Health-care-associated infection (HAI) is a major global safety concern for both patients and health-care professionals. (1-3) HAI is defined as an infection occurring in a patient during the process of care in a hospital or other health-care facility that was not manifest or incubating at the time of admission. This includes infections acquired in the hospital and any other setting where patients receive health care and may appear even after discharge. HAI also includes occupational infections among facility staff. (1) These infections, often caused by multiresistant pathogens, take a heavy toll on patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and sometimes death. (4-6)
The burden of HAI is already substantial in developed countries, where it affects from 5% to 15% of hospitalized patients in regular wards and as many as 50% or more of patients in intensive care units (ICUs). (7,8) In developing countries, the magnitude of the problem remains underestimated or even unknown largely because HAI diagnosis is complex and surveillance activities to guide interventions require expertise and resources. (6) Surveillance systems exist in some developed countries and provide regular reports on national trends of endemic HAI, (9) such as the National Healthcare Safety Network of the United States of America or the German hospital infection surveillance system. This is not the case in most developing countries (10) because of social and health-care system deficiencies that are aggravated by economic problems. Additionally, overcrowding and understaffing in hospitals result in inadequate infection control practices, and a lack of infection control policies, guidelines and trained professionals also adds to the extent of the problem.
This review provides a general overview of the endemic burden of HAI in Africa based on the information available in the scientific literature. It also identifies information gaps, examines differences in HAI epidemiology between developed and developing countries and highlights the possible role of the World Health Organization (WHO) in preventing HAI.
Search strategy and selection criteria
A literature search was performed from January 1995 to December 2009 with no language restriction to retrieve publications on the epidemiology of the most common HAIs in African countries: health-care-associated urinary tract infection (HA-UTI), surgical site infection (SSI), hospital-acquired pneumonia/ ventilator-associated pneumonia and health-care-associated bloodstream infection. PubMed was searched using a combination of the following keywords, including "cross-infection" as the MeSH term: "nosocomial infection", "hospital-acquired", "incidence", "prevalence" and "rate" together with the individual country names. The Cochrane Library was searched for any relevant review papers. Reference lists of retrieved articles were hand searched for additional studies.
A separate search was run in the WHO regional medical database for Africa, African Index Medicus, using a shorter list of essential keywords and with no time restriction. The abstract books of the following international conferences were also searched from 2004 to 2009: Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Annual Congress of the Society for Healthcare Epidemiology of America (SHEA), European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), International Federation of Infection Control (IFIC), the International Congress on Infectious Diseases (ICID), and the first African Conference on Infection Prevention Control (IPCAN), held in 2009. For the purposes of this review, African countries are defined as those belonging to the WHO African Region, which comprises all African countries except for Egypt, the Libyan Arab Jamahiriya, Morocco, Somalia, Sudan and Tunisia. …