Leptospirosis in Sub-Saharan Africa: a systematic review

•Leptospirosis constitutes a neglected tropical disease in sub-Saharan Africa•Climate change, increasing flooding risk, population growth, and urbanisation could increase the disease burden in the region•Leptospirosis moves into the light as an important differential diagnosis in non-malarial febrile disease•Most research has been conducted in animals, probably because of the larger economic losses caused in livestock (e.g. abortion)•Future leptospirosis research should be a multi disciplinary effort, to attain the optimal health for individuals and animals

SummaryBackgroundLeptospirosis is an emerging zoonotic infection worldwide, possibly due to climate change and demographic shifts. It is regarded as endemic in Sub-Saharan Africa; however, for most countries scarce epidemiological data, if any, exist. The primary objectives were to describe the prevalence of leptospirosis in countries in Sub-Saharan Africa, and to develop options for prevention and control in the future.MethodsA systematic review was conducted to determine the prevalence of leptospirosis in Sub-Saharan Africa; the PRISMA guidelines were followed. Medline/PubMed, Embase, The Cochrane Library, Web of Science, BIOSIS Previews, the African Index Medicus, AJOL, and Google Scholar were searched.ResultsInformation about the prevalence and incidence of leptospirosis in humans is available, but remains scarce for many countries. Data are unavailable or outdated for many countries, particularly those in Central Africa. Most data are available from animals, probably due to the economic losses caused by leptospirosis in livestock. In humans, leptospirosis is an important cause of febrile illness in Sub-Saharan Africa. It concerns numerous serogroups, harboured by many different animal carriers.DiscussionA wide variety of data was identified. Prevalence rates vary throughout the continent and more research, especially in humans, is needed to reliably gauge the extent of the problem. Preventive measures need to be reconsidered to control outbreaks in the future.