Prevalence of Microalbuminuria Among Diabetes Patients in Africa: A Systematic Review and Meta-Analysis

Figures & data

Figure 1 Flow chart of studies’ search and retrieval process.

Table 1 Overview of Included Studies Conducted in Africa (N=3885)

Authors (Year) [Reference]	Country	Study Design	Setting of the Study	Mean Age (Year)	Sample Size	Types of DM	Comorbidity	Duration of DM in Years	Prevalence of MAU N (%)
Rasmussen et al (2013)^Citation39	Zambia	Cross-sectional	Hospital	NA	193	Type 1 and 2	Yes	NA	57 (29.4)
Rahlenbeck et al (1997)^Citation40	Ethiopia	Cross-sectional	Hospital	31.4±8.8	99	Type 1	Yes	6.0±4.9 years	32 (32)
Rahlenbeck et al (1997)^Citation40	Ethiopia	Cross-sectional	Hospital	56.7±11.3	71	Type 2	Yes	5.3±3.9 years	26 (37)
Muse et al (2020)^Citation41	Ethiopia	Cross-sectional	Hospital	55.9±13.3	204	Type 2	Yes	NA	98 (48)
Ogiator et al (2020)^Citation42	Nigeria	Cross-sectional	Hospital	53.12±11.66	93	Type 2	Yes	NA	33 (35.5)
Ufuoma et al (2016)^Citation43	Nigeria	Cross-sectional	Hospital	55.2 ± 8.5	200	Type 2	Yes	8.1±6.8 years	116 (58)
Halliru et al (2016)^Citation44	Nigeria	Case-control	Hospital	42± 1.8	100	Type 2	Yes	NA	34 (34)
Erasmus et al (1992)^Citation45	Nigeria	Cross-sectional	Hospital	51.1	113	Type 2	Yes	5.1 years	59 (52)
Bissong et al (2017)^Citation46	Cameroon	Cross-sectional	Hospital	NA	81	Type 2	Yes	NA	28 (34.6)
Efundem et al (2017)^Citation47	Cameroon	Cross-sectional	Hospital	55.3 ± 10.2	162	Type 2	Yes	6.3 ± 5.2	23 (14.2)
Rahamtalla et al (2012)^Citation48	Sudan	Cross-sectional	Hospital	NA	58	Type 2	Yes	NA	26 (44)
Lutale et al (2007)^Citation49	Tanzania	Cross-sectional	Hospital	NA	91	Type 1	Yes	3 years	11 (12)
Lutale et al (2007)^Citation49	Tanzania	Cross-sectional	Hospital	NA	153	Type 2	Yes	4 years	15 (9.8)
Ghosh et al (2012)^Citation50	Tanzania	Cross-sectional	Hospital	61.3±10.5	149	Type 2	Yes	8±7 years	43 (29)
Kantarama et al (2021)^Citation51	Tanzania	Cross-sectional	Hospital	NA	124	Type 2	Yes	NA	77 (62.1)
Martin et al (2018)^Citation52	Uganda	Cross-sectional	Hospital	46 ± 15	140	Type 2	Yes	2 months	64 (45.7)
Martin et al (2018)^Citation52	Uganda	Cross-sectional	Hospital	NA	35	Type 1	Yes	2 months	19 (54.3)
Kiconco et al (2019)^Citation53	Uganda	Cross-sectional	Hospital	NA	140	Type 1 and 2	Yes	6.8 years	32 (22.9)
Lubwama S (2022)^Citation54	Uganda	Cross-sectional	Hospital	8.4	153	Type 1	Yes	4.35 years	21 (13.7)
Kalk et al (2010)^Citation55	South Africa	Cross-sectional	Hospital	34.9±8.6	68	Type 1	Yes	8 years	27 (39.7)
Molefe Baikai et al (2018)^Citation56	Botswana	Cross-sectional	Hospital	52	289	Type 2	Yes	NA	129 (44.6)
Ramaphane et al (2021)^Citation57	Botswana	Cross-sectional	Hospital	18.7 ±5	127	Type 1	Yes	6.6 ±4.6 years	36 (28.3)
Fetni et al (2021)^Citation58	Algeria	Cohort	Hospital	55±15.9	252	Type 2	Yes	NA	87 (34.5)
Fetni et al (2021)^Citation58	Algeria	Cohort	Hospital	20	40	Type 1	Yes	NA	16 (40)
Eghan et al (2007)^Citation59	Ghana	Cross-sectional	Hospital	54.2±10.9	109	Type 2	Yes	11.96 ±7.4 years	47 (43.1)
Amolo P (2010)^Citation60	Kenya	Cross-sectional	Hospital	10.9±4.5	65	Type 1	Yes	NA	4 (6.2)
Omar et al (2010)^Citation61	Egypt	Case-control	Hospital	11.78±3.83	40	Type 1	Yes	6.77±3.1 years	31 (77.5)
Djiby et al (2018)^Citation62	Senegal	Cross-sectional	Hospital	56.6±8.0	221	Type 1 and 2	Yes	NA	63 (28.5)
Chaamba S (2019)^Citation63	Zambia	Case-control	Hospital	52±13.6	45	Type 2	Yes	NA	28 (62.2)
Sobngwi et al (1999)^Citation64	Cameroon	Cross-sectional	Hospital	52.491.8	64	Type 1 and 2	Yes	5.8±90.8 years	34 (53.1)
Mohamed A (2005)^Citation65	Sudan	Cross-sectional	Hospital	13.6±2.6	86	Type 1	Yes	4.4±3.4 years	33 (38.4)
Bunza et al (2014)^Citation66	Nigeria	Case-control	Hospital	NA	100	Type 1 and 2	Yes	5.33 years	22 (22)
Yarhere et al (2020)^Citation67	Nigeria	Cross-sectional	Hospital	13.3± 3.7	20	Type 1	Yes	2.9 ± 0.44 years	12 (60)

Abbreviation: NA, not available.

Figure 2 Forest plot showing the pooled prevalence of microalbuminuria among diabetes patients in Africa.

Table 2 The results of Subgroup Analysis by Different Categories of the Studies in Africa

Subgroup	Category	No. of Studies	Prevalence of MAU (95% CI)	P-value	I^2 (%)
Sub-region	Eastern	12	30.57 (20.3, 40.83)	<0.001	96.0
	Western	8	40.81 (30.85, 50.76)	<0.001	90.3
	Central	3	33.47 (10.46, 56.48)	<0.001	94.8
	Northern	5	46.50 (32.29, 60.71)	<0.001	88.8
	Southern	5	39.79 (29.81, 49.77)	<0.001	86.3
Types of DM	Type 1	11	35.34 (23.89, 46.80)	<0.001	94.2
	Type 2	17	40.24 (32.00, 48.47)	<0.001	94.9
	Type 1 and 2	5	30.02 (22.41, 37.63)	<0.001	80.5
Sex	Male	23	36.6 (29.50, 43.69)	<0.001	87.4
	Female	23	33.95 (26.83, 41.08)	<0.001	91.4
Year of publication	1992–2002	4	43.34 (32.61, 54.08)	0.005	76.7
	2003–2012	8	27.11 (16.37, 37.85)	<0.001	93.7
	2013–2022	21	39.68 (32.71, 46.65)	<0.001	93.9
Duration of diabetes	< 5 years	7	31.48 (18.73, 44.23)	<0.001	94.4
	> 5 years	13	38.73 (29.34, 48.13)	<0.001	93.8
Study design	Cross-sectional	27	35.56 (29.12, 42.01)	<0.001	94.7
	Case-control	4	48.46 (24.14, 72.78)	<0.001	95.2
	Cohort	2	35.22 (29.74, 40.69)	0.51	0.0

Figure 3 Bias assessment plot of reported prevalence of microalbuminuria among diabetes patients across studies published in Africa.

Table 3 Trim and Fill Analysis of Overall Pooled Prevalence of Microalbuminuria Among Diabetes Patients in Africa

Meta-Analysis
Method	Pooled Est.	95% CI	Z-value	p-value		No. of Studies
Fixed	30.78	29.42–32.14	44.50	<0.001		33
Random	37.11	31.27–42.95	12.45	<0.001
Iteration	Estimate	Tn	# to Trim		Diff
1	30.78	406	8		561
2	26.57	459	11		106
3	23.41	492	13		66
4	22.50	502	14		20
5	22.31	503	14		2
6	21.31	503	14		0
Filled meta-analysis
Method	Pooled Est.	95% CI	Z-value	p-value		No. of Studies
Fixed	22.31	21.11–23.50	36.66	<0.001		47
Random	23.94	17.56–30.33	7.35	<0.001

Notes: Test for heterogeneity: Q= 569.22 on 32 degrees of freedom (p= 0.000). Moment-based estimate of between studies variance = 268.38. Trimming estimator: Linear. Meta-analysis type: Fixed-effects model. Test for heterogeneity: Q= 1276.74 on 46 degrees of freedom (p= 0.000). Moment-based estimate of between studies variance = 470.26.

Table 4 Sensitivity Analysis for Single Study Influence of Pooled Estimate

S.No	Study Omitted	Estimate	95% CI
1	Rahlenbeck et al (1997)^Citation40	37.28	31.28–43.29
2	Rahlenbeck et al (1997)^Citation40	37.12	31.15–43.09
3	Muse et al (2020)^Citation41	36.75	30.83–42.67
4	Ogiator et al (2020)^Citation42	37.17	31.18–43.16
5	Ufuoma et al (2016)^Citation43	36.37	30.66–42.09
6	Halliru et al (2016)^Citation44	37.22	31.22–43.22
7	Erasmus et al (1992)^Citation45	36.63	30.74–42.52
8	Bissong et al (2017)^Citation46	37.20	31.21–43.18
9	Efundem et al (2017)^Citation47	37.87	31.95–43.79
10	Rahamtalla et al (2012)^Citation48	36.91	30.97–42.85
11	Lutale et al (2007)^Citation49	37.92	32.03–43.82
12	Lutale et al (2007)^Citation49	37.98	32.25–43.71
13	Ghosh et al (2012)^Citation50	37.39	31.35–43.43
14	Kantarama et al (2021)^Citation51	36.27	30.53–42.0
15	Martin et al (2018)^Citation52	36.84	30.89–42.79
16	Martin et al (2018)^Citation52	36.64	30.74–42.55
17	Kiconco et al (2019)^Citation53	37.59	31.56–43.62
18	Lubwama et al (2022)^Citation54	37.88	31.97–43.79
19	Kalk et al (2010)^Citation55	37.04	31.08–43.0
20	Molefe et al (2018)^Citation56	36.87	30.89–42.85
21	Ramaphane et al (2021)^Citation57	37.41	31.39–43.44
22	Fetni et al (2021)^Citation58	37.23	31.14–43.32
23	Fetni et al (2021)^Citation58	37.03	31.09–42.98
24	Eghan et al (2007)^Citation59	36.93	30.96–42.90
25	Amolo P (2010)^Citation60	38.09	32.37–43.80
26	Omar et al (2014)^Citation61	35.88	30.18–41.58
27	Djiby et al (2018)^Citation62	37.42	31.33–43.52
28	Chaamba S (2019)^Citation63	36.38	30.52–42.24
29	Sobngwi et al (1999)^Citation64	36.63	30.73–42.53
30	Mohamed A (2005)^Citation65	37.08	31.10–43.05
31	Bunza et al (2014)^Citation66	37.61	31.61–43.60
32	Yarhere et al (2020)^Citation67	36.57	30.68–42.46
33	Rasmussen et al (2013)^Citation39	37.39	31.32–43.46
	Combined	37.11	31.27–42.95

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