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BMC Pulmonary Medicine
Published in: BMC Pulmonary Medicine 1/2017

Open Access 01-12-2017 | Research article

Prevalence and etiologies of pulmonary hypertension in Africa: a systematic review and meta-analysis

Authors: Jean Joel Bigna, Jean Jacques Noubiap, Jobert Richie Nansseu, Leopold Ndemnge Aminde

Published in: BMC Pulmonary Medicine | Issue 1/2017

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Abstract

Background

Despite the recent increasing worldwide attention towards pulmonary hypertension (PH), its epidemiology remains poorly described in Africa. Accordingly, we performed a systematic review and meta-analysis of PH prevalence, incidence and etiologies in Africa.

Methods

We searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus. Published observational studies until September 20, 2017, including adult participants residing in Africa were considered. Two review authors independently selected studies, assessed included studies for methodological quality, and extracted data. A random-effects model was used for meta-analysis. Heterogeneity was evaluated by the χ 2 test on Cochrane’s Q statistic which is quantified by I2 values. Using Newcastle-Ottawa Scale, we considered a score of 0–4, 5–7, and 8–10 as indicative of high, moderate, and low risk of bias in included studies, respectively.

Results

Of 1611 entries, 25 studies were retained. Twelve (48%), seven (28%), and six (24%) papers had respectively a low, moderate and high risk of bias. The prevalence of PH widely varied across different populations: 9.8% (95% confidence interval: 3.2–19.3; I2 = 99.4%; 6 studies) in 11,163 people presenting with cardiac complaints; 10.6% (4.3–19.1; I2 = 90.3%; 4 studies) in 937 HIV-infected people; 32.9% (17.6–50.4; I2 = 97.2%; 3 studies) in 2077 patients with heart failure; 23.2% (15.2–32.2; I2 = 59.4%; 3 studies) in 248 patients on hemodialysis; 12.9% (11.8–14.0; I2 = 79.7%; 2 studies) in 3750 patients with rheumatic heart disease; 36.9% (29.7–44.3; I2 = 79.7; 2 studies) in 79 patients with sickle cell disease; 62.7% (49.0–74.7; 1 study) in 51 patients with chronic obstructive pulmonary disease; 25.4% (16.3–37.3; 1 study) in 63 patients with systemic lupus erythematous; 68.7% (62.8–74.1; 1 study) in 259 patients with cardiac surgery; and 7.4% (4.6–11.9; 1 study) in 202 patients with systemic sclerosis. No study reported PH incidence. From one international study (n = 209), PH etiologies were: left heart disease (68.9%), pulmonary arterial hypertension (15.8%), lung disease and/or hypoxia (12.0%), chronic thromboembolic PH (1.9%) and unclear/multifactorial PH (15.8%).

Conclusion

The prevalence of PH is relatively high in some populations in Africa, perhaps mainly driven by left heart diseases, highlighting the need for context-specific interventions.
Appendix
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Metadata
Title
Prevalence and etiologies of pulmonary hypertension in Africa: a systematic review and meta-analysis
Authors
Jean Joel Bigna
Jean Jacques Noubiap
Jobert Richie Nansseu
Leopold Ndemnge Aminde
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2017
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-017-0549-5

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