Dominance of antimicrobial resistance bacteria and risk factors of bacteriuria infection among pregnant women in East Africa: implications for public health

Abstract

Background

Bacterial infections in pregnancy pose significant health risks in East Africa. This study estimates pooled prevalence and identifies key risk factors, addressing limited data to improve maternal health outcomes in the region.

Methods

This study employed a systematic review and meta-analysis, analyzing data from eight East African studies (2016–2021). Searches spanned PubMed, Embase, Scopus, and more, with manual reference checks. Data quality was assessed via the Newcastle-Ottawa Scale. RevMan software with a random-effects model estimated pooled prevalence and hazard ratios for risk factors.

Results

A pooled analysis of antimicrobial resistance (AMR) bacterial isolates from pregnant women in East Africa highlights concerning prevalence rates of various pathogens. Escherichia coli emerged as the most common pathogen, present in 43% (95% CI: 37–48%) of cases, followed by Staphylococcus aureus at 20% (95% CI: 0.12, 0.29) and Corynebacterium, Enterococcus, and Nocardia species (CONs) in 16% (95% CI: 10–23%) and 16% (95% CI: 12–21%) (Prevalence of K. pneumoniae). A very small proportion 6% (95% CI: 2 − 11%) was found to be infected with Pseudomonas aeruginosa. The forest plot highlights risk factors for infections in pregnant women in East Africa: antibiotic use (HR: 2.0, 95% CI: 1.5–2.6), smoking (HR: 1.3, 95% CI: 1.0–1.6), poor sanitation (HR: 1.8, 95% CI: 1.2–2.4), diabetes (HR: 2.1, 95% CI: 1.5–2.8), and age > 30 years (HR: 1.5, 95% CI: 1.1–2.0).

Conclusions

This analysis reveals a significant prevalence of bacterial infections, particularly Escherichia coli, among pregnant women in East Africa, with antimicrobial resistance (AMR) complicating treatment. The study identified several key risk factors, including antibiotic use, smoking, poor sanitation, diabetes, and age over 30, which are associated with higher rates of infection. While these findings emphasize the need for further research, the results suggest that routine bacterial screening, AMR surveillance, improved sanitation, and antibiotic stewardship are important steps in mitigating the impact of these infections. Public health strategies should prioritize high-risk groups, encourage hygiene practices, and continue to guide policy and interventions through ongoing studies.

Introduction

Infections caused by bacterial pathogens are a significant concern in pregnant women, especially in low-resource settings like East Africa. Pregnant women are particularly vulnerable to infections due to physiological changes during pregnancy, which can lead to severe maternal and fetal outcomes [1]. Bacterial pathogens such as Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Coagulase-negative staphylococci (CoNS), Klebsiella spp., and Pseudomonas aeruginosa are commonly implicated in urinary tract infections (UTIs) and other complications in pregnant women. The prevalence of these infections varies across regions, and the associated risk factors are not well understood in many East African countries. While some studies have examined bacterial infections in pregnancy, there remains a lack of comprehensive data on the pooled prevalence of these pathogens in the East African context [2].

The relationship between bacterial infections and adverse pregnancy outcomes such as preterm labor, low birth weight, and maternal sepsis has been well-documented in global literature. Pathogens like E. coli and S. aureus are commonly identified as major causes of infections in pregnant women, and factors such as poor sanitation, inadequate antenatal care, and the overuse of antibiotics have been recognized as contributing risk factors [3].

Antimicrobial resistance (AMR) is a growing concern in East Africa, with rising resistance to common antibiotics, particularly in hospital settings. However, antimicrobial stewardship (AMS) practices are often poorly implemented due to challenges such as inadequate infrastructure, insufficient funding, and a lack of trained personnel. Some countries have AMS guidelines, but they are not consistently enforced, and the overuse and misuse of antibiotics persist, especially in rural areas. This study will examine the prevalence of bacterial infections among pregnant women and explore how AMS practices impact infection control, with the goal of identifying gaps and recommending strategies to improve antimicrobial use in healthcare and community settings across the region [4].

By synthesizing data from various countries—of east Africa including Ethiopia, Kenya, Tanzania, and Uganda—this study aims to provide a more accurate and comprehensive estimate of the prevalence of bacterial pathogens in the region. Additionally, it will explore the associated risk factors, which are often inadequately addressed in individual studies. Understanding the prevalence of these pathogens and the risk factors that contribute to infections in pregnant women is crucial for public health initiatives [5]. Despite the increasing recognition of the problem, there are still significant gaps in the available data, particularly with regard to the region-specific risk factors, diagnostic challenges, and the influence of antimicrobial resistance.

The findings of this study have significant policy implications [6]. First, understanding the prevalence and risk factors of bacterial infections can guide the development of targeted interventions in East Africa. Health policies could focus on improving maternal health care, enhancing sanitation facilities, and promoting awareness about the importance of early screening and treatment for bacterial infections. Policymakers could also consider implementing antimicrobial stewardship programs to mitigate the growing threat of antimicrobial resistance, which is increasingly recognized as a challenge in managing infections in pregnant women. The data from this pooled analysis could serve as a basis for advocacy to improve maternal health infrastructure, access to diagnostics, and quality of antenatal care in East Africa [7].

The primary aim of this study is to estimate the pooled prevalence of key bacterial pathogens—E. coli, S. aureus, Coagulase-negative staphylococci (CoNS), Klebsiella spp., and Pseudomonas aeruginosa—in pregnant women from East Africa. Additionally, the study aims to identify and assess the risk factors associated with these infections. By addressing these aims, the study hopes to provide a more robust understanding of the scope of bacterial infections during pregnancy in the region. Furthermore, it seeks to inform evidence-based policy recommendations that can help improve maternal health outcomes and reduce the burden of bacterial infections in East Africa [8].

The importance of this study lies in its potential to contribute to the reduction of maternal morbidity and mortality related to bacterial infections in East Africa. With high rates of preventable infections in pregnant women, a better understanding of the prevalence and risk factors can lead to more effective health interventions [9]. In addition, the study’s findings could serve as a baseline for future research in the region, facilitating the development of targeted interventions and better healthcare management practices. This study will also fill the gaps in knowledge by providing a pooled prevalence estimate, which will be invaluable for health authorities in the region to allocate resources effectively. While this study aims to provide critical insights into bacterial infections among pregnant women in East Africa, it also lays the foundation for further research in this field. Future studies could explore more granular data on specific bacterial strains, their resistance patterns, and their clinical outcomes. Additionally, research on the effectiveness of interventions designed to mitigate these infections could be explored. In conclusion, this study provides a much-needed comprehensive overview of bacterial infections in pregnant women in East Africa, offering vital information that can influence public health policies and practices in the region [10].

Methods

Study design and setting

This study utilized a pooled analysis of eight peer-reviewed studies conducted from 2016 to 2021 across Ethiopia, Kenya, Tanzania, and Uganda. The included studies employed cross-sectional, cohort, or case-control designs to investigate bacterial isolates and associated risk factors for infections among pregnant women.

Review question

The review question seeks to determine the pooled prevalence and distribution of bacterial pathogens, including E. coli, S. aureus, Coagulase-negative staphylococci (CoNS), Klebsiella spp., and Pseudomonas aeruginosa, isolated from pregnant women in East Africa. Additionally, it aims to identify the key risk factors associated with these infections. Using the PICO framework, the population of interest is pregnant women in East Africa, while the intervention involves assessing the prevalence of these bacterial pathogens and their associated risk factors. The comparison focuses on differences in risk factors between infected and non-infected pregnant women, with the outcome being the prevalence, distribution, and identification of significant risk factors. This question is designed to be clear, focused, and actionable, addressing a critical public health concern in the region.

Databases searched

Comprehensive searches were performed across multiple electronic databases to identify relevant studies, including PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar for grey literature and supplementary sources. To ensure a thorough search, manual searches of reference lists from identified studies and related review articles were also conducted. The PRISMA guidelines for reporting protocols and the PRISMA checklist were employed to guide the search and screening process. The inclusion criteria were limited to studies published in English between January 2016 and December 2021, focusing on capturing the most recent and relevant literature. This comprehensive approach ensures the robustness and completeness of the evidence base.

Search strategy

A combination of medical subject headings (MeSH) and keywords was employed to ensure a comprehensive search. Key terms included “Bacterial pathogens,” “Pregnant women,” “East Africa,” as well as specific bacterial pathogens such as “E. coli,” “S. aureus,” “Coagulase-negative staphylococci,” “Klebsiella,” and “Pseudomonas.” Additional terms like “Prevalence” and “Risk factors” were also included. Boolean operators (AND, OR) were used to refine the search, and filters were applied to restrict the results to studies published in English. This strategy aimed to capture all relevant literature within the specified time frame.

Inclusion and exclusion criteria

The inclusion criteria for this study were as follows: studies that examined bacterial isolates from pregnant women using microbiological culture methods, reported the prevalence of bacterial pathogens such as E. coli, S. aureus, Coagulase-negative staphylococci (CoNS), Klebsiella spp., or Pseudomonas aeruginosa, and were conducted in East Africa, published in English between 2016 and 2021. Only English-language studies were considered for inclusion. Studies were excluded if they lacked detailed microbiological data, did not differentiate between symptomatic and asymptomatic bacteriuria, or focused exclusively on non-bacterial pathogens or animal studies.

Data collection and extraction

Data were extracted from full-text articles using a standardized form. Key variables included the study location and design, year of publication and study period, sample size, prevalence of bacterial pathogens, and reported risk factors. These variables were systematically recorded to facilitate comparison and analysis across the included studies.

Statistical analysis

Data analysis was conducted using RevMan software. A random-effects meta-analysis was performed to calculate pooled prevalence estimates with 95% confidence intervals (CIs) for each bacterial isolate, including E. coli, S. aureus, Coagulase-negative staphylococci (CoNS), Klebsiella spp., and Pseudomonas aeruginosa. This approach was chosen to account for variability between studies and provide a more accurate overall estimate of the bacterial prevalence. The degree of heterogeneity among the studies was assessed using the I² statistic, with values less than 25% indicating low heterogeneity, suggesting a relatively high level of consistency in the findings. In addition, associations between identified risk factors—such as poor sanitation, antibiotic use, and smoking—and bacterial infections were analyzed using hazard ratios (HRs) with 95% CIs. These estimates were pooled using a fixed-effects model, assuming that the studies shared a common effect size.

Quality assessment

Study quality was evaluated using the Newcastle-Ottawa Scale (NOS), focusing on selection, comparability, and outcome domains. Studies scoring ≥ 6 were considered high quality.

Results and discussion

Key study characteristics

The systematic review and meta-analysis included observational studies from Ethiopia, Sudan, Tanzania, and Uganda, with sample sizes ranging from 169 to 587 participants. Prevalence rates varied widely, from 3.75% in Uganda to 28% in Tanzania. The studies reported different numbers of isolates and methodological quality scores based on the JBI checklist, ranging from 5 to 8 (Table 1).

Table 1 Baseline characteristics observational studies included in systematic review and meta-analysis

Prevalence and types of bacterial isolates in urinary tract infections among pregnant women in East Africa

A pooled analysis of 2,611 urine samples from eight studies conducted in four East African countries identified five major bacterial isolates, with E. coli being the most prevalent at 43% (95% CI: 37–48%). This was followed by S. aureus at 20% (95% CI: 12–29%), coagulase-negative staphylococci at 16% (95% CI: 10–23%), Klebsiella species at 16% (95% CI: 12–21%), and Pseudomonas aeruginosa at 0.1% (95% CI: 2–11%). These isolates were identified in both asymptomatic and symptomatic bacteriuria cases, with E. coli being the dominant pathogen. The findings reveal a significant public health challenge, as E. coli is a leading cause of urinary tract infections (UTIs) that can result in severe maternal complications, including preterm labor, low birth weight, and neonatal sepsis. Despite a low heterogeneity (I² = 21.88%, p = 0.26) (Figs. 1, 2, 3, 4 and 5), the variability in prevalence rates (27–54%) reflects disparities in geographic settings, healthcare access, and diagnostic practices. Additionally, the high prevalence of antimicrobial resistance (AMR), particularly among E. coli strains, exacerbates treatment challenges, prolongs illnesses, and increases healthcare costs. To address these issues, routine bacterial screening and AMR surveillance should be integrated into antenatal care programs. Public health strategies must also prioritize improving water, sanitation, and hygiene (WASH) practices, expanding diagnostic and laboratory capacities, and implementing effective antimicrobial stewardship programs. Raising community awareness and tailoring interventions to reduce AMR risks are essential for mitigating the burden of bacterial infections and safeguarding maternal and neonatal health in East Africa [19].

Forest plot analysis of each bacterial prevalence

The forest plot presents a meta-analysis of the prevalence of E. coli among pregnant women in East Africa, based on data from multiple studies. Each study’s prevalence estimate is represented by a black square and a horizontal line, indicating the 95% confidence interval (CI). The size of the square reflects the study’s weight in the analysis, with larger weights typically corresponding to larger sample sizes or more precise estimates. For instance, Joshua et al. (2019) has the largest weight (22.18%), while Nteziyaremye et al. (2020) contributes the least (8.01%). The pooled prevalence of E. coli is estimated at 43% (95% CI: 37–48%), as depicted by the diamond at the bottom of the plot. The heterogeneity among studies is low, as indicated by an I² statistic of 21.88% and a p-value of 0.26, suggesting minimal variation between the studies’ results (Fig. 1). These findings underscore the significant prevalence of E. coli infections among pregnant women in East Africa and highlight the need for targeted public health interventions in this population [20]. These findings highlight the pressing need for targeted interventions to prevent and manage E. coli infections in pregnant women, particularly in East Africa. Strengthened antenatal care programs, improved hygiene education, and enhanced access to diagnostic and treatment facilities are critical. Moreover, AMR surveillance and antimicrobial stewardship programs should be prioritized to mitigate the risk of resistant E. coli strains. Future research should focus on understanding the underlying drivers of infection and AMR, with a particular emphasis on regional variations, healthcare access disparities, and effective prevention strategies [21].

Fig. 1

Forest plot showing the prevalence of E. coli among pregnant women in East Africa, 2024

Figure 2 presents a forest plot showing the prevalence of S. aureus among pregnant women in East Africa, based on data from several studies. The effect sizes (ES) and 95% confidence intervals (CI) are listed for each study, along with their respective weights, which are based on sample size. For instance, the study by Alemu et al. (2012) has the largest weight at 16.62%, while Nteziyaremye et al. (2020) has the smallest weight at 14.22%. The overall pooled effect size for the prevalence of S. aureus is 0.20 (95% CI: 0.12, 0.29), indicating a moderate prevalence across the studies. However, there is a significant level of heterogeneity (I² = 60.75%, p = 0.03), suggesting variability in the results across the different studies. The diamond shape at the bottom of the plot represents the overall effect size, with the dashed vertical line indicating no effect (ES = 0). This high heterogeneity indicates that the prevalence of S. aureus varies between studies, highlighting the need for further research to explore the factors contributing to this variability (Fig. 2). The findings of this meta-analysis underscore the moderate prevalence of S. aureus among pregnant women in East Africa, highlighting it as a significant public health concern. The presence of substantial heterogeneity suggests that the burden of S. aureus infections varies across settings, potentially due to differences in healthcare access, hygiene practices, socioeconomic conditions, or regional variations in antimicrobial resistance [22].

These results call for targeted public health interventions, such as strengthening antenatal care programs to include regular screening for S. Aureus and providing timely treatment to reduce the risk of complications. Improved hygiene education and awareness campaigns tailored to pregnant women can mitigate infection risks. Additionally, addressing the variability in prevalence through region-specific studies can help identify high-risk populations and factors driving the disparities [23]. Policymakers and healthcare providers should prioritize investments in diagnostic facilities and antimicrobial stewardship programs to monitor and manage S. aureus, especially given its potential role in maternal and neonatal infections. Future research should explore the contextual factors contributing to the observed heterogeneity, focusing on environmental, demographic, and clinical determinants to inform more effective interventions [24].

Fig. 2

Forest plot showing the prevalence of S. aureus among pregnant women in East Africa, 2024

Figure 3 displays a forest plot that illustrates the prevalence of Corynebacterium, Enterococcus, and Nocardia species (CONs) among pregnant women in East Africa, based on data from three studies. The effect sizes (ES) and their 95% confidence intervals (CIs) are shown for each study, representing the estimated prevalence of CONs in the sampled populations. The study by Alemu et al. (2012) reported an effect size of 0.22 (95% CI: 0.12–0.36), contributing 29.67% to the overall estimate. Abu et al. (2021) showed a prevalence of 0.13 (95% CI: 0.06–0.27), with a weight of 28.94%, while Gessesse et al. (2017) found a prevalence of 0.14 (95% CI: 0.07–0.26), contributing the largest weight of 41.39%. The overall pooled effect size, representing the combined data from all studies, was 0.16 (95% CI: 0.10–0.23), suggesting a moderate prevalence of CONs among pregnant women in East Africa. The diamond at the bottom of the plot indicates the overall estimate, and the vertical dashed line marks the no-effect value (ES = 0). The low heterogeneity (I² = 0.00%, p = 0.48) signifies minimal variability among the studies, reinforcing the reliability and consistency of the findings (Fig. 3). These pathogens, though less frequently highlighted than common pathogens, represent important contributors to maternal infections that can compromise both maternal and fetal health [25].

The findings highlight the need for routine microbial screening in antenatal care to detect and manage infections caused by CONs, especially in resource-limited settings where diagnostic capacity may be restricted. Healthcare providers should integrate awareness and prevention strategies into maternal health programs, including promoting hygienic practices and timely treatment to reduce potential adverse outcomes [26].

Given the relatively moderate prevalence, targeted research should investigate the pathogenicity, antimicrobial resistance patterns, and risk factors associated with CONs infections in pregnant women. This will help refine treatment protocols and public health interventions. Furthermore, efforts to strengthen laboratory capacities in the region can enhance the identification and management of these infections, ultimately improving maternal and neonatal health outcomes [27].

Fig. 3

Forest plot showing the prevalence of CONs among pregnant women in East Africa, 2024

Figure 4 presents a forest plot showing the prevalence of K. pneumoniae infections among pregnant women in East Africa, based on multiple studies. The individual effect sizes (ES) for each study range from 0.07 to 0.24, with corresponding 95% confidence intervals (CIs) varying between 0.02 and 0.23 and 0.11–0.35. The weight for each study reflects its contribution to the overall pooled effect size. The overall pooled effect size is 0.16 (95% CI: 0.12–0.21), suggesting a moderate prevalence of K. pneumoniae infections among pregnant women in the region. The I² value of 27.63% indicates moderate heterogeneity between the studies, which is further supported by a p-value of 0.22, suggesting that the variation between studies is not statistically significant. This suggests that while there is some variability across studies, the pooled estimate provides a reliable assessment of the prevalence of K. pneumoniae in East African pregnant women (Fig. 4). The findings underscore the importance of incorporating K. pneumoniae screening in antenatal care, particularly in regions with limited access to healthcare resources. Early detection and appropriate antibiotic treatment are crucial to managing these infections and preventing complications such as preterm birth, low birth weight, and maternal morbidity [28].

Additionally, the rising concern of antimicrobial resistance (AMR) in K. pneumoniae further emphasizes the need for better stewardship of antibiotics in pregnant women. Public health interventions should focus on improving diagnostic capabilities, enhancing hygiene and infection control practices, and promoting awareness about the risks associated with K. pneumoniae infections [29]. Future research should explore the environmental, clinical, and demographic factors contributing to the spread of K. pneumoniae in East Africa and assess the role of antimicrobial resistance in complicating treatment regimens. Strengthening maternal healthcare infrastructure to routinely identify and manage K. pneumoniae infections can significantly reduce maternal and neonatal health risks in the region [30].

Fig. 4

Forest plot showing the prevalence of K. pneumoniae among pregnant women in East Africa, 2024

The forest plot in Fig. 5 shows the effect sizes (ES) from three studies, each contributing to the analysis of Pseudomonas aeruginosa infections among pregnant women in East Africa. Handan et al. (2011) reports a small effect size (ES = 0.03, 95% CI: 0.01–0.15), while Taye et al. (2018) and Metayemew et al. (2020) both report moderate effect sizes (ES = 0.07, 95% CI: 0.02–0.18 and 95% CI: 0.02–0.23, respectively). The overall combined effect size is 0.06 (95% CI: 0.02–0.11), indicating a small but statistically significant positive effect. The I² value of 0% suggests no heterogeneity between the studies, and the p-value of 0.75 supports the consistency of the results. These findings suggest that there is a small but significant effect, highlighting the prevalence and potential impact of P. aeruginosa on maternal health in the region (Fig. 5). The findings emphasize the need for ongoing surveillance of P. aeruginosa infections in maternal health settings. Healthcare providers should be aware of the potential for P. aeruginosa infections and consider it in their differential diagnoses, especially for pregnant women presenting with symptoms of respiratory or urinary tract infections. Routine screening and timely treatment of infections can help mitigate the risk of adverse outcomes for both the mother and the fetus [31].

Additionally, the low prevalence does not diminish the importance of infection prevention and control measures, particularly in healthcare settings where P. aeruginosa can be opportunistic, especially in immunocompromised individuals such as pregnant women. Implementing strict hygiene practices, improving infection control measures in hospitals, and promoting antimicrobial stewardship can help reduce the burden of this pathogen [32]. Given the increasing global concern about antimicrobial resistance (AMR), it is important for future research to examine the resistance patterns of P. aeruginosa in East Africa, as this could impact treatment outcomes. Policymakers should prioritize interventions aimed at improving diagnostic infrastructure and strengthening healthcare systems to address infections caused by P. aeruginosa in pregnancy, ultimately improving maternal and neonatal health outcomes in the region [33].

Fig. 5

Forest plot showing the prevalence of P. aeruginosa among pregnant women in East Africa, 2024

Risk factors of bacteriuria infection among pregnant women in East Africa

The forest plot illustrates the risk factors associated with infections among pregnant women in East Africa, presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Antibiotic use is associated with a significantly increased risk of infection, with an HR of 2.0 (95% CI: 1.5–2.6), indicating that women who used antibiotics were twice as likely to develop infections compared to those who did not. Smoking shows an HR of 1.3 (95% CI: 1.0–1.6), suggesting a 30% higher likelihood of infection, though the lower CI bound of 1.0 indicates a borderline association. Poor sanitation significantly elevates infection risk, with an HR of 1.8 (95% CI: 1.2–2.4), highlighting the importance of addressing environmental hygiene. A history of diabetes is strongly linked to infection, with an HR of 2.1 (95% CI: 1.5–2.8), demonstrating that women with diabetes are more than twice as likely to experience infections. Age greater than 30 years is also a significant risk factor, with an HR of 1.5 (95% CI: 1.1–2.0), indicating a 50% higher risk compared to younger women. The overall risk, considering all factors, is summarized as an HR of 1.7 (95% CI: 1.4–2.0), confirming a statistically significant increase in infection susceptibility among this population. These findings emphasize the critical need to address modifiable risk factors such as sanitation, smoking, and proper medical management to reduce infection risks (Fig. 6).

Fig. 6

Forest Plot of Risk Factors Associated with Infections among Pregnant Women in East Africa, Showing Hazard Ratios (HRs) with 95% Confidence Intervals

Antibiotic use was found to significantly increase the risk of infection, indicating that women who used antibiotics were twice as likely to develop infections compared to those who did not. This association points to the potential misuse or overuse of antibiotics, which could contribute to antimicrobial resistance (AMR) and complicate the treatment of infections in pregnant women. Public health strategies should focus on promoting responsible antibiotic use, alongside antimicrobial stewardship programs, to reduce unnecessary prescriptions and curb the rise of resistant pathogens [34].

Similarly, smoking was found to be a risk factor for infections, suggesting a 30% increased risk of infection among pregnant women who smoke. Although this association is borderline, smoking during pregnancy is known to impair immune function and increase the likelihood of infections. Public health campaigns aimed at smoking cessation for pregnant women could significantly reduce these risks and improve maternal and fetal health outcomes [35].

Poor sanitation also emerged as a significant risk factor, emphasizing the need to address environmental hygiene. Poor sanitation is a well-established risk factor for a range of infectious diseases, particularly in vulnerable populations like pregnant women. Interventions to improve sanitation infrastructure and hygiene practices, particularly in rural and underserved areas, are essential to reduce infection rates. Additionally, improving access to clean water and sanitation facilities should be a priority in public health planning [36].

A history of diabetes was found to strongly correlate with an increased risk of infection. Diabetes impairs immune function, making pregnant women with diabetes more susceptible to infections. Public health interventions should focus on early screening for gestational diabetes and managing pre-existing diabetes to reduce infection risks. Education on diabetes management, especially during pregnancy, is critical to lowering infection rates in this high-risk group [37].

Lastly, age greater than 30 years was identified as a risk factor, indicating a 50% higher likelihood of infection among older pregnant women. As immune function naturally declines with age, older pregnant women may be more vulnerable to infections. Targeted healthcare interventions for this group, including regular screenings for infections and preventive care such as vaccinations, could help mitigate these risks [38].

Together, these findings highlight the need for public health initiatives that address modifiable risk factors such as antibiotic misuse, smoking, poor sanitation, and diabetes management. By focusing on these factors, it is possible to reduce the risk of infections among pregnant women in East Africa, ultimately improving maternal and neonatal health outcomes. Public health programs should also incorporate age-specific care and interventions for older pregnant women to further enhance maternal health [39].

A limitation of this review is that it only focuses on studies conducted in East Africa, which may limit the generalizability of the findings to other regions with different environmental, social, and health contexts. To address this, future research should incorporate broader geographical regions to compare and contrast findings, and consider including studies from other parts of Africa or globally to enhance the robustness and applicability of the results.

Conclusion and recommendations

Conclusion

The pooled analysis of bacterial isolates among pregnant women in East Africa highlights a high prevalence of bacterial infections, particularly E. coli, followed by S. aureus, coagulase-negative CONs, K. pneumoniae, and P. aeruginosa. The prevalence of E. coli ranged from 27 to 54%, with significant regional variations, reflecting a major public health concern. The study emphasizes the growing challenge of antimicrobial resistance (AMR), which complicates treatment strategies and contributes to increased maternal and neonatal morbidity. These infections, particularly urinary tract infections (UTIs), are linked to severe maternal complications such as preterm labor, low birth weight, and neonatal sepsis. Risk factors including antibiotic use, smoking, poor sanitation, diabetes, and maternal age were found to significantly increase the likelihood of infections. These findings highlight the importance of addressing modifiable risk factors and strengthening diagnostic capacity. To mitigate the burden of these infections, it is critical to improve water and sanitation practices, adopt effective antimicrobial stewardship, and implement region-specific interventions. Further research is needed to explore the underlying causes of regional disparities in infection prevalence and resistance patterns. The results underscore the urgent need for routine bacterial screening, AMR surveillance, and comprehensive public health strategies to improve maternal and neonatal health outcomes in East Africa.

Recommendations

To address bacterial infections among pregnant women in East Africa, routine bacterial screening should be integrated into antenatal care programs, focusing onE. coliand other common pathogens. Strengthening AMR surveillance and enhancing sanitation and hygiene, especially in rural areas, is vital to reduce infection rates. Antibiotic stewardship programs should be established to minimize unnecessary antibiotic use. Public health interventions should target high-risk groups with tailored monitoring and treatment. Community awareness campaigns should emphasize proper hygiene, early detection, and safe antibiotic use. Further research on environmental and socioeconomic factors will guide future health policies and interventions.