable, shared with policymakers and health authorities in SSA.

PROSPERO registration number

This protocol is registered with the International Prospective Register of Systematic Reviews, registration number CRD420251120357.

Time of onset of pre-eclampsia as a determinant of risk of cardiovascular disease and renal impairment at six weeks post partum: a cohort study in Lagos, Nigeria

Por: Kusamotu · O. A. · Babah · O. A. · Udenze · I. · Oluwole · A. A. · Afolabi · B. B.
Objectives

Pre-eclampsia causes significant maternal and perinatal morbidity and mortality. It also causes changes in the cardiovascular, endothelial and metabolic systems, from which women may not fully recover after delivery. This study examined the association between the time of onset of pre-eclampsia and the risk for cardiovascular disease (using glucose tolerance, lipid profile and blood pressure) and renal function at 6 weeks post partum.

Study design

A prospective cohort study.

Setting

Lagos University Teaching Hospital, Idi-Araba, Mother and Child Centre, Gbaja, Surulere and Lagos Island Maternity Hospital, Lagos, Nigeria.

Participants

44 women with pre-eclampsia were studied and data on their sociodemographic characteristics, gestational age at diagnosis and blood pressure were collected on admission. They were followed up through delivery till 6 weeks post partum, when blood pressure check, 75 g oral glucose tolerance test, fasting lipid profile and serum creatinine were done.

Outcome measures

The exposure was pre-eclampsia. The outcomes were cardiovascular disease risk markers, viz persistent hypertension, glucose intolerance and dyslipidaemia, and renal function at 6 weeks post partum in women who had pre-eclampsia.

Statistical analysis

Data were analysed using Stata V.16.1. Mann Whitney-U test was used to compare medians and Fisher's exact test was used to compare the categorical variables.

Results

Of the women studied, 13 (29.5%) had early onset pre-eclampsia and 31 (70.5%) had late onset pre-eclampsia. Mean gestational age at diagnosis was 30.8±1.57 weeks in women with early-onset pre-eclampsia and 35.6±1.26 weeks in women with late-onset pre-eclampsia (p

Conclusion

The prevalence of persistent hypertension at 6 weeks post partum is high in women with pre-eclampsia. Serum triglyceride concentration was significantly higher in early onset compared with late onset pre-eclampsia; subsequent studies powered to determine the full cardiovascular risk and how long to follow postnatal women up will be beneficial.

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