A systematic review of the burden and risk factors of sudden infant death syndrome (SIDS) in Africa

Background While sudden infant death syndrome (SIDS) has long been rec-ognized as a leading preventable cause of infant mortality in high-income coun-tries, little is known about the burden of SIDS in Africa. To address this knowl-edge gap, we conducted the first systematic review of SIDS-related publications in Africa. Our objective was to assess the prevalence of SIDS and its risk fac-tors in Africa. Methods We systematically searched PubMed, Embase, Web of Science, Co-chrane, and Google Scholar to identify studies published until December 26, 2020. Review authors screened titles and abstracts, and selected articles inde-pendently for full-text review. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) or a modification. Data on the proportion of infants who died of SIDS and reported prevalence of any risk factors were extracted using customized data extraction forms in Covidence. Results Our analysis rested on 32 peer-reviewed articles. Nine studies present-ed prevalence estimates on bedsharing and prone sleeping, suggesting near-uni-versal bedsharing of infants with parents (range, 60 to 91.8%) and frequent use of the prone sleeping position (range, 26.7 to 63.8%). Eleven studies reported on the prevalence of SIDS, suggesting high rates of SIDS in Africa. The prev-alence of SIDS ranged from 3.7 per 1000 live births in South Africa, 2.5 per 1000 live births in Niger, and 0.2 per 1000 live births in Zimbabwe. SIDS and other sudden infant deaths accounted for between 2.5 to 21% of infant deaths in South Africa and 11.3% in Zambia. Conclusions Africa may have the highest global rate of SIDS with a high bur-den of associated risk factors. However, majority of the studies were from South Africa which limits generalizability of our findings to the entire continent. There is an urgent need for higher quality studies outside of South Africa to fill this knowledge gap.